Teen Social Anxiety Group (Cognitive Behavioral Therapy/Group Therapy)

Posted by in CBT, Group Therapy, Social Anxiety Teens with social anxiety unite! In this paid treatment group, teens will support each other in developing cognitive behavioral skills to combat social anxiety. This workshop will be interactive and fun. Note: If you are an adult with social anxiety, there’s a group for you coming soon! If you’re interested, please call our office or reply to this email so that we can better gauge demand for an adult social anxiety group. With the new school year quickly approaching, there is no better time to work on tackling your social anxiety. The intent of this group is to provide a supportive environment for developing cognitive behavioral skills and completing exposures. Because social anxiety can co-occur with other types of anxiety, you do not need a social anxiety diagnosis to benefit from this group. In some cases, this group may also be helpful for individuals with obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), panic, agoraphobia, and others who may be self-conscious or concerned what others may think of them. This group will meet on Saturday (8/17/13), 11am-1pm. The fee for attending this group is $100. Insurance will not be accepted; however, if you have out-of-network benefits, you may be eligible to submit your bill for reimbursement by your insurance company. Subsequent 2-hour sessions may be held based on interest and/or may be held in conjunction with an adult social anxiety group. Participants MUST BE APPROVED BY DR. SEAY in order to attend. Future meetings will be announced via our Events calendar and email distribution lists. Space is limited, so please secure your spot today by calling our office to register. Questions about this group should be directed to me (Dr. Seay) at (561) 444-8040. The group will meet in my office in Palm Beach Gardens, FL. The address is 11641 Kew Gardens Avenue, Suite 207, Palm Beach Gardens, FL 33410. Thanks, and I hope to see you at our...
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Vomit Phobia – Fear of Vomiting (Emetophobia)

Posted by in Agoraphobia, Health Anxiety, Obsessive-compulsive disorder (OCD), Panic, Phobias, School Refusal, Social Anxiety Flu season will be quickly upon us and with it comes an unfortunate increase in the likelihood of experiencing fevers, coughs, runny noses, vomiting, and the like. Although no one enjoys being sick, this time of year poses particular challenges for individuals suffering from “vomit phobia”, or emetophobia, the fear of throwing up. The fear of vomiting can affect individuals of all ages. It sometimes emerges in childhood and, if untreated, may follow a relatively chronic course. However, it can also develop well into adulthood, sometimes taking root after a negative health experience (e.g., after getting food poisoning or after experiencing an episode of severe or uncontrolled vomiting). Vomit Phobia in Children and Teens Consequences associated with the fear of throwing up can be extreme. In children, vomit phobia can lead to school refusal and avoidance. Academic performance may suffer, and children may miss out on certain developmentally important social milestones. If a child or teenager is afraid of getting nauseous or throwing up, he or she may avoid birthday parties, sleepovers, dating, and eating out at restaurants. Missing out on these activities can affect relationships and impact social development, which may lead to chronic social impairments. Even when longstanding social problems do not develop, children with vomit phobia still experience a great deal of unhappiness, fear, anxiety, and distress. Fear of Vomiting in Adults Adults with the fear of vomiting may also be significantly impaired by their symptoms. They may have more absences from work and may avoid work-related travel, which can affect opportunities for advancement. They will often dread meetings, during which they may feel trapped and uncomfortable, and may avoid certain job responsibilities like public-speaking or presenting.  This can leave otherwise bright and capable individuals stagnating in jobs that are beneath their true capabilities. Vomit phobia also affects travel for leisure and dining out, and can wreak havoc on romantic relationships. Women with the fear of vomiting may experience extreme distress at the thought of becoming pregnant and experiencing morning sickness. Women with the fear of morning sickness may delay starting families, and some may choose to never have children at all due to the fear of recurrent vomiting during pregnancy. Clearly, this can have profound and lasting effects on one’s life. What is Emetophobia? Emetophobia is defined as an excessive or irrational fear about the act, or possibility, of vomiting. However, this relatively straightforward definition...
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Fear of Saliva Swallowing & Choking: Treatment & Symptoms (OCD)

