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Q. Lately I don’t like to go outside or
take the subway because of fear of panic attacks. Is this
normal or should I see a doctor? (written soon after 9/11)
A. Given the current world situation,
it is not unusual to have the fears you describe. It is no
longer easy to determine what is a “rational”
fear and what is an overreaction. Have you suffered with panic
attacks for awhile, or are these new for you? If they do not
subside, I would recommend talking with your doctor about
the attacks.
Q. If you were to give three tips to a person
trying to overcome their shyness, three reminders they were
to put in a frame above their bed, to read every day, would
those tips be?
A. Thanks for a great question. Here
are our three tips:
- Shyness is a sign that I am sensitive
and caring. Those are good things.
- Taking risks is also important. All
great accomplishments require risk.
- I will try something new every day
(such as saying hello to a different person at work or school)
and I will learn that positive things often happen as a
result of my sense of adventure.
Q. I am in the 10th grade, a sophomore in high
school, and before the 10th grade I had no trouble talking
in front of large groups of people. In fact, I volunteered
to do so. At the beginning of my 10th grade year we were required
to talk in front of a group. I found I wasn’t able to
talk clearly and often lost my breath while talking. After
several such instances of having to pause for a couple of
seconds, I started become nervous about talking or giving
speeches in front of a large group. I am able to talk to total
strangers one on one or even groups of about five, but if
it is a large group I find myself becoming extremely nervous.
Do I have social anxiety or is it a hormonal thing I may outgrow?
A. We can’t say for sure if you
have social anxiety disorder or not. Difficulty with public
speaking is very common. There was a survey done several years
ago where people ranked their biggest fears. Public speaking
was number one, followed by death at number two. With this
in mind, the comedian Jerry Seinfeld said, “If you’re
going to a funeral, you’re better off being in the casket
than giving the eulogy.”
Chances are that you simply had a mild
variation of hyperventilation during one presentation. This
may have caused your heart to race, made it difficult to catch
your breath, etc. This may have happened for no reason other
than the fact that you were probably breathing too quickly.
This reaction then caused you to fear future situations where
it could possibly happen again.
From your description, we’re thinking
it is less likely that you have social anxiety disorder. You
have been too successful at doing presentations in the past.
We would suggest that you practice diaphragmatic
breathing techniques. You can find information about this
in our book, Painfully Shy. If you practice these, and you
are well-prepared for your next presentation, chances are
that it will go well. Good luck!
Q. I have a five year old daughter who is shy.
Although she has a hard time warming up, after she is comfortable,
there are no major problems. When asked what she would like
to do for her sixth birthday, she says that she does not want
a party because she is scared of everyone singing Happy Birthday,
clapping, and looking at her. What should I do in a situation
like this? Any help you could give would be greatly appreciated.
A. Your daughter’s feelings are
quite common. We would suggest trying to find ways to gradually
introduce her to uncomfortable situations. For example, you
might try having a small birthday gathering with just two
or three friends. Some kids feel better if there are activities
so that no one is focusing on them. For example, some kids
enjoy going to a movie (if there is an age-appropriate one
out) or just go out for pizza. Some prefer a small gathering
at home with a few close relatives. If people are going to
sing Happy Birthday, you might even practice this at home
to help her get used to it.
Q. I have had social phobia most of my life.
I always assumed it was something in my character that I would
just have to deal with. Well, it really started to get in
the way as I got older, hampering my growth in my career,
family, and social life. Then all at once I started to get
info on the subject quite innocently. I saw a TV special
on Donny Osmond and that was the first time I ever heard the
term “Social Phobia.” Then I started seeing commercials for
Paxil that again addressed SP. Then I did some Internet research
and came up with referrals to the books Painfully Shy
and Dying of Embarrassment. I read both and
instantly could relate. I then consulted a doctor and she
prescribed Paxil. It’s been six months now and the medication,
along with the information from your books, has turned my
life around. I am still not cured completely, but I am so
much better and I really feel like I am living a new life—one
that I was afraid of before. I would like to say thank you
for the information and research as it has helped make me
a new person.
A. What a nice thing for us to hear. It
is so rewarding to hear from people who have been helped by
our books. The growing awareness of social anxiety is allowing
many more people to receive treatment.
Q. I live in Hamilton,
Ontario, Canada. Can you recommend a psychologist who treats
social anxiety?
A. MacMaster University in Hamilton has been
a center for research in social anxiety and I would expect
that they would be able to connect you with a highly qualified
therapist. You can contact them through their web site www.macanxiety.com.
Q. I am a 19-year-old college student and have
been painfully shy my whole life. I have a happy family life
but I never knew why I could never make friends and why I
would get shaky and blush. I thank God for allowing me to
find your book. Just knowing that I have an actual disorder
is a comfort. (Not because I know I have the disorder, but
because I know there is not some unexplainable thing wrong
with me!) Your book has given me hope. Thank you for the
methods on how to overcome shyness. Shyness has held me back
from so many things in life and I feared it would always be
that way for me. No matter how long it takes or how many
setbacks I have I am determined to overcome my shyness and
believe I can, with help from God and you book. Thank you!
A. We hope Painfully Shy continues
to be helpful. Thank you for sharing your story.
Q. My husband and I recently read your book,
Painfully Shy. We were very impressed and felt
that it would help our daughter whom is in her 20s. When
we showed her the title and asked her if she knew anyone that
might benefit from reading this book, she named a friend of
the family. Then with a little more time, she said that maybe
she could learn something about herself from it. We have
been going through the book with her, chapter by chapter,
and discussing our reactions and answering the questions.
