What works for social anxiety?

Now that I only have major depressive episodes a couple of times per year (not constantly anymore), and I have made progress with getting my life on the track I want it to be on, I'm noticing that it's anxiety that still limits me and never really goes away. I tend to not notice my anxiety a lot of the time, but lately I'm aware of it, and aware of everybody else being aware of it too. In fact, the awareness tends to make it worse.

I avoid this forum. It is overwhelming to read about anxiety so much.

It is time to find some answers and get my anxiety under control. Mostly, I have social anxiety. I get so nervous when anybody is observing me or might be evaluating me or might think that I'm not good enough. Talking about it, even writing about it, intensifies my anxiety.

Facing what you are afraid of is a great strategy. I teach people to do that. But it's harder than it looks. I really do try. I do a lot of the things that I'm afraid of. I'm still nervous, and other people react to it too, and that makes it worse.

Relaxation and breathing and meditation techniques can help a little bit. It never quite seems to be enough though.

St. John's Wort works for my depression, but herbal remedies aren't working for my anxiety. I've tried kava, and don't see a difference. Chamamile, valerian, etc. do help for sleep, but I don't go to bed because I need the time when the house is quiet and everyone is asleep, so that I can think and be alone (or sit or cuddle with my cats).

Observing the cats and trying to be a cat is another strategy. Cats don't care who is watching them. They do what they want to do, and don't care what anybody thinks about it. And they are good at relaxing too. T said that I should learn how to purr (in a human-equivalent and socially appropriate way). So how to people purr? I am better when I have a cat on my lap. But I can't always have a cat on my lap, and it still isn't a complete cure.

I've been thinking about medication. I picked up the intake packet and filled it out, but haven't taken it back or made an appointment. I'm scared. What will they think about a therapist who is crippled by social anxiety? What if I'd rather work at this place than be a patient there? My thoughts when I went to get the paperwork were that I could see myself applying for a job instead. They have a facility for youth there, which is quite similar to where I'm working. But, that was a side track. I told T that I was thinking about meds. That was really scary. She observed that I kept checking, lookin at her, to see how much trouble I was in. I was afraid she wouldn't approve. But I know that if I were one of her cats, I'd be on valium and/or something, like her "special needs" kittie is (the cat has impaired reality testing though, and keeps trying to communicate with the mother ship - I have offered to make a tin foil hat for the cat to block the transmissions and see if that helps). Anyway, T said that the problem with meds for me is the risk that I would abuse them. Maybe that's why I have stayed away from meds before. I don't trust myself with them. I told her that I estimated a 20-30% chance that I would have a day that I just didn't care, and might use meds inappropriately somehow. I think that's understating the risk. And I don't know if it would even help. I don't want to give up my herbs that do help for depression. And I still do need them. I'm not very consistent with my herbs though. I skip them sometimes (depression comes back), and I have tested them by quadrupling the dosage too, reasoning that I didn't think they really could be doing anything (I got hypomanic).

Do meds actually work for anxiety? I want something that will help me to be confident and able to be myself and perform. Not just make me groggy and sleepy. And I don't want weight gain. And I don't believe that meds are the answer to everything, but when 5 years + of therapy, and getting my own master's degree in it too, aren't enough, maybe I need something more. And I hate myself for that because I don't think I should need more. I'd rather be able to do this myself, with no chemicals. I don't trust them.

Ok, this is a lot longer than I intended. After all that, my question is still "what works for social anxiety?" Does anyone have any answers?

Hi zoloft and effexor and xanax

Talking about the underlying reasons for the fear of being watched, exposed, judged is what helped me. Still talking about those things in therapy. May always need to do that.
I have Xanax but I only use it rarely. I like that I can use just a quarter or eighth of one. If I liked alcohol, I would have a glass of wine. About the same effect. But it really doesn't do anything for confidence or the underlying reasons around the discomfort.

Social anxiety sucks I suffer from it too and Its hard having friends with it.

I've been taking Klonopin (a benzodiazapine) for almost 20 years. As my body has become acclimated to it, I've had to increase my dosage from .5 once daily to 1mg 3x day. It doesn't even work, anymore, & I'm not sure that it ever did. Now I am so addicted that I can't even walk if I miss a pill. All I know is that my social anxiety is so debilitating that I have NO LIFE, & I'm severely depressed. So, my advice is to stay away from that crap b/c not everything can be cured with a pill. I understand your desperation, but if it does help you, it will only be for a short time. Echoes suggested that you work on the underlying reasons for your social phobia. I agree, & would add that forcing yourself to exercise, eating healthfully & avoiding sugar & processed foods, & working on breathing techniques will help, too. I've just started incorporating these things into my routine as of the new year, & have found them to be helpful. Many Pdocs are hesitant to prescribe benzos now (as they are just discovering after how many years???) how addictive they are, & clinics aren't allowed to prescribe them anymore b/c they are being sold on the street. (Don't ask me why-I never got any sort of high from them). Plus, I'm worried that I'll never be able to get off of these pills & it can't be good for my liver or kidneys,etc., & it does inhibit cognitive functioning. Sorry if this scares you, but I genuinely understand what you're going through & would rather you learn healthier & more productive ways to deal with your problem. If I had done that, I'd probably be better by now.
Good luck.

