Social Anxiety

Social Anxiety – What Is It, And How Can Therapy Help?

Listen to my social anxiety podcast

First off, I was recently a guest of the ‘Ask the Therapist’ podcast, so if you want to hear me chatting away about all things social anxiety then get yourself over to iTunes and download the episode now.

I had a lovely time recording this with host Sarah Rees, who is a fellow CBT therapist with 20 years working in mental health. We chatted about what social anxiety looks like, how it can affect us, and how therapy could help.

Where does social anxiety come from?

Social anxiety is in many ways a feeling most of us can relate to; we worry what others think about us and about being judged which leads to feelings of anxiety. We all have a desire to fit in, to be part of the group, and being rejected (or thinking we will be) feels extremely threatening to us. If we think of this in terms of human evolution we have to first consider that we are mammals, and like all mammals we live in groups.

This has big advantages; think about an animal like a lion. They hunt in groups because they will be more successful, can bring down bigger prey, and can protect the younger or weaker members of the pride. This is why belonging becomes vital – if we’re kicked out of lion club, we are much less likely to survive.

Our world has become much more complicated and we now likely belong to multiple groups outside of our direct families. More groups means more chances of being rejected. And while our brains have also become more complicated, we haven’t lost that need to belong, even if we won’t die as a result of leaving a particular group.

It is important to be kind to ourselves when we feel that need to belong, or that anxiety about fitting in. It isn’t wrong to want that; we all want it, and if anything it shows that your brain is doing its best to keep you safe.

What does social anxiety look like?

This can be tricky as it can look different for different people, and can affect someone’s whole life or just part of it. Fear of public speaking is a form of social anxiety, but it may only happen at work or school when giving a presentation. For others it might happen almost anytime they have to speak in public e.g. ordering a drink in a cafe.

People who experience social anxiety report physical symptoms of anxiety such as feeling hot, sweating, their heart pounding, feeling sick, and often fear (on top of the original anxiety) that other people will notice these symptoms and judge them. They often say it feels like there is a spotlight on them and everyone can see them and is staring. Common thoughts might include:

  • I’m going to stutter/say something wrong and people will laugh
  • they are going to see me shaking and think I’m weird
  • I’m going to make an idiot of myself

When this happens, we want to do our best to not make a fool of ourselves, so we turn inward and become highly self-conscious. We start to monitor what we are saying, how we are standing or moving, what our bodies are doing (e.g. how much we are sweating) and we stop paying attention to what is happening around us. As a result we stop giving eye contact, we go quiet, avoid, and might even make an excuse to escape the situation.

Once we are safely home that is when the rumination starts: replaying the events, the conversation, what we did or didn’t do and guessing what everyone else must have thought about it. I’ve never had a client tell me this phase made them feel any better. The self criticism and judgements just keep going round making us feel worse.

How can therapy help?

Cognitive behavioural therapy can help but getting us to make links between are thinking, our emotions, and our actions. This means that it can help us break down exactly what is keeping us stuck and allow us to challenge it. From that point we can evaluate how we are thinking about an event, and make changes in how we respond. Therapy provides a non-judgemental space to talk openly about your worries and with compassion turn towards those concerns.

Sessions might include examining thoughts that are keeping you stuck, or you might be setting up an experiment to carry out between the sessions to test your assumptions.

If you would like to learn more, please call to book a 20 minute consultation.

What is EMDR?

EMDR (Eye Movement Desensitisation and Reprocessing) is a psychotherapy that is used to help people who are experiencing symptoms of trauma such as nightmares, flashbacks, or hyper-vigilance to threat.

When someone is suffering from these symptoms it is likely that the memory of the traumatic event has not been stored correctly in the mind and is stuck in the short term memory. This means that it can pop up unwanted and bring back the sights, sounds, feelings, and even smells from the original event.

EMDR has been found to be effective at helping the mind to process the traumatic event and move it in to the long term memory storage, so the event becomes more like a story, without all the unwanted feelings attached. As the name suggests, it uses eye movements to help process the distressing memory. This is where the kind of therapy differs from other more traditional talking therapies.

During a processing session, a specific memory would be targeted, and while focusing on say an image from that time, the therapist will ask the person to follow their hand with their eyes to create the eye movements. This will continue in short sets for some time and most clients report changes to the memory as it begins to process.

I remember an early client of my reporting at the end of a session how strange it was that she could still remember the event, but it no longer felt the same.

