Treating Anxiety in Both Individual and Social Contexts

Given the narrowness of affordable professional psychological support available, it is vital that those who experience fear and anxiety difficulties find ways of strengthening their own capacities. In the UK, most readily available for social anxiety disorder are Cognitive Behavioural Therapy (CBT) and antidepressant medication.

Even if available, given the socio-economic and other norms underlying treatments, their suitability may not be universal. In a recent blog post titled, Understanding Social Anxiety and Social Power, Nyteshade references the difference between people’s psychological capacities in social situations: “We are not all ‘neurotypical’ (I highly doubt I am); some of us are suffering a constant inner-battle. And we are not all the ‘neutral’ agents of this society, namely white and middle class. Being placed in the wrong social category is a high cause of anxiety…”

An inherent socio-economic and/or psychological capacity presumption of some CBT treatments for social anxiety disorder is that patients have safe social spaces in which to regularly expose and thus reduce their fears, to fulfil the behavioural aspect of the treatment. Another presumption in some CBT treatments is that most social fear that give rise to anxiety or phobia are by definition ‘cognitive distortions’ and unrealistic. The individual’s sense of vulnerability is, seemingly, judged from a ‘typical’ standard.

Klodo writes, in a blog post, titled, Flaws in CBT: “if you act shy people dont notice or are to busy to care? BULLSHIT. they all notice, many comment especially on your blushing , think you act weird. why is he so quiet, strange and never speaks first? Then they ignore you and want nothing to do with you.”

For those who feel as if they fall through the gaps in treatment, other approaches must be sought, including individual training. In a recently published piece titled The Plasticity of Well-Being, researchers from the University of Wisconsin-Madison propose a framework for understanding and training in well-being with four parts: awareness, connection, insight and purpose: “These dimensions are central to the subjective experience of well-being and can be strengthened through training. In this respect, they can be likened to skills, and the cultivation of well-being to building a repertoire of skills.”

In their proposal, which they present as a starting point for further research and discussion, the researchers argue that lack of a state of awareness, which is estimated as 47% of time we spend in a state of distraction, is linked to a variety of ill-health outcomes and markers, including stress, anxiety, depression and attention deficit hyperactivity disorder. They suggest that training in attention-based meditation and psychotherapy can boost meta-awareness – “awareness of the processes of conscious experience, such as the recognition that one is experiencing an emotion, a thought, or a sensory perception as it occurs in real time.”

Awareness of one’s thoughts activates, the researchers write, the prefrontal cortex (PFC) that form part of the brain’s central-executive network and, when resulting in self-regulation of emotions, specifically, the dorsolateral prefrontal cortex (dlPFC). Training, they argue, can develop these neurological processes with different effects, they suggest, depending on the type: “Focused attention meditation, for instance, is linked to reduced activations in regions of the default-mode network (DMN), a network associated with mind wandering and self-referential thought, while open monitoring meditation is not, suggesting that meta-awareness may lead to reduced mind wandering in some cases and to meta-aware mind wandering in others.”

The researchers also present their two more social dimensions of well-being, connection and purpose, in a subjective manner, suitable for personal training through, for example. compassion-based meditation or as part of therapy, such as Acceptance and Commitment Therapy (ACT). It is likely that, to be most effective, these social states would require some form of social or community integration, which the researchers leave open for: “It is also likely that individual differences in baseline characteristics play an important role in moderating the impact of strategies to cultivate well-being. We envision a future “precision-medicine” approach that tailors training protocols for different types of individuals based on baseline individual differences.”

This framework by researchers from the University of Wisconsin-Madison offers a wider approach to treating anxiety disorders and other mental health illnesses, looking beyond cognitive approaches with rigid underlying norms and standards of psychological capacity, which can exclude some. It points towards a social-individual understanding of well-being and treatment but, in the absence of this ideal, for now, those who suffer from fears and anxieties can pursue training to improve their own capacities, alongside other support they may get. This may be affirmations or mantras, meditation, prayer, therapy or any other method that works upon vulnerabilities.

