Social Anxiety Disorder

Social anxiety disorder, also called social phobia is said to be the third most common mental disorder.  This is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations.  The intense nervousness and self-consciousness comes from a fear of being closely watched and being judged or criticized by other people.

Social anxiety disorder can make a person feel scared they’ll make a mistake, perhaps be asked to make a very basic decision, or just answer a simple question that requires them to think of reply that is somehow different from their normal day to day conversation and communication. Being put on the spot to respond instantly to a question can be quite terrifying to someone with social anxiety disorder, no matter how normal or straightforward the question may appear to someone who has confidence and is able to communicate more easily. 

The fear of embarrassment or of being humiliated in front of others can be great. While one person can take a casual comment as just a throw away remark, to someone suffering from social anxiety, the same comment can feel totally mortifying. .The fear can be made worse by a lack of skills and experience in dealing with social situations – if something scares you, you’ll often try to avoid it where possible. While it may feel easier in the short term, the downside is that of course you then can never become good or confident at doing whatever “it” is.

The anxiety can build into a panic attack.  As a result of the fear, the person can become increasingly tempted to start avoiding social situations altogether. They may also only mix with the few people they feel comfortable with and trust like perhaps immediate family members.

People with this problem may spend a good deal of their time one step removed from face to face contact, relating to others via their computer. Their experience of life can be largely gained from reading books, watching the news, TV programmes online information, and most, communication taking place via social media platforms such as Facebook. They console themselves with the idea that they have lots of friends, but these are often “virtual” and “online”.

Anticipatory anxiety is the fear of a situation before it even happens, for example dreading the date of a forth coming wedding to which you have been invited, and have accepted the invitation. You find yourself panicking about what sort of an idiot you will make of yourself in front of all those people. In many cases, you are aware that the fear is unreasonable, yet on your own somehow you just can’t seem to overcome it.

This social anxiety disorder can distort one’s ability to think reasonably and logically. The person predicts all sorts of catastrophes, which make them dread any social event, as they “know” it will be awful. And even when it is fine, this does not stop the catastrophosising about how lucky you were that you just got away with it that time….. but wait for the next!

Without treatment, social anxiety disorder can interfere with the person's normal daily routine.  Ordinary dealings with people at work, communicating effectively with peers and more personal relationships can be an ongoing battle. The ever-present fear and reluctance to say yes to social activities can turn into a vicious cycle, whereby eventually others automatically expect you to refuse, and so no longer invite you to anything.

People with social anxiety disorder often find difficulty:

• Meeting people for the first time
• Eating or drinking in front of others.
• Writing or working in front of others.
• Being the centre of attention.
• Interacting with people, including dating or going to parties.
• Asking questions
• Silence during conversations
• Using public toilets.
• Talking on the telephone.

Social anxiety disorder can be linked to other mental illnesses, such as depression, panic disorder, obsessive compulsive disorders. 

Researchers from MIT, Boston University (BU), and Massachusetts General Hospital (MGH) in the Archives of General Psychiatry in July this year, have taken brain scans of patients with social anxiety disorder. Their research is exploring if it is possible to predict which people with this problem are likely to be helped by cognitive behavioural therapy (CBT), and who is more likely to be helped by medication.  Cognitive behavioural therapy aims to enable people to change their thoughts and behaviour patterns which can otherwise lead to anxiety. For social anxiety disorder patients, that might include undertaking “behavioural experiments” to gather data and check out whether others are actually watching or judging them. If you avoid some one’s gaze, you will never know if they are looking at you!  Likewise, if you smile, and they smile back, perhaps they are not mentally criticising you. Currently both CBT and medication are used to treat social anxiety, though the National Centre for Clinical Evidence (NICE) guidelines suggest that CBT is likely to be particularly helpful, and should be the first choice of treatment, before offering medication.

Having worked over the years with a number of people who suffer from social anxiety, including extreme fears of blushing and sweating, it has been extremely satisfying to see people who have blossomed in confidence, begun and maintained new and satisfying relationships, and say that the quality of their life has improved immeasurably.

Overcoming your fear of flying – is it stopping you enjoy life?

Here in the UK we can sometimes feel spoiled for choice by all the beautiful countryside, villages, towns, cities and sights there are to be visited. Indeed a lifetime would not suffice.

But many of us want to experience new countries and cultures, as well as exploring our own.

Guess how many of us in the UK would love to travel to another country for a holiday, but are too frightened to fly? Estimates put the number at around 6 million people.

This number also includes people who sadly may miss out on fantastic opportunities to travel through work, as they turn them down because of a fear of flying?

There’s certainly nothing new in having such scary thoughts, especially when you see the terrible results of plane crashes like the recent one in San Francisco.

But putting this into context, how often do you hear about serious plane crashes?

