Tag:

psychology

Steps I Take To Be A Stigma Free Psychiatrist

It’s a busy week for raising mental health awareness. Today is World Mental Health Day (October 10th), which is a day observed for discussing issues, garnering support, and mobilizing efforts to improve the treatment and public attitudes towards people living with mental illness worldwide (this year’s theme is “Dignity In Mental Health”). Today is also the final day of Mental Illness Awareness Week (Oct. 4-10), which falls each year during the first week of October to recognize the efforts of the National Alliance on Mental Illness (NAMI) to fight stigma, provide support, and educate the public. This year’s theme is #IAmStigmaFree. As a psychiatrist, I wanted to utilize this opportunity to identify the steps that I regularly take to eliminate stigma in my practice. My process has required a lot of personal work — learning, self-examination, self-reflection, patience; and I acknowledge that I am still a work in progress. However, I want to emphasize that I am working on myself to ensure that my patients receive the best care possible because I know what it’s like to be judged prematurely based on others’ hurtful perceptions.

Our own misconceptions of people living with mental illness are reflected in our interactions. As a physician, I believe it’s important that my fellow colleagues especially be aware of how their actions and words impact patients (ie, anger, impatience, frustration, labeling, etc). Even mental health professionals can perpetuate stigma by not utilizing proper language nor acknowledging how our own stigma impacts the therapeutic relationship (to all of you who’ve ever looked at your patient schedule and uttered phrases such as “greatttt, another psych case,” or “oh geez, it’s that one guy again who can’t stop drinking,” or “she’s so borderline and difficult,” etc — YES, I’m talking to YOU). And again, I admit that I’m not perfect because I’ve mumbled similar phrases in the past myself. Therefore, the following are steps that I take in my own life to ensure that my patients feel understood, rather than stigmatized and judged:

Be open to changing your perspective towards mental illness
- As I’ve mentioned in previous posts, earlier in my training I was quick to label patients as being “non-compliant,” “agitated,” etc. A stark contrast to my current way of practicing, I didn’t allow proper time to get to know my patients beyond going through a checklist of DSM diagnostic criteria (though one factor may have been naivete as a “green” intern physician, the predominant factor was the influence of the broader society’s stigmatization of the mentally ill population). However, I noticed a drastic shift immediately after I switched residency programs and was introduced to a more humanistic way of practice (the way Psychiatry SHOULD be practiced), where my mentors immediately encouraged me to eliminate words such as “non-compliant,” “agitated” and to get to know patients for who they are as people, NOT just their diagnosis.
- I remember initially resisting my new program’s approach (mostly because I realized that it requires far more effort to be humanistic than it does to robotically rehearse a checklist of information and churn out medication recommendations based on symptoms alone, while minimizing any type of emotional connection with a patient), but welcomed the change in order to grow both personally and professionally.
- Note: For all the providers out there who feel there’s no time allotted in your jam-packed schedule to have empathy while seeing > 20 patients in one day, I feel your pain. The moment I realized the negative impact that being an overworked physician had on my interactions with patients, I decided to quit.

Separate my own issues from my patients
- When meeting patients for the first time, I admit that sometimes I’m exhausted from work and the last thing I want to do is meet a new patient because, in general, it takes far more effort to meet someone new than it does to see someone whom I’m already familiar with (this sentiment applies to social interactions in day to day life as well). I may start the session off feeling a bit irritable, however, once I start talking to my new patient, my anxiety settles (because I realize their anxiety levels about meeting a new doctor far exceed mine) and realize that my exhaustion and irritability interferes with giving my patient the attention he/she deserves.
- I recall the first time I met my psychotherapist and how high my anxiety levels were during session. How horrified would I have felt if my therapist was quick to judge me for reasons such as wanting to complete the interview within the the shortest time-frame possible rather than taking the time to get to know me? The moment that I identify my own anxiety brought to session when with a patient, I allow myself to relax, which in turn helps my patients feel more at ease as I proceed to ask not only my standard questions, but also thought-provoking questions about their lives in order to better understand them as unique individuals.