I use to literally forget my name in social situations where I was at meetings and supposed to introduce myself or make a little talk about myself, etc.

Becoming good in some area (for me, formal research/nonfiction writing) helped me some. That and constantly going toward what I am afraid of instead of avoiding. You say people react to your being anxious but I think some of that is our our reactions to their reactions? I gave a talk (about writing :-) before 100 professors as part of a panel and it was about myself and, sure enough, less than a paragraph into it I forgot what I was going to say, forgot the details (of my own life, LOL) but I'd had enough therapy and been in enough "real" situations like this among "friends" that I gave myself time to work with myself, relax, and think of what I wanted to say and get back on track by backtracking a little.

One thing that was enormously helpful was that the people either don't know me (so why would they not like or be "against" me?) or they're "friends" like teachers, therapists, etc. and want me to do well. I still remember when I was complaining to my therapist about my group therapy and she responded, "I don't know much about group therapy but I don't think those people are out to get you" and that (accidentally) hit the nail on the head! From then on I wasn't afraid anymore in group, expecting something horrible to happen any moment. I had literally been feeling/treating the situation like they were out to get me.

I love "a-ha" moments and look for them! (Leap and the net will appear :-) My therapy went much better when I realized either the sky wasn't falling (like I thought it was) or my thearpist was crazy :-) She was always relaxed and comfortable so it had to be me who had the skewed perspective. And that's another help for me, perspectives aren't "me" so there's nothing wrong with me that learning/continuing to work and try to get better won't fix. I'm the right size, it's the pants that are too small :-)

Rapunzel,

I take Effexor, Abilify - they help with my social anxiety. I am sorry you are suffering this way, one T describes it to me as having too much water in a glass and the glass overflowing, as the same thing with anxiety. I think you could definitely benefit from taking a med, that could help the anxiety.

Hi Rapunzel:

Social anxiety is my primary issue. I've had it since I can remember. I happen to know quite a bit about it because I learned from the guy who is the guru, as far as I'm concerned, when it comes to SA. This is Dr. Thomas Richard's who runs the Social Anxiety Institute in Phoenix, Arizona. He's very much respected as someone who knows this disorder. He suffered with it himself for twenty years before he cured himself and started helping others. I'll tell you what I know about it and you can follow up with your own research.

*Social anxiety does not respond to traditional talk therapy in general. It's a specific disorder that requires specific treatment from a professional trained in the disorder.

*Simply repeatedly exposing yourself to situations that cause social anxiety in an effort to "push through" or fight it, does not work. In fact, this can make the anxiety worse over time.

*The therapy that has produced the most effective results with SA is cognitive behavioral therapy. CBT works because it gets at the root cause of SA, erroneous or automatic negative thoughts (ANTS)-- and works on changing behaviors that keep the anxiety going.

*The often prescribed SRI's help some people but not most. Beta blockers and benzos like Klonopin tend to be more effective. I've known several people with SA who have used drugs. Most say that the drugs keep it at bay to help get through particular events but doesn't take the anxiety away entirely.

*If you decide to use drugs it is better to include CBT therapy and some form of relaxation/meditation techniques.

*Another type of therapy that is getting promising reviews is Acceptance and Mindfulness therapy. A good book recommendation to learn about this is The Mindfulness & Acceptance Workbook for Anxiety.

Mindfulness Therapy has a somewhat spiritual basis. The idea behind it is if you can learn to sit with and "be still" with the anxiety when it comes up, it will pass. The theory is that each time you do this, the anxiety becomes weaker and weaker. Of course, the therapy helps teach you the tools whereby you learn to do this.

I have recently started using mindfulness/acceptance myself. There is a sort of "magic" to it that does seem to gradually unlock the grip that anxiety has. It's not easy by a long shot but it has benefit if you stick to it. It's a lot like being told to sit on a hot stove and no matter how hot it gets it really can't burn you. And if you can sit there long enough eventually the discomfort will turn into exhilaration and bliss of the most wonderful kind. I'm sure you can see what I mean by it has a sort of spiritual ring to it.

