Facing Social Anxiety - And Winning

Increased heart rate. Profuse sweating. Difficulty breathing! Symptoms suitable for the emergency room. But what may not be apparent to many is that these are all physical manifestations of social anxiety, or the “. . . persistent fear of social situations where the individual fears that he will act in a way that will be embarrassing and humiliating”, as defined by one of ICC’s therapists who served a client exhibiting this condition.

Fred came to Intercommunity Counseling Center as a young adult with an extreme fear of interacting with people. The strong emotion led him to avoid what many consider the highlights of life, including meeting new people, interpersonal communication and any kind of attention. This behavior interfered with his job, social activities and relationships, leading to a profound sense of isolation.

Like numerous others who face social anxiety, Fred experienced the scary symptoms listed above, plus other physical indicators like dry mouth, tensing of muscles and the tendency to blush, in social situations. His ICC counselor notes “The recognition of these symptoms leads to a vicious cycle, where their presence exacerbates the individual’s embarrassment and thus worsens their anxiety and fear. Experiencing this intense reaction is uncomfortable and distressing; thus, in an attempt to prevent the discomfort, many individuals begin avoiding social interactions and isolate themselves.”

Considering that social anxiety is impelled by negative thoughts, our therapist chose to use the cognitive behavioral model, created by Aaron Beck back in the 1960s. “I work from a cognitive behavioral model, meaning I address both maladaptive thoughts and maladaptive behaviors that contribute to the persistence of anxiety symptoms.”

The cognitive component of this approach focuses on how the client perceives troubling situations. Together, therapist and individual specify problems, then identify thoughts and behaviors that accompany these challenges. “These thoughts may revolve around believing that everyone is paying attention to the individual, catastrophizing future events, or the belief that the individual knows what others are thinking of him. I helped Fred find evidence that supported and contradicted each of his fears and negative thoughts, something that is new to individuals as we usually tend to find only evidence that supports our beliefs.”

The behavioral component centers on changing responses to emotional triggers. Unfortunately for the client, the most effective progress is achieved through confronting fears. For Fred, “some sessions were extremely difficult for him to get through, causing him intense emotional reactions and fear responses. These sessions usually involved role-playing through various social situations, imaginative simulation of distressing events such as job interviews, and homework assignments that involved social tasks such as simply saying ‘hello’ to a stranger.”

Long-term coping strategies provided to Fred by our therapist included:

• Diaphragmatic breathing: slow breathing technique promoting relaxation
• Progessive muscle relaxation: diversion practice focusing on muscle groups and away from current threat
• Thought stopping: interruption method banishing negative beliefs 

In as few as twenty sessions, Fred’s life dramatically improved as he reconnected with old friends, started attending social events, made new friends and even landed a job. “Throughout the entire process, Fred was able to enthusiastically share how he was able to utilize several of the techniques he learned in session during all of these social situations . . . when faced with a crowd of people, Fred said he was able to refocus his attention on something other than his anxiety and search for evidence that contradicted his negative thoughts. Overall, Fred was more than happy with the different skills he learned in therapy that helped him manage and control his anxiety.”

The online Social Anxiety Fact Sheet declares the disorder to be the third largest mental health care problem in the world. At some point in their lives, thirteen percent of the population stand the chance to develop social anxiety. But cognitive behavioral therapy is reported to be widely successful. President of the Social Anxiety Association, Thomas A. Richards, Ph.D, notes “Twenty years of experience points to the fact that people who have lived with this condition and overcome it, make the best group leaders.”

Because cognitive behavioral therapy is shown to be effective for so many psychological ailments, Intercommunity Counseling Center promotes and supports its practice by its numerous, talented therapists. 

Living Well in Sobriety

Life after sobriety should be carefree. A fresh start, clean slate and new adventures must lie ahead. While that sentiment is certainly a positive by-product of sobriety, most individuals find they face challenges and struggles to work on long after taking their last drink or hit. “The fear of being vulnerable that newcomers experience in the early stages of sobriety is so intense that some can’t get past it”, states George Joseph, a Licensed Chemical Dependency Counselor and CEO of The Right Step rehabilitation center.

Thirty-eight-year-old Lily had been less than three years’ sober when she sought support with one of Intercommunity Counseling Center’s compassionate therapists. She did have two major advantages: a stable living situation and a good job. Our counselor soon learned that Lily did not have any real “diagnosis”: no clinical depression, anxiety or personality disorder. What she did have was a heart-wrenching history consisting of alcoholism, homelessness, beatings, incarceration, hospitalization and institutionalization. She clearly needed skills to help her cope as a sober person, as well as a way to deal with her past. “If I could look back and try to recall my impression of this woman in her late thirties, I would somehow compare her to a burn victim who had just walked out of the ashes of her life.”

