Silhouette of man sitting on a park bench at sunsetI am primarily an introvert. Growing up, I didn’t give it much thought. I just remember that I enjoyed my alone time and would get annoyed if my mother pressured me to go out and play with friends. I was having fun with my books, war toys, and train sets, and did not understand what the problem was. She seemed to think I was being antisocial, uninvolved, and perhaps depressed.

It was as if I was doing something unhealthy and it was going to be her fault if she could not find a way to change me.

The thing is, I always had a few good friends. We just got together when we felt like it. Not seeing much of each other for a week or two did not matter. We always had fun when we got together, and have remained friends across time.

There were other things we had in common:

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One time, an extroverted girlfriend told me that my need for downtime was unhealthy, that I had a serious problem. This bothered me, so I decided to find out what people who are supposed to know about these things had to say about my inclination to introspection. I did not like what I found.

Among the descriptive terms for introverts in both standard dictionaries and psychological glossaries were: self-centered, primarily concerned with their own thoughts and feelings; reticent; lacking in energy and positive emotion; difficulty adjusting to social situations; excessive daydreaming and introspection; and withdrawal under stress.

A particularly annoying comment was found in the American Psychological Association’s Glossary of Psychological Terms—the message being that these behaviors and processes were matters of choice and, when not, may point to an underlying pathology such as a social phobia or avoidant personality disorder.

Talk about sandbagged! I was not choosing to enjoy solitary activities, I just enjoyed them. I was not choosing to be drained at times by ongoing interactions with others, I was just drained. Furthermore, I like people. When I choose to connect, I do so at a deep level, with genuine empathy.

However, according to some “experts” on human behavior, I run the risk of being perceived as seriously disturbed. Needless to say, I did not mention this to my girlfriend.

Years passed before I happened upon information about introversion that actually made sense. This information came from Carl Jung’s theory of psychological types and is the basis for the Myers-Briggs Type Indicator, arguably the measure of personality most widely referenced over the past 30 years.

Jung noticed that human beings have a birth nature. This nature, or psychological type, is determined by an individual’s natural and normal degree of response orientation toward one pole or the other on four behavior and/or process opposite dichotomies. Introversion-extroversion is one of these dichotomies.

A solid base of empirical evidence regarding the introverted process has grown from over 40 years of experience using the MBTI in both counseling and employment settings. Natural and normal traits and characteristics associated with the introverted process include:

As a general rule, the stronger an individual’s introverted response orientation, the greater the likelihood that the characteristics and traits above will apply.

Conclusion

There is a reason introverts experience a deep sense of satisfaction, even joy, in solitary pursuits, and it is not because there is something wrong with them. It is because they are, by nature, designed to generate life energy in this manner.

As with extremes in general, there is a point where one’s drive for solitude may become problematic. However, I have been working with introverted people in individual, couples, and family counseling settings for over 14 years now and, with rare exception, have found a person’s drive for solitary pursuits to be in balance with his or her degree of introverted response orientation.

AdobeStock 164133536For people who define themselves as socially awkward, the perceived risk of being seen in endlessly negative ways—inadequate, ugly, boring, stupid, anxious, depressed, empty, arrogant, fat, pathetic, etc.—is always present. When I think about people in therapy who see themselves as socially awkward, I find little correlation between how I experience each individual as a social person and how they think of themselves. Every one of them seems to have characteristics that I enjoy and admire, and they are often (but not always) in occupations of respectable social status. However, for the “socially awkward” person who supposedly “knows” how little they have to offer to the world, the facts of their occupational status or character are irrelevant.

What I have come to recognize about many people in therapy who feel severely socially awkward is that they share the belief that when they were growing up they missed out on learning the rules of social discourse. As a consequence, they are intensely anxious about how they will be responded to if they are socially off the mark. For example, Robert, an attorney, worries about phone calls and what to do after you say hello. Paula, an information technology manager, panics about being in a social situation and not knowing how to approach someone. Tanya, a college graduate, unemployed for the past year, keeps asking “what are the rules, how long do you talk with someone at a party and how do you get yourself out of a conversation?” Everyone worries about silence and eye contact.

While many of us might experience similar social concerns, a “socially awkward” person believes that their anxiety and inability to navigate these situations will be blatantly evident, and they expect to be responded to with rejection and disgust. Even when there are no evident responses that confirm their fears, such people continue to experience bad feelings about how they behaved and consequently justify their continued self-attacks and self-hate.