I have written two articles about SA that you might find interesting or helpful in some way. Here are the links:

How Does Social Anxiety Feel?
http://jonsmom.wordpress.com/2009/12/21/%e2%80%9cwho-me-shy%e2%80%9d-what-social-anxiety-is-not/

Who, me -- Shy?/What Social Anxiety is Not
http://jonsmom.wordpress.com/2009/12...-anxiety-feel/

Wow, thanks for all the input and suggestions! Jooker, I'm reading your articles now. I know that mindfulness helps me. That was the first thing that I told my T I was working on as a way to deal with my anxiety. Even though when I pay attention to my anxiety, it gets worse, as noticing how nervous I am and how obvious it must be to others multiplies it exponentially. Maybe I need to be mindful of something else other than my anxiety.

I finally did go turn in my intake paperwork so that I can get meds. It was really hard. I thought how much I would rather be applying to work there as a therapist than to be a patient. I think I have applied there before, but they never responded. I want them to accept me as a colleague and to see me that way. They have several pdocs there. One, the receptionist said, uses a holistic approach and is ok with herbs and stuff that I use, but he was not taking new patients. I made an appointment for two weeks from now. I think I was shaking when I went in there, and even more leaving, and then had to go to work. Fortunately, it's a 30 minute drive to get to work. I couldn't focus on my audiobook though, and missed most of it, but I was ok the rest of the day.

I'm glad you found the info helpful Rapunzel. I've heard other people say that focusing on their anxiety makes it worse.

This is the cycle of noticing you're anxious and becoming anxious about being anxious. If mindulness if practiced properly you learn to break the cycle. How?

By NOT becoming anxious because you're anxious. It's like stepping outside of it and "watching it" WITHOUT judgment. It's the judgment about feeling anxious that causes more anxiety. The process is something like this:

Thought: "Uh oh, I'm anxious."
Judgment: Anxiety is bad because it means _____________.
Reaction: Increase in anxiety.
Result: Resistance --> fight or flight

With mindfulness the process should work something like this:

Thought: I'm feeling anxious
Judgment: Neutral/None
Reaction: Being ok for now with being anxious
Result: Acceptance -->calming decrease in anxiety

I hope you enjoyed reading the articles and found something that resonated with you in them.
Take care

i feel like that too i have xanax and i still feel awkwad when i take it, i have a oral presentation mon and am looking for some advice am so scared and cant stop thinking bout it, i dont want to stand up and gat a panic attack infront of everyone

Rapunzel, I have some social anxiety. I wouldn't call it phobia, but I am uncomfortable in some social situations, especially when it is large groups with lots of people who are standing around talking in little groups. I don't know how to become part of those little groups and what to say in them. Sometimes it works out OK, but I don't like it, it's not fun. It's stressful. I am better talking one on one with a person, not at some big gathering. I am an introvert and somewhat shy, but not at the far end of the scale. I "recharge my batteries" by being alone. I handle my social anxiety by knowing my limits--how much of this socializing can I take without feeling miserable?--and don't try to overdo it. If I know I can escape from the socializing, it is easier to bear, because I know it will not last endlessly--I am in control. So I don't try to commit to really long events. I can go to dinner with friends without a problem, or have coffee with a friend. Really, I can do a lot of stuff. Is it so bad for me to hate larger social gatherings where I get tongue-tied? I feel as I have become older, I have become more content with who I am and accept that I am not going to be comfortable in life with every situation. Sometimes I do find this somewhat impairing, but not usually. At work, I have to make phone calls to strangers sometimes, or even colleagues. This is really hard for me to do. Talking on the phone is scary. What do I say? I have been known to delay and delay having to make a call at work, and the task doesn't get done, or someone says, "has anyone called so and so? here, I'll call them." So at work, I feel slightly impaired but it hasn't cost me a job or a raise yet.