Vestiges arising from her painful existence unfolded as misguided choices she made concerning relationships, especially apparent in picking men who devalued her. Making unwise choices can be typical for those new to sobriety. Our ICC therapist also realized that Lily experienced role confusion due to early detachment from her mother, revealed in her tendency to display different aspects of herself, almost as separate personalities. “The angry, tough Lily; a sweet, humble girl; the determined student that vowed to never fail again; the forgiving Christian; and even the competent professional, showed herself in the counseling room.”

Although looking at the past is valuable, effective treatment includes techniques to move forward. “Of course, a therapist must help search in the ashes to try to unveil what caused the fire in an area of one’s life. Was it the abuse of her mother, the physical, emotional or sexual abuse of the men she pursued for love, or was it her insatiable appetite for affirmation?” Whatever is ultimately to blame, the aftermath tends to be distorted thinking that leads to unhealthy behavior.

Using cognitive therapy, our counselor uncovered her false beliefs, one by one, and challenged what was true and what was a lie. The cognitive approach developed in the 1960s by Aaron Beck involves “identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors”, according to the Beck Institute website. Lily’s ability to discuss her history allowed her to recall the messages and labels she received in the past, and then eliminate them.

Our therapist also taught Lily keys to living a healthy, sober life. For a person early in sobriety, there are behaviors and circumstances to avoid:

• letting guard down after goals seem to be completed
• isolation
• compromising situations
• triggers
• associating with former drinking buddies
• and, especially for Lily:
• calling former partners from bad relationships 

Carole Bennett, M.A. and author of Reclaim Your Life - You and the Alcoholic / Addict states that the newly sober individual needs to live and obtain:

a “total clean and sober existence”

“therapy to help a loved one in recovery deal with some deep-seeded, personal and emotional conflicts that may be stuffed somewhere deep down inside”

“a daily work schedule that was specific and regimented” for consistency and accountability

“Living life on life's terms . . . brace themselves to these new bumps in the road”

Through six years of therapy and counting, Lily has met and conquered all four challenges. She has just completed one round of schooling and seeks additional education to further her career. Being driven in everything she does, she works long hours and feels the pressure to succeed. But this drive has served her, and she has improved impressively in the past years. She even works with other women who need support. “Lily’s past failures have facilitated her ability to be a wealth of insight and experience that is impacting other women in recovery”, notes her therapist.

Counselors like these, willing to partner with a client through the duration, are typical of the Intercommunity Counseling Center team. Our confidence in our staff leads to creative solutions that often incorporate several modes of assistance. Although cognitive therapy and a good, listening ear were the primary techniques applied to Lily, her spirituality was also supported throughout the course of therapy. “I know if I were to ask Lily ‘What was the major key to your success?’, she would say holding onto her faith in the God who created her for more. He told her how valuable she is and how much she is loved. He brought her out of the ruins and gave her hope for a better future. She would say that He took the ashes of her life and made something beautiful out of it.”

Living with Grief

Taking time for grief. In this demanding world, many of us don’t honor ourselves when the time has come to slow down, look inward, and perceive life beyond everyday details. Although a normal part of life, grief affects us in ways we aren’t always aware of, especially when unexpressed or unprocessed. One of our therapists at Intercommunity Counseling Center notes “In life, each of us go through seasons when difficult circumstances may become more of our normative experience for a time. During these times, it can be very helpful to have someone else, often a therapist, walk through the experience with you and assist you in gaining clarity and direction for what is most important to you.”

This therapist provided short-term therapy to 48-year-old Rebecca. Married with three children, three grandchildren and a mother with advanced dementia, Rebecca had little time to think about or deal with the death of her father. Her care for her mother was full-time, leaving her with about a 20-minute window per day to run errands. Being extremely conscientious, Rebecca wanted to honor her father by giving her mother the highest-quality, loving care.

“Rebecca came into Intercommunity Counseling Center and asked to work with a therapist in processing her grief over the loss of her father. Rebecca had realized that even though he passed away six months ago, she had been so busy with caring for her mother that she had not processed her grief which was now beginning to feel overwhelming.”

