I can't link the full text article due to copyright issues, but if you google "cycloserine social anxiety disorder" you should find a full text study in .pdf format.
Cycloserine is an antibiotic originally developed as a treatment for tuberculosis. However, research in the late 90s and 2000's revealed that it works on a receptor in the brain known as the NMDA receptor which scientists believe is in charge of learning processes with regards to anxiety and the amygdala.
Research showed that rats who were administered the drug prior to exposure to a feared stimulus were able to undergo "extinction" faster than rats who had no cycloserine. Extinction is the process in which a person's brain learns to drop automatic fear responses to previously feared stimuli.
Further research showed that people with social anxiety disorder who were given this drug in conjunction with exposure sessions reported a far greater reduction in social anxiety symptoms and much sooner than patients who were given placebo.
On the account of this research, I've become very excited to try this medication in conjunction with my own exposure therapy. I have to be honest, the exposure therapy I've done just hasn't seemed to reduce my symptoms. This last Christmas I experienced a great amount of physical anxiety symptoms coupled with an inability or unwillingness to communicate with my family members. Further, in events like ordering food or going to the bathroom I experienced the same heart racing/severe anxiety symptoms that I've experienced in the past.
I understand that treatment isn't meant to be constant progress and that I should expect to sort of "oscillate" between being better and worse, and I would be lying if I said there haven't also been times where I usually would have had physical anxiety symptoms and I didn't. It's just that progress hasn't been what I'd expected it to be and I feel I need to have something to "augment" my treatment.
This medication is still in the experimental stage for use in treating anxiety disorders, however other studies have been able to replicate its use in treating anxiety disorders such as panic disorder and acrophobia. So I'm fairly optimistic in its ability to treat anxiety disorders.
But as I've said, since it is still in an experimental phase in regards to anxiety disorders, getting prescriptions for it means that it would have to be prescribed off-label. This has proven to be an exceedingly difficult barrier to overcome, I've been to many general practitioners with little to no success. Tomorrow my mother is going to another doctor who'll hopefully give me the prescription.. otherwise I'm going to have to start calling psychiatrists and hope to find one who's willing to experiment.
I do think this is a promising treatment option, and encourage people who're willing to do exposure exercises to try to get this medication as it might help facilitate your treatment progress.
Please comment if you're reading this, I'd like to have discussions.
Sunday, December 26, 2010
Wednesday, December 22, 2010
hello
I haven't really been doing any work in regards to the CBT since school is out of session and I'm in New York. Symptoms have been quite strong lately, with family gatherings. I feel that if I don't play with the kids and be social that it'll be a reflection on me as someone who just can't be around other people. However, I know that despite not living up to the social expectations I have for myself, my grandparents talk to me the same (probably isn't such a big deal to her, if she even notices) and really if people form that opinion of me as someone is secluded and incompetent socially well - I HAVE SOCIAL ANXIETY DISORDER. So ya, of course I'm socially inhibited. Furthermore it really doesn't effect me, like at all. If someone thinks I'm socially awkward or incapable of talking then they form that opinion and it stays in their brain. It might change the way the behave around me, and they may gossip to other people if they have nothing better to do. But it's not like it really effects MY life. Even if people view me negatively, they're just people I see every once in a while and there are plenty of other people in this world to whom first impressions can still be made.
In any event the impression of anxiety or quietness leaves once you've overcome the SA and become like yourself again, as I've noticed people who've commented on how boring I've been and how little I talk seem to forget all about that in the times my SA is in remission. I do long for the days when I don't feel this great weight on me in social situations but I recognize that a lot of hard work is left ahead of me if I'm going to get better.
In any event the impression of anxiety or quietness leaves once you've overcome the SA and become like yourself again, as I've noticed people who've commented on how boring I've been and how little I talk seem to forget all about that in the times my SA is in remission. I do long for the days when I don't feel this great weight on me in social situations but I recognize that a lot of hard work is left ahead of me if I'm going to get better.
Wednesday, December 15, 2010
Progress
Alright, so I haven't updated in a while, no I haven't suddenly forgotten about CBT. Actually these past few weeks I've sort of quasi ended treatment due mostly to an OVERWHELMING amount of school work and job obligations. I don't very much enjoy complaining so I won't go into those aspects, but suffice to say I've more regressed than progressed these past 3 weeks.
Today however was quite successful. I had my first appointment in 1 and a half weeks. I did what's known as an "in vitro" exposure, which honestly I think are best for beginning SA treatments. Exposures are absolutely essential to the treatment process and so it makes it even moreso important to have successful exposures. Doing exposures with strangers or friends/acquaintances is inherently more difficult because you don't have the opportunity to carry out a long conversation, you have to be assertive and find creative things to justify talking with strangers (which can be quite difficult), and furthermore you don't get feedback from them.
So my train of thought is (in in vitro exposures) is that the people enlisted to listen to me talk are doing so with the knowledge that I have SA, that I'm working to getting better, and so they're understanding if I show anxiety. This allows me to focus on getting better, rather than worrying so much about showing my anxiety.
Case in point:
Today I was to give a series of presentations to a group of 4 people, and as I went through my chart, I felt like my peak anxiety would be around 90. I felt my heart racing in anticipation, I felt the sweaty palms, the nervous tension. etc etc.