Learn and educate yourself
- When I first had a patient with autism, borderline personality disorder, eating disorder, traumatic encephalopathy, etc, I prioritized researching and gathering as much information as possible in order to better understand and help them. Oftentimes, stigma regarding a specific illness is propagated due to lack of willingness to learn and understand a person’s experience. If I want to fully understand what my patient’s experience with having a specific disorder is like beyond the literature, I ask them! I noticed that my patients appreciate when I ask because inquiring demonstrates that although I may not have firsthand experience with what they’re going through, I truly have an interest in wanting to know what it’s like to live in their shoes.

Be connected
- The first time I met someone living with mental illness was when my aunt, who has been diagnosed with profound intellectual disability and schizophrenia, came to live with my family when I was in my early teens. Rather than live in fear and avoidance of my aunt (fear and social distancing are contributors to stigma), I made a goal to connect with her on a regular basis (say “hello,” ask questions about her day, shake her hand, comb her hair, etc). Eventually, she warmed up to me and I appreciated her unique qualities such as her love for simple things (dog stuffed animals, a glass of water, sitting outside to get fresh air) and the rotation of her favorite phrases that she’d randomly blurt out (usually pertaining to wanting to visit the Philippines and her sister’s guide dog). Having the connection with my aunt taught me early on of the importance of looking beyond someone’s mental illness.
- Being active on social media also allows me to connect with mental health advocates and people living with mental illness. Outside of clinic, I find that reading their posts and being a part of the social media community provides a deeper perspective of their experiences as clinicians and consumers within the mental health system.

Share and teach others
- Sharing my experiences and advocating for a humanistic approach to psychiatry is exactly the reason I blog. I recall attending a meeting while working on an inpatient psychiatric hospital during residency and my supervisor yelled at the staff members for laughing at a stigmatizing quip made about one of the patients (staff members clearly felt ashamed and never made such comments during meetings thereafter). I admired my supervisor for standing up for the patients and from that moment on, I never tolerated stigmatizing remarks made in the various places I have worked. Sure, I’ve been the buzzkill during meetings in various clinical environments, but such comments should not be made in the first place. If I can change someone’s perspective and reduce the perpetuation of stigma, then I’ll keep advocating, buzzkilling, sharing, and fighting.

October 10, 2015 17 comments

Psychiatry therapy

The Crucial Transition From Work to Home

written by freudandfashion

{Beverly Hills, California}

One of my patients told me that the most frustrating part of his day occurs the moment he arrives home from work when his family accuses him of being isolative and uninterested (due to his first activity upon arrival consisting of sitting in his parked car in the driveway and/or watering the lawn instead of immediately engaging in family affairs). When my patient told me this, I actually thought about my own behavior upon arriving home from work, and to be honest, I can be pretty bitchy. That is, unless I allow proper time to switch gears from work mode to home mode. Those who live with me have observed that my mood typically goes from snappy/serious/irritable to talkative/cheery/joking over the course of 30 minutes.

Not much research exists on this topic, but I assume that there are various reasons that the lingering effects of work can have a negative impact upon arriving home. Here are a few factors to consider that may contribute to the tough transition:

Traffic congestion – feeling trapped in your car, moving inches on the freeway, dealing with aggressive drivers, running behind in your schedule due to delays, and the potential threat of car accidents are all factors that can easily raise one’s heart rate, blood pressure, level of arousal, and automatically trigger you to go into a protective/defensive mode.
Work stress – having an extensive to-do list, meeting project deadlines, dealing with coworkers’ differing personalities, tolerating conflicts in opinions of supervisors or administration, etc, are all situations in the work environment that require excess mental energy to deal with, leaving incomplete tasks and unresolved issues that may carry over into the home environment.
Home responsibilities – in a perfect world, we might be able to come home after a stressful day and be able to relax and worry about absolutely no other responsibilities. Yet, in reality, leaving work means moving from one set of responsibilities to another (children or a spouse demanding your attention, chores to complete, dinner to prepare, bills to pay, friends’ events to attend, etc).

