Case Study - Social Anxiety
Dan from Muswell Hill, counselling for social anxiety:
I have suffered from anxiety for what seems like most of my adult life. Over the last few years, it has really got in the way of me doing things. From working with Andrew, I realised I was suffering from what he called 'social anxiety'.
In my social life, I ended up avoiding events like parties and after-work drinks. Once I even ducked out of a good friend's wedding, which left me feeling really bad about myself. My head would fill with horrible thoughts about how I am not interesting to talk to, and how people don't tend to like me. I would imagine standing by myself feeling nervous with a drink in my hand, whilst the other party goers would be talking, laughing and having a really good time.
My social anxiety also affected my work. I would have thoughts full of dread when my boss would want to talk to me about the state of my projects. I would also have a great deal of difficulty sitting in meetings. I would get really anxious about being asked a question I couldn't answer. I would have nasty thoughts about how I would make a fool of myself if I had to speak up, and how stupid I would look.
Even if I did know what to say in the meetings, I would usually sound all nervous, my voice would shake, and I found the fear of this happening made my ability to talk in public even worse. I ended up calling in sick for work on days when there was a big meeting or if I had to give a presentation.
I don't know for sure, but I think my boss was starting to see a pattern, and I was worried that he might confront me and ask me what was going on. At this time I started seeing Andrew for anxiety counselling in his Muswell HIll clinic.
I saw Andrew for about six months and I feel I made real progress. I learned how my thoughts and feeling worked together to make me anxious, and how I had unknowingly been my own worst enemy.
By routinely avoiding the situations that made me anxious, I was learning that I was not capable of facing life's challenges. I had unconsciously taught myself that the only way I could get through the horrible thoughts and feelings that made my life so hard was to run away from the events that triggered them.
The outcome was that I had robbed myself of the ability to see that I was much more capable than I usually think and feel I am. I saw that my self-image and esteem have taken a real battering due to my avoidance, and this was all making the anxiety worse and my life much smaller.
I felt like I learned a lot about what's been driving me, which felt great; and I felt like I was actually going to be able to do something about it, which also felt great. It was hard work and at times quite challenging. When I look back I can see it was the more challenging stuff that's been most valuable to me now.
I know I've turned a corner, that I have the knowledge and a good set of tools so I can face the situations I used to run away from. It has not been the easiest thing I've ever done, but it has been one of the most rewarding.
Assertiveness in Relationships
I want to give a general overview of how anxiety can be at the core of relationship difficulties. “John” is not an actual client but rather a typical example that best illustrates what many of my relationship clients say to me, and the work we typically do together to help resolve their relationship problems.
John is a 36-year-old man who has been married to Sarah for the past 3 years. He comes to me seeking psychotherapy to help with depression and relationship issues. He says that he is no longer getting on with Sarah, they bicker all the time, and can’t seem to have a conversation without it turning into an argument.
In fact John discloses that he feels quite intimidated or even scared by Sarah. He is worried that if he says what he actually thinks to her she will lose her temper with him, and so he says nothing as that feels easier.
Over time John has become resentful and feels like the only option he has left is to leave the relationship. However, when he seriously thinks of leaving Sarah, he is aware that this is really not what he wants at all. He fears he will lose access to their young children and also that he will be lonely. Moreover, he’s sure he still loves her. What he really wants is to be able to have the relationship that they used to have, where he felt that they were a team and he was not scared of her irrational angry responses to what he says.
How to understand what is happening for John:
Although John has come to me with depression and relationship issues, that is not what I see as the main cause of the depression and breakdown in his relationship with Sarah.
The depression is there because John cannot imagine a way through the relationship problems and feels trapped and hopeless. He sees his options as being either to stay as things are with a wife he walks on eggshells around and cannot be honest with, or to leave her, giving up his chance at a family life. Both options seem terrible to John. In my opinion, this sense of being trapped, unable to find a way out, is what is causing the depression.
Anxiety in relationships:
As we work together, John starts to see that he has got into the habit of not being honest with Sarah about his real thoughts and feelings. It doesn’t matter if it’s about what they are going to have for dinner that night or what school to send their child to. Big or small, John often no longer tells Sarah his truth. John has got into the habit of being sensitive to what Sarah wants and then just going along with it. He is worried about what he sees as her irrational and angry reaction to anything he says that she doesn’t agree with.
What started out as a simple case of not telling her his truth so he did not have to deal with her anger has now become an ingrained set of roles in the relationship that both parties have fallen into without even noticing it.
John is doing what we all do when we are suffering from almost any kind of anxiety disorder. He is avoiding short-term pain (the chance of confrontation if he is honest with Sarah), but the outcome of this avoidance is that he experiences long-term, chronic pain instead ( feeling depressed, bitter, resentful, blaming Sarah for the problem, feeling trapped). This may also affect his self-esteem and confidence in other areas of life.