I was going through a rough patch in my life, and having a lot of anxiety in general. I took Buspar for this. (Buspar is not a benzo, so doesn't have addiction potential.) You have to take it regularly, not "as needed." The Buspar did not help at all with my high anxiety, but amazingly, it helped with my social anxiety! I had not even taken it for that! It had actually never occurred to me that a drug could fix my social awkwardness, and I had not perceived myself as having a disorder that required medication. On Buspar, I was more outgoing, I talked to strangers in the elevator, or who I saw outside on a walk (I never did this before). I had been in a new building at work for over a year, and had never once gone to the cafeteria to eat lunch, or even to buy a coffee or sandwich to take back to my office. I just didn't want to go in that place. It was scary with this big open space and all of these people chatting noisily at tables, All these people seemed to have people they knew and talked to at these tables where they ate. It was the same as the little groups of people at social gatherings. This just seemed a bad situation so I never went to the cafeteria for a whole year. Almost overnight on Buspar, I began hanging out at the cafeteria. I stood in line to buy food and chatted with others in line, some of whom I knew casually from my job, some who were strangers. I sometimes took a coffee break there and enjoyed sitting at a table reading the newspaper. It was a nice atmosphere. I ate lunch at the tables. Sometimes I found someone I knew to sit with. Other times I didn't and sat by myself. No big deal--I'm certainly not the only person in the world who ever ate alone. I didn't worry that other people would see me eating alone and think ill of me (what a loser!). Frankly, I just didn't really care what people thought of me anymore, and I had not really realized that was a problem before I started taking the Buspar. The whole experience was kind of amazing, actually.

I did have some worries that this drug was changing my personality, and I was kind of uncomfortable with that, but not terribly. Gradually, over about 4 months, the Buspar stopped having any effects on me (it had other effects besides the lessening of social anxiety). Since it had never helped with my (non-social) anxiety anyway, my doc said to stop taking it.

That was a couple of years ago. I now won't eat lunch in the cafeteria anymore. I don't talk to strangers when I am out on walks. Etc. I am back to my normal self. It's OK. It was fun being less socially anxious while it lasted, but I don't pine for it.

Rapunzel, I share that story because I think that medications can make a big difference, although it can be hard to find the right one. On the whole, though, I am OK with who I am and don't feel impaired without medication. I am my introverted self who doesn't like big gatherings or talking on the phone. It's not a bad way to be.

Oh, another med I tried, also not a benzo, was propanolol (sp?). My doc gave me this to take right before extremely stressful situations. This is good if you know you will have a stressful event, but of course not useful if the unexpected could provoke anxiety. People often use it for stage fright. I only tried it a few times, and it worked OK. I don't need it anymore as I am not stressed out so much anymore. Maybe it might be helpful if you knew in advance you were going to be in an uncomfortable social situation.

Good luck, Rapunzel.

Thanks. Buspar is one med that I am interested in. I understand that a lot of people don't think it works very well, but if someone is used to fairly dramatic or noticeable effects, such as with benzos, they would most likely not be impressed with Buspar. It's good to know that it can be helpful.

I am pretty good at predicting the situations that are stressful and anxiety-provoking. When you used propanalol, did it affect your memory after the events were over? The things that provoke anxiety for me are things that I need to be able to remember. In fact, part of my fear is that I won't be able to remember something that I am expected to know, or that I will be embarrassed by not remembering someone's name or some key bit of information.

What other effects did Buspar have on you? Feel free to PM if that is more comfortable.

It makes sense that large groups with smaller, more intimate groups within the large group are uncomfortable. That's a situation that I avoid too.

Thanks!

Dear Rapunzel,
Somebody told me this a long, long time ago and it really helps me being in public. They said: 9 out of 10 people around you have other things on their mind and don't give a hoot what's going on in yours!"

I turned that around and realize I wasn't thinking about the people around me either! (unless I was actually talking to one of them)

But I also take valium (tranquilizer) for general anxiety/panic attacks and it seems to help with being around others too.

One more thing...I tend to judge myself too harshly, thus think others do too, but this just isn't true.

Thankyou jooker for your posts on social anxiety. Its such a lonely, misunderstood disorder to have. The amount of times I have been in tears because I could not perform well enough under social situations has been a strain and put me off socialising even more. Looking at it in a strategic way puts it into perspective. I have tried time and time again to expose myself to social group settings and yet feel terribly anxious that I end up babbling rubbish to them, they look at me like I have lost the plot and then I feel inferior and even more self concious, I nearly border a panic attack right in front of them but I can't coz that would mean I would draw even more attention to myself. Its a terrible vicious cycle.
The way you layed it out though has been very good to compare to my own thoughts and reactions. Thankyou for that. I hope one day to be gone of this disorder as it has well and truly run its course and I'm fed up with having it.

As far as medications go, I have had the best experience with klonopin (clonazepam). It's probably one of the better benzodiazepines because it has a long half-life, unlike xanax (alprazolam) which is only 6 hours which can leave you feeling dependant and thinking/obsessing about your next dose. Klonopin has a half life of 18-50 hours, is pretty much just as strong, has less side effects and also has some mild anti-depressant effects.

SSRI and SNRI treatment for social anxiety has very limited results.

Best of luck to you, and I hope you can enter the social world again and realize it's not so scary. Much love!