How to make the transition:

Establish a routine that works for you. This involves evaluating your current routine going from work to home and incorporating practices that help you eliminate or get around triggers and negative thoughts. The Wall Street Journal published an article about “rethinking your after-work routine” and I definitely agree with Cali Williams Yost‘s recommendation to think about the transition from work to home in terms of three stages: leaving the workplace, getting home, and walking through the door.

Stage 1: Leaving the Workplace
- To ward off negative feelings, consider a routine that acknowledges your accomplishments of the day or think about positive things that occurred during your day.
  - I make sure to leave 10 minutes at the end of the workday to look at my list of accomplishments (ie, the items I checked off on my to-do list) and prioritize tasks left to complete the following day. This routine works for me because I’m left with a sense of accomplishment focusing on the tasks that I actually DID complete, rather than focusing on what I did not complete. I also like to organize and tidy my desk so that upon arrival to work the next morning, I feel as if I’m starting new rather than being left with a sense of disorganization from the previous day. I also try to check in with the nurses and thank them for all their hard work from the busy day.
Stage 2: Getting Home
- As mentioned above, the commute from work to home can evoke excess stress, so consider methods to minimize aggression.
  - I always admired one of my mentors during residency because he’d bike home from work (something I’d consider doing if I still lived in Oregon rather than southern California), but since it’s far easier for me to drive, I make sure to blast uplifting music on the radio or talk on the phone with one of my close friends (who is also a psychiatrist that commutes home around the same time of day). I also may volunteer to make a stop at the grocery store, which allows additional buffer time before arriving home.
Stage 3: Walking Through The Door
- Identify triggers that may set you off upon arriving home (ie, your children demanding your attention, the need to cook dinner, a messy home in need of cleaning, etc) and figure out ways to get around the triggers.
  - For example, I suggested to my patient above that he communicate to his family the need for a few minutes of alone time each day after work to water the grass or sit in his car.
  - For me, I am easily triggered when I come home to a messy kitchen, so in the morning I try to empty the dishwasher and load any dirty dishes left on the counters or sink.

Thought of the Day: What are some practices that you can incorporate into your routine to ease the transition from work to home?

October 1, 2015 12 comments

Personal therapy

Weekly Insights

written by freudandfashion

{Ventura, California}

I am a perfectionist (sometimes to a fault) and most of my writing is edited at least 10 times until each and every word is as perfect as can be (at least in my mind). One of the reasons that I don’t post more frequently is due to my perfectionism, because I’d much rather NOT post than write anything that doesn’t meet my standards. So I am trying really hard to let go of my strong inner self-critic. Even during residency, my psychiatry supervisors would find me at the clinic after hours typing notes documenting my patient visits. However, the reason I was there late was not due to having a pile of tasks to complete — it was because I took way too long typing and perfecting each note.

During my training, I recall a free association exercise that my psychoanalytically-trained Program Director had us do as part of an intro to psychoanalytic theory. Free association is a psychotherapy technique where a patient talks or writes freely about whatever comes to mind in relation to a specific topic, with the goal of bringing unconscious thoughts to the forefront or the emergence of repressed memories, which can provide valuable insight of a patient’s problems.

So, with this exercise in mind, here goes my attempt at free associating by typing nonstop for 3 minutes whatever comes to my mind regarding the following topic: lessons learned from this week. And, go:

that it’s extremely hard to say goodbye to several of my patients. a part of me wants to take all of my patients with me to my practice, though I know that it’s probably in some of their best interest to stay within a system with resources to monitor them more closely.