Posted by in ERP, Obsessive-compulsive disorder (OCD), Social Anxiety Question: I have sensorimotor OCD, and I’m suffering from conscious swallowing. My main fear is that I’ll choke or swallow my own saliva whenever I’m speaking or singing. Any tips for how to tackle this fear via exposure and response prevention (ERP)? Great question. Consistent with general exposure and response prevention (ERP) principles, your exposures need to address your specific feared outcomes. Feared outcomes can vary greatly for individuals with the same presenting problem. I discuss this idea in a different context here: feared outcomes in OCD. For people with a fear of swallowing or drinking saliva, there are several possibilities. Fear of Potential Embarrassment: Social Anxiety If you are afraid of potential embarrassment due to coughing or choking while speaking, your symptoms might actually reflect underlying social anxiety (rather than somatosensory OCD). However, it’s also possible for social phobia symptoms to coexist with sensorimotor OCD. I touched on the intersection of OCD and social anxiety in my post about the fear of cursing/swearing/blurting out obscenities. I also discussed it more extensively in my post on compulsive swallowing. Those posts describe somewhat different OCD symptom domains, but the social fears sound quite similar to what you’re describing. Social anxiety fears can be targeted via behavioral exposures that do not actually involve saliva swallowing. You might practice stuttering on purpose, tripping over your words, or “freezing up” intentionally so that it looks like you don’t know what to say. These examples of intentional mistake practice can help you become less frightened of the potential social consequences of getting interrupted while speaking or singing. Such exposures would also be appropriate for targeting perfectionism-related OCD obsessions. OCD Fear of Swallowing Saliva: Coughing/Choking OCD fears based on saliva swallowing itself can also be tackled directly through non-avoidance and exposure exercises. For example, you might practice having conversations and/or singing with spit in your mouth. Your goal should be to resist rituals (i.e., compulsions) that involve clearing your mouth of excess saliva. During these exposures, don’t let your fear of coughing/choking cut your interactions short. Coughing and choking can be uncomfortable but these symptoms are not dangerous. When you do cough, it is critical that you continue with the conversation. If you stop your exposure upon choking or coughing, you run the risk of inadvertently strengthening your fear. Always continue the exposure until your anxiety has decreased significantly. Other creative OCD exposures might involve...
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Sensorimotor OCD & Social Anxiety Differential Diagnosis: “Obsessive Swallowing”

Posted by in ERP, Obsessive-compulsive disorder (OCD), Social Anxiety Reader Question: For the past year, I have been dealing with OCD-related sensorimotor obsessions focused on swallowing. My symptoms started during a class discussion in which I noticed myself swallow. Since then, whenever I am in a lecture or quiet place surrounded by people, I become deeply focused on my own swallowing and worry that others will notice my swallowing and then judge me. I am practicing meditation and daily exposures in which I sit down in a quiet room and intentionally invite the swallowing in. I also purposefully invite the swallowing in throughout the day, even when I am in the presence of friends. I try to be mindful of my swallowing without doing anything to avoid it or mask it. Even though my awareness of swallowing has not entirely gone away, the anxiety associated with it has decreased significantly. However, I find myself feeling impatient and worried on the random days when my OCD-related anxiety flares up. For me, the most difficult situations continue to be one-on-one conversations, especially when I notice other people swallowing after I do. This makes me worry that I am spreading the condition, even though I know rationally that this is not possible. Do you have any recommendations for how to deal with OCD-related swallowing obsessions when they are triggered by interactions with friends? Should I seek professional help to address my sensorimotor obsessions and compulsions? I have always felt like a very confident and outgoing person, but this frustrating obsession has kept me from being my normal self. Your general approach of allowing yourself to focus on the swallowing is sound as long as you are not doing anything to intentionally change the behavior (i.e., trying to swallow with less force or with less sound) or “perfect” the behavior. However… Based on your description, it is likely that you are experiencing significant symptoms of social anxiety in addition to OCD-related symptoms. It is also possible that your symptoms might be primarily social in nature, rather than being OCD-based. This important differential diagnosis issue should guide treatment selection. Social Anxiety vs. Sensorimotor OCD Obsessions/Compulsions: Treatment Implications Unfortunately, meditation and imaginal exposure will not address the social aspects you’ve described. You must specifically target these social situations directly in order to habituate to your fear. Your in vivo exposures should address the mistaken belief that swallowing loudly will lead to a negative outcome...
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Social Anxiety Treatment: CBT & Intentional Mistake Practice (an example)

