Cognitive Therapy Basics

Social anxiety disorder can stem from a variety of reasons and understanding the causes can help with overcoming social anxiety and shyness.The following are some of the causes that lead to social anxiety.Causes of Social Anxiety DisorderGenetic Causes – People with a close relative suffering from social anxiety disorder are likely to have it too. Psychological Causes – Some people have a mental conditioning that does not allow them to be comfortable in social situations and even experience aggressive symptoms of reaction. They might harbor feelings of low self-worth and may panic greatly in such situations.Past Social Experiences – In most people who suffer from SAD, the social experiences that they have had in their past life play an important role. Social anxiety patients might have suffered from uneasy situations with their peers or at school. Submissive methods might have been used in their behavior modification such as using corporal punishment to train them or using comparison or humiliation techniques by their parents or teachers. They might have had some social accidents before, such as being called on stage to say something and failing at that. Such past social experiences can leave indelible marks on children and grow with them as they grow, developing into social anxiety disorder.Treatment of Social Anxiety Disorder

Anxiety disorders are one of the most common psychiatric illnesses affecting both children and adults.  There are about 40 million known cases in the United States alone.  These disorders usually develop from a complex set of risk factors which may include personality, brain chemistry, genetics, and life events.  Though anxiety disorders may be derived from so many factors, they are highly treatable.  However, perhaps because of the stigma attached to anxiety disorders, only about one in three people afflicted actually receive any type of treatment.

It is important to know that the phrase “anxiety disorder” is an umbrella term for more specialized disorders including Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Posttraumatic Stress Disorder (PTSD), Social Anxiety Disorder (Social Phobia), and Specific Phobias.  Regardless of what specific anxiety disorder a person has, they can be quite debilitating with a variety of symptoms.  In most cases, anxiety disorders present themselves with other mental disorders such as depression.

The symptoms of anxiety orders may manifest themselves at an early age or start suddenly, perhaps after a triggering event.  During high stress periods, anxiety disorder symptoms may present themselves more frequently or with greater severity.  Symptoms include sweating, headache, muscle spasms, hypertension, palpitations, fatigue, and exhaustion to name a few.

As mentioned, anxiety disorders are highly treatable.  Patients suffering from anxiety orders may be treated by psychosocial therapies, medication, or a combination of both.  Psychosocial therapies are usually attempted first and include Cognitive-Behavioral Therapy (CBT), anxiety management, relaxation therapies, exposure therapy, and psychotherapy.  These therapies always involve working closely with a mental health professional, usually a psychiatrist, psychologist or social worker.  During such therapies, patients and professionals discover what the source of the anxiety disorder is and how to deal with it.

Cognitive-Behavioral Therapy is one of the most useful of the therapies for anxiety disorders.  CBT actually helps people change their thinking patterns so that their reactions to anxiety-provoking situations become less severe.  Successful CBT can make patients understand that their panic or anxiety attack is not really a heart attack

Many times, anxiety disorders are treated with not only psychotherapies but also with medications.  The drugs most commonly associated with anxiety disorder treatment include SSRIs, which are selective serotonin reuptake inhibitors, beta blockers, benzodiazepines, tricyclic antidepressants, and MAOIs, which are monoamine oxidase inhibitors.  Medication alone will not cure anxiety disorders, but will help keep them under control.

The most successful treatments of anxiety disorders involve the combination of medication and psychotherapy.  Many doctors will prescribe medication shortly after diagnosis so that the symptoms are alleviated quickly (usually within 4 to 6 weeks) and allows the psychotherapy protocol time to become effective.

Panic attacks leave a terrible impact on a person´s life. There are several symptoms that tend to disturb a person in many ways. An individual with panic attack disorder also lives in constant worry that he may have to soon suffer an attack and feel embarrassed in front of other people.

However, what most people are not aware of is that panic attack disorders are treatable, no matter how serious or intense the case. Experts in the field of medical science tend to recommend different types of techniques and therapies to facilitate the sufferer to lead a normal life. They believe that the disorder is a result of a combination of several environmental as well as biological factors just as other serious disorders like diabetes and heart disease.

People can be relieved of the scary symptoms via professional care. Success of the treatment depends and varies from one individual to the other. Some people may respond to a therapy within a few months while others may require about a year. The treatment method may also be made complex keeping in mind the exact state of the individual and intensity of the disorder.

The professional needs to understand whether the individual is suffering from depression or substance abuse. Sometimes, people may also suffer from more than one anxiety disorder. This also makes the treatment procedure, a little complicated.