I am sad and exhausted usually by the end of clinic because i didn’t realize saying goodbye would be harder than I thought.

i hate feeling lazy when I get home, but I’m so tired that all I want to do sometimes is lay on the couch and watch shark tank, hotel impossible, or other reality tv-type shows mostly because I don’t want to think. But then I feel bad because I feel like I should be cleaning my house, writing a blogpost, exercising, going grocery shopping, going out for a run, or anything else that makes me feel like i’m not being useless.

i wish I had the energy i once did because I feel guilty knowing that I need rest, need more sleep, get injured when working out, takes me longer to recover from workouts and pretty much anything that makes me aware that i’m getting older.

i look at other bloggers and wish that I blogged more often like them, wish it didn’t take me so long to write wish that i could go eat a cheesecake or something that was fattening and sweet like a lot of skinny bloggers posting food shots on their social media sites as if they actually eat those things. how much of reality is blogging anyway, how can we believe anything that people actually write or say and how i can we tell if someone is being authentic or not. i can’t be fake and maybe that’s why it’s so hard for me to write yet at the same time I don’t know how my image will be perceived and that takes editing that i wish i didn’t have to do.

Thought of the Week: Interesting that my recurrent body image issues and fear of judgment appeared in this post. Perhaps a sign that I should process this material with my therapist?

September 26, 2015 20 comments

Personal therapy

Love Thyself

written by freudandfashion

{Sonoma, California}

Sure, when I first heard Hailee Steinfeld’s single, “Love Myself,” on the radio, I initially became excited that such a popular song celebrated a love for one’s self. And even after dissecting the song’s lyrics (to discover the actual allusion to masturbation), I still remained inspired to write a post that paid homage to myself, particularly because I have been feeling more self-conscious and self-critical lately. The thought of writing about oneself may stir some anxiety due to fear of being judged as narcissistic, self-centered, self-absorbed, conceited, etc, etc. However, our inner critic can be the worst critic of all (I swear my therapist points out my harsh self-criticism at each and every therapy session). And as cliche as it sounds — if we can’t love ourselves, how can we expect anyone else to love us? For me, promoting a healthy sense of self-worth outweighs any risk of judgement.

I vividly recall having to write an acrostic name poem during elementary school and struggling to come up with words that described me. So, as I sit on my couch tonight full of regret for eating pastries brought home from clinic and guilt for not waking up early enough to hit the gym this morning, hear goes my attempt to write a positive ode to myself:

Thoughtful, caring, interactive

I’m reliable, proactive

Down for an outing or adventure

If something new, you’ll be my mentor

Comfortable with leading

Will call you out if misleading

Advocate for those in need

A dog lover of many breeds

A perfectionist constantly inspired

Motivated to grow by those I admire

Smart, sarcastic, smiley

Environmentally-friendly, candid, kindly

Family comes first

Friends down to earth

Finds beauty unrehearsed

Always something to converse

Discount shopping in bursts

Will gladly help unless you’re curt

Spiritually immersed

So hardworking that it hurts

I know what I’m worth

Thought of the Day: Care to try writing one for yourself? (much respect to you if it comes easy…this took me longer to write than I’m willing to admit!)

September 19, 2015 10 comments

Psychiatry therapy

Termination Point

written by freudandfashion

Saying “goodbye” can stir a variety of emotions including sadness, anger, and relief. The whole experience can feel quite uncomfortable, so is it better to say “goodbye” or to say nothing at all? Clearly, the more thoughtful and courteous action would be to leave with at least some type of acknowledgement (a wave, a handshake, the verbalization of “goodbye,” etc), though it might be less anxiety-provoking to slip away unnoticed.

In the context of terminating treatment in Psychiatry, there are various reasons why treatment between the psychiatrist and a patient may end:

a patient wishes/chooses to end treatment
the psychiatrist gets a new job, retires, or leaves the practice
the patient changes insurance plans
the patient moves
the psychiatrist passes away

For the sake of this post, I will focus on what I’m currently experiencing — saying goodbye to patients due to a new job. In this situation, the ending of treatment is not the patient’s choice, which can stir a combination of emotions such as abandonment, sadness, loss, betrayal, anger. Though some psychiatrists may feel that sending a letter or written notice informing of their leave will suffice (I won’t get into the complex legal aspects here), effort should be made to ensure that the patient does not feel at fault for the termination of treatment (ie, a patient may feel that the doctor is ending treatment because the doctor doesn’t like them, etc). Which is exactly the reason a termination phase (or at the very least, a final session) is crucial to help process emotions that may come up, allot a decent amount of time to coordinate transfer/continuity of care, and most importantly, to provide closure (for both the patient and psychiatrist).