Typical symptoms of grief include low energy, burn-out, difficulty concentrating, difficulty accomplishing daily tasks, sadness and crying multiple times per day. Rebecca experienced all of these at the point she started therapy, but because of a lack of familial support, also felt deeply lonely and isolated. Her adult children were not helping her, and she received no assistance from her siblings with her mother. Still, her profound sense of commitment and love kept her going.

Our ICC counselor selected both cognitive and solution-focused therapies to combine psychological and behavioral treatments for a powerful, yet short-term course of therapy for Rebecca. The realization that perceptions and thoughts contribute to individuals’ emotions and behaviors is behind the cognitive model. This treatment was developed by Aaron Beck in the 1960s. Solution-focused therapy, created by Insoo Kim Berg and Steve de Shazer in the late 1970s, is based on discovering, then using methods that have worked for individuals in their pasts.

Through cognitive therapy, clients first identify distorted beliefs, then modify them, with the help of their counselors, who in turn, teach them to practice this process themselves. “We examined thoughts that kept her feeling trapped in her role as caregiver. For example: I am not honoring my parents if I ask others for help in their care. We also utilized exception finding to see how the black-and-white thinking was not always true nor beneficial.” Further, sharing her own experience of losing her father helped her recall what she appreciated and missed about him, as well as facing the weaker aspects of their relationship. Her self worth was restored when she started recognizing her own strengths.

Next, to devise active steps, our therapist and client partnered in the practice of solution-focused therapy. The model stresses what can be done now, and not the problems that necessitated the therapy. To achieve specific goals, build on the individual’s strengths, discover what has worked for her in the past, and determine how she can incorporate these actions in daily life. Our ICC therapist comments “In these times, it is important to remember your own strengths and actions you have previously used to help you achieve goals you’ve longed for.”

Specific tools of the treatment encompass a series of queries (paraphrased from the Solution-Focused Therapy website):

• Identifying client’s previous solutions to be applied to present challenges
• Finding similar occasions from the past when outcomes were positive
• Asking questions to focus on present or future actions leading to success
• Paying compliments to reinforce how client’s methods are working
• Encouraging client to do more of what has been effective
• Asking scaling questions (rating her own progress, etc., from 0 to 10)
• Asking coping questions to reinforce measures she has taken to persevere 

“As Rebecca began to feel more able to contribute and navigate within her environment, she recognized that previously, she had several sources of support which she utilized to bring in healthy life patterns.”

Within just two months of therapy, Rebecca amazingly accomplished several goals:

Recalled her background in faith and began attending church services

Gained support from others in her community with the side benefit of getting help with her mother

Spent more time with friends and loved ones

Shifted to self-care (instead of constantly caring for others). Components included:

• Time/space to grieve and rest
• Exercise
• Proper nutrition 

Rebecca’s time at ICC also served as an education. She was able to observe grief responses in her family members and then help them build healthy habits. When the support eventually became mutual, her feelings of isolation subsided. What a positive outgrowth of receiving therapy: client becomes benefactor!

Our ICC therapist remarks, “As a normal part of life experience, grief or loss is a familiar experience for all of us. At times, continuing to live our ‘normal’ daily life rhythm can be very challenging after the passing of a loved one. Therapy is a beneficial place to process your experience in a safe space.” Intercommunity Counseling Center is honored to provide that refuge for our clients.

Superheroes Aid Angry Boys

Superheroes have problems, too. Did you know the Incredible Hulk suffered physical abuse at the hands of his father? The beloved anime character Naruto was orphaned and shunned by his village. And Spiderman’s Uncle Ben was murdered by a thug. The natural feelings of anger welling up in all these characters ultimately resulted in their determination to, if not seek revenge, sublimate their feelings to the fight for good.

All children experience anger, and they should be encouraged to allow themselves these feelings. But when their emotions consistently emerge in extreme, disruptive and inappropriate behavior, we must teach them how to manage the feelings. Insisting her child stop having angry feelings , then yelling or punishing him when he expresses the emotion, is the most damaging measure a parent can take.  Anger

“. . . can be triggered by embarrassment, loneliness, isolation, anxiety, and hurt.” says Richard Niolon, PhD, Professor at The Chicago School of Professional Psychology and writer of PsychPage.

However, children displaying consistent, extreme anger problems that affect their everyday lives may have Oppositional Defiant Disorder. Youths challenged with this condition exhibit ongoing defiant behavior towards teachers, parents and other authority figures. More than likely, these children have experienced some sort of trauma, neglect or sense of powerlessness.