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Parental Expectations

A major source of the feelings of social inadequacy and the consequent self-hate that people often express is related to parental expectations. Both Tanya and Robert had parents with very high expectations. Robert talked about his parents pushing him to work harder at all the extracurricular activities they insisted he engage in: “They thought I was a virtuoso and kept pushing me to do more with the violin. My mother kept telling me what a wonderful writer I was and that I should try and get published. But she also insisted on critiquing any creative writing I tried.”

Tanya described how her parents pushed her to succeed in high school so she could get into an Ivy League school: “They would compare me to their best friends’ son and list all his achievements. On the surface, they seemed to be saying they thought I had what it took to be superior. But I never felt I could really be good enough, no matter how well I did. I upset them when I didn’t apply to Harvard, but I couldn’t bear the thought of disappointing them by not getting in.”

Paula also was negatively affected by her parents’ expectations. They wanted her to “be good.” The worst thing she could do was make anyone outside the family think any negative thoughts about her. This would shame and humiliate her parents and result in physical or verbal abuse. The most Paula could hope for from her parents was to avoid anger and criticism. She recalled: “My mother would scream and berate me if I didn’t smile the right way at a neighbor. I remember, when I was about 9, she dragged me from the Thanksgiving table at my aunt’s house because I didn’t say ‘please’ when I asked for the turkey. I was a very scared kid and never knew when I was going to get hit or criticized. I never knew what the right thing to do was. I still don’t know.”

The Importance of the Audience

Robert and Tanya needed to be high achievers so the parents could feel pleasure and ego satisfaction about their parenting. By pushing achievement on their children, the message, consciously and unconsciously, was that you must do more, be better, and shine or you will hurt and disappoint me. For all three people in therapy, the ultimate authority on how they were doing as children was the social audience their parents looked to and empowered. Most importantly, the incredible power of the “audience out there” cast the final judgment on how the parents were doing.

Without audience approval, the parents felt inadequate and humiliated and put the responsibility for these bad feelings onto their child. The parents held the child responsible for their own feelings of inadequacy, which were then attributed (projected) to the child who was designated as inadequate. The child not only felt the shame of insufficiency, but experienced the badness of having socially hurt, disappointed, and shamed the parents. It is no surprise, then, that for the humiliated, “inadequate” child, the social world would feel like a constant source of scrutiny with the mission of detecting and identifying the guilty party.

Developing Feelings of Social Adequacy

These three individuals have great certainty and strong emotional attachments to their belief that they are socially inadequate people. While they typically begin therapy with some hope that they can do something to improve their experiences, feelings of hopelessness often outweigh the hope. The journey to feeling more socially able begins with people becoming aware of the ways in which their social awkwardness has been shaped and confirmed by their early and continuing life experiences. While this provides a rational understanding of how their feelings of social inadequacy developed, it does not alter the strong emotions that arise when they find themselves in social situations.

I often hear about their intense anxiety in social situations and how they become panicked. With intense agitation, they scan faces of others to detect the expected negative reactions. If I wonder how it would be if I helped them to strategize for a social situation, the response is usually negative: “It won’t work; I’m too anxious; it’s useless.” I believe this is an expression not only of hopelessness but of the self-hate that the person feels. If I can help the person reflect about this and put his self-hate into words, it can help break through the paralysis and allow the person to agree to try and practice some new behaviors before a social situation.

Even when a person may bravely go to the party and try out a strategy, it is unusual for the person to feel that he or she has had success. As Robert told me: “It was horrible. I saw a woman standing alone near the bar and I went over to her and introduced myself and asked her name and how she came to be at the party (like we planned). I couldn’t make eye contact very well, but I tried. She did answer my questions, but then this other girl came over and started talking to the first girl and I panicked. I couldn’t say anything and left.”

The example above illustrates how, even with a strategy, it is difficult to succeed with the plan. What is even more difficult is to change the negative feelings about one’s self that influence our social behaviors. With considerable work, repeated experiences of small successes can lead to incremental but steady changes in behavior and self-perceptions.

I am going to list some steps that represent what happens in the therapy process that can help in altering self-defeating behaviors and feelings of self-hate and social inadequacy. To undertake these steps, with or without the help of a therapist, requires commitment to tolerate frustration and painful unwanted, and intolerable feelings. There must be a willingness to fail and try again repeatedly.