In the last few days, I’ve experienced random moments of feeling sad and numb. Some of my followers on Snapchat may have noticed my absence of posts for over one week (I usually post on a daily basis). My videos are generally motivated by something exciting from my day or a psychiatric tidbit of knowledge that I wish to share, however I haven’t been as inspired lately. Even while writing this post, I’m interrupted by moments of abruptly staring into space and my mind wandering to more superficial thoughts such as shopping, what to make for dinner, and celebrity gossip.

With only a few weeks left until my final day in clinic, I fight the urge to flee and avoid the discussion of termination. But then I refocus and put my psychiatrist hat on and consider the potential impact that avoidance of the topic may have on my patient. However, the professional aspect of fulfilling my duty and ensuring proper transition to another provider for continuation of care is the easier part. The more difficult aspect is letting go of the strong connections that I’ve built with my patients, especially those who watched me grow from a newbie psychiatrist straight out of residency to one they grew to depend on and trust.

Despite the complex mixture of emotions, I know that I’m doing what’s best for me personally and professionally by taking this next step in my career. Yet, if I’m having a tough time, imagine how my patients must feel.

September 10, 2015 10 comments

Lifestyle Medicine

Thankful Thursdays

written by freudandfashion

{Venice Beach, California}

For this week’s Thankful Thursdays, I would say that I am very thankful for one of my best friends from medical school, who flew into town for a quick visit. My resolution for the remainder of the year (mentioned in my previous post) included being spontaneous and free to explore. Surprisingly, in all my years living in southern California, I have never experienced biking along the beaches of Santa Monica and Venice, nor have I ever gone shopping on Abbott Kinney (a well-known boulevard located in Venice lined with trendy/urban shops, earthy/cool restaurants, and more). We had a wonderful time catching up, eating delicious food, and discovering new fixtures in the area that we’d never noticed before. I figure that Los Angeles still has a LOT to explore, therefore, to kick off my resolution, I might as well begin locally!

Thought of the Day: What are you thankful for from this week?

For background information of the reasoning behind my Thankful Thursdays posts, check out my 1st post of the series here! (And subsequent posts here, here, and here).

August 20, 2015 8 comments

Personal

Find The Light

written by freudandfashion

{San Luis Obispo, California}

Sometimes in the darkest moments, it’s hard to imagine that there’s light at the end of the tunnel. Friends, family, or therapists may try and provide reassurance that life gets better, things get better, fate will lead you to something better, and that you deserve better. Such thoughts sound so passive in nature, as if we have to wait and rely on fate or other external factors, rather than rely on ourselves, in order to see any change and progress. I’ve become more proactive lately and in some ways feel as if I’m cleansing myself of any major factors in my life that have suppressed me in any way because, frankly, I’m tired of living a life filled with constraints. However, more often the restraints we have are those placed upon ourselves. I know my writing in this post may sound vague, but the ultimate point I’m trying to make is that only you can set yourself free of anything in life that makes you feel trapped. The imperative tool needed is the courage to advocate for yourself and take action instead of being a passive bystander in your own life. Have a wonderful weekend.

“I learned this, at least, by my experiment: that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours.”
― Henry David Thoreau, Walden

August 8, 2015 11 comments

Psychiatry

Summertime Sadness

written by freudandfashion

{Santa Monica, California}

I’ve been intermittently unmotivated lately and am trying to analyze the reason why. Then I realize how hot, humid, and sweaty I feel as I scroll Facebook and view photos of my friends’ fabulous summer vacation trips as I sit at my desk all by my lonesome. Perhaps my current mood is triggered by the summer season? If you have a tendency to feel lazy, unmotivated, or depressed during the summer season, you’re not alone. There are several reasons that the summer months may bring about a drop in mood. The good news is that there’s ways to overcome these feelings and bring some pep to your mood this time of year.

What are some potential reasons for the shift in mood?

