Social anxiety is the most common type of anxiety there is.  We all want to be accepted, respected and have a sense of belonging.  Most of us worry about making a good impression and being liked.  However, with social anxiety this fear is blown out of proportion.  People are overly concerned about doing or saying something that could be embarrassing and being judged and criticized by others.  You may not want to be the center of attention, or worry that others may notice and judge you for showing signs of anxiety like blushing or sweating.

Social anxiety can interfere with developing friend or romantic relationships, completing school, and applying for jobs or promotions.  You may have it in specific situations, like performing in front of a group or public speaking, or it may be generalized to starting conversations with people or going to social events.  It usually develops in childhood or adolescence and continues into adulthood.

Typical situations that cause anxiety are:

• Starting or maintaining a conversation
• Appearing nervous to others or being observed blushing, sweating or shaking.
• Using a public restroom
• Participating in small groups
• Eating in front of others
• Giving a presentation
• Asking someone out
• Being observed by others
• Being the center of attention

Children and teens with social anxiety may avoid asking the teacher for help, answering questions in class, going to P.E., having their picture taken and oral presentations.  Very young children may have what is called selective mutism, where they avoid talking in school and to people they are unfamiliar with, but have no problems speaking at home.

Cognitive-behavioral therapy is very effective in overcoming shyness and social anxiety.  Using gradual exposure to feared situations and changing underlying beliefs about oneself, social anxiety can be mastered.

Listen to Jennifer Shannon’s podcast for the Anxiety and Depression Association of America on Teen Social Anxiety Disorder.

You can take the Liebowitz Social Anxiety Scale to self-assess your own social anxiety.

We often talk about being obsessed with something, like a song, a food, a person.  Though it is true that it may be hard to get your mind off of these things, they are not necessarily upsetting to think about.  In the case of obsessive-compulsive disorder, or OCD, the obsessions always cause anxiety.  OCD obsessions are intrusive thoughts, images or urges that you do not want to have and cause significant distress. The obsessions, unlike worries in generalized anxiety, can be a little strange, like wondering if you may have hurt someone accidentally, thinking something bad might happen if you don’t do or say something, worrying about your cloths being contaminated and getting you or someone you care about sick.

Most obsessions fall into these categories:

• Contamination, fears you will “catch something” or be poisoned by touching a surface or object
• Harm or aggression, thinking you caused or will cause physical or emotional harm to yourself or someone you care about
• Forbidden sexual or religious thoughts, that threaten your sense of being a good or decent person
• Symmetry or exactness, having a general sense of discomfort unless things are “just so,” or done in a certain way

Compulsions

Compulsions are the things you do to attempt to decrease the anxiety that the obsessions cause.  They are repetitive behaviors or mental acts that you have a strong urge to do. They are unlike a normal routine, in that they take up more time than you would like them to.  Much like obsessions, you may know they are excessive or unreasonable, but this does not make them any easier to resist.

Common compulsions are:

• Checking that you did not forget something, make a mistake, cause harm or turn something off.
• Cleaning or washing your hands or body, cloths or belongings, or using hand sanitizer
• Repeating like touching or tapping things, going in and out of doorways, blinking or body movements, rereading, erasing or rewriting things.
• Ordering or arranging things like having all your cloths color coded, things lined up at right angles, or your room or desk arranged in a certain way.
• Mental compulsions like making mental lists, using or avoiding certain numbers, words or phrases, repeating prayers, trying to remember things.

Treatment

Exposure and response prevention therapy (ERP) is a form of cognitive-behavioral therapy that has been shown to be highly effective in treating OCD. You can learn more about this type of therapy by listening to  a Podcast with Dr. Jonathan Abramowitz, a leading expert in the treatment of OCD.

Panic Disorder

50% of all adults have experienced a panic attack at some point in their life.  If you are experiencing frequent panic attacks that often occur out of the blue and you are afraid of having more, you may be suffering from panic disorder.  The most common fears people with panic disorder have are a fear of dying, going crazy, and/or losing control.

The most common physical sensations people experience during a panic attack are:

• Feeling dizzy, light headed or faint
• Difficulty catching one’s breath
• Rapid, pounding or fluttering heart
• Tightness in one’s chest or throat
• Nausea or abdominal cramping
• Sweating, shaking and trembling
• Numbness or tingling
• Derealization (things don’t seem real) and/or depersonalization (thoughts and feelings seem unreal or not belonging to oneself)

Panic symptoms are similar to physical illnesses like heart attacks.  People experiencing panic for the first time often go to the emergency room because they are worried they are having a heart attack.  While panic attacks themselves are harmless, it is important to rule out an underlying illness that may cause panic like symptoms.