Steps to Changing Feelings of Social Inadequacy

  1. Gain knowledge through self-reflection to hypothesize how your “social awkwardness” has been shaped and confirmed by your life experiences.
  2. Self-talk to remind yourself of (1) positive qualities, (2) feelings that seem intolerable, and especially (3) your resilience, i.e., ability to withstand those intolerable feelings. (After all, you are still standing and functioning, and have had many encounters with those feelings, and you’re still here.)
  3. Develop strategies to help manage behavior in social situations, e.g., what to say when approaching a stranger at a party or subjects to talk about on a date. (Google your questions if you can’t come up with your own strategies.)
  4. Try out behaviors and be prepared to fail.
  5. Learn to see failed attempts as success. This means overriding old patterns of self-attack and bad feelings and allowing yourself to feel courageous for trying.
  6. Try out behaviors again and be prepared to fail again.
  7. Keep trying to feel successful for trying.
  8. Repeat steps 1 through 7 as long as necessary until you begin to feel more positively about yourself and more able to tolerate your unwanted feelings.
  9. Come up with a new thought which reflects positive feelings about yourself.
  10. Come up with a new thought about yourself as someone who is feeling a little more socially adequate.
  11. Allow yourself to consider that you can change and be aware of your anxiety about change.
  12. Keep repeating steps 1 through 11.
  13. Never stop working on developing positive feelings about yourself.
  14. Never stop working on your ability to tolerate unwanted feelings, change your behavior, and feel positive about yourself.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

Thank you for this question. Handling the extroversion/introversion combination in a couple is something that many couples face. I’ve seen it quite frequently in my practice. Your “opposites attract” reference makes a lot of sense to me in understanding this dynamic. In the early days of dating, the extrovert/introvert match can create a certain ease in the interaction—the introvert can sit back, observe, and reflect on how he/she is experiencing the date while the extrovert can process his/her experience of the date by talking, sharing, asking questions, and driving the conversation. After the first couple of dates, the introvert can go home and quietly reflect and the extrovert can go home and talk about the date with friends and family.

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Everything moves along quite smoothly until casual dating turns into a more serious relationship. At this point, some of the challenges of the introversion/extroversion combination start to become clearer. That seems to be where you and your boyfriend are now. Like most extroverts, it sounds like you thrive on having a very active social life and you want your boyfriend to be a part of that social life. But, like most introverts, he probably thrives in a quieter environment with more solitude.

Extroverts tend to have a preference for, and gain energy, by engaging in an external world of people and things. Introverts tend to have a preference for, and gain energy by, engaging in an internal world of thoughts and ideas. It’s important to understand this concept because it can help both of you avoid taking these things personally. Absent this understanding, your boyfriend might feel controlled and scheduled by your attempts to include him in your social life, and you might feel rejected by his hesitation. Another benefit of fully understanding this concept lies in the word preference—neither of you is dealing with an inability here, and that means you can both compromise. For example, when you are hosting, maybe your boyfriend can be there for an hour or two and then he can slip out and return when the gathering is over. Or perhaps there can be an agreed-upon limit on the frequency or duration of the gatherings.

I think open and honest communication is going to be the key here. If you two can develop a deeper understanding of where you are each coming from and the role that your preferences toward introversion and extroversion are playing, you’ll likely be able to come up with some compromises that feel agreeable. Working through this process together may even improve and deepen the relationship that you have with each other. If you find you are having trouble getting through these conversations on your own, consider enlisting the help of a couples therapist. I know you mentioned your boyfriend was not interested in individual therapy, but perhaps he would be agreeable to couples therapy that focused on addressing this issue in your relationship.

Best wishes,
Sarah

Woman looking anxiousMost of us experience anxiety at different times in life; it’s when it takes over our quality of life that that it becomes a problem. But what is anxiety, and do you experience it?

There two different types of anxiety: external and internal.

External anxiety comes from outside events that produce an internal reaction inside us. Examples include sitting in traffic jams and worrying about being late, or perhaps an argument with a spouse.

Internal anxiety is when a person internally generates anxiety with an internal thought.

Thinking, “What if my boyfriend doesn’t like what I said and he leaves me, and then I’m all alone and I can’t take care of myself and I break down?”

We think the worst, and then our thoughts become a generator of this biochemical reaction in our bodies. A moment of anxiety automatically sends an alarm system to our brains. In this case, the anxiety is all in the mind, and it manifests into a physical reaction. When this happens, we start to question the physical symptoms.

The fuzzy, anxious feeling won’t hurt you. It’s only an adrenaline response. But when you focus on the fear, you may create more cortisol and adrenaline, which will create more body symptoms and more confusion. When adrenaline hits the lymbic system of the brain, we feel intense terror. The thinking part of our brain reacts, and we start to question how we feel and we want to fix it.

