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Overcoming Social Phobia using Cognitive Behaviour Therapy - Andrew's Story
Page uploaded 21 August 2009
Andrew’s Story
by Sarah Edelman
Psychologist Sarah Edelman talks with Andrew, who was a sufferer from social phobia, about how he was able to confront his fears, using CBT techniques, and change his thinking about what people thought of him.
For as long as he can remember life has been a struggle, although most of the time he had no idea what was wrong with him. From his mid teens Andrew spent hours scouring through self-help sections of bookstores, trying to find some clues to the demons that tormented him, and how he could keep them at bay. All he knew was that he was different to others – being with people made him nervous, and he worried too much about what others thought of him.
By age 14 Andrew was seeing the school counsellor on a regular basis. From there followed a string of referrals to psychiatrists, psychologists and mental health specialists. One of the psychiatrists diagnosed anxiety and prescribed Serapax – the wonder drug of the day. Although it made him feel better the effects quickly wore off, and he needed more and more to get any relief. Within a few weeks Andrew was hooked – gripped by an addiction that further complicated his life for the next six years.
At age 17 Andrew stumbled across another elixir. This one was not prescribed but discovered one night at a party, when Andrew became drunk and noticed that his anxiety had disappeared. Getting plastered appeared to work, so from then on the goal at any social event was to get drunk as quickly as possible. The relief from anxiety was a powerful motivator, and soon Andrew had developed a chronic binge drinking habit. The combined effects of Serapax and alcohol had a disinhibiting effect, and Andrew would often make a spectacle of himself. One evening he came home and swallowed the remaining contents of his supply of Serapax and anti-depressant medication. He was rushed to hospital and spent two days at Northside Clinic.
Approximately 3% of Australians suffer from social phobia. According to Stephanie Rosser, Clinical Psychologist at St. Vincent’s Anxiety Disorders Clinic, the disorder usually develops during adolescence and often becomes chronic. The core fear is negative evaluation by others - sufferers worry about being seen to be anxious or socially incompetent. The condition affects most areas of their lives and prevents them from achieving their full potential personally, socially and occupationally. For Andrew the disorder affected his ability to work, study, sleep, have normal relationships and sometimes even to walk down the street. “On bad days if there was someone walking towards me on the footpath I’d cross the road” he recalls. “I would be housebound for days at a time, totally crippled by fear”. The phobia also interfered with his ability to study, and Andrew recalls seven separate courses that he started but did not complete because of his inability to cope with the social environment.
In 1997 Andrew finally completed a Diploma of Computer Programming and started a job as a programmer. Although the work was not difficult, the most gruelling aspect was having to deal with people. After six months it became unbearable and Andrew fled. His next job at the Commonwealth Bank was even harder. The large open plan office design provided little opportunity for seclusion, and at times when he felt someone approaching Andrew would make a tactical escape to the toilet. “I was worried that they might say ‘hi’ and I wouldn’t know what to say” he recalls. To avoid the anxiety of having to pass people on the way to and from his desk Andrew would arrive at work before anyone else, and stay back late until they had gone.
A key event on the path to his recovery happened in 1990, when Andrew read an article in a Sunday paper about social phobia. It was a term that he had never heard of before, and it described his symptoms exactly. Suddenly he understood what was wrong with him and it had a name. He was not just weird, he had a known psychological disorder, and it had a name. The discovery led to a search for more information, and via the internet Andrew subsequently linked up with a news group that proved an invaluable source of information and support.
Excited by his discovery Andrew went to see a psychologist and described how his symptoms matched those in the article. The psychologist interpreted his problem as shyness and referred him to a confidence building course. This, like many other “therapies” was a dismal failure. “The program had nothing to do with social phobia and it didn’t address my problems” he says. “The other people in the course weren’t like me – I couldn’t relate to them at all”. In the end Andrew found the experience totally alienating and dropped out after a few sessions. “The psychologist didn’t have a clue about social phobia or how to treat it” he recalls. “It is not just shyness or lack of confidence. You’re constantly thinking, ‘there is something very different about me. Whatever I say is dumb. Everyone can see how nervous I am. They think I’m weird, pathetic and a loser. They’re only talking to me because they feel sorry for me…”.
In the final days at the Commonwealth bank Andrew was physically and emotionally exhausted. His anxiety was out of control and he was barely sleeping. His vision had become blurred, to the point where he could no longer read the screen. The increasing pressure of work and his inability to deal with the social environment had become unbearable, and Andrew was starting to think about suicide again. Finally, he broke down in front of his parents and told them the whole story. Although shocked his parents were extremely supportive and encouraged Andrew to see a psychiatrist, who subsequently referred him to the Anxiety Disorders Clinic at St. Vincent’s Hospital.
After a two-month wait, Andrew commenced a six-week program that was to change his life forever. The program was based on Cognitive Behaviour Therapy (CBT) – an evidence–based psychological therapy that is increasingly used in the treatment of many psychological disorders. It involves teaching people to identify and challenge their irrational thinking patterns, and to modify some of the self–defeating behaviours that perpetuate their problems. Participants learn to challenge faulty thinking such as “mind reading” – making assumptions about other people’s thoughts. For example, “they think that I’m weird … they can see how awkward I am … they obviously think I’m a loser”. Another common faulty thinking pattern amongst social phobics is “personalising” – assuming that other people’s behaviours are always directed at us. For instance, when a work colleague doesn’t look up and smile, a rational response might be “she’s busy – she probably didn’t see me”; a personalising response would be “she’s snubbing me – she obviously doesn’t like me”.