‘Ring Ring: telephone work at the end of the world’ – The Challenges of Distance Therapy

Noiz-Vr1_AnnaVanes
Image designed by Anna Vanes (c)

Deprived of social interactions as a form of comfort and as treatment for their illness, individuals with social anxiety disorder symptoms will rely more than ever on therapy and counselling during the COVID-19 virus pandemic. Whilst the NHS in Britain has been providing talking therapies using a variety of delivery methods for some time now, the virus pandemic and government health measures have meant a sudden, greater shift towards electronic delivery, sometimes, without full training for staff.

The necessity of treatment at this time is outlined well in a recent article by a Canada-based psychologist: “Anxiety and trauma is cumulative. The thing that tips the jar of anxiety over causes a whole bunch of issues to spill out. It can bring up other things in a person’s past that they haven’t dealt with before like a sexual assault, a trauma, an affair, a divorce. It can bring out things that remained buried for a long time. So, people have to be aware of that.”

Both patients and therapists will benefit from reading the blog-post linked below in which an anonymous NHS ‘Low Intensity Therapist/Psychological Wellbeing Practitioner’ (LIT/PWP) writes about challenges and recommendations for electronic delivery for therapists/practitioners. Patients too can benefit from understanding some of the challenges faced.

The blogger writes mainly of Low Intensity Therapy, that is therapy which is, according to the British Psychological Society, “delivered in such a way as to reduce the need for extended one-on-one time with a qualified psychotherapist. It typically incorporates self-help books and internet exercises, usually completed under the guidance of a “well-being practitioner” or coach who is trained to follow a highly structured programme rather than having any formal psychotherapy training.”

Being based on skills training, rather than relationship building, and rigid principles and structure, the blogger suggests that Low Intensity Therapy is highly suitable for distance treatment: “I’ve suggested to trainee LITS/PWPs that working on the phone uses the same skills as working with someone who has a visual impairment; plenty of non verbal signals don’t rely on sight: pace, tone, choice of words, reflection, summary and verbal empathy, the use of silence.”

Therapists and other practitioners may experience their own anxiety or uncertainty using what may be a new delivery method: “I used to have quite severe anxiety symptoms when I got phone calls or had to make calls; that subsided after the first few weeks of doing regular telephone assessments! But seriously, if you’re anxious about phone calls generally then use supervision and be gentle on yourself, but don’t let the anxiety stop you.”

The blogger describes feedback from colleagues expressing a concern about emotional detachment: “What was difficult was a feeling that if we took our physical presence away the patient would lose something vital to their recovery. There’s also a sense that we, the PWPs (and I would imagine therapists in other modalities) would lose something about the work that helped and refreshed us too.” The blogger’s own view seems quite clear: “…we thought that we were the magic ingredient, and we wanted to keep that sense of connection for ourselves.”

There are other potential practical shortcomings, such as difficulty conveying visual formulations which are integral to, for example, Cognitive Behavioural Therapy (CBT) and the patient data collection required to measure progress. One suggestion is that this information is provided via digital format before a telephone session.

Face-to-face interaction is particularly suitable for therapies dependent on a therapist-patient relationship and for treatment of specific conditions, such as social anxiety disorder. It provides for more complete human interaction, including physical cues and expressions. However, alternate delivery formats can supplement this through greater focus on, for example, vocal (telephone) and facial communication (video). With more therapy being conducted through electronic means, therapist and patients must consider how to ensure effectiveness – as well, as considering the longer-term place for such formats.

Image designed by Anna Vanes.

To read the full blog-post by ‘Not A Guru,’ click the link below:

Not a Low Intensity Guru

First, you might want to play this song while you read. Thanks Patricia for the mood music!