Went through the CBT exercises, then went into the conference room.
First exposure duration: 10 minutes.
So when I first started talking, I was very visibly nervous. Shaking, incoherent talking, losing breath, heart pounding etc etc. Then I started to kind of level off, I still felt an intense radiation of anxiety come over me as I felt they were judging me negatively. I forgot a lot about what I was talking about and hence I received a lot of "he looked nervous, etc etc" feedback
Second exposure duration 12 minutes:
I started off anxious again, but not as much. I felt like I knew it wasn't going to escalate, and I was able to focus on what I was talking a little bit more than my anxiety. Overall, the peak anxiety I felt was the same as the first session but on the average I was getting to pockets of time where I felt comfortable.
Third exposure duration 12 minutes:
I really started to engage the audience, I felt a little more confident due to an absence of anxiety symptoms, I was able to bring out more of my confidence and as I brought my confidence I felt a further decrease in my anxiety. By the end of this exposure, I literally felt no anxiety. Like I could talk for as long as I needed and it would have been as if I was talking to air.
Fourth exposure duration 15 minutes:
Felt no anxiety, had an increased sense of confidence, really got an engaging conversation going, I felt in control and the people enjoyed my personality. Again, to reiterate, I couldn't feel anxiety symptoms and my mind was able to enter a creative world that's only accessible in non-anxious states.
So the point I want to drive home here, is that I started out in anxiety attack mode, but by repeated exposure, I was able to get to a point where my anxiety was the same as that as someone without SA. That's a huge confidence booster and the fourth exposure session really made me feel happy! Because I don't get a lot of attention and I felt like for the first time in a long while I was able to accrue positive feedback which was reflected in their notes on my presentations.
The exposure session totaled about 2 hours which is actually short for what most "successful" exposure sessions should be. I want to layout this experience for readers to understand how they themselves should be conducting their exposure sessions that is to say, with repetition with the mindset that eventually your body will lose the ability to sustain the anxiety response and your anxiety will come down and as it comes down your mind will undergo what's called "extinction" where it reprograms itself to not automatically initiate the anxiety response in future situations.
Today however was quite successful. I had my first appointment in 1 and a half weeks. I did what's known as an "in vitro" exposure, which honestly I think are best for beginning SA treatments. Exposures are absolutely essential to the treatment process and so it makes it even moreso important to have successful exposures. Doing exposures with strangers or friends/acquaintances is inherently more difficult because you don't have the opportunity to carry out a long conversation, you have to be assertive and find creative things to justify talking with strangers (which can be quite difficult), and furthermore you don't get feedback from them.
So my train of thought is (in in vitro exposures) is that the people enlisted to listen to me talk are doing so with the knowledge that I have SA, that I'm working to getting better, and so they're understanding if I show anxiety. This allows me to focus on getting better, rather than worrying so much about showing my anxiety.
Case in point:
Today I was to give a series of presentations to a group of 4 people, and as I went through my chart, I felt like my peak anxiety would be around 90. I felt my heart racing in anticipation, I felt the sweaty palms, the nervous tension. etc etc.
Went through the CBT exercises, then went into the conference room.
First exposure duration: 10 minutes.
So when I first started talking, I was very visibly nervous. Shaking, incoherent talking, losing breath, heart pounding etc etc. Then I started to kind of level off, I still felt an intense radiation of anxiety come over me as I felt they were judging me negatively. I forgot a lot about what I was talking about and hence I received a lot of "he looked nervous, etc etc" feedback
Second exposure duration 12 minutes:
I started off anxious again, but not as much. I felt like I knew it wasn't going to escalate, and I was able to focus on what I was talking a little bit more than my anxiety. Overall, the peak anxiety I felt was the same as the first session but on the average I was getting to pockets of time where I felt comfortable.
Third exposure duration 12 minutes:
I really started to engage the audience, I felt a little more confident due to an absence of anxiety symptoms, I was able to bring out more of my confidence and as I brought my confidence I felt a further decrease in my anxiety. By the end of this exposure, I literally felt no anxiety. Like I could talk for as long as I needed and it would have been as if I was talking to air.
Fourth exposure duration 15 minutes:
Felt no anxiety, had an increased sense of confidence, really got an engaging conversation going, I felt in control and the people enjoyed my personality. Again, to reiterate, I couldn't feel anxiety symptoms and my mind was able to enter a creative world that's only accessible in non-anxious states.
So the point I want to drive home here, is that I started out in anxiety attack mode, but by repeated exposure, I was able to get to a point where my anxiety was the same as that as someone without SA. That's a huge confidence booster and the fourth exposure session really made me feel happy! Because I don't get a lot of attention and I felt like for the first time in a long while I was able to accrue positive feedback which was reflected in their notes on my presentations.
The exposure session totaled about 2 hours which is actually short for what most "successful" exposure sessions should be. I want to layout this experience for readers to understand how they themselves should be conducting their exposure sessions that is to say, with repetition with the mindset that eventually your body will lose the ability to sustain the anxiety response and your anxiety will come down and as it comes down your mind will undergo what's called "extinction" where it reprograms itself to not automatically initiate the anxiety response in future situations.
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