Hi,
There appears to be much more information on this condition than what
was available only a few years ago.
-- What are *consistently* effective treatments of social and general
anxiety as documented by independent studies? Provide as many details
as possible.
"Medical Care: A combination of pharmacotherapy and psychotherapy is
usually indicated for persons with social phobia.
Pharmacotherapy
Selective serotonin reuptake inhibitors (SSRIs): SSRIs are quickly
becoming the standard first-line medication for social phobia.
Paroxetine received US Food and Drug Administration (FDA) approval for
this indication in 1999 and was the first SSRI to gain such approval.
In 2003, sertraline received FDA approval for short- and long-term
(20-wk) treatment of social phobia in adults. Venlafaxine, a
serotonin/norepinephrine reuptake inhibitor, was also approved for the
treatment of social phobia in 2003. Studies suggest that other SSRIs
also may be effective.
Benzodiazepines: Benzodiazepines may be effective for social phobia,
but they are more dangerous (lesser safety profile). Alprazolam and
clonazepam have been used successfully.
Buspirone: Some studies suggest efficacy in persons with social phobia.
Gabapentin: New studies suggest efficacy.
Propranolol: Beta-blockers have been used to block the autonomic
response in persons with social phobia. Preventing symptoms such as
tremor and increased heart rate may lead to successful performance in
social situations despite anxiety.
Monoamine oxidase inhibitors (MAOIs): Phenelzine has been demonstrated
to be effective in controlled studies. The dietary restrictions
required when taking MAOIs reduces their popularity. Moclobemide, a
newer reversible MAOI, has had some efficacy in persons with social
phobia.
Psychotherapy
Behavioral: Behavioral psychotherapies, such as gradual
desensitization, may be useful in persons with social phobia. This
technique involves gradually exposing the patient to simulated
situations that normally cause anxiety in the patient. By mastering
the situation without anxiety, the patient is eventually able to
tolerate more situations that previously induced anxiety.
Cognitive: Cognitive and insight-oriented therapies have proved useful
in treating social phobia. Individuals with social phobia often have
significant cognitive distortions related to what other people could
be thinking about them that might respond to restructuring."
http://www.emedicine.com/med/topic3121.htm
That page has further information on each of the drugs as well as some
good background information on the condition itself.
I found some studies which looked the effectiveness of Phenelzine on
social anxiety which you can look at here:
Phenelzine vs atenolol in social phobia. A placebo-controlled comparison
http://archpsyc.ama-assn.org/cgi/content/abstract/49/4/290?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Generalized+Social+Phobia&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Venlafaxine Extended Release vs Placebo and Paroxetine in Social Anxiety Disorder
http://archpsyc.ama-assn.org/cgi/content/abstract/62/2/190
Generalized social phobia. Reliability and validity
http://archpsyc.ama-assn.org/cgi/content/abstract/52/3/230?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Generalized+Social+Phobia&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
-- How long does it take on average for a breakthrough or treatment?
According to Anxiety Disorders Association of America (ADAA), most
people can be treated effectively. With behavioral therapy the
treatment periods are normally around 12 weeks. Treatment therapy that
relies only on medications can be as short as several weeks, or
several years. It really depends on the patients ability to work
through the other aspects of the condition while using the medications
to alleviate the avoidance and depressions associated with this
condition. Recovery is possible with the proper professional care.
-- How much does it cost and is it usually covered by insurance?
Doctor's fees can range from $75 to $550 a visit, it really depends on the doctor.
Paxil prices depend on the dosage, and bottle amounts, but can range
between $55 and $125 (http://tinyurl.com/lxa8f )
As far as insurance goes, many plans do cover treatment for this
condition and it would be best to call your agent and request
information directly through them (or get someone to call for you).
Since this condition often results in more costly (to the insurance
company) conditions such as drug and alcohol dependency, it is common
for insurance companies to support the treatment of social anxiety
disorder.
Another option may be to find a study being conducted in your area.
Studies often offer free treatment and resources for those willing to
participate in the study. These studies often involve little more than
showing up once a week and answering a series of questions, so they
could be a good deal for you.
http://www.drexel.edu/coas/psychology/AnxietyResearch/Pages/index.htm
http://crnet.mgh.harvard.edu/clinical_trials/view_trial.asp?ct_id=839&clinic=&NoEdit=
-- What specific doctors or centers are well-known for their effective
treatments of social and general anxiety? What methods do they use?
Again, provide as many details as you can.
