hi everyone i'm emma mcadam i'm a licensed marriage and family therapist and by the time
you watch this video i'm gonna have a new baby so dr tracy marks agreed to help me out and she is
one of my favorite youtubers she's a psychiatrist and she uses such great evidence-based treatment
research back to treatment in such a helpful way she always gives people a lot of good ideas
and today she's going to be teaching you about a couple of treatment approaches for social anxiety
she's going to be talking about two medication options for social anxiety
and one behavioral option for social anxiety which is learning how to set
up a very gradual and gentle approach to exposure therapy with social anxiety
and this looks like setting up a fear ladder so breaking down tasks into
very small steps so i'm really grateful to dr marx for joining us today and sharing her
wisdom with us and please check out her new book and her youtube channel if you haven't seen it
already it's great i learn from her all the time so without further ado here's dr marks [Music]
hi i'm dr tracy marks a psychiatrist and i make mental health education videos i am excited to
borrow the mic from emma to give her some needed time away to spend time with her sweet baby
today i'm going to be talking about three approaches to social anxiety two of them involve
medication and one is behavioral social anxiety used to be called social phobia but the name
change actually reflects better on the various ways that this problem actually affects you it's
not just fear of being social you're preoccupied with what people think of you being judged
humiliated or embarrassed around people or you can be obsessed over offending people by something
that you say or do and this problem really affects your self-esteem and your confidence around people
sometimes your fears are not related to social interactions but are triggered by needing to
perform and perform in this scenario can mean performing on a stage like playing an instrument
or making a speech but it can also be on a smaller scale like speaking up in a group taking a test
or sexual activity how do you know if you should see a doctor for medication it depends on how much
your anxiety is interfering with your functioning are you skipping out on important events are you
failing to meet certain responsibilities like calling out sick from work or school every
time you have to do something that involves a presentation are you unable to be physically
intimate because you have stomach upset every time someone wants to touch you if you've engaged in
some of these avoidance behaviors you may be at the point where something needs to change quickly
like let's say you've been asked to give a talk about a project that you're working on
and you've managed to get out of it a couple of times but you know that it's just a matter of
time before you're gonna be asked again you can't create excuses forever you can only get sick so
many times and there's only so many funerals that you can go to so in a case like this you need to
make a quick turnaround before you're faced with the situation again or your job may be at risk
therapy is always good and in many situations may be the better approach to handling social anxiety
but therapy is not quick it takes time to unpack your fears and examine your cognitive distortions
around feeling judged by people or fearing embarrassment or shame when you engage in
avoidance behaviors the anxiety intensifies and gets locked in medication may be what you need
to reduce your anxiety enough so that you can at least perform your duties however medication
won't change how you think but it will lessen the anxiety that you have around those fears so
that you can rationally process through the fears another reason someone may start medication before
therapy is some people are just too anxious to work through the therapy or do exercises and they
need medication to reduce their anxiety enough to facilitate better work in therapy there are two
medication approaches using serotonin enhancing antidepressants or a beta blocker to address your
body's response to the anxiety first let's talk about the antidepressants we use antidepressants
to treat anxiety even if you are not or have never been depressed they're called antidepressants
because that's how they were first classified until studies showed that they also treat anxiety
usually anxiety needs a higher dose of the medication than for depression the antidepressants
that work for anxiety are the ones that enhance serotonin which are most of them some examples are
fluoxetine brand name prozac s cytalopram brand name lexapro and vinlofaxine brand name effexor
while butrin is the only antidepressant we have that does not affect serotonin and as such it's
not that great for anxiety it may help a little but because it's a stimulating antidepressant
it may actually make you feel more anxious at the higher doses so that's something for you to watch
out for if you're on it to see improvement from an antidepressant you need to take the medication
every day and give it at least a couple of weeks to work now you may be thinking
i thought you said meds work fast well they don't work immediately but they do work faster
than therapy and can be used to support your therapy the second faster option is propranolol
propranolol is called a beta blocker because it blocks the beta adrenergic receptors in your body
adrenergic refers to adrenaline also known as epinephrine so these medications reduce your
epinephrine levels which slows your heart rate and lowers your blood pressure these medications
also reduce shaky hands sweating and flushing you do get an immediate effect from this medication
similar to taking pain medication you take it and maybe 30 minutes to an hour later your heart slows
your hands stop trembling and so on how does this help your anxiety though beta blockers help the
person who experiences a lot of physical symptoms with their anxiety imagine you're riding in a car
and an animal runs into the street and the driver suddenly breaks and swerves to miss the animal
it's completely normal to feel your heart pounding out of your chest or for you to hyperventilate and