One of our therapists at Intercommunity Counseling Center took on a group of eight-year-old boys who had been acting out in home and school, and elected to use the idea of superheroes to progressively tackle their anger issues. Dr. Lawrence Rubin, PhD, wrote the book Using Superheroes in Counseling and Play Therapy, which describes creative methods to help children devise their own coping strategies after identifying with a favorite superhero. Like many angry children, most superheroes have a backstory. If a child discovers common ground with a particular character, he can learn how that hero resolved his own difficult history, then mimic the positive behaviors. They get to enjoy this process through drawings and creative imagery.

The Superheroes To the Rescue group formed by our counselor comprised children who consistently talked out of turn, yelled, fought, threw tantrums, broke the rules and generally had low impulse control. Learning their own triggers for anger was the first step, and sprang from a guided visualization: pretend you are stuck in Spiderman’s web, then identify what “bugs” you.

Next, the counselor helped the children to discern differences between appropriate and inappropriate responses to anger. In the moment, effective actions include taking a deep breath, taking a break, deciding what to do next, talking to someone or getting help.

Finally, the ICC therapist facilitated the boys in the creation of their own long-term coping strategies and cool-down techniques. They employed deep breathing, stress balls, hitting a pillow or other soft item, and talking to friends and parents.

“One hero that all kids were able to identify with was Superman, so we used his ‘super cool breath’ to demonstrate deep breathing as a calming technique. We also focused heavily on the Hulk and how to use ‘super strength’ for good rather than harm. We shared the Hulk's story of how he used his strength for bad to harm innocent people, break things, aggress toward others when he got angry and that it's normal because when we are mad, we tend to say and do hurtful things. But later he learned to channel that energy for good to save people's lives and learned to express his anger only for saving other people.” An offshoot of this study of the Hulk included using Hulk hands to smash away angry thoughts.

Within the group, one boy stood out among the others, both at the beginning and end of the process. This young man was so extreme, that even among the group of children with anger management problems, he became an outsider. At some point, he was eliminated from the group, but later welcomed back. Using the techniques suggested by our ICC therapist, he gradually became a standout in his excellence: he apologized for his behavior, became attentive, generous and encouraging of his peers. The boy has had no reported trouble since leaving the group. Nor have the other members.

Because of Intercommunity Counseling Center’s willingness to empower our therapists with the freedom to use new and inventive methods such as these, clients are more likely to function at an optimum level, affording them the potential for healthy, happy lives.

When Times Are Bad and You're All Alone

In life, each of us go through seasons where difficult circumstances may become more of our normative experience for a time. During these times, it can be very helpful to have someone else, often a therapist, walk through the experience with you and assist you in gaining clarity and direction for what is most important to you. In these times, it is important to remember your own strengths and actions you have previously used to help you achieve goals you’ve longed for. This is a brief story, with names and identifying information changed, of someone who reached out for help during a challenging time.

Rebecca is a 48 year old Latina, who is married, has three adult children and three grandchildren. Rebecca is currently living with her mother, who has advanced dementia. Rebecca is her only caretaker and most days, is only able to leave the house for approximately 20 minutes to pick up her grandchildren from school or to purchase a few groceries. Rebecca’s father passed away approximately 6 months ago and they were very close. Rebecca’s father entrusted her mother’s care to her alone, and while she longs to provide excellent care for her mother, she often feels tired and is beginning to feel burned out. Prior to her father’s passing, Rebecca provided care for her mother and her father for several years. Rebecca has minimal social support from her children and receives no assistance from her siblings in providing care for her mother. Rebecca came into Intercommunity Counseling Center and asked to work with a therapist in processing her grief over the loss of her father. Rebecca had realized that even though he passed away 6 months ago, she had been so busy with caring for her mother that she had not processed her grief which was now beginning to feel overwhelming. Rebecca found herself crying multiple times a day, she experienced low energy levels, had difficulty concentrating and it was becoming harder to accomplish daily tasks.

In working with an ICC therapist, Rebecca was able to share her own experience of losing her father. She gained space to verbalize what she appreciated and missed about her father, and aspects of their relationship that she wished were different. In therapy, Rebecca had space to focus on re-integrating aspects of her life that provided her with strength through difficult seasons, including her faith background. Rebecca began to reach out to others in her community, which decreased her strong sense of isolation. Her community was supportive of her needs and began to volunteer to watch over her mother for one to two mornings a week, so that Rebecca could have time to take care of her own needs and family. Throughout therapy, Rebecca began to realize the importance of allowing herself the space to grieve and rest. Prior to therapy, Rebecca primarily focused on caring for everyone besides herself. While this came with many short term benefits to her family, Rebecca was living in isolation, loneliness, sadness, despair and often felt overwhelmed.