If you can post the city you are in, I can be of more help on this
question. If you would prefer not to, then this webpage has a great
deal of information for finding a therapist in your area familiar with
your condition.
http://www.adaa.org/GettingHelp/FindATherapist.asp
" Since 1978, Jonathan Berent, L.C.S.W., A.C.S.W., has pioneered
psychotherapy for social, public speaking and performance anxiety,
blushing, shyness, and any other related disorder. He and his staff
have worked with thousands of individuals of all ages. He is the
author of ?Beyond Shyness: How to Conquer Social Anxieties? (Simon &
Schuster). An expert in media performance, Jonathan has been featured
in over 1000 placements including Oprah, Sally Jesse Raphael, NBC,
CBS, ABC, CNN, CNBC, FOX, The New York Times, Newsday, The Chicago
Tribune, and the Boston Globe. Jonathan is a ?Diplomate? in clinical
social work and is certified by New York State. In addition he is
certified as a biofeedback therapist by the Association of Applied
Psychophysiology and Biofeedback. "
http://www.social-anxiety.com/
Kiki D Chang, MD, Director, Pediatric Mood Disorders Clinic, Assistant
Professor, Department of Psychiatry, Division of Child Psychiatry,
Stanford University School of Medicine . You can contact him through
this page:
http://www.emedicine.com/med/topic3121.htm
Anxiety Disorders Association of America (ADAA)
11900 Parklawn Dr., Suite 100
Rockville, MD 20852-2624
(301) 231-9350
Dr. John Grayson
Anxiety and Agoraphobia Treatment Center
Bala Cynwyd, PA 19004
(610) 667-6490
Association for Advancement of Behavior Therapy (AABT)
305 Seventh Ave., 16th Floor
New York, NY 10001
(212) 647-1890
References and sites of Interest
Social Phobia/ Social Anxiety Association
http://www.socialphobia.org/
Anxiety Disorders Association of America
http://www.adaa.org/
Social Anxiety Network
http://www.social-anxiety-network.com/
Social Phobia's Traumas and Treatments
http://www.fda.gov/fdac/features/1999/699_phobia.html
Social Anxiety on Wikipedia
http://en.wikipedia.org/wiki/Social_Anxiety
DMOZ Directory Social Anxiety
http://dmoz.org/Health/Mental_Health/Disorders/Anxiety/Social_Anxiety/
thanks,
webadept-ga |
Clarification of Answer by
webadept-ga
on
31 May 2006 18:01 PDT
Hello again,
In searching for your "A-list" in this area, what I came across is an
over-whelming agreement that cognitive therapy is the most effective
method of dealing with this condition. I understand that your previous
attempt at therapy was not a good experience but perhaps he/she was
simply not the right therapist for you at the time. While I know
something of dealing with such a condition myself, I don't really have
a professional opinion or even an educated opinion on your situation
-- but the professional agreement amongst peer-reviewed researchers
and groups I've come across suggest that cognitive therapy is the best
way to go.
This doesn't mean there are not other options, and I would like to
point out that there are many different methods of going through
cognitive therapy. There are several approaches to
cognitive-behavioral therapy, including:
Rational Emotive Behavior Therapy
http://en.wikipedia.org/wiki/Rational_Emotive_Behavior_Therapy
Rational Behavior Therapy
http://www.minddisorders.com/Py-Z/Rational-emotive-therapy.htmlb
Physician Maxie C. Maultsby, Jr.,(
http://www.provisionsconsulting.com/maxie_maultsby.htm
) developed this slight variation about ten years after Ellis first
developed his. Rational Behavior Therapy is distinctive in that the
therapist assigns ?therapeutic homework? to the client, and places
?emphasis on client rational self-counseling skills?
(http://www.nacbt.org/historyofcbt.htm). Clients are urged to take
added initiative in their own recoveries, even beyond that encouraged
by many other forms of CBT.
Rational Living Therapy
Cognitive Therapy
"Cognitive Behaviour Therapy (CBT) is based on the idea that how we
think (cognition), how we feel (emotion), and how we act (behaviour)
all interact together. Specifically, our thoughts determine our
feelings and our behaviour. Therefore negative thoughts can cause us
distress and result in problems."
http://en.wikipedia.org/wiki/Cognitive_therapy
Dialectic Behavior Therapy.
http://en.wikipedia.org/wiki/Dialectical_behavior_therapy
" Marsha Linehan (1991) pioneered this treatment, based on the idea
that psychosocial treatment of those with Borderline Personality
Disorder was as important in controlling the condition as traditional
psycho- and pharmacotherapy were. Concomitant with this belief was a
hierarchical structure of treatment goals. Paramount among these was
reducing parasuicidal (self-injuring) and life-threatening behaviors.
Next came reducing behaviors that interfered the the therapy/treatment
process, and finally reducing behaviors that reduced the client's
quality of life. In 1991, Linehan published results of a study that
seems to do remarkably well at achieving these goals."
http://www.palace.net/~llama/psych/dbt.html
Overview of Dialectical Behaviour Therapy
http://www.priory.com/dbt.htm
Therapy Sources:
Dr Richard Heimberg
Dr Richard Heimberg, the world?s leading author and researcher on
group cognitive- behavioural therapy for social phobia.
" Richard Heimberg is a researcher, psychotherapist, and current
professor at Temple University. Cognitive behaviour group therapy was
founded on principles developed by Heimberg at the University of
Albany's Centre for Stress and Anxiety Disorders. His focus lies on
anxiety disorders, specifically social phobia. He has published more
than 250 articles and books on social phobia.
In 1983, he became the first researcher to receive National Institute
of Mental Health (NIMH) funding to study psychosocial treatments for
social phobia after the term first appeared in the third edition of
the Diagnostic and Statistical Manual of Mental Disorders in 1980."
Wikipedia Page on Richar Heimberg
http://en.wikipedia.org/wiki/Richard_Heimberg
Interview with Dr. Richard Heimberg
http://www.spnewsletter.com/selections/interviews/v2i1-Heimberg.html
Richard Heimberg is the Director of the Adult Anxiety Clinic of Temple
http://www.temple.edu/phobia/
Publications: -- Books
Generalized Anxiety Disorder : Advances in Research and Practice
Managing Social Anxiety : A Cognitive-Behavioral Therapy Approach
Therapist Guide (Treatments That Work)
Social Phobia: Diagnosis, Assessment, and Treatment
Other articles:
Social Anxiety
http://www.anxietyandstress.com/sys-tmpl/socialanxietydisorder/
Clinical Trial: Adding Cognitive Behavioral Therapy to Drug Therapy
Treatment for Social Anxiety Disorder
http://www.clinicaltrials.gov/ct/show/NCT00074802
Debra A. Hope
http://psycweb.unl.edu/psypage/faculty.asp?id=26
" Dr. Hope is the director of the Anxiety Disorders Clinic, one of the
speciality services within the Psychological Consultation Center. Her
work on psychopathology emphasizes information processing models that
describe the role of attention and memory in social phobia and the
impact of these cognitive processes on interpersonal functioning. Dr.
Hope also has ongoing research on both the outcome and process of
psychotherapy. Research on psychotherapy outcome includes examining
predictors of successful treatment, the mechanisms underlying
cognitive-behavioral treatment for anxiety disorders, and adapting
protocols developed for research to non-research clinical settings."
Books
Perspectives on Anxiety, Panic, and Fear (Nebraska Symposium on Motivation)
Other Articles
Can Kids Blame their parents for Social Phobias?
http://www.healthyplace.com/Communities/Anxiety/children_social_phobia.asp
Barbra G Markway Ph.D. and Gregory P. Markway, Ph.D
Barbra G Markway Ph.D. and Gregory P. Markway, Ph.D. who have written
several books, and do most of their work in this field. Barbra is the
founder and director of The Anxiety and Stress Management Center of
Mid-Missouri and Greg practices at St. Marys Health Center.
Anxiety and Stress Management Center of Mid-Missouri
1007 Southwest Blvd., Suite C
Jefferson City, Missouri 65109
(just south of Schnucks and Mike Kehoe Ford)
Phone: 573-635-5055
Fax: 573-635-5014
http://www.markway.com/center/menu.htm
Publications :
Painfully Shy: How to Overcome Social Anxiety and Reclaim Your Life
Dying of Embarrassment: Help for Social Anxiety & Phobia
When Your Child is More than ?Just Shy?: Proven Strategies to Help
Kids and Teens Overcome Social Anxiety Disorder
Confronting your Phobias
http://www.markway.com/markways/articles/msnbc.htm
No More Shrinking Violets
http://www.markway.com/markways/articles/prevention.htm
Jefferson City psychologist an expert in anxiety disorders
http://www.markway.com/markways/articles/ap.htm
Do you Dread Cocktail Parties
http://www.markway.com/markways/articles/bottomline1.htm
Other articles are listed on their website:
http://www.markway.com
Julian Herskowitz,
Julian Herskowitz, PhD, director of the TERRAP Anxiety and Phobia
Program in Huntington, N.Y.
http://therapists.psychologytoday.com/rms/prof_detail.php?profid=34704&sid=1123651565.9694_14593&city=Stony+Brook&state=New+York
Anxiety and Panic
http://www.anxietyandpanic.com/index.mv?screen=readthis&content=news
Psychology Today -- Confronting your Phobias
http://psychologytoday.webmd.com/content/article/49/39670.htm?pagenumber=3
Michael Kahan
Michael Kahan, MD, a psychiatrist who specializes in the treatment of
phobias at Hillside Hospital, part of North Shore-LIJ Health System in
New York.
