Overcoming social anxiety through group therapy


Worried about what others think? Feel tongue tied when you try to speak? Do you hold yourself back from career opportunities to avoid public speaking?

social anxiety

Image credit: Sara Petterson/Getty Images

You may have social anxiety. Social anxiety disorder is quite common – roughly 12% or 15 million Americans will experience social anxiety that impedes their typical functioning and goals within their lifetime. Cognitive Behavioral Therapy, and group CBT in particular, have been proven to be effective in treating social anxiety, helping individuals to better understand the nature of their fears and thoughts in social situations, and also to develop and strengthen social skills through hands-on practice and behavioral experiments.

What is social anxiety?

Social anxiety disorder is marked by intense anxiety and fear of social interactions, particularly the fear of judgment and scrutiny from others. Those with social anxