Shyness and Social Anxiety Workbook for Teens (16 page)

Understanding your social anxiety can help you realize that there are thousands of others exactly like you. Recognizing how distorted thoughts drive feelings and behaviors can help you question your thoughts and break the chain of avoidance. By facing fears one at a time, using coping strategies, and taking manageable risks, you can move from a life limited by social anxiety to one in which you can go where you want and have the friends you deserve.

If you have tried the techniques outlined in this book, hopefully you’ve experienced a decrease in your social anxiety and are able to do some things that you were avoiding before. To maintain the gains you have made, you will want to continue to practice your coping thoughts and pushing yourself to keep doing exposures. You are like an athlete in training; if you stop exercising, your muscles weaken. If you challenge yourself with regular workouts, you will get stronger.

There’s no guarantee that your social anxiety will completely go away. Even after significant progress, you will undoubtedly still have days when you want to avoid situations that didn’t bother you at all the day before. This is normal. Your level of anxiety, like other moods, can be influenced by lack of sleep, what you eat, menstrual cycle, and the use of alcohol and drugs, to mention just a few factors. If you can identify what seems to make you feel more anxious, you can help yourself by regulating that influence. In fact, just identifying it can bring some relief. For example, if you notice that you feel more anxious after a poor night’s sleep, you can remind yourself that you will feel better when you are more rested.

Disruptive life events—like starting a new job, going to a new school or away to college, or moving to a new neighborhood or city—can all trigger an increase in social anxiety. These are all opportunities to review what you have learned in this book and practice the techniques.

So how can you tell whether you are really making progress? The best way is to look honestly at what situations you are avoiding. Your motto is Avoid Avoiding! If you are avoiding what is important to you, you have fallen into your old traps of social perfectionism or any of the other disastrous distortions. Get out your values compass, and remember what is important to you. Then turn to the skills that helped you before; they are the same skills that will help you again. Remember …

You are not alone

and

You can master social anxiety!

Appendix A

This book is a self-help book. It explains what social anxiety is and how to get through it so that it does not get in the way of doing what you want in life. But sometimes self-help is not enough. If you are having trouble following through with the exercises and exposures in this book, or if you are doing the exercises but don’t seem to be moving ahead, finding a therapist to work with may be what you need.

It is sort of like learning a sport. You might read about how the game is played and what you need to practice to get good at it, and yet still need a coach. Therapists are like coaches. They can work with you to develop the skills you need and point out things that you may not be aware of, like safety behaviors. They can also give you the encouragement to follow through with exposures that are especially challenging.

This book is based on cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). CBT focuses on the relationship between thoughts (cognitions), feelings, and action (behavior). A CBT therapist will help you identify and challenge the thoughts that are making you more anxious and change the behaviors that are making your problem worse. ACT is a type of CBT that focuses more on changing behavior and less on changing thoughts. The objective in ACT is to identify values and commit to actions that will lead you to live a more rich and meaningful life.

CBT and ACT are very effective for all anxiety problems, including social anxiety. If you decide to see a therapist, it is very important that you find one who is trained in CBT or ACT.

You will want to feel comfortable with the therapist you see. You have every right to ask questions to make sure that the therapist you choose will be a good fit for you and has the experience to treat the issue you want to work on.

These questions are good ones for you and your parent or guardian to ask:

What is your training in cognitive behavioral therapy? (Therapists will ideally be able to talk about workshops they have taken, experienced clinicians they have consulted with, organizations they belong to, and certificates they hold in CBT.)

What is your training or background in treating social anxiety?

How much of your current practice involves treating social anxiety?

Do you feel you have been effective in treating social anxiety?

What techniques do you use for social anxiety? (You want your therapist to talk about using exposure techniques and working with distorted thinking.)

If needed, are you willing to leave your office to do behavioral therapy? (Some of your exposures may require you and your therapist to be in public spaces.)

You may be wondering or have heard about medication for social anxiety. In fact there are medications that can help with social anxiety, as well as other types of anxiety. There are basically two types:

Benzodiazepines

Benzodiazepines are relaxants that work very quickly in the body and brain. People usually take them when they become anxious or panicky or when they are going into situations that make them anxious.

Common benzodiazepines include Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam). Each name in parentheses is the generic version of the brand name and is based on the drug’s chemical structure.

There are pros and cons to taking benzodiazepines.

Pros:

• They are quick acting.
  
• They can be taken as needed.
  
• They are not that expensive.
  
• Most people find it easy to take pills.
  

Cons:

• There can be side effects, like drowsiness, light-headedness, confusion, and depression.
  
• They can be deadly if you mix them with alcohol.
  
• They can become physically addicting.
  
• They can become a safety behavior that you are dependent on. Even if you are not physically addicted, they can get in the way of your facing your fears and gaining confidence in yourself.
  