There is ongoing research into its uses in multiple conditions, and it’s currently recommended by the UK’s National Institute of Health and Clinical Excellence (NICE) for post-traumatic stress disorder (PTSD).

Please book a free 20 minute consultation phone call by visiting my contact page.

Talking About Suicide Does Not Cause Suicide

This week marked 2019 World Mental Health Day. This year the emphasis was on suicide prevention, which brings with it some sad statistics.

All the advice out there in coping with suicidal thoughts starts with talking, but most people don’t even know where to begin. They are often afraid that telling someone how they feel will upset others, or cause them to panic. Some people don’t want to ask in case they ‘put the idea in their head’. This is a myth!

Talking about suicide does not cause suicide.

Talking about suicide can save someones life.

Start with someone you trust, a friend or family member, or a professional. Use a clear statement or question, like “I’m feeling suicidal”. Try to avoid vague colloquialisms about “ending it” – ending what? A Netflix subscription? Suicidal thoughts are much more common that we think, mainly because no one talks about it. If you know what support you need, ask for it directly.

If you are supporting someone who has disclosed suicidal thoughts, try to listen; don’t get angry or blame them for how they feel. Tell them that you are thankful they felt able to speak to you, and ask what has brought them to this point. If you are able, offer support in areas they are struggling with. People who are experiencing depression, for example, may not be eating well, doing day-to-day tasks, or may be cut off from others. Offering to check in with them or cook them a meal may make a difference. Do not promise something that you are not able to do; be realistic about what you can offer. You can encourage them to speak to their GP or a therapist if they feel they need more support.

If the thoughts have moved on to making plans, writing notes, or other preparations, then it is time to access more professional support. Ask if they have seen a GP recently. Do they have a psychiatrist, therapist, or mental health nurse that they can call?

Sometimes none of these are an option, in which case they can visit the emergency department, and ask to speak to the mental health team. The team will conduct a full assessment and make recommendations as to what support is might be appropriate. This could include medication, referral to psychological services or community mental health teams, home based treatment, and as a very last resort hospitalisation.

There is support; it starts with talking.

If you require support and need to speak to someone now please contact The Samaritans: phone 116 123 – it’s free and open 24 hours a day, 365 days a year.

If it is an emergency, please visit your local emergency department, dial 111, or 999.

How To Choose A Therapist

Thinking about therapy? But you have no idea where to start, and are nervous about not knowing what you need? I know how difficult it can be to find a therapist. There are so many specialities, approaches and models, it can seem overwhelming. So, here are my top tips:

  • Start with the therapist – not the problem or the speciality. This might seem counter-intuitive, but if you do not click with your therapist, then a hard thing (going to therapy in the first place) will have just got a whole lot harder. I don’t care if they are the world’s leading expert in whatever disorder, if they don’t get you or you don’t get them, I would recommend looking for someone else. 
  • Think about the kind of therapy session you are after. Some people want to talk all session, some like a more guided approach. Do you want a space to offload, or a place to focus on making changes with input from both you and the therapist? Some therapists are more reserved than others, which you might find soothing, whilst others might find it frustrating. Understand what you expect from therapy so you can ask the therapist about their approach to see if it will fit your needs.
  • What is the difficulty you would like help with? If there is a specific area or diagnosis, it is helpful to know which approaches aim to tackle that directly. For example, Cognitive Behavioural Therapy has a solid evidence base for difficulties such as social anxiety, PTSD, obsessive compulsive disorder, panic attacks, and depression – whereas counselling and more psychodynamic approaches look more closely at relationships and long standing patterns. 
  • Call or email them. Most therapists offer a free initial telephone conversation, so make a few calls if you need to. Have a little list of questions ready based on what you feel is important. After that first conversation consider: did you feel at ease? Were they able to get an initial grasp on what you were saying? Were they able to answer your questions? Do they have appointment hours that work for you?

It is normal to feel anxious about sending an email or making a call to start therapy. I know how often people put it off, or make excuses, but there is no shame in asking for help. 

First post

A quick introduction to say – Huzzah! We exist!

I founded Green Door Therapy after 10+ years working in the NHS and reaching burnout – twice. Through supervision, friends, and therapy, I finally I learnt that it wasn’t me, it was the system.

I love being a therapist. The bit where I am sat with another human being working through some distress, thoughts, or some golden lightbulb moment, that bit is the best. I think most of the magic of therapy comes from being completely present with another person. That is what I want to do more of.

So while I’m not leaving the NHS completely (because I love it too), I am making some space for me to do the stuff I love doing and that I’m best at.