Lichtenstein Creative Media -- The Infinite Mind: Fears and Phobias
http://www.lcmedia.com/mind9912.htm
Phobias and Fears on MedicineNet.com
http://www.medicinenet.com/script/main/art.asp?articlekey=51790
Virtual Reality Exposure Therapy Effective for Patients With Specific Phobias
http://www.psychiatrictimes.com/p000501b.html
Jerilyn Ross
http://www.rosscenter.com/
From the About Jerilyn Ross Page --" For the past 25 years I have been
an active psychotherapist, patient advocate and author, combining my
academic training in psychology, my personal experience of overcoming
a phobia, and my commitment to raising public and professional
awareness about the seriousness and treatability of anxiety disorders.
To this end I founded and direct The Ross Center for Anxiety & Related
Disorders in Washington, D.C., am co-founder, President and Chief
Executive Officer of the Anxiety Disorders Association of America,
author of Triumph Over Fear: A Book of Help and Hope for People with
Anxiety, Panic Attacks and Phobias (Bantam Books, 1994), and producer
of Freedom From Anxiety (2001), a comprehensive audio and video tape
self-help program."
Bio on adaa.org
http://www.adaa.org/aboutadaa/articles/biojerilyn.htm
Bio on Healthy Women.org (basically the same bio)
http://www.healthywomen.org/aboutnwhrc/womenshealthadvisorycouncil/jerilynrossmalicsw
Books
Triumph over Fear
Other Articles
USA Weekend -- Social Anxiety
http://www.usaweekend.com/chat/transcripts/ross_tscript.html
Anxiety Tip Sheet
http://www.helpstartshere.org/mind_and_spirit/anxiety/tip_sheets/anxiety_tip_sheet.html
Medical News Today -- Treating Generalized Anxiety Disorder
http://www.medicalnewstoday.com/medicalnews.php?newsid=17137
MSN Health and Fitness -- Anxiety Disorder
http://health.msn.com/centers/mentalhealth/articlepage.aspx?cp-documentid=100135461
Neurofeedback
http://en.wikipedia.org/wiki/Neurofeedback
One of our commenters below mentioned this so I did some research to
see if I could find anything substantial. I could not find any studies
published for using Neurofedback to effectively treat social or
general anxiety. While I did find several webpages suggesting that
social and general anxiety were one of the items on the list of
conditions that Neurofeedback was effective for, none of them
referenced any peer-reviewed publications or studies. Thus I was
unable to find anyone who would be considered an A-List candidate for
this type of treatment. It does seem to be a well publicized cure-all
for everything from Alcoholism to Epileptic Seizures.
http://start.eegspectrum.com/Newsletter/nov2001.htm
While your focus is for treatments which do not include medications,
there have been several recent studies which suggest that the root
cause of social anxiety in many people is biological in nature and not
psychological. Some investigations suggest a biochemical basis for the
condition centered in a small structure in the brain called the
"amygdala". The amygdala is the part of the brain that evaluates the
environment for potential dangers and which controls fear responses.
PET (Positron emission tomography) scans have shown that individuals
with social phobia experience increased blood flow in the amygdala
during stressful events like public speaking. Other studies suggest
that social phobia is caused by dysregulation of neurotransmitter
systems, especially the neurotransmitters serotonin, noradrenaline and
dopamine.
Lifeline Anziety Disorder Newsletter
http://www.designandcopy.ca/lifeline/backissues/5-2.html
Time Magazine : Understanding Anxiety
http://www.time.com/time/europe/magazine/2002/0826/anxiety/story3.html
Psycology Today -- Generalized Anxiety Disorder
http://www.psychologytoday.com/conditions/gad.html
Anxiety Disorders Research at the National Instituted of Mental Health
http://www.nimh.nih.gov/publicat/anxresfact.cfm
Other Information
Complementary Therapies
http://www.cambsmentalhealthinfo.nhs.uk/support/complementary_therapies.html
This is a nice run down on several other therapies.
Health Information -- Anxiety
http://www.sutterhealth.org/health/healthinfo/index.cfm?page=article&sgml_id=hn-1010008
A look at some alternative methods of therapy other than CBT
Research Studies
http://nyspi.org/Kolb/researchstudylist.htm#novel
A proposed study that will look into using Repetitive Transcranial
Magnetic Stimulation (rTMS) as a method of helping Obsessive
Compulsive Disorders, and Anxiety.
Social Phobia -- Social Anxiety Fact Sheet
http://www.socialphobia.org/fact.html
Other Comments:
What you might find a great deal of on the Internet are pages like these :
http://www.anxiety-and-depression-solutions.com/articles/anxietytreatment.htm
Generally speaking, pages and websites such as these need to be looked
at with a raised eyebrow -- the reason being is that many of them are
written by hired freelance writers, who are more interested in search
engine results and keyword placement, than the accuracy of their
topic.
There is nothing wrong with herbal approaches to healing and therapy,
however, it is very difficult to find a supply of herbs that are
consistent in strength, and predicable in effectiveness. Kava Kava may
help you, but I'm betting that CBT will help you faster, and more
effectively.
Just a parting comment.
thanks,
webadept-ga
|
