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Freud & Fashion

...BECAUSE IT'S STYLISH TO TALK ABOUT MENTAL HEALTH, ESPECIALLY HOW WE MAINTAIN OUR OWN.

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social anxiety

PersonalPsychiatry

Look You In The Eye

written by freudandfashion
Look You In The Eye

Several friends have pointed out to me their observations of my interactions when in public places: that people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc.  These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that I’m trained to listen to people’s issues.  Or, perhaps, as one friend pointed out, I appear to be the antithesis of “bitchy resting face” syndrome.

Flashback to around twenty years ago when I was a loner preteen in the girls’ locker room, where my locker was located in the same aisle as the most popular girls at my school.  As I stared at the floor too shy to make eye contact, I recall trying to muster the courage to say something to them…anything…in hope of some kind of acknowledgement, a wave, even a “hi” — anything to feel slightly less invisible than I already was.  When I looked up directly towards them, words never left my mouth.  All I had the courage to do was smile.  A forced, awkward, and uncomfortable smile that caused my cheeks to fatigue.

And all that effort and energy exerted for the end result of coming off as creepy: “That girl is smiling too much,” was all they said.  From then on and for quite some time, I became known as “that weird smiley girl.”  As if smiling was a negative thing.  And, as one could imagine, I didn’t smile for months thereafter.  Little did they know how much of a hit to my self-esteem that one incident would have. Putting yourself out there only to get rejected sucks and may hinder further attempts to connect with others in the future.

One may perceive me as a highly sensitive, socially anxious person, and I don’t deny possessing those traits.  However, rather than being identified with a label or descriptor (ie, “That weird, smiley girl” or “Vania is anxious and highly sensitive”), I prefer that people acknowledge the different facets of my personality that make up who I am as an individual (ie, “Vania has social anxiety and can be sensitive”).  The general tone changes depending on the wording and language used.  In the former statement, being “anxious” and “highly sensitive” are inferred to be words that define me, whereas the latter refers to “anxious” and “highly sensitive” as traits.

For many years, I viewed myself as abnormal.  That is, until the last few years where I grew to appreciate the qualities that make me who I am as a unique individual, which I attribute to surrounding myself with an amazing support system, including my therapist, who helped me realize it.  As a result, I no longer stare downward nor feel afraid to smile and chat with others.

An issue that I have with how Psychiatry is perceived is the tendency to create labels.  Many people have enough anxiety about seeking psychiatric help in the first place, and the fear of being labeled and stigmatized might sit at the top of one’s list of concerns.  I’ve encountered several patients who told me they were diagnosed with a specific mental illness after one brief, initial 30-minute interview.  “The doctor told me I’m Bipolar without barely getting to know me” is a statement of different variations that I’ve heard several times in my practice.  I try to maintain an open mind about my colleagues, especially those who are only allotted 20-30 minutes to meet with a new patient (which is ridiculous in medicine, especially in psychiatry) because the ability to see a high volume of patients within a short time frame AND fully get to know each patient seems unrealistic and virtually impossible to maintain.

However, the last thing any person, including any medical provider, should do is make you feel like another label and essentially invisible or judged.  Often when people muster up the courage to reach out and seek help are in times of desperation and in highly vulnerable states.  The most therapeutic thing any person (or provider) can do is look you in the eye (even if you might be too afraid to look directly at them) and acknowledge you for who you are.

September 2, 2015 8 comments
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Psychiatry

Overcoming Social Anxiety

written by freudandfashion
Overcoming Social Anxiety

{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
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Psychiatry

Popular Party-Pooper

written by freudandfashion
Popular Party-Pooper

{Port Hueneme Pier}

Introvert = energized by activities alone

Extrovert = energized by activities around people

Introvert tends to negatively associate with being a “loner” or “party pooper” and conversely, one may assume that an extrovert is “the life of the party.”  Growing up in southern CA, I felt pressure to be an extrovert because who really wants to be viewed as a loner or party pooper?  But then again, I was also quite young, naive, and superficial, with minimal sense of self-identity, at the time.  Pretty standard for a growing teen.

I completed a Myers-Briggs personality test during residency and scores revealed that I was an extrovert.  My past young adult self would’ve jumped for joy at the thought of having proof and objective data verifying that I am indeed an extrovert, and therefore NOT lame.  But rather, my older, more mature self viewed the scale as demonstrating patterns observed over the last few years, which is that after a bad, exhausting day, I enjoy doing activities with others (such as dinner with a group of friends) to feel more like myself again.

I’ve had patients, especially college students, treated with meds for social phobia, but upon further questioning discovered that they were urged by family members or friends to seek help.  Their desire to do solo activities were perceived as “abnormal” by those around them.  I educate them about the misconceptions of being an introvert versus extrovert in hopes that they’ll feel less guilty about wanting to stay in for a quiet night at home rather than get wasted at the frat party down the street.  Several introverts are also socially outgoing, but may prefer “down time” to relax rather than impressing partygoers with their best keg stand.  Great introverted talents and leaders (Steven Spielberg, Julia Roberts, Warren Buffett, JK Rowling, to name a few) excel in different ways than extroverts, such as listening, problem-solving, thinking things through, and leading proactive group members.

Thought of the Day:  Which type of activities energize you after an exchausting day?

November 28, 2012 27 comments
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