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Start by making a list of situations that make you uncomfortable and you find yourself wanting to avoid. Here are some possible examples:

Now write down the body sensations you could experience during an anxiety episode.

Here are more examples:

Now that you’ve thought about what makes you most anxious and how you react, don’t worry—you are not crazy, and you are not alone.

Anxiety can be caused by the following:

The following is a six-part approach to helping manage anxiety:

  1. Recognize that you are feeling anxious and accept feelings as a sign that something is bothering you.
  2. Try to figure out what is really bothering you. Is it some kind of conflict you don’t want to deal with? Is it a scary thought? Is it a ridiculous expectation you have of yourself. Did you eat chocolate or drink caffeine last night?
  3. Give yourself permission to feel anxious about whatever it is that is bothering you.
  4. Use compassion and self-talk to move past anxiety. It will be ok. You can go about your business until it passes.
  5. Get busy. Do something productive with all the energy.
  6. Try to see a little humor in the way you feel and laugh at yourself a little. For example, if you don’t like confronting someone, say to yourself, “I don’t like confronting people. That is a normal, OK reaction to have.”

Being aware of what is causing your anxiety is the first step. Once you find out what is bothering you, you can use the six-part approach above to help cope with and diminish your symptoms. Remember, anxiety is often caused by a physical reaction to our thoughts. If one can stop and take time to recognize the thoughts and where they are coming from, one can then learn to do self-talk and understand that there are healthy ways to manage anxiety.

Young shy boy clinging to his motherIt’s fairly common to see a child sheepishly hide behind a parent when greeting a new person, and some adults vividly remember the anxiety they experienced in childhood upon entering new environments. Recently published research, which tracked children over 15 years, argues that shyness isn’t just a personality quirk. It frequently indicates anxiety, and is often a precursor to high fearfulness in adulthood.

Childhood Shyness: The Study

Koraly Pérez-Edgar is a developmental psychologist who began studying children’s social interactions when she was a postdoctoral fellow. She found that children who displayed extreme shyness were more likely than other children to face anxiety as adults. A brief moment of trepidation meeting a new person wouldn’t rise to the level of such shyness, but a child who lurks anxiously in the background in an attempt to avoid other children is displaying severe inhibition.

Why Childhood Shyness Matters

Drawing upon previous research,Pérez-Edgar calls extreme shyness a form of behavioral inhibition. This inhibition involves more than just a case of nerves about trying something new. The personality trait appears as early as infancy, and involves an ongoing fear of new stimuli. Most babies might startle in response to a jack-in-the-box, then laugh as they realize the toy isn’t dangerous. Behaviorally inhibited babies are more likely to panic and cry.

[fat_widget_right]For children with behavioral inhibitions, meeting a new person is just one more frightening stimulus. These children aren’t just shy. They’re displaying a temperamental quality that is stable across the lifespan and a relatively accurate predictor of adult fearfulness.

Drawing Children Out of Their Shells

Behaviorally inhibited children tend to limit their own environments, giving them few opportunities to practice social interaction—a behavior that can make anxiety even worse. Consequently, Pérez-Edgar isn’t sure whether behavioral inhibition is an innate trait that appears early in childhood, or a learned disposition that shy children practice daily.

She wants to help shy children overcome their inhibitions, in the hope that doing so might reduce adult anxiety. In a new study, she and her colleagues are using behavioral therapy to help ease children’s anxieties. By drawing children’s attention to something other than the source of fear, researchers hope that they might train the brain not to fixate on sources of anxiety. If the approach works, it could work to undermine the connection between early shyness and adult anxiety.

References:

Inhibited children become anxious adults: Examining the causes and effects of early shyness. (2014, April 17). Retrieved from http://www.sciencedaily.com/releases/2014/04/140417155901.htm

Therapy groups are formed around a common interest to promote cohesiveness, a central factor in the strength of the group. Generally, this central factor includes common life experiences as well as a common issue. Social anxiety is certainly an issue that affects all ages.

The group you’ve joined has three teenagers and three adults (ages 25-45). As you mentioned, generally groups of adolescents are kept separate from adult groups; this was addressed by the psychiatrist leading the group, but you do not write if there was any discussion around this issue. Discussion is a vital part of group therapy, as it is in individual treatment. I have questions about the group, and if there was a real discussion. Will the split ages split the group? Has good two-way communication been established?