1. Changes to your regular schedule. Basically, anything that throws off one’s routine can contribute to a change in mood and motivation. The kids are out of school, which means increased responsibilities monitoring them and taking them out on activities to keep them occupied throughout the day (this also means decreased “alone/me” time). And although summer vacations are usually planned and much-needed, it takes time to adjust back to your regular routine upon return. Many also travel to different time zones, which contributes to even more difficulty to readjust.

2. Expectations to have a fabulous summer. Several of us continue to work, attend summer classes, or stay home during the summer months (due to budget, other responsibilities, etc) and with modern life dominated by social media, we are bound to come across our friends’ seemingly exciting vacation photos. Not spending a few weeks in Hawaii or the Hamptons? That’s okay, but one can’t help but feel the pressure and envy to be on vacation especially when it appears that everyone else is jet-setting away.

3. Increased pressures to have the ideal swimsuit body. I used to hate summers in so-cal as there’s nothing that made me more self-conscious than being surrounded by model’esque women in bikinis. I vividly recall skipping out on pool parties as a teen (partially because I didn’t know how to swim) because I was body-conscious and oblivious on how to choose a flattering swimsuit.

4. Summer seasonal depression. Seasonal Affective Disorder (SAD) is a recurrent depression that is experienced only during a specific season, but is NOT experienced during the rest of the year. Though the prevalence of SAD during the winter time is much higher compared to summer, studies have shown a correlation between summer seasonal affective disorder and higher, hotter temperatures.

5. Losing a sense of purpose during the summer months. People who have time-off during the summer months (ie, teachers, school employees, etc) may have difficulty shifting their priorities from work to something else around this time of year. It’s well-known that utilizing skill and having a career that strengthens and contributes to a person’s sense of identity tends to improve mood. When a sense of purpose is taken away (even if for a few months), one’s mood may decline.

6. Weather change. Some people just don’t like basking in the sun or going out when temperatures are high. Period. But the distaste for heat can lead to social isolation and difficulty leaving the comfort of an air-conditioned home, which can contribute to a decline in mood and lack of motivation. Also, the heat and longer days can cause insomnia, which may cause a decline in energy levels as well.

WAYS TO BREEZE THROUGH THE SUMMER MONTHS

1. Seek help from a professional. If you feel that the summer season is causing impairment in your daily life, then seek help from a professional (physician or therapist). Medications, such as antidepressants, might be an option to help you get through the season. Also, therapy (particularly cognitive behavioral therapy) has been shown to help seasonal depression.

2. Stay active. As I wrote in a previous post, exercise has been shown to be just as effective as antidepressants for the treatment of depression. While on vacation, try to maintain an exercise routine as much as possible. Many people understandably avoid outdoor exercise due to the heat, so consider exercising later at night, early in the morning, or join a nicely air-conditioned gym for a few months.

3. Get some rest! Our circadian rhythm plays a large role in the maintenance mood. Despite the temptation to stay up late, try your best to maintain a regular sleep schedule as variations (especially lack of sleep) contribute to irritability, increased anxiety, and depression. Also, if you’re tired after a busy or stressful day, allow yourself to get some rest instead of overexerting yourself.

3. Keep your environment cool. I’m admittedly cheap at times and avoid turning on the air conditioner unless absolutely necessary, but if the heat makes you moody, then your wellbeing will hopefully prevail as the utmost priority over cost.

4. Don’t let social media bring you down. Keep an open mind and remember that pictures on social media generally display near perfect appearances. Get annoyed by the person in your group who obsessively snaps away trying to obtain the perfect photo instead of engaging in the activity at hand? I get irritated and would love to throw their phone in the toilet, but I exercise restraint. I’d like to think I’ve learned to maintain good boundaries by allotting only a few minutes to take pictures per each activity (if any of my friends or family think otherwise, please let me know). I found this article, which explains the concept of perfection in social media, quite interesting.