Antidepressants

You may be wondering why antidepressants are prescribed for anxiety. The reason is that the way the drug works in your brain to decrease depression decreases anxiety as well. Also, it is not uncommon for people who have social anxiety to have depression too. These medications can help with both problems.

The most common type of antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. Serotonin is a brain chemical that influences mood, and these drugs work by increasing serotonin levels; they also work on other chemicals in the brain that affect mood. Some common SSRIs include Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), Zoloft (sertraline), Lexapro (escitalopram), and Luvox (fluvoxamine). Other antidepressants that are sometimes used are Effexor (venlafaxine), Cymbalta (duloxetine), Serozone (nefazodone), and Remeron (mirtazapine).

Like benzodiazepines, SSRIs have pros and cons.

Pros:

• They are not that expensive.
  
• Most people find it easy to take pills.
  
• These medications are not addictive.
  
• Because you take these medications every day, as opposed to only when you feel anxious, they are less likely to be used as safety behaviors.
  

Cons:

• There can be side effects. The most common are nausea, diarrhea, constipation, drowsiness or jitteriness, dry mouth, headaches, yawning, shakiness, and sexual side effects, such as difficulty having an orgasm and/or decreased sexual drive. Many of these side effects decrease over time.
  
• These medications can take from four to six weeks to have a noticeable effect.
  
• Going off the medication can cause uncomfortable symptoms, like dizziness, nausea, headaches, difficulty sleeping, or flu-like symptoms. If you decrease your dose slowly when going off these medications, these effects will be less intense.
  
• When you stop taking these medications, social anxiety symptoms often come back.
  

Should you or shouldn’t you take medication for your anxiety? Well, first of all, thinking you should or should not do anything is the wrong approach. These words imply that there is an absolute right and wrong for everyone, which is perfectionist thinking.

If you are experiencing extreme anxiety that is getting in the way of your functioning, like getting out of the house and going to school, or doing the exercises in this book, you may want to talk to your doctor about medication. It is usually a medical doctor who prescribes medication for anxiety, most commonly a family doctor, general practitioner, or psychiatrist (a medical doctor who specializes in mental health).

For those who try medication, the best results have been obtained by people who combine it with CBT. This makes sense. The medication can help lower the volume on your anxiety. The therapy will teach you skills to overcome the anxiety now and in the long run. That way, when you stop taking medication, you will be much less likely to experience a return of your social anxiety.

Appendix B

My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic
by Michael A. Tompkins, PhD, and Katherine A. Martinez, PsyD

Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries, and Phobias
by Tamar Chansky, PhD

If Your Adolescent Has an Anxiety Disorder
by Edna B. Foa, PhD, and Linda Wasmer Andrews

These sites offer information about anxiety, CBT, and ACT:

Anxiety Disorders Association of America:
adaa.org/

This organization is dedicated to spreading awareness about the severity of anxiety disorders and effective treatments.

Association for Behavioral and Cognitive Therapies:
abct.org

This organization focuses on promoting ongoing research regarding the effectiveness of therapies used to treat a variety of mental health conditions.

Academy of Cognitive Therapy (ACT):
www.academyofct.org

This organization helps people access cognitive therapy resources, learn more about mental health disorders, and find a certified cognitive therapist.

Appendix C

If you have ever had trouble peeing in a public restroom, you are not alone. Most of us have experienced this at some time in our lives. The technical term for this problem is paruresis (pronounced par-yu-REE-sis). It is commonly referred to as shy bladder or bashful bladder, and it can range from mild to quite severe.

Millions of people suffer from paruresis, but they usually suffer alone because they are embarrassed to tell anyone. Shy bladder is caused by social anxiety. Sufferers are usually afraid of being watched, listened to, and in some way negatively judged. Their anxiety makes it impossible to allow urine to flow, no matter how full the bladder is. So not only is this problem embarrassing, it can also be very painful.

As we know, socially anxious teens will always attempt to avoid situations that make them anxious: in this case, peeing in a public facility, or even at home when there are other people around. This avoidance can really get in the way of living their lives and doing the things that are important to them. Going to restaurants, to friends’ houses, to parties, or anywhere can be a big problem.

This self-test can help you figure out how much of a problem paruresis is for you.

The more yes answers you gave, the more of a problem paruresis probably is for you. The good news is that the problem is very treatable with many of the same strategies outlined in this book. Because of the unique brain-bladder connection, however, there are specific ways to go about treating paruresis that are not covered here. These resources can help you learn more:

Shy Bladder Syndrome: Your Step-by-Step Guide to Overcoming Paruresis
by Steven Soifer, MSW, PhD, George D. Zgourides, PsyD, Joseph Himle, MSW, PhD, and Nancy L. Pickering

Shy Bladder Center:
shybladder.org

International Paruresis Association:
paruresis.org