Did everyone in the group start at the same time? It might be easier to have a discussion where everyone is equally new, although your questions should be addressed in any case. Was the group invited to share reactions, questions, and thoughts? There might have been a discussion, but in your questions you say that the “psychiatrist addressed” the age difference. Does that simply mean he or she mentioned it, and then the subject wasn’t taken up by group members? If there was no discussion including all members of the group, then there was not much dialogue and the question must still be addressed.

Will you meet for a certain number of weeks, months, or is this left open-ended? Will people be joining the group as you go along? Will group members have a say in this? At this time, the group is evenly split. This would change by the addition of one other member.

One factor in creating a group is homogeneity, which includes age. Homogenous groups are generally easier to manage from the group leader’s viewpoint and also show greater and quicker improvement than heterogeneous groups.

Are there external factors affecting the group leader, in this case a psychiatrist? The psychiatrist might have invited different age groups to attend so that enough people would participate to make a group.

To help you make your decision, I thought you might like to know some facts about group therapy, as explained by Irvin Yalom in his book, The Theory and Practice of Group Psychotherapy. Yalom is a pioneer in group therapy who identified what makes group therapy work.

Here is a list of five important factors:

  1. Universality: Shared feelings and experiences. Members of your group have similar experiences pertaining to social anxiety, for example, but the age difference will have an effect here.
  2. Altruism: Group members help each other, which has a powerful effect. Will the older members be able to help the younger members? Will the younger members accept help? Will their help be valued by the older members? Helping and being helped by group members is a powerfully curative experience.
  3. Instillation of hope: If people in your group have been members for different lengths of time, then someone who has been working longer might be a good role model for a new member. The older members in general might be good role models for the adolescents.
  4. Corrective recapitulation of the primary family experience: Sometimes people in therapy groups feel as though the group members are like members of their own families. This happens in a group where everyone is about the same age, but also in a group like yours, where the generations are a split. In this case the family experiences might feel a bit too real, which could hinder optimal group functioning.
  5. Cohesiveness: This is the most powerful and elementary factor affecting the group. Each member of the group has to feel that he or she belongs in the group and is accepted and validated. This might be a problem in the group that you described.

If you like, you can think about these points and see what your answers are, or even bring them to the group, first consulting with the group leader as to the policy regarding outside references, which might be experienced as interference.

Thanks for asking this interesting question. I hope this helps you decide what to do.

Kind regards,
Lynn

Researchers have determined that at least two violent video games, Grand Theft Auto and Call of Duty, seem to have relatively no negative impact on prosocial behavior. Unlike Donkey Kong and Frogger, two tried-and-true nonviolent games that have raised virtually no concern with regards to violent behavior and prosocial attitudes, the onslaught of extremely violent video games that has taken over the thumbs and minds of today’s youth have been troubling parents and social critics for years.

Grand Theft Auto and Call of Duty are two of the most commonly played and criticized. Critics of the games point to research that suggests these activities increase violent behavior in children and decrease social empathy and awareness. But according to a new series of studies conducted by Morgan J. Tear of the School of Psychology at the University of Queensland in Australia, these games have virtually no negative effect on prosocial behavior at all.

Tear performed three separate experiments on a sample of young people to determine how the type of game and the length of playing time would affect prosocial attitudes. After several tests, the participants playing the violent games had almost identical social responses as those playing nonviolent games. When Tear compared the prosocial attitudes of participant after playing classic versus nonclassic video games, the results were the same. Finally, when duration of play was assessed, there were no social attitude differences between those participants who played for short periods of time and those who played for longer durations.

Another interesting finding was that even though the participants’ social attitudes were tested against strangers, they were still deemed prosocial. This finding contradicts existing research that suggests individuals maintain higher prosocial attitudes toward familiar individuals like family members and friends when compared to strangers. Although the findings of this research do not support the theory of antisocial attitudes resulting from violent video games, Tear does not believe public concern is completely unwarranted. “Research on the effects of video game play is of significant public interest,” said Tear. “It is therefore important that speculation be rigorously tested and findings replicated.”

Reference:
Tear, M.J., Nielsen, M. (2013). Failure to demonstrate that playing violent video games diminishes prosocial behavior. PLoS ONE 8(7): e68382. doi:10.1371/journal.pone.0068382

People who have social anxiety (SAD) may find it difficult to interact with others. They may become overwhelmed with feelings of anxiety when they are in crowds or around people they do not know. But how does SAD affect interpersonal relationships, and in particular friendships? Thomas L. Rodebaugh of Washington University in Saint Louis, Missouri was curious to see how the constraints of anxiety spill over into personal relationships. Warmth, reciprocity, and genuine interest in another are at the core of all close friendships. If these elements are impaired they could significantly damage the relationship.