5. Carve out time for yourself. I emphasize the concept of self-care so much in my blog that no further explanation is needed, but if so, please refer to my entire blog 🙂

August 5, 2015 10 comments

Psychiatry

Overcoming Social Anxiety

written by freudandfashion

{Claremont, California}

To continue my series on conquering our fears (see Part 1 here), Part 2 consists of one of the more common phobias: Social Phobia. I struggled with social anxiety since childhood (as I discussed in a previous post) and often felt uncomfortable in any situation that involved interacting with people. It wasn’t until six years ago during my psychiatry residency training that I finally gained control of my symptoms. Some of the common thoughts that would race through my mind:

– “Are people judging my appearance?”

– “What should I say so that I don’t sound stupid?”

– “Hurry up and say something so that people don’t think I’m shy and quiet”

– “What I said was so stupid, they must think I’m an idiot”

– “What excuse can I give to avoid going to the event?”

My social anxiety dominated a huge part of my daily life.

If you also struggle with social anxiety, the following are some steps you can take to work towards overcoming your fear:

1. Avoid Avoidance

One of my supervisors always emphasized “avoiding avoidance” in application to overcoming all forms of anxiety, and the statement definitely applies to social situations. The more you avoid, the more you reinforce your anxiety symptoms. Sure, it might be far less anxiety-provoking in the moment to stay at home, but how will you cope with anxiety-provoking situations in the long run? Social anxiety impacts all facets of daily life, from something as common as participating in a regular conversation or going to the grocery store to giving a talk at work.

An example of avoiding avoidance: one of my patients rarely left her home during the day (and would run errands only at night to avoid the crowds) due to social phobia, except to attend her appointments with me. Therefore, in order to encourage avoiding avoidance during the day, I made sure she scheduled weekly, daytime appointments with me in order to challenge her fears of running into people during the day.

2. Climb the social anxiety “ladder”

If you don’t have too much difficulty with shyness and feel motivated enough to expose yourself to a series of social situations, then create a list of approximately 10 situations and rank them in terms of level of anxiety (1 = lowest anxiety situation, 10 = highest anxiety situation). Start with #1 and work your way up. And be sure not to skip because you run the risk of getting too overwhelmed and exacerbating your anxiety, which could lead to increased discouragement, self-doubt, and feelings of failure.

For example, my hierarchy would look something like this:

1 = speak to the cashier at the grocery store

2 = go to the bank after work when it’s busy

3 = attend a new exercise class at the gym

(I’m skipping #4 – 9 for the sake of brevity)

10 = Give a talk/lecture to a large group of people (#10 should be a goal to work towards)

3. Get a self-help manual, workbook, or internet-based self help program for social anxiety

Cognitive behavioral therapy (CBT) is one treatment modality shown to be effective for social anxiety disorder. One study found that an internet-based self-help program helped university students with social phobia and public-speaking fears. CBT examines the engrained, negative patterns of thinking (for example, “everyone at the party is judging me” or “anything I say is going to sound stupid”) in order to modify and challenge these irrational thoughts/beliefs. CBTrequires commitment, a lot of homework, and practice of the techniques in order to be successful. After all, the origins of such distorted ways of thinking have likely been engrained since childhood.

The following is a list of recommended resources (if you are currently seeing a therapist, please be sure to run the resources by them before using):

The Shyness & Social Anxiety Workbook

In The Spotlight, Overcome Your Fear of Public Speaking & Performing (for public speaking anxiety)

Overcoming Social Anxiety: Step By Step (Audio/Video Series)

3. Work on self-acceptance and feeling comfortable with being less than perfect

This is something I definitely struggle with, especially since much of our social anxiety centers around our fears of being judged and wanting to maintain a “close to perfect” image, yet at the sacrifice of openly being ourselves. How many times have you been at a meeting or lecture and are hesitant to ask a question or verbalize an opinion, but then someone else speaks up and says the exact same thought before you (this has happened to me numerous times)? Or maybe you have a fear of doing something embarrassing in front of a group of people? Recognize that your opinion is just as valuable as others and that as a human, something clumsy or embarrassing is bound to happen from time to time (even celebrities have major televised fail moments).

4. Seek help from a competent mental health professional

Seeking support from a professional who specializes in anxiety disorders is always an excellent option especially if your social anxiety is preventing you from enjoying and/or moving forward in life.

