In part one of this two-part series, we discussed the experience of the Social Anxiety sufferer.  In part two, we examine how to treat this condition with Cognitive Behavioral Therapy (CBT), and how Social Anxiety relates to other Obsessive Compulsive Spectrum Disorders.

Treatment of Social Anxiety

Social Anxiety

Social Anxiety can be successfully treated with
Cognitive Behavioral Therapy (CBT).

The most effective form of treatment for Social Anxiety is the same as in other Obsessive Compulsive Spectrum Disorders – Cognitive Behavioral Therapy (CBT).  This is because, like the other disorders in the spectrum, Social Anxiety involves an obsession and a series of compulsions which form a cycle.

The fundamental obsession in Social Anxiety is the fear of being evaluated negatively.  This generally includes fears of being rejected, as well as the fear of being singled out for humiliation and traumatized by emotional abuse from others.  The primary compulsion in Social Anxiety is the phobic avoidance of social situations in which one fears rejection and/or humiliation (thus its synonym, Social Phobia).

It is tempting to look at avoidance as the absence of engaging in social behavior.  However, avoidance is an overt physical and mental behavior, the primary goal of which is to reduce or eliminate anxiety.  For the individual with Social Anxiety, the act of choosing not to go to the party thus serves the same function as the act of choosing to wash one’s hands serves for the individual with OCD.  Further, those with Social Anxiety who are able to commit to a social interaction may find themselves escaping mentally in the process by spending their energy focusing on things other than the present situation. Read More »

    

“If I knew then what I know now.”

Chances are, if you’re reading this, you’ve found yourself saying the same thing at some point in your adult life.  Nowhere is this more relevant than from the perspective of someone looking back on a childhood with Obsessive Compulsive Disorder (OCD) or an Obsessive Compulsive Spectrum Disorder.  When I meet a new client under 18, there is a powerful sense of traveling through time.  I think, “If only I had someone like me to go back and talk to me when I was someone like this.” How much time might I have saved being able to resist repetitive, unnecessary rituals?  How many more events, relationships, and simple moments of peace might I have been able to enjoy if only I had known what was really happening to me? Read More »

    

Last week, we discussed recent news reports about professional baseball players struggling with Social Anxiety.  This week, we broaden the topic to cover athletes in numerous sports with various anxiety disorders.  Second of a two-part series.

As we noted last week and in prior posts, the past few years have seen a significant increase in the number of professional baseball players going on the disabled list due to Social Anxiety.  This trend is remarkable for numerous reasons, the most noteworthy being that the issue of mental health in baseball is being openly discussed at all.  The overall issue of mental health has long been shrouded in secrecy and shame, leading many public figures to go to great lengths in order to ensure that their mental health issues remain private.  So when professional baseball players not only acknowledge their psychological issues, but actively seek help for them, this is a sign of cultural progress. Read More »

    

There have long been rumblings that the American Psychiatric Association (APA) was undertaking a thorough review of its Diagnostic and Statistical Manual, Fourth Edition (DSM-IV).  The ostensible goal of such a review would be to create a more accurate and in-depth edition of the DSM, which was last updated in 1994.

After ten years of ongoing debate, the numerous APA work groups investigating potential revisions to various diagnoses and categories to be included in a planned fifth edition have presented their suggestions to the APA.  Some of these changes are likely to be as controversial as current classifications in the DSM-IV, while others will pass barely noticed into the new DSM-5 (for example, the switch away from Roman numerals in the title).  A number of these proposed changes directly impact conditions treated here at the OCD Center of Los Angeles.  To wit: Read More »

    

The OCD Center of Los Angeles often receives calls from people seeking treatment for various phobias.  One of the most common phobias we treat is emetophobia – the intense fear of vomit and/or vomiting.

Most people who call us with emetophobia are initially quite surprised to learn that this problem has a name, and often equally surprised to learn that they are not the only person in the world to suffer with it. Read More »

    

Exposure Therapy for OCD and Anxiety

Exposure therapy is the key to
effective treatment for OCD and anxiety.

At the heart of Cognitive-Behavioral Therapy for OCD and related anxiety disorders is the process of “exposure therapy”. There are numerous variations on exposure therapy, depending on which specific condition is being treated – for example for OCD, the treatment of choice is a specific therapy called Exposure and Response Prevention (ERP). All variations of exposure therapy focus on the same core principle, which is that those suffering from these conditions will experience the greatest reduction in their symptoms by repeatedly doing the very thing that most terrifies them, without responding with any behaviors that are meant to reduce or control their anxiety.

For someone with OCD focused on contamination fears, exposure therapy will likely include purposely touching doorknobs or other allegedly “dirty” items without then washing. For those with variants of Pure Obsessional OCD (Pure O), effective treatment will almost certainly include imaginal exposure, in which the client purposely and repeatedly thinks the very thoughts that they would prefer to avoid, such as thoughts of being a pedophile or a murderer. A person with Body Dysmorphic Disorder (BDD) may be asked to go out for a walk without the hat they usually wear to hide their face, or to go to a brightly-lit restaurant with a group of friends. For those with Panic Disorder, exposure might mean driving on the freeway or taking a plane flight. And an individual with Social Anxiety may be urged to go to the mall to initiate conversations with strangers. Read More »

    

Recent months have seen an enormous amount of discussion on the issue of developing a national health care plan.  This issue has become a lightning rod for activists on the left and right, and promises to provide ongoing debate for months to come.  One part of this story that has not received much discussion in the media is how a national health plan might address mental health care. Read More »

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