Rodebaugh led a study that involved 27 participants with generalized SAD and 23 with no history of anxiety. The participants were presented with a simulated social dilemma that required they make decisions and interact with a hypothetical friend. The results revealed that the SAD participants were less giving and less willing to participate in the task than the non-SAD participants. The lower level of giving resulted in increases in coldness as well. This result provides a clue as to why SAD may erode even close friendships.

If people are unable to convey warmth and return feelings of genuine interest to others, those around them, even close friends, may perceive that behavior as distant, callous, or uncaring. “Potential or current friends may interpret lower warmth as indicating coldness or lack of interest, both of which may reduce the likelihood that they will continue such interactions,” said Rodebaugh. This explains the pathway through which anxiety can erode friendships. Rodebaugh believes that people with SAD do not intend to alienate their friends but rather are unable to convey closeness because of their heightened anxiety. Most approaches aimed at reducing anxiety do not address interpersonal interactions. Rodebaugh believes that efforts designed to teach people with SAD how to display warmth and caring may serve to strengthen those relationships that are most important to them.

Reference:
Rodebaugh, T. L., Shumaker, E. A., Levinson, C. A., Fernandez, K. C., Langer, J. K., Lim, M. H., and Yarkoni, T. (2012). Interpersonal constraint conferred by generalized social anxiety disorder is evident on a behavioral economics task. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0030975

In recent years, support of psychodynamic psychotherapy for the treatment of schizophrenia spectrum and other forms of psychosis has diminished. This is not entirely a result of lack of validity or efficacy, but rather an investigative shift from traditional methods of therapy to more novel approaches. However, according to a recent study led by Bent Rosenbaum of the Department of Psychology at the University of Copenhagen in Denmark, psychodynamic therapy is still one of the most effective forms of treatment.

Rosenbaum compared treatment as usual (TaU) to TaU with supportive psychodynamic psychotherapy (SPP) in a sample of 269 adults admitted for psychosis. The participants were measured for global functioning and symptom severity before, during, and after the two-year treatment period. Rosenbaum found that the SPP group improved far more than the TaU group with respect to all levels of functioning and symptoms of psychosis. Over the course of two years of treatment, there were significant gains on social functioning and significant decreases on maladaptive symptoms for the participants in the SPP group.

These findings demonstrate that psychodynamic therapy and the core elements associated with that approach can still adequately serve the needs of many individuals with schizophrenia and other psychotic issues. Rosenbaum believes that when working with psychotic clients, clinicians should focus on the fundamental aspects of psychodynamic therapy. This includes overcoming obstacles to emotional processing, mental functioning relating to sense of self, and the development and maintenance of relational bonds. Cognitive development and attention to the present should also be incorporated to ensure maximum benefits for clients who struggle with these issues.

Rosenbaum hopes that this research will bring clinicians back to SPP and approaches of that kind. “It furthers recovery when it is used as a supplement to medical and social treatment modalities.” He added, “SPP should thus be taken into account as a modality in future research and treatment.” Doing so will open avenues of treatment for clients with varying levels of mental illness.

Reference:
Rosenbaum, Bent, Susanne Harder, Per Knudsen, Anne Koster, Anne Lindhardt, Matilde Lajer, Kristian Valbak, and Gerda Winther. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: Two-year outcome. Psychiatry: Interpersonal & Biological Processes 75.4 (2012): 331-41. Print

Woman peaking out her windowFood Network chef Paula Deen is known for her bubbly personality, so many fans were shocked when she explained in her biography that she had agoraphobia for 20 years. Deen is hardly the only celebrity to experience this potentially debilitating condition, however. Kim Basinger and Woody Allen also reportedly have experienced it, and the father of modern psychiatry himself—Sigmund Freud—may have struggled with the issue as a young man.

In an increasingly busy, crowded, and connected world, anxiety can be overwhelming even for famous people, and agoraphobia will affect about 1.4 percent of the U.S. population at some point, with 40% of cases reported being “severe,” according to the National Institute of Mental Health.

What Is It?
Agoraphobia means “fear of the marketplace,” and is commonly associated with a shut-in lifestyle and social avoidance. However, agoraphobia is distinct from social phobia and characterized by a chronic fear of feeling anxiety or panic in a place where one is unable to escape or get help. For this reason, many people with agoraphobia are hesitant to leave their homes, unwilling to go out alone, or visit only familiar locations. Some people with the condition experience panic, generalized anxiety, and other issues classified as anxiety disorders.