Agoraphobia

Agoraphobia is a big word that sounds scary and is often misunderstood.  It is the fear of going to places or situations that you may have a symptom attack with no easy way to escape or get someplace you think of as safe.  A symptom attack could be a panic attack, diarrhea, a sudden headache, nausea, loss of bladder control, or asthma.  You can suffer from panic disorder with agoraphobia, which means you have panic attacks in certain situations as opposed to out of the blue.  Common situations that people fear being trapped are:

• Cars, trains, and buses, tunnels, planes, boats
• Bridges
• Crowds
• Standing in line
• Being far away from bathrooms, hospitals, home.

Cognitive-behavioral therapy is an effective treatment for panic disorder and agoraphobia.  It teaches people how to respond to physical sensations differently and slowly face the situations they have been avoiding allowing them to live more fully with less anxiety.

Phobias are very common.  In fact, most people have some type of phobia.  Being frightened of things like insects, heights and needles is part of being human.  But when this fear is extreme, preventing you from doing things you want to do or go places you want to go, you may have a specific phobia disorder.

Specific phobias can be about almost anything, in fact if you search on the internet for a list, there are literally hundreds!  However here are some of the most common types:

• Animals: dogs, cats mice, rats birds, snakes, insects
• Things that occur in the natural environment: heights, water, thunderstorms, or lightening
• Situations and places: traveling in a car, plane, bus, train, or boat; closed-in spaces such as closets and tunnels
• Medical issues: injuries, blood, needles, dentists, doctors, hospitals
• Illness and bodily functions: vomiting, stomach flu, food poisoning, choking on pills or food, having a dry or closed throat, not being able to breath

One of the more common phobias that I treat is a fear of vomiting, which is technically called emetophobia.  No one likes to throw up, but if you have this phobia your fear of vomiting is out of proportion.  If people around you get sick, including family members, you may become extremely anxious that you will get the stomach flu.  People with this phobia will often monitor their body carefully for signs of nausea.  This, like other specific phobias can cause significant disruption in one’s life.

Cognitive-Behavioral Therapy (CBT) helps people to face their fears in a gradual and supportive way. CBT is one of the most effective treatments for phobias, most people report feeling significantly less fearful after only 12 sessions or less.

Separation anxiety usually begins in childhood and relates to the fear of being away from a person one feel particularly attached to. For children this is usually parents, siblings, or a close relative and for adults it may be a spouse, a romantic partner,  their child or a close friend.  When separated, even for a few hours, one begins to feel anxious or on edge, worrying that something bad might have happened to the other person and that they will be alone forever. 

When children have separation anxiety they often have trouble sleeping alone.  They don’t like to be left with babysitters, and when away from a parent or attachment figure, they will often want to check in repeatedly.  They may become panicked if a parent is even a few minutes late coming home or picking them up.  The child often wants to know exactly where the parent is going to be at all times, sometimes even within their own home.

Children with separation anxiety often experience stomach aches, headaches, and sometimes even vomiting when anticipating or when separated from the person they are attached to.

Adults can have many of the same symptoms as children, not wanting to be alone at night, becoming distressed when their partner is away on a trip, checking in with the person repeatedly and panicking when the other person is late or does not respond to their calls or texts.

Cognitive behavioral therapy is effective treatment for separation anxiety.  It focuses on helping people think more realistically and gain confidence being away from the person they are attached to.

Insomnia is extremely common, with over half of all adults experiencing it in their life time.  Chronic insomnia can be a real problem, causing fatigue and low energy, difficulty concentrating, causing poor moods, and decreased performance at work or school.  It is defined as disrupted sleep at least 3 nights a week for 3 months or longer.  People with insomnia may have problems falling asleep, staying asleep, early morning wakening or restless sleep.  People often begin dreading going to bed, feeling anxious and stressed about not being able to depend on whether you will sleep or not.

CBT-I, or Cognitive behavioral therapy for insomnia is a proven method to treat chronic insomnia and is aimed at changing sleep habits and sleep scheduling.  It focuses on education about the different stages of sleep and understanding how your thoughts and behaviors have contributed to making this a chronic problem and how to change.   

Listen to an interview with Jennifer Shannon about CBT-I for insomnia on Dream Talk Radio with Anne Hill.

Post Traumatic Stress Disorder 

Depression