For John it is essential to understand that his partner cannot know what he isn’t telling her. His silence guarantees his ongoing misery and hopelessness. However, it is not as simple as saying to a client like John “Off you go, and tell your partner what you actually think”. This doesn’t work for two reasons.
2. A client like John will not see that he is playing out an ingrained role, that both partners are in fact playing out roles, and that it takes a thoughtful, structured approach to move out of these roles.
John’s avoidance of confrontation with his partner is motivated by an ingrained anxiety issue. We work on changing the way John’s problem is unfolding not by just saying “Get on with it and pull your socks up,” but by treating his underlying anxiety which leads to the avoidance.
This is actually good news because anxiety is one of the most well researched and eminently treatable conditions that clients seek help for. If John chooses to work through his issues with Sarah, he is likely to find that he feels empowered by the process and gains in general confidence, as well as helping with the immediate situation.
This is not a gender-specific issue; you can swap John in this story for Sarah, and it will play out in just the same way. The point to take away is that when relationships are not working very well it can sometimes be explained by one party not being willing or able to be honest with the other due to an underlying anxiety that makes them avoid the confrontation that may be involved.
Stephan's case study: Mindfulness for Anxiety
I first approached Andrew for therapy after having experienced panicky feelings of unreality in increasing frequency over the last few years. In May this year, I began having these panic experiences every day. My heart would race, I would become disoriented, I would not be able to understand or pay attention to others. Worst of all, I could not understand what was happening to me.
In the past, I have always had nervousness about health, which culminated in me going to the doctor and sexual health clinic more often than average. I had also had a bad trip whilst eating edible marijuana in Holland a few years ago. It was at this time that I experienced ‘unreality’ for the first time.
For the next few weeks, my mind became obsessed with thoughts that I was going crazy or losing my grip on reality. I approached Andrew with a vague idea that I might be experiencing anxiety; however, I knew almost nothing about it.
Andrew identified my experience as anxiety caused by the feelings of unreality and began treatment based on mindfulness and acceptance.
Treatment was not without its challenges, as I was very easily overwhelmed towards the start of the process. A big stage in my treatment was realising the difference between resignation and acceptance. I have defined it for myself in this way: resignation is ‘giving up’ and resigning yourself to experience pain — nobody wants to live like that. Acceptance, on the other hand, is to acknowledge that certain eventualities could happen, and if they do, you will be ready with the tools available.
In matters of the mind, it would seem that if you are not prepared or dread to feel anxious and to think negative thoughts, you will think more of them. This is a difficult paradox and one that involved me facing my fear of unreality. I believe this process is what many people describe as a journey.
With Andrew’s help, I was able to accept the unreality and allow it to pass me by. This radically reduced the fear I had of it, and I quickly ceased to feel anxious in this regard.
This was not the end of my journey. In many ways, I feel as if my real journey was just beginning. I had begun to have many anxious thoughts about many different topics that seemed to change quickly, and it hurt very much to engage in them. I believe that I progressed into General Anxiety Disorder.
How to rob anxiety of its power:
For this, Andrew and I talked about Mindfulness. In my own definition, this is the ability to think on two separate levels: to know that you are thinking something. I could think to myself ‘What if I do not sleep this evening?’ and I would cause myself great pain trying to avoid this thought, whilst I attempted to live in the gaps between thoughts when my mind was calm.
It took me a long time to realise that the object of anxiety treatment is not to never have the thought again. It is to feel fully prepared so that when you have the thought, you will be able to deal with it, and it will not hurt you. For negative thoughts, the ability to allow a thought to live with you whilst not engaging with it is an excellent way to rob it of its power. For emotions, again, mindfulness that they will come and go (and that you do not need to interact with or suppress them in any way) is the best course of action. In both cases, mindfulness allowed me the tool necessary to feel prepared in advance of the thought or feeling.
What I learned:
I have had a number of revelations over the course of the journey. I firmly believe that knowledge dispels fear, and that as I became more aware of why I was experiencing what I was experiencing, my journey became much easier. The most insightful thing I realised was that I was scared of anxiety, and this fear is what made that anxiety worse.
This may have seemed obvious, and it probably was, but I never connected it with the reason my mind would throw up hundreds of different scenarios for me to attempt to deal with. For a long time, I had no idea why this was happening. I believe my mind had become so wary about the feeling of anxiety, it was simulating different situations ‘just in case’ they happened. This piece of insight was illuminating; it allowed me to fully understand what was happening, and further reduced my negative thoughts.
My journey is ongoing and gets slightly easier every day. With the awareness and understanding I now have, I have very little fear of negative or catastrophic thoughts or even the feeling of anxiety itself. I hope one day to reflect on this experience as untimely ultimately beneficial to my life, equipping me as it has with a number of tools to manage thoughts and emotions, and opening the door for me to think differently about the pursuit of happiness and success in my life.