Although everyone experiences anxiety in unfamiliar or social settings from time to time, people with agoraphobia experience overwhelming anxiety and panic on a regular basis. They might feel dizzy, restless, short of breath, or confused in unfamiliar settings. Agoraphobics are often fearful of feeling out of control, and the physical symptoms of anxiety can exacerbate this fear.

What Causes It?
Agoraphobia is typically a side effect of panic disorder. People who have had panic attacks in public settings may fear that they’ll have another panic attack and grow increasingly fearful of going out in public. Sometimes agoraphobia is caused by other circumstances, such as a traumatic event in a public place, social anxiety, or other mental health conditions that cause anxiety and panic. The disorder may be caused by a combination of genetic and environmental factors. Children of parents with panic disorder are more likely to develop agoraphobia; this could be due to either genetics or parental modeling.

How Is It Treated?
Because people with agoraphobia are often terrified of having panic attacks, one of the most important steps in treatment is giving the person a sense of control over his or her tendency to panic. Relaxation techniques can help many people regain a sense of control. Medication is also highly effective. Anti-anxiety medications and antidepressants can also help people with agoraphobia.

Sometimes agoraphobia causes so much fear that people refuse to leave their homes. People with severe agoraphobia sometimes need several months of progressive desensitization to fearful settings. For example, a person might start by walking outside, graduate to getting in the car, progress to driving to a parking lot, and ultimately master going to the grocery store. Most people with agoraphobia undergo some form of psychotherapy. Cognitive behavioral therapy can be especially helpful, and some people with the issue benefit from group therapy. Group members often share coping strategies and can help an agoraphobic feel less isolated; the group setting itself can also serve as a form of desensitization to unfamiliar people and settings.

References:

  1. A.D.A.M. Editor Board. (2011, November 18). Panic disorder with agoraphobia. PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/
  2. Agoraphobia among adults. (n.d.). NIMH RSS. Retrieved from http://www.nimh.nih.gov/statistics/1AGOR_ADULT.shtml
  3. Agoraphobic celebrities. (n.d.). The Daily Beast. Retrieved from http://www.thedailybeast.com/galleries/2011/12/13/photos-paula-deen-kim-basinger-and-other-famous-people-with-agoraphobia.html
  4. Mayo Clinic Staff. (2011, April 21). Agoraphobia. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/agoraphobia/DS00894
  5. Moskin, J. (2007, February 28). From phobia to fame: A southern cook’s memoir. The New York Times. Retrieved from http://www.nytimes.com/2007/02/28/dining/28deen.html?pagewanted=all

Close up of hands being washed

Most people experience some form of irrational fear or anxiety, and many are concerned about germs and disease in particular. Amid a flurry of films and media reports about antibiotic-resistant infections and life-threatening flu strains, it’s easy to understand why some people actively worry about what they touch and breathe.

While concern about germs can motivate people to make health-conscious decisions such as frequently washing their hands, a serious germ phobia can drastically alter how a person functions and engages with society. Even actor and television host Howie Mandel concedes he has been unable to shake the grip of mysophobia—the technical term for fear of germs. Phobias are differentiated from general fears by degree. A person who is concerned about germs might wash his or her hands or get a flu shot, but a germ phobia can interfere with every area of life. Phobias are treatable, and people experiencing them should seek medical or psychological assistance.

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Symptoms
The primary symptom of mysophobia is an irrational fear of germs. This can manifest differently in different people. One person, for example, might be fixated on a specific germ or disease, while another person might be afraid of germs and dirt in general. Common behaviors associated with mysophobia include:

Effects
Mysophobia doesn’t simply inspire fear and avoidance. The phobia can be all-encompassing and life-altering. While people with mysophobia often recognize that their reactions are irrational, they can’t control them. They may avoid going out in public, developing intimate relationships, or eating food they did not cook. Because mysophobia affects so much of a person’s life, it can lead to other mental health issues such as depression, social isolation, and anxiety. Complete avoidance of germs can actually contribute to the development of health problems. Overuse of antibacterial and disinfectant products has been implicated in the spread of new, resistant infections, and children who are not exposed to germs are more likely to develop allergies.

Causes
No one knows exactly why people develop phobias, but mental health experts have developed a few theories. Some believe that people are more likely to develop phobias that protect from danger. These phobias include germ phobias, fear of large animals, and fear of heights. People who develop phobias may take these natural fears too far and react with extreme anxiety, placing them in danger they are believed to be trying to avoid.