So, how did I overcome my social anxiety? Well, I went into a field that forced me to learn more about myself, started seeing a psychotherapist, participated in group therapy with my co-residents (a requirement in my residency program, which I believe should be mandated in all programs), exposed myself to situations that challenged and forced me to learn to cope with being in uncomfortable group and public settings (becoming chief resident was among the more challenging roles, yet provided the most growth), among other things. Not to say you have to do ALL these exact same steps to conquer your fear, but that’s the process I underwent in order to feel confident and comfortable being myself in social settings. And yet I STILL have to put in work on a regular basis to prevent my anxiety from getting the best of me (one of the reasons I’m in a weekly psychotherapy group). I took a one year break from therapy after graduating from residency and noticed that my ability to work through my anxiety didn’t come as easily, which motivated me to restart group psychotherapy last year.

Medications can help alleviate your symptoms, but fully gaining control and overcoming the anxiety for the long term requires work, so you have to be willing to expose yourself to uncomfortable situations, willing to keep learning, and willing to face and challenge your fears on a regular basis.

If you also struggle with social anxiety, would love to know which techniques you find most helpful to cope with social situations.

Photo by Marlon Santos

July 30, 2015 11 comments

Psychiatry

Conquer Your Fears (Part 1)

written by freudandfashion

{Lake Tahoe, California}

At the request of one of my awesome readers, I am writing a post on conquering our fears. Being an ENFP personality type (Extroverted, Intuitive, Feeling, Perceiving), I interpreted this in a more global, existential sense: getting over the fears and barriers that may interfere with moving forward in life and/or discovering one’s life purpose. However, others may be more interested in something more specific such as the treatment of specific phobias and social phobia, so I will be writing on conquering symptoms of those diagnoses in future posts next week.

Every psychotherapist has their own style, but the following are questions that I may ask my patients when it comes to conquering some of their biggest fears (if they can even put a name to what their biggest fears are because oftentimes, people are not even sure of what they’re afraid of):

1. Identify your fear. Once you’ve identified your biggest fear (ie, when it comes to a certain situation, such as pursuing a new job, finding love, etc), what is the very 1st thought that comes to mind if I was to ask you to close your eyes and think of the following question: When it comes to _______ (insert goal here), what is the one thing you are most afraid of??

Once aware of the biggest barrier/fear getting in the way of your goal, being consciously aware of this fear puts you more in control.

2. Origins of the fear. Where do you think this fear stems from? Have you experienced a similar, familiar sense of fear in your past or during your childhood?

Having a certain level of fear is normal because the reaction helps identify danger and take action to protect, but when the fear becomes excessive, there’s usually an origin to such fears based on past experience. Recognizing the connection with your past and how irrational the fear is in the present time can be enough for one to take action towards handling the fear more effectively this time around.

3. Take the next step. What small steps can be taken to slowly start working towards overcoming your fears?

For example, someone who is afraid of heights may start by going up to the roof of lower level buildings and working their way up to whatever their end goal might be to conquer the fear of heights (ie, skydiving, looking down while at the top of the empire state building, etc). Or, someone who is afraid of pursuing their dream career might start out by researching how to achieve the career, reach out to others to get advice, or start submitting applications to obtain the educational requirements or job experience needed to improve chances of getting their dream job.

4. Be open to disappointments and any challenges that come along the way. Fear of failure is a common barrier towards taking risks in life. Overcoming fears takes time and practice, so try to be as open as possible to learning and growing from the process. Surround yourself with those who support you in your goals and failures, and motivate you to stay on track. Wanting to give up is a normal feeling (I’ve experienced this numerous times, especially in the process of becoming a doctor) and NOT a sign of weakness.

But each time you get overwhelmed by the fear, ALWAYS REMEMBER and believe in yourself enough to recognize that you have a choice: either have power over your fears, or give power to your fears. So visualize the end goal, look your fear straight in the eye and say “f*** you, I’m the one in control” (yes, I’ve actually told some of my patients to say this).

July 23, 2015 4 comments

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