Last night, our daughter said she would like to talk to a
therapist. She would prefer a female therapist who can get
to the “nuts and bolts” of her problem quickly. Do you recommend
anyone in the St. Louis area?
A. Dr. Teresa Flynn works at the St. Louis
Behavioral Medicine Institute and was a coauthor of Dying
of Embarrassment. We have both worked with her
in the past and would recommend her highly. Also, depending
on your location, insurance, etc., Dr. Monica Frank, who has
an office in South St. Louis County, is quite good as well.
Q. Thank you so much for the help I have gotten
from your book, Painfully Shy. I know that
you 2 are psychologists and was wondering if you could answer
a question. Human beings are social creatures who need social
interaction. Do you think if a person spends most of his
time by himself that it would be normal to feel sort of incomplete
without enough interaction?
A. Interesting question. In general, I agree
that we are social beings and we need some connection with
other people to feel complete. At the same time, we may all
have different ways of satisfying those needs. The original
meaning extraversion and introversion is useful here—some
of us get energized by being with people and some of us get
rejuvenated by time alone, and most of us need some of each.
Also, some people need larger quantities of social connections
while others do great with a small number of high quality
interactions. Everyone has somewhat different needs. People
with social anxiety disorder generally want interaction
with other people but fear holds them back.
Q. I have recently been diagnosed with social
anxiety disorder. I have tried Paxil for about two months
(up to 40 milligrams daily). This has improved my symptoms
about 65-70%. My doctor prescribed a new medication to try
this week—Effexor XR. He has started me on 75 mg a day for
a week. Next week I will begin 150 mg per day. He is a family
practice physician and I trust his judgement, but wonder if
this is a good medicine to use. It says it treats depression
and does not refer to anxiety at all. I would say I am somewhat
depressed because of discouraging situations, but am more
anxious than depressed. In fact, after taking the Paxil for
a week, my sad feelings were gone. What do you feel is the
best medication to take? Any advice would be great. I have
suffered with this since a young child and now am the mother
of two.
A. In answering your question, I need to
emphasize that I am not a physician, and therefore, I am not
qualified to prescribe medication. I can give you some general
information though. Effexor XR may very well help you. Effexor
XR is used for depression and anxiety. Most medications prescribed
for depression also have varying degrees of effectiveness
for specific anxiety disorders. Effexor XR has an official
indication from the FDA for treating Generalized Anxiety Disorder
as well as depression. I would encourage you to ask your
doctor directly about any medication questions you have (I
know this can be extremely difficult if you have social anxiety).
Some people feel more comfortable writing down their questions
and handing them to their doctor. In response to your last
question—there is no “best medicine to take.” Each patient
is different and a good doctor tries to tailor the treatment
to the specific patient. Generally, though, the SSRI antidepressants
(Paxil, Prozac, Zoloft, Celexa) are the first treatment option,
but there are very good reasons to try a medication such as
Effexor (which works in a similar fashion as the SSRIs when
prescribed at low or moderate doses).
Q. I discovered that my whole life I have been
suffering from social anxiety. I am fifteen and I have a
question. This year, at school, I chose creative writing
as my elective. What I didn't know was that we would be reading
everything out loud. I now hate the class so much and have
tried to change it, but was unable to. I was wondering if
it would be good for me to take this class so that I could
get over SA? My mom keeps telling me that the class might
help me, but I doubt it. It just seems like it would cause
great stress and worry. I would really appreciate it if you
could answer my question.
A. Ah…I can just hear your parents telling
you how this will be good for you. This reminds me
of when I was a child and my grandfather bought a new pony
for me to ride. I was thrown off the pony three times in
one day and everyone kept telling me how important it was
to get back on the pony. Your parents are right in theory.
Avoiding situations generally makes anxiety worse. On the
other hand, being totally overwhelmed with anxiety makes it
difficult to experience the healing effects of getting through
a tough situation. I would suggest finding a way to talk
to your teacher to see if there is a way to gradually offer
more in class. I have spoken with teachers before who were
willing to ask an anxious student a prearranged question in
class to help the student “break the ice.” Perhaps your teacher
would be willing to work out a plan to help you progress a
little at a time. Depending on your situation, you may want
to talk privately with the school counselor to see if they
can help. Most teachers will try to work with you if they
know you are not trying to avoid the work of the class. If
you would feel more comfortable presenting in a small group,
perhaps your teacher could arrange for this to happen.
Q. I just bought your Painfully Shy book
and it has already helped me tremendously. I was so excited
to read about other people having the same problems as I was,
and that many of my symptoms were included. It is so hard
to find a book about social anxiety. In fact, I found only
two about shyness, yours included. I was diagnosed with social
anxiety a few years ago, and my psychologists have primarily
been very uneducated on the matter. Your book has already
given me a great deal of hope, and inspiration. I will definitely
want to help others as you have with the awareness and treatment
of this disorder one day.
A. Thanks for the kind words. You might
want to show the book to your therapist. I have had people
bring in books on other disorders to my office and I have
sometimes used these books as the outline for our treatment.
Good luck!
Q. I came across your web site when I researching
performance anxiety on the Internet. My teenage son is a
very good athlete, but his anxiety interferes with his performance.
Do you know of anyone who specializes in social anxiety in
Southern California? We are in the San Diego area.
A. You are in luck! Murray Stein, M.D.,
at the University of California at San Diego, is one of the
leading researchers in social anxiety. I would suggest contacting
his office for a recommendation. Performance anxiety is a
common problem among athletes and sport psychology is a rapidly
growing field. There are many good books on this topic such
as: The Mental Game of Baseball, The Inner Game of Tennis,
and The Mental ABCs of Pitching. In Painfully Shy,
we have a chapter devoted to this topic.
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