Early experiences also can make a person more likely to develop a phobia. Childhood illness, the death of a parent, or painful medical procedures can condition a person to be extremely fearful of germs and to take extreme measures to avoid them. Phobias also tend to run in families; they may be genetic or simply learned from parents.

Treatment
Phobias are highly treatable and often require only a few sessions with a qualified mental health professional. Cognitive behavioral therapy, which helps people to reframe intrusive and phobic thoughts, can be extremely beneficial. Desensitization, a process whereby a person is slowly exposed to a frightening stimulus, also is highly effective. Some doctors may prescribe anti-anxiety medications to help people with mysophobia cope with their fears during treatment or to enable them to function in public. Some clients also experience success with hypnotherapy, often in only two or three sessions.

References:

  1. Audesirk, T., Audesirk, G., Byers, B. E. (2008). Biology: Life on earth with physiology. Upper Saddle River, NJ: Pearson Prentice Hall.
  2. Overcoming your Fear of Germs. (n.d.). Fear of Germs. Retrieved from http://www.fearofgerms.com/
  3. Kring, A. M., Johnson, S. L., Davison, G. C., Neale, J. M. (2010). Abnormal psychology. Hoboken, NJ: John Wiley & Sons.
  4. Phobias. (n.d.). U.S. National Library of Medicine. Retrieved from http://www.nlm.nih.gov/medlineplus/phobias.html

 

Office birthday partyThis is the third in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

I had a client we’ll call Brian, a man in his mid-thirties with a diagnosis of Asperger’s syndrome who came to me to discuss what he referred to as “issues he was having with people at work.”

It is not an unusual request for a person with Asperger’s to want to work on the confusion that surrounds social interactions in general. Interactions at work often are more challenging because in the office, not only do the normal social protocols apply, but there often is an additional layer of a particular corporate culture overlaid upon this basic structure, invisibly directing everything.

Bryan was a pleasant and engaging man. He held good eye contact, spoke with precision, and demonstrated a light touch with humor. His demeanor changed, though, when I asked him about his colleagues in the office where he worked as a certified public accountant.

A quiet earnestness overcame him. He spoke clearly and without breaking to collect his thoughts or in expectation of response. He discussed one individual after another in great detail, including information about the kind of work they did, their areas of responsibility, and where they stood in the hierarchy. This was precisely the sort of information I expected to get from Brian on the topic of work relationships.

Then, however, he began to speak of his colleagues in more personal terms. He knew who was married and who was single. He knew who had children, their names and ages, and the schools they attended. Brian told me who had recently vacationed and where they had gone; who golfed and who played tennis; who had iPhones and who used Androids. He knew the makes and models of everyone’s cars. He knew the names of spouses. He knew which neighborhoods his coworkers called home. He even knew who had housekeepers and who did not.

It might appear surprising on first glance to read that I was given such detailed and personal information about others from a man with Asperger’s who came into my office with self-identified problems related to interpersonal relationships. But I have seen this before. Once you look at this apparent contradiction in another light, you may recognize it, too.

I’m talking about the illusion of friendship.

Further discussion with Brian demonstrated to me that he had gleaned all this information about his coworkers not from interactions with them over time, the way you or I might imagine getting to know the people we work with. Instead, Brian had developed his extensive knowledge of everyone around him by listening and even eavesdropping on conversations others were having around him, but in which he had not once been involved personally.

And he was having problems with his coworkers when he would make a statement revealing his knowledge about a person, info he had no apparently legitimate way of knowing. People became uncomfortable around him because of this and withdrew from him, which left him utterly confused.

Of course, this became the starting point for our work together. Brian had to learn about the ways that acquaintanceships and friendships develop over time. Importantly, he also had to learn the concept of reciprocity: It is not enough to know things about another person, but one must also share personal information about oneself as well in the give-and-take manner of casual conversation. This is how trust develops between people. This is the foundation from which we can make a statement such as, “Oh, yes, I know Brian,” with legitimacy.

Brian had to learn that knowing confidential or intimate facts about another person without that reciprocity was considered socially gauche, and that it had the potential even to be frightening to some individuals. Brian had to learn the difference between having friends and having the illusion that he had friends.

Once we began to tease this distinction apart, Brian began making progress in his social interactions. We used role-playing techniques and many “what-if” exercises, and Brian’s distress around the topic of his work environment noticeably decreased over time.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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