Posted by in CBT, Social Anxiety When I was a kid, one form of mischief that was briefly popular in my neighborhood was crank calling strangers. Usually, the bravest kid in the group would pick up the phone, and with the encouragement of all the other kids in the room, would dial a random telephone number. A brief, very Bart Simpson-esque conversation would then ensue. Usually it would go something like this: Kid: Hello, ma’am. I am conducting a brief survey for the Grocer’s Association. Do you have a minute to answer a quick question? Stranger: Of course. How can I help you? Kid: I was wondering if you have Sara Lee in the freezer. Stranger: Why, yes I do. Kid: Well then let her out!!! We would then bust out in laughter and hang up the phone, leaving the recipient of our phone call both perplexed and annoyed. This process would typically repeat itself two more times before we got distracted by something more entertaining. It’s pretty interesting to consider in retrospect.  What strikes me is this: Typically, the bravest kid in the group would make the first phone call. However, once the ice was broken, kids of nearly any temperament would then follow. Even kids who were shy by nature became emboldened after making just a few phone calls. In this situation, just as in any other social anxiety-related situation, practice helped.  Even if you feared potential embarrassment at first (e.g., freezing up, not knowing what to say, stuttering, tripping over your words), these fears quickly dissipated with practice.  Moreover, the social nature of the prank was able to quickly transform what might have been a troubling, socially-awkward situation into something more game-like.  It’s simply harder to feel afraid when you’re trying to one-up your friends. Of course, friends are also good at helping keep anxiety in check. For every kid prone to catastrophizing, there’s another laid-back kid who would set the record straight. Social Anxiety & Intentional Mistake Practice: CBT in Action As I mentioned in an earlier blog post, one key to recovering from social anxiety is something called “Intentional Mistake Practice” (IMP).   For some individuals with social anxiety, engaging in intentional mistake practice can be one helpful component of cognitive behavioral therapy (CBT) for social anxiety.  IMP gives you the experiences you need to recalibrate your thinking about social situations. In reality, other people are far less critical and are less aware of our behavior...
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OCD perfectionism & social anxiety treatment: Tweet your way to greater health

Posted by in Obsessive-compulsive disorder (OCD), Perfectionism, Social Anxiety Looking for ways to overcome social anxiety or OCD-related perfectionism?  At the end of this post, you’ll find some strategies I use to help individuals in South Florida (Palm Beach, Fort Lauderdale, Boca Raton, Boynton Beach, & Miami) overcome their anxiety.  These exercises are examples of “Intentional Mistake Practice”, a CBT-based technique that can be used to challenge some of the problematic perfectionistic beliefs that are central to social anxiety and OCD. First, though, what do social anxiety and OCD-related perfectionism have in common?  Although on the surface, these anxiety disorders are quite different, individuals with social phobia and OCD often share many perfectionistic beliefs about the world.  Social anxiety (or “social phobia”) is characterized by excessive worry about being perceived negatively by others.  Individuals with social phobia often have perfectionistic expectations about their own behavior and question their social competence.  They fear potential shame, embarrassment, or rejection in social settings. In OCD, perfectionistic cognitions may also involve “performing” in front of others but more often involve personal perfectionistic standards.  These individuals often feel a moral imperative to live up to their true potential.  They often seek to give nothing but their best (100% of the time) and fear making mistakes because of what this might imply about their value as a person. Many research studies have found that the most effective treatment for OCD-related perfectionism and social anxiety is cognitive behavioral therapy (CBT).  If you have one of these conditions, find a therapist who uses exposure and response prevention (ERP), a specific form of CBT that will be an important part of your recovery.  ERP will help you challenge your perfectionistic beliefs, which will reduce your symptoms and make you less vulnerable to future relapse.  I should note that although ERP is commonly thought of as an OCD-specific intervention, its principles apply readily to social anxiety treatment. As I have discussed earlier, ERP has two main components: exposure – purposely doing activities that are designed to elicit your anxiety response prevention – actively resisting the urge to complete a ritual You should only complete exposures if you are able to maintain good response prevention while doing so.  This applies both to external/behavioral rituals, as well as mental rituals.  Even the most challenging, high-level exposures will be ineffective if you are not maintaining good response prevention.  Moreover, ritualizing during your exposures will actually strengthen your anxiety in the long run.  In some cases, acting in a self-deprecating...
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