In working with the therapist, Rebecca was able to recognize her strengths and deep commitment to her family while also holding her need to care for herself through proper rest, exercise, nutrition and social support. Through processing her experience of grief and her corresponding feelings, Rebecca was able to recognize grief responses within her family and encourage her family members to build in healthy habits of caring for themselves and supporting each other in enjoyable and painful seasons of life. As Rebecca began to feel more able to contribute and navigate within her environment, she recognized that previously she had several sources of support which she utilized to bring in healthy life patterns. For Rebecca, these life patterns included attending church services with her faith community, having regular enjoyable time with friends and loved ones, and building in time for rest and reflection.

As a normal part of life experience, grief or loss is a familiar experience for all of us. At times, continuing to live our ‘normal’ daily life rhythm can be very challenging after the passing of a loved one. Therapy is a beneficial place to process your experience in a safe space. Remembering and integrating your strengths and beliefs, allows space in developing understanding and meaning in our experience, often leading to new beginnings even within a season of loss. 

Assessment at ICC (Intercommunity Counseling Center)

Have you ever thought to yourself "Why do I always do that" when you're hanging out with friends? Or have had that moment in life where you wonder "why can't I reach my potential, what's holding me back?" Or maybe you're that person that has always struggled in school and you ask yourself "is it just me?"

Assessment helps us answer those difficult and intimidating questions you might have about yourself. Assessment is a process that helps us discover together how you think and understand the world. You get the opportunity to get to know yourself in a way you never have before. You might be a man in his 60s wanting to understand why you feel sad and can't seem to find joy in life. You might be a young student that has always struggled in school and you're frustrated because you don't know how to get your grades up. No matter what you’re struggling with, assessment is a GREAT place to start. We can explore how your “clock ticks” and then decide what the next steps are to help you experience healing and support to live your life to the fullest. That way you can be all that you want to be!

Treating Adjustment Disorder

General consensus is, our lives comprise three core spheres: relationships, work and health. If any one of these key aspects is changing or failing, we are on alert. But if two or more of them are in transition, we may have trouble coping.

Take, for example, a young man who changes his job and living situation in a short span of time. The job is really a career move with a new environment, new protocol, etc. His home is in a different city, away from the friendly neighbors he used to spend time with. Since he had stopped using substances some time before this, the coping mechanisms he once used are no longer available. He finds himself experiencing increasing anxiety to the point at which he decides to seek help.

The therapist may diagnose this man’s condition as adjustment disorder. Tending to be short-term, this state is characterized by finite periods of depression and/or anxiety brought on by major life changes or loss. Once an individual adapts to his new circumstances, the disorder ends for him.

But in the meantime, the feelings associated with the affliction can be excruciating, leading many to pursue counseling. Symptoms can include (abbreviated from the WebMD website):

• Hopelessness
• Sadness
• Crying
• Anxiety
• Worry
• Headaches or stomachaches
• Palpitations
• Isolation
• Absence from work or school
• Dangerous or destructive behavior
• Changes in appetite
• Insomnia
• Low energy or tiredness
• Substance abuse

A mode of treatment useful for numerous psychological conditions can also be successfully applied to adjustment disorder. That is, cognitive therapy. This model, developed by Aaron Beck in the 1960s, argues that individuals’ own thoughts and perceptions  about events directly affect their emotional responses, as opposed to the actual events. Counselors attempt to discover their clients’ distorted beliefs about themselves or provocative situations, through questioning and teaching them to examine their own thinking.

Because the cycle of therapy for adjustment disorder is relatively short (often from three to six months), and the individual sessions can be as little as 45 minutes, homework is key. Therapists guide clients to track or log negative thoughts, then ask questions for each thought: “Is this true?” “If part of it is true, what isn’t true?” Keeping a schedule to track how one feels at different times is also useful for pinpointing triggers. Finally, the individual is encouraged to devise his own replacement behaviors for less healthy activities. For instance, connecting with loved ones is a good substitute for isolation. Turning to old, favorite hobbies trumps drinking or overeating.

Generally, the scrutiny of one’s beliefs coupled with the new, healthy behaviors will empower an individual, ending the disorder and achieving his adjustment within a few months. If not, perhaps client and therapist need to consider other possible conditions, such as long-term depression or generalized anxiety disorder.