With all the millions more people travelling by air year on year, the actual percentage of accidents and incidents with air travel is minimal compared to other forms of travel. And despite the tragedy at San Francisco, air travel certainly continues to live up to its reputation of “the safest form of travel”. Just look at our motorways, or your own day to day journey to and from work for comparison, or listen to your local news – it can be quite an eye opener.

Having a fear of flying is usually not a ‘fear of aeroplanes’ but a fear related to a ‘loss of control’, either externally i.e. something to do with having no control over what happens to the pane, or internally – feeling something terrible will happen to your body or mind that you cannot control. Individual fears in the first group can include heights, turbulence, bad weather, and things happening to the plane, including terrorism. The second group of fears are about something happening to you, yourslef – worries about claustrophobia, agoraphobia, making a fool of yourself, and having a panic attack are part of this group of fears.

All of these feelings and thoughts trigger scary pictures in our minds. They can create a barrier which stops us from doing the fun stuff like getting on a plane to go on holiday, or makes us turn down that dream job abroad.  What you think influences how you feel, and how you feel often determines how you behave. 

It’s all about learning to question what we’ve come to believe. If we can experiment and find out that things aren’t as awful as we anticipate they will be, it’s then possible to challenge that scary picture in your mind, test it out, and from the positive results, come up with a new view on what we can achieve, and the enjoyment we can have.

This process is very doable. 

About Cognitive Behaviour Therapy

Cognitive behaviour therapy has been developed from extensive research.  People's behaviour and emotions depended to a large extent on what they understand is happening.  As mentioned before what a person thinks and anticipates can greatly affect his or her reaction to events and people

From the cognitive behavioural perspective, fear of flying can be seen as a conditioned response to an experience such as a near miss, a particularly turbulent flight, or a catastrophe that took place during a flight.  A pattern of avoidance behaviour is set up which feeds into the anxiety, making it stronger, and thus prevents the testing, and invalidating, of the feared prediction of future catastrophes.

So finding a well-qualified psychologist with skills and experience in the treatment of anxiety is very important. It can also be helpful to ensure they have prior experience with your particular difficulties.

Mental health issues – it’s good to talk

It was good to see Mental Health Awareness Week discussed in the media last month - highlighting the impact of mental health on individuals, their family members and friends.

The BBC wrote an article last month about 'when does your mental health become a problem'.

It stated that one in four people are expected to experience a mental health problem, and highlighted that sadly stigma and discrimination are still very common. Indeed myths assuming that mental illness is somehow down to a 'personal weakness' still exist.

So how do we define mental health?

A person considered 'mentally healthy' is someone who can manage the day to day normal stresses of life and can easily go about their activities in order to look after themselves.  However, as we’ve all experienced at some time, our state of mind can radically change in response to events that happen in daily life.

The question is, when is someone thought to be mentally ill, how is it diagnosed?

This illness cannot be 'tested' by checking blood or body fluids. Instead the usual practice is diagnosis by an experienced psychiatrist or clinical psychologist.

Taken from the Royal College of Psychiatrists – these statistics below paint a clear picture of how common mental illness is in the UK. They show how important it is to have  a good understanding of mental health issues, which should be taken seriously.  It’s really important to raise awareness of these sometimes complex issues, to help people with such problems reduce feelings of isolation, loneliness and a reluctance to admit to such difficulties.

·         Anxiety will affect 10% of the population

·         Bipolar disorder will affect one in 100

·         One in every 150 15-year-old girls will get anorexia, as will one in every 1000 15-year-old boys

·         20% of people will become depressed at some point in their lives

·         Obsessive compulsive disorder (OCD) will affect 2%

·         Personality disorder will affect one in 10, though for some it won't be severe

·         Schizophrenia will affect one in 100

Well known actor and presenter Stephen Fry is a relentless campaigner of mental health issues. He is President of the mental health charity Mind. Having such a well known personality involved in this area can help break down barriers. 

There are many ways a person can seek information about mental health issues. While the internet contains a wealth of information, not all of it is accurate and so checking for reputable sources is extremely important.  Books are also a good source of information, but once again it is important to check out the credentials of the author. Self-help books can offer expertise, advice and support and there are many written by professionals in their field of practice. 

The Books on Prescription scheme, recently launched Nationally with books available through the local libraries provides an excellent source of information. The list is available through the Reading Well Agency . They provide a good selection of books covering numerous topics, ranging from depression, anxiety and eating disorders through to obsessive compulsive disorders.

The Dummies Series on ‘Overcoming Depression’ and ‘Overcoming Anxiety’, along with the ‘Anxiety and Depression Workbook’, are also good source of well documented and easy reading books to consider as a source of information., along with many other books on this topic, including “An introduction to CBT” published by Icon,

http://www.freedomtofly.biz/booksign.htm

Elaine Iljon Foreman BA (Hons), M.Sc., AFBPsS

Consultant Chartered Clinical Psychologist specialising in the treatment of fear of flying.

Mental Health Awareness Week

The 13 to 19 May is Mental Health Awareness Week - highlighting the impact of mental health on wellbeing. 

It is wonderful to see these really important issues being raised on the BBC News channel and the radio, especially with so many people suffering from depression and anxiety related disorders.  I expect most people know of someone amongst friends and family that have suffered from either depression or anxiety, or even both at some time in their life.

It highlights on the Mental Health Foundation website that isolation and loneliness can cause as big a health risk as smoking – which is quite startling.  With our ever growing aging population, it is a concern that increasing numbers of the elder generation will be impacted by depression and anxiety related issues at some point in their lives.  Many of us have older family members and have experience of how so often they can become more anxious, more sensitive to daily happenings that we take for granted and how they become less able to cope with issues and decisions that they found easy to adapt to when they were much younger. 

There are many anxiety related problems, a familiar one being agoraphobia.  A person can feel as if they are trapped in their own home, because they are terrified of going out and being in a variety of situations such as  wide open spaces, crowds of people and even of bumping into people they know, feeling they must stop for a chat, but very frightened as it feels like a situation with no escape. Imagine this applied to you. It can totally take over your life, spoil your social life and all the things you wanted to do in retirement, and can feel like it will last forever.

The treatment of agoraphobia is very possible.  Using both cognitive behaviour therapy via self-help resources such as books, and specialist support from professional therapists can help overcome this very common phobia.

You can begin to understand what’s happening when you have a panic attack, and how the fear of going anywhere where you might experience this can be enough to make you want to stay well away from such places. But the more you stay away, the less opportunity you have to learn that perhaps you can cope with panic and manage it, and it need not rule your life. It is important to realise that help is available, and the problem for most people can be overcome.

I was quite surprised to hear Rebecca Adlington admit live on the BBC One Show that she did not like swimming in the sea.  What a revelation for a fantastic award winning Olympic swimmer.  This just goes to show that practically everyone, even celebrities, can have a fear of something.

The fear of flying – what makes those thoughts feel so overpowering?

Most of us watch or listen to the news, so chances are we’ll come across aeroplane related headline stories at some time – and the ones that make the news are generally bad news!. But though it may seem like there are loads of these stories, the reports cover the world, and include even small private planes. How many car accidents around the world do you come across making headlines?

For those of you who are afraid of flying, just thinking about booking a ticket and stepping on a plane can feel as likely as a return flight to Mars – and it’s fascinating that they’re now talking about a future one way mission to Mars…. Though getting back is still a very long way off.  What will we find there, one wonders. Thinking about the Universe brings to mind the well-worn cliché – “We are not alone”. And with this in mind, it can be reassuring to know that the fear of flying is actually shared by many, many people worldwide.  You’re not alone!  But if you’re never done something, then what is it that stops you from giving it a go?

Quite a few people say they just know they won’t like something – and aren’t prepared to even try it. We all know people with food fads, who won’t sample anything outside the normal range of what they know they like. So what is it that puts these thoughts, images in our heads before we even try things out? It can be that you feel particularly vulnerable at a point in your life, and so believe the chance of something happening, despite being very unlikely, could actually occur – and that it will be just your luck and your flight.

A story which caught my attention was the BBC’s One Show on Monday evening when they covered the story on the police investigating whether a man found dead recently on a west London street was a stowaway who fell from a plane, who had hidden himself in the landing gear of a plane flying to Heathrow.  How often do you hear of this?

Yes we do hear about frightening plane crash stories like the one which took place this month.  The airliner that came down in the ocean while on arrival to Denpasar-Ngurah Raj Bali International Airport. But it’s really important to remember that all 108 passengers and 7 crew survived, though very sadly 45 people were injured. 

So what do we do with all this information and how do we relate it to our life’s ambitions?  Do we just put our ambitions to one side and give ourselves an easy excuse that we just can’t do it, or do we face it head on and find a way of dealing with it?

Isn’t getting on a plane and travelling to some far flung destination or even taking a short flight for a weekend trip worth doing?  What about the old friend over in Spain that you chat with on Skype every weekend – or the new job you’ve taken that could well involve a lot of travelling overseas?  The world is a small place and getting even smaller.  The option of travelling will grow ever greater, to the point where more and more of us will have to move around to get work, so overcoming this very real fear of flying could make all the difference to your life.

Elaine Iljon Foreman BA (Hons), M.Sc., AFBPsS   BPS Chartered Psychologist

Consultant Clinical Psychologist specialising in the treatment of fear of flying.