CBT: current progress and future direction

I want to use this blog to chart potential progress, and provide a realistic perspective of what a person going through treatment actually experiences. We read the literature on social anxiety disorder and we see the numbers of responders CBT offers as a treatment, but there is no detailed account of what reduction in symptoms we can quantitatively and qualitatively expect from treatment. There is very little knowledge at least in accessible form of what we can expect going through treatment, how progress is made, what's being done etc. etc. So I hope this blog serves to elaborate on these issues and provide a motivational support for readers which I assume are also SA sufferers.


So, I guess to be relevant I should write about what has happened so far, what my future directions are, and I want to conclude with a discussion on medication (I say discussion because I'm hoping readers will comment on their opinions on the matter.)

I was diagnosed with moderate to severe social phobia, that is to say that on many ratings I am near maximum anxiety provocation - such as socializing with crushes, giving presentations to large audiences, or opinions in a group meeting. However, I retained the "moderate" status because I'm still functional, that is to say I attend classes, I can go on a bus, I can walk/eat in public, and to some extent have acquaintances that I communicate with.

The "testing" phase actually consisted of about 4 sessions in which I took several personality and anxiety questionnaires and interviews, that really highlighted where my focus is, my own individual beliefs that are contributing to my social anxiety etc.

In fact I want to comment on this briefly as I feel it is very important. I want to start with an example using OCD. OCD is of course a disorder in which people have obsessions that can last weeks to months in duration where they're constantly worrying over a potential harmful event occurring in some form or another. However, there are various forms of OCD. Some sufferers worry about germs, such to an extent that they'll wash and scrub their hands until they're raw and bleeding - other OCD sufferers couldn't careless about germs but rather are deadly afraid of having terminal illnesses such as cancer or HIV. Still other OCD sufferers think people who worry about diseases are mental cases but are deathly afraid of having things out of order and may spend hours making sure everything is aligned and categorically placed.

Now, transition to social anxiety disorder, which exhibits (in a more subtle form) the very same versatility in focused fear. Some SA sufferers are deadly afraid of blushing, that's the symptom they focus on in public - others are afraid of trembling - and myself, I'm afraid of losing my voice (by running out of breath) and not being able to communicate.

Of course, on the more severe side of SA, people worry about all of these symptoms or any physical symptom that could be interpreted as showing anxiety.

To me, I couldn't careless if people see me blushing, ya they might interpret that as showing anxiety, but the symptom itself isn't severe enough to warrant any concern from me. I don't feel like it's something a person really cares about at all. Same thing for trembling, if my hands are shaking or my legs are shaking it's not severe enough to warrant concern from me. But gosh forbid if my voice!! trembles or I lose breath I feel like an escalating sense of impending doom and utter patheticness at not being able to communicate (and the wealth of negative thoughts that come from that)

So my "form" of SA is mainly centered around voice concern.

So I began the "treatment" phase roughly 3 weeks ago. I don't really want to comment on all of the things I've done so far as that would make this blog extraordinarily long. So I want to summarize.

Basically I did "exposures" in and out of the lab. In lab exposures consisted of me making small talk with a stranger several times (each time we graded my performance on several measures such as "how anxious did I appear" "how weak was my voice" "how likable was I?" etc. etc.) there was also me reading in front of a small group of other undergraduates doing the same grades of performance..

and then recently there was an out of lab exposure where I went outside and made small talk with strangers at a bus stop (communicating for a little bit then asking them a question). With obviously no grading of my performance.

So, I want to comment on the progress I've made so far in the three weeks of treatment. The first thing that I'm still beginning to realize, is that showing anxiety is in absolutely positively no way as severe as we think it is. There is a HUGE misconception of what people actually think about someone who shows anxiety in our brains. I did an exposure where I talked until I ran out of breath and couldn't talk anymore, and instead of the other people looking at me with disdain and ridicule they looked concerned and wanted to help me. In fact that's what they commented on.

Then I talked with them normally, and it was as if they totally forgot I showed anxiety! We communicated normally, I got them to laugh GENUINELY not out of pity. By no means is anxiety this permanent brand that once you show it - you're branded forever in the eyes of the people you're communicating with to be looked down upon, to have your opinions slighted, and to not want to be around.

Now, obviously this is a pretty pathetic summary of what I've done so far - maybe I'll come back in another blog and write more intensively on the subject but again for the sake of brevity I don't want to write a book.


I guess I want to comment on symptoms I've noticed have improved and what has happened so far. So for one thing, communicating with acquaintances have become easier. I feel lighter, like I'm less inhibited, I don't feel as anxious, and I'm able to focus on what they're doing and not be as concerned about what I'm doing.

That's been the most noticeable symptom improvement thusfar.

Now also, recently I was giving a rather extended talk >1 minute (i.e. potential to lose my voice if anxiety increases) to a group of acquaintances where the focus was explicitly on me. I felt the anxiety, the sort of adrenaline escalating feeling and that they were noticing my voice etc. etc. and that I was losing control.. BUT unlike previous circumstances where this would happen - from my exposure, I knew that the anxiety had a stopping point, that I've been there before and that people actually AREN'T noticing the symptoms like I think they are and that that feeling though unpleasant was actually in my control.

So the anxiety didn't dissipate, but I was able to tolerate it enough to finish my talk, which is something I could not say in the past. I then went on to give another talk in an even larger setting and I didn't feel the physical symptoms of anxiety but I did get the mind going blank thing a little bit.

But the point was, was that mid anxiety-feeling - my mind was able to kick in alternative thinking skills very much different than what it was used to.. So I can begin to see how this treatment is supposed to work and how it is GOING to work.


Ok, so as I said in the beginning I want to talk about medications.

There is a study that a certain antibiotic - D-cycloserine can improve exposure therapy by assisting the mind in learning new behaviors. Unfortunately it is virtually impossible to obtain a prescription for this medication as it is off-label (it's traditionally used as an antibiotic).

There is however another study, about Phenelzine Sulfate it's an MAOI that in studies have shown to dramtically improve the chances of SA remission... however whenever you hear the word MAOI you best panic like shit because that shit will fuck you up. Like no joke, this stuff can actually kill you as there are a plethora of potential dietary interactions such as if you eat cheese while on this stuff you could potentially die.

As much as I want to get better, I'm not sure if I want to seriously risk my life..

It's just very ironic that the meds I want with no serious side effects I can't get, but the ones that could kill me I could get??

What are your opinions?