There are certain steps recommended by the experts to people with panic attack disorder. Following these steps will help overcoming disturbing symptoms and even over-come avoidance of panic attacks.

Before following the steps given below, it is important to remember that avoiding places and situation that leads to occurrence of panic is not recommended. Avoidance tends to stimulate panic development.

Steps to follow:

a) Step one: Prepare a list: You must prepare a list of all types of safety behaviors you can imagine as well as exact reasons for adopting these. Also make a note of what you fear in case, you don’t follow these safety behaviors. 

b) Step two: Rate Behaviors:  You need to rate each of these behaviors on a scale of 1 to 10.

c) Step three: Prepare a list: Now, make a new list again and write down all the items in order of severity. The lowest severe should appear on top.

d) Step four: Rational alternatives: You need to have a look at all your reasons one by one. Now write down alternatives that are more rational. For instance, my heart seems to be fine hence, I can walk a little faster.

e) Step five: Decision to change: You must take the first behavior appearing on your list and try as hard as possible to resist it. Doing this will provide you an opportunity to understand that things are fine around you.

Please, visit my blog for related articles: www.PanicGoodbye.com/blog

Sometimes people ask me why I spend so much time on what generates panic attacks. My usual response is, beyond my natural curiosity, I simply don’t see how one can manage something if one doesn’t fully understand just what that something is. And, at least to me, a complete understanding has to include insight into genesis. I mean, if you were experiencing chronic chest pain, wouldn’t you want to know what was causing it? And let’s no forget that knowing why something happens leads to more efficacious management strategies and techniques.

I have always placed emphasis on both the psychological and physical contributors to panic attacks. But, in this article I’d like to stick with the psychological and address two theories of treatment. Needless to say, there are many floating about; however, I’d like to briefly discuss the psychoanalytic and cognitive points of view with regard to the generation of panic attacks.

Psychoanalytic

A psychoanalyst would likely submit the generation of panic attacks goes back to infancy and childhood. They would, however, acknowledge that panic attacks may also occur as a result of assorted cues in the present, such as the fear of having a panic attack in a situation where one recently occurred. For the record, an attack occurring within this context could either be situationally-bound or situationally-predisposed. The psychoanalysts consider both conscious and unconscious panic triggers as representations of intense early life wishes and fears. So, panic attacks, in large part, occur in response to cues associated with long past psychological and biological threats to one’s existence. By the way, these cues are based in retained themes of intensely feared eventualities such as castration, separation, and parental disapproval.

Cognitive

A cognitivist would likely submit that a panic attack is a manifestation of an intense feeling of helplessness in the face of intense danger. The vicious cycle of panic, which we know all too well, is generated and sustained by combining the very real terror of vulnerability with one’s traditional distorted thought and feeling responses. Within the context of human genetic predisposition, which from a phylogenetic perspective leans toward the anxious for purposes of survival, it naturally flows that these thought and feeling responses appear to be designed to produce the belief that out-of-control internal distress can lead to grave danger, even disaster. Doesn’t it make sense that it’s this dynamic that so often generates the intense need to seek a caregiver for immediate assistance? I mean, at this point all bets on reason and logic are absolutely off as our primal instincts take over. And then all sorts of physical symptoms arrive on the scene because our mind really believes we’re in imminent danger, and it’s getting us ready to fight the good fight. And the snowball just rolls on down the hill from there.

Finally, the cognitivists would likely submit that though panic attacks are often thought of as spontaneous, some sort of event had to have tripped the trigger. Who knows, the culprit may have been a sudden physiological change; say, feeling faint upon standing, sensing a rapid or palpitating heart beat, or detecting a shortened breath. The thought is that events such as these, in the absence of reason, are interpreted as indicators of immediate physiological danger. And, boom, off to the races we go.

It’s my belief that, individually, both the psychoanalytic and cognitive angles hold great merit. But, for my money a combination of the two is truly the ticket. I mean, so okay, according to the cognitivists a physiological change, such as a shortened breath, may trip the panic trigger. Well that’s great; however, I’d like to know what existed unconsciously that led to the perception that that shortened breath was a signal of coming catastrophe. Hmmm.

As always, the more we understand about our circumstances, the better we become at managing them.

Exposure therapy as treatment for Social Phobia is exactly what it sounds like, exposing your mind and body to that which you fear. By gradually exposing and training your mind that the feared event is not as horrible as you think it is, you are working to desensitize yourself to the stimulus. 

A). During exposure therapy, you expose yourself to small doses of the feared event and increase the duration of exposure over time. If you are afraid of talking in groups, start by imagining yourself in front of groups, then speak in front of a couple of family members or close friends, then a couple of acquaintances and build up to a room full of strangers. 