In reflecting back on the program, Andrew cites the group format as one of its most valuable aspects. Meeting other people who reported being crippled by social phobia in terms no less dramatic than his own was very reassuring, especially because they all looked so normal. Even though they described feeling overwhelmed by fear, they didn’t look like they were dying inside. For a brief instance an intriguing idea started to dawn on him: “could it be that maybe I also appear normal to the rest of the world?”
The big breakthrough came in week two of the program when each participant had to give an impromptu one-minute talk to the group that would be video–taped and then played back to them. “It was one of the most frightening things that I have ever done” he recalls. Each participant had to predict on a scale of 0 to 100 how nervous they would look. Like everyone else Andrew predicted that his terror would be obvious – about 85% on the nervousness scale. Yet when they came to watching each other’s talks it became clear that each person had highly over-estimated the visibility of their discomfort. Upon seeing Andrew’s presentation the group estimated that his nervousness looked 15%, and upon watching himself on the video Andrew could only but agree. His earlier suspicion now turned into an exciting prospect. “It started to dawn on me that the way I feel inside is not the way I project myself to the world. For years I had believed that everyone could see how nervous I am and that they thought I was weird; suddenly I realised that all this time I had mistaken the way I feel for the way I look. This was a “Eureka!” moment for me.
On the last session of the course the group members were asked to bring along guests, in order to make the situation more challenging. Here was the ultimate test: participants were required to give a five minute presentation in a lecture theatre in front of a wider audience – not just fellow social phobics, but friends, acquaintances, and other psychologists. To add to the challenge Andrew chose to do an impromptu presentation – no preparation. “I enjoyed myself” he confesses. “I think I actually love being the centre of attention, and once I was no longer terrified I was having fun”.
By the time he finished the program Andrew knew that he was cured, even though he occasionally experienced brief periods of relapse when he was tired or anxious. “One thing I learned from the program was that as soon as those feelings start, you have to jump on them – snuff them out”. To maintain the momentum Andrew set himself a personal challenge: to find a job that forced him to keep pushing the boundaries. He chose door-to-door sales. Amazingly, this was not something that he dreaded – now he actually liked the idea of knocking on people’s doors. Andrew reflects that selling itself wasn’t difficult. “The most difficult aspect of the job was being in an environment with ‘pumped up sales types’”. He started fitting in. The thought of going into a room full of sales people was no longer frightening – in fact, when he was feeling confident Andrew could be quite gregarious. Soon he became the team leader, which involved among other things, giving motivational talks and presentations to sales staff. “It was no longer terrifying – I enjoyed it”.
“Realising that my thoughts create my feelings, and that I can change the way I think has been a radical shift for me” he says. He stresses that this doesn’t mean that he always feels good: “I don’t always feel the way I would like to feel, but I know that my emotions are always created by my thoughts – they come from the story I tell myself.”
These days Andrew’s life is radically changed. He has released some of his earlier friendships that were sustained by drinking and drug taking and has established a broader social network. He is no longer terrified of talking to people, and for the first time in his life he has embarked on a healthy love relationship. The ability to self-disclose and to feel loved and accepted in spite of revealing his darkest secrets has been extremely liberating. His girlfriend has been extremely supportive, and ironically, has said that she has never been with someone so open.
In seeking treatment for his disorder Andrew saw countless therapists and underwent an array of treatments, including supportive counselling, Freudian therapy, Serapax, anti-depressant medication, and an alternative therapy that involved being spun in a hammock. He has been an in-patient in two psychiatric institutions, attempted suicide on one occasion, lost thousands of hours of sleep and read volumes of self-help books.
In addition to the personal suffering, there has been a huge cost in terms of time and money. And yet, for at least the last 10 years, there has been a brief, well-evaluated treatment for social phobia that has been repeatedly shown to be effective. Perhaps one of the most powerful lessons of Andrew’s experience is the importance of evidence-based therapies and consumer access to good information on what works and what doesn’t.
According to Stephanie Rosser not every person who presents for treatment with CBT makes a recovery as dramatic as Andrew’s. While the majority of participants in the St. Vincent’s program improve, the extent of their recovery often depends to their initial symptoms. Those with mild to moderate social phobia are more likely to make a full recovery than those who enter the program with very severe symptoms. Stephanie adds that in Andrew’s case, choosing a job in sales would have helped him to maintain and consolidate the gains from the program, and may explain why he has done so well.
When asked if he still receives counselling, Andrew replies that he doesn’t need it any more. In fact, he is currently doing a Diploma in Counselling, with the aim of one day helping people with social phobia and alcohol related problems. “I feel content now,” he says. “I can go to a social function and talk to people and enjoy myself without using alcohol. The last ten months have been fantastic. I never knew that life could be so good”. Recently Andrew started a new job in sales. A substantial part of his role involves cold calling potential customers, a prospect that is not the slightest bit daunting. “I enjoy it” he says. “I’ve got the ball rolling now, I’m happy to keep it rolling”.
Guests in this story:
Sarah Edelman
Research psychologist at the University of Technology, Sydney
Andrew
Works in sales, previously suffered from social phobia
bluecherry666@hotmail.com
Publications:
Change your thinking
Author: Sarah Edelman
Price: $29.95
Publisher: ABC Books
Reprinted with permission from Sarah Edelman and Andrew
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