Contents

Unfortunately I can’t do hyperlinks within a post in this version of WordPress so I’m sorry for difficulty navigating. There is unlimited room to add to this. If counsellors would like to include any specific learning from their experience please let me know – I can only get my hands on CBT folks at short notice! Roughly the post is organised into:

  • Introduction
  • Setting up an appointment
  • General skills during an appointment
  • PWP/IAPT specific notes
  • High Intensity CBT specific notes
  • Links to online resources
  • References

Introduction

Welcome to the first NaG post written from the self isolation couch. I promise that the cough wont transmit through the keyboard. Please be kind and…

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Reblogged: ‘Thanking God for Anxiety’ – a faith-based approach to social anxiety

Fire inside anna vanes
Fire inside by Anna Vanes ©

The intense and overwhelming self-focus of social anxiety symptoms has apparent parallels with traits of egotism or selfishness. In the blog-post linked below, the writer, at the time a university student, makes this association about her social anxiety symptoms – whilst making it clear that her judgments are purely personal – and finds a silver lining in the revelation that they have provided, in the context of her Christian faith, which calls her to be humble and selfless.

When experiencing social anxiety symptoms at a university freshman event, the writer, Julia Ann Gilbert, describes turning to her faith for strength: “I remember stepping away from everyone to take time to pray and go over Bible verses I memorized to help me cope with my anxiety and for awhile it worked! I stopped focusing on myself and met new people. As my gaze shifted from myself to God others I became more and more at peace.”

She subsequently experienced an anxiety attack in her car, causing her to reflect further on her symptoms and behaviour: “This weekend, the more I considered these things the more I realized just how selfish these fears are. (I know I might raise a lot of eyebrows by saying that anxiety is selfish but as I mentioned at the beginning of this post everything I write is solely reflective of my own struggle with anxiety!).”

Viewing her social anxiety as a moral failing, the writer sees humility as a remedy: “It takes our fears about how we are viewed and replaces them with thoughts on how we can serve others. Humility seeks no personal gain, no words of affirmation, and no recognition.”

The writer’s faith-based understanding and response to her social anxiety does have parallels with medically approved treatments, such as cognitive behaviour therapy (CBT) and mindfulness, in terms of flawed thinking and focus – albeit with overt moral judgement which treats the anxiety as a personality trait rather than an illness. CBT involves the identification and correction of ‘cognitive distortions’ or negative thinking towards more realistic and rational thinking. Mindfulness therapies involve the conscious attempt to focus on one’s surrounding environment and thus to reduce focus on self-thoughts.

However, as with some medical definitions of social anxiety, this moral interpretation largely treats anxiety as a personal aberration rather than a response to particular vulnerability. If a sufferer has a particular sense of vulnerability, her anxiety response cannot be viewed merely as selfishness or weakness but an attempted act of self-protection.

There is a risk that the ‘aberrant thinking’ understanding of social anxiety, be it moral or medical, focuses overly on faulty thoughts of the sufferer when a more individual, contextual and holistic approach might be needed to examine the cause of the sense of vulnerability, which may require assessment of concurrent illnesses or symptoms, subconscious beliefs and social contexts.

Image designed by Anna Vanes.
For stock image credits, click here.

To read the full blog-post, Thanking God for Anxiety, by Julia Ann Gilbert and her more recent posts, click below.

Moments of Meditation

This past weekend something happened that forced me to reflect on the main truths I am learning through my current struggle with anxiety. Before I share this story, however, I would like to provide the following disclaimer: By writing about my own personal struggles I am by no means trying to make light of anyone else’s experiences with anxiety. The topics I write about come from my own personal experience and I write them for the purpose of sharing what God is teaching me in this time.

This weekend, I attended a required Society Induction to welcome freshmen and transfer students to my society. Though the evening was filled with exciting activities and I was surrounded by friends I was still plagued with an overwhelming sense of fear and anxiety. I remember stepping away from everyone to take time to pray and go over Bible verses I memorized to help…

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