maybe even feel like you're going to throw up but then as you process what happened you calm
down and your body goes back to normal if you don't have an anxiety problem you can handle your
anxious reaction because you know it's because of what just happened the reaction was appropriate
and you accept that but the person with anxiety can have these same body sensations spontaneously
without a recognizable trigger emma talked about panic attacks like this in her video called what's
the difference between panic attacks and anxiety attacks and panic disorder social anxiety can
also generate anxiety like this that you feel physically and here's how it can play out when
you anticipate needing to perform or interact with people you can get your initial nervous
response of maybe sweaty palms or a lump in your throat then in some people feeling these body
sensations ramps up your anxiety even more you don't see it as a normal reaction to being afraid
of the situation instead it becomes evidence that something is seriously wrong with you
you may even worry that any and everyone will see just how anxious you are and then that
becomes another source of anticipated criticism what will they think of me if they see my hands
shaking and see me blushing everyone will know that i don't know what i'm talking about now your
distress has devolved into a mixture of negative thoughts about your ability to perform or interact
fears about your body betraying you and worries about what these physical signs mean
if this is you a beta blocker can help by blocking or dampening the physical response
so that it doesn't send you into an anxiety spiral because it has this immediate effect
on your body's response it's a medication that you don't have to take every day to see an effect
some people take it daily because if if they have daily anxiety like daily panic but some
people will take it only when they need to do something that aggravates their social anxiety
so let's say your anxiety is manageable except when you need to lead a team meeting
give a talk to a small group or attend a networking event that you loathe
propanelol is something that you could take just before those events now there's some trial and
error with finding the right dose of medication but the usual range is 10 to 40 milligrams an
hour before you need it those are the two medication options you may have noticed that i
didn't discuss benzodiazepines or benzos for short benzos have their place in anxiety treatment but
given their habit-forming nature they are not the best choice for daily anxiety and not part of the
protocol for treating social anxiety i mentioned that therapy is the better treatment for social
anxiety whether you take medications or not the medication can help bring down your distress level
but with social anxiety you still have to address your cognitive distortions that
feed your fears and eliminate your safety and avoidance behaviors there are several ways to
address this you can make faster progress with a therapist trained in cognitive behavior therapy
one self-help approach is to face your fears with graded exposure exercises
avoidance makes your fear and anxiety grow bigger and exposure desensitizes you to the thing that
you fear therefore reducing your anxiety one way to do this is to create your own fear ladder where
you identify situations that you avoid because of your fears to do this you take an inventory
of your fearful situations you may have several for each situation break down the situation into
several steps that go from somewhat scary to very scary here's an example let's say you fear going
to small social gatherings where you have to do a lot of small talk but it's something that
you have to do for your job so you can't avoid it here's how your ladder might look with eight steps
step 1 look at pictures of people chatting at a party step 2 say hello to the cashier at the store
that you frequent step 3 say hello to a stranger at the grocery store step 4 ask a stranger cashier
something about themselves now you're getting more personal it's the beginning of the small talk
step five give a stranger a compliment while looking them in the eye step 6 ask a co-worker or
classmate about their weekend here the stakes are getting higher because you're talking to someone
who you'll see again step 7 let yourself be in a group of people talking then make eye contact with
each people while they're talking and the last step step 8 join a conversation of people talking
and have something to say you want to practice each step until you become comfortable with each
one you will feel anxious while you're doing this but if you keep at it the anxiety will level off
then you move up the ladder until you get to the last step and feel less anxious
you want to practice these steps often but you don't want to rush through them
just keep doing each step until you feel comfortable moving to the next one there
are some other things that you can do to address your thinking like affective labeling affirmation
journaling and reframing negative thoughts i teach you how to do these things in chapter 8 of my new
book called why am i so anxious powerful tools for recognizing your anxiety and restoring your peace
this book is jam-packed with information to help you understand where your anxiety comes
from and what to do about it it publishes on august 16th but if you order before then
you can get this illustrated guide that has some extras in it like how to get started journaling
some affirmation cards and 11 sample fear ladders two of which are related to social anxiety
this guide is only available as a free download if you pre-order and you can do
that at getyourpreorder.com in the meantime watch emma's video on the exposure hierarchy
and how to do exposure exercises i hope i'll see you around on my channel too thanks for watching
okay thank you so much tracy for sharing your wisdom and experience with us and again i would
encourage all of you guys please check out tracy's channel um it's right here on youtube
the links in the description and also check out her new book thank you for watching and take care
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