You don´t need to pay someone to help you; you can work on this at home.

1. Start off imagining an event that causes severe anxiety, talking to your boss, asking a girl out, talking in front of your class, whatever it may be. Feel the anxiety, nervousness and agitation wash over you. After a minute or two, withdraw your mind from that situation. You have endured it and you are still here to tell about it. 

2. Increase your exposure time gradually and then work your way up to real life exposure to the situation.

B). Image desensitization is a great way and process to implement exposure therapy on your own or in a group setting. 

A great place to find support while you are working to desensitize yourself to the social phobia inducing situations is to work in a group with other sufferers. By rehearsing stressful situations within a group, not only do you know you are in a safe place where you will not be judged but you might learn from other sufferer´s coping strategies. 

The second part of the cognitive behavior approach involves retraining the thought process in your mind. For many anxiety sufferers, the immediate and instinctive thought reaction to stressful situations is negativity. Social phobic don´t see the glass as half full but rather half empty and dirty. 

It is important to substitute positive thoughts for the negative ones and not to overestimate the dangers, reactions and thoughts in any given social situation. You have a surprising ability to cope with what the world throws at you; you just need to uncover those resources. 

Cognitive restructuring is used to help social phobia sufferers uncover the thoughts that automatically flood their minds whenever they are in stressful situations.  The thoughts flooding in the head probably involve fears of messing up a story, sounding stupid, having people think you are an idiot or maybe they´ll just turn their backs and walk away, completely uninterested in anything that comes out of your mouth. 

Are these fears realistic? You need to test these notions to see if they compare with what will happen in the real world. You have told funny stories before, so you can probably do it again. Even if the story is stupid or uninteresting, the listeners would surely never be so rude as to turn their backs and walk away and most if not all will at the very least pretend to be interested. 

However, you could also tell an interesting and engaging story that starts you down the road towards new friendships and better interaction with colleagues. If you constantly look at and examine your beliefs and rationalize them it can chip away at the long-held, negative beliefs that are holding you back. You can train your mind not to react negatively in every circumstance and certainly not to overestimate or over exaggerate the negative.  

The fact is that cognitive-behavioral therapy and medications work. Countless people all over the world have been helped by either one or a combination of both of these approaches. Research and clinical practice have repeatedly supported their efficacy. No self-respecting clinician who is knowledgeable about anxiety disorders fails to utilize them.

But not everyone who receives cognitive-behavioral therapy and/or medication achieves satisfactory recovery. And there are some persons who, having received good treatment, get better for a while and then relapse. Thus it appears that, at least sometimes, something more than CBT and medication is needed to ensure a lasting and high level of recovery.

The technologies of cognitive-behavioral therapy and psychopharmacology, while very helpful, might not always be sufficient.

If, for example, people didn’t change their lifestyles, work on overcoming anxiety-prone personality traits such as perfectionism, address interpersonal conflicts at home or work, or find some larger meaning in their life, they might continue to remain anxious in spite of the best efforts of their cognitive-behavioral therapists and psychiatrists.

Rather than offering specific techniques to address physiology, thoughts, and behavior, the approach taken in these articles deals with the whole person. As you read through them, you’ll be examining such issues as:

• how to simplify your life to achieve greater peace of mind

• how to address difficult personality issues that create anxiety

• what “alternative” therapies might be helpful

• how learning to meditate regularly can reduce worry

• how finding your unique life purpose and embracing a more spiritual outlook might offer a deep healing in your life

You didn’t develop an anxiety disorder out of the blue. It happened because of an accumulation of stress over a long time, or perhaps just one major stressor, in combination with your genetic makeup; your childhood; and your particular lifestyle, priorities, personality, and interpersonal situation as an adult. Yes, of course, you want to get rid of your symptoms. But you might also view your symptoms as an ally.

Your symptoms are calling you to understand yourself better to really examine yourself and figure out what changes you need to make in yourself and your life to feel better.

Look at it this way: If your anxiety disorder didn’t stop you in your tracks and call you to pay attention, you might have gone on in your habitual ways until something even more serious happened. Your body is giving you a warning signal that you need to make some changes.

The change required may be to deal with a long-standing personality pattern, resolve an interpersonal conflict, make a shift in your priorities and values, and/or find new meaning in your life.

When you figure out what is needed and make the necessary changes, your whole life works better and you start to feel better. Your problem with panic, phobias, or obsessive worry will certainly get better and so also may your depression, headaches, insomnia, and/or tendency to be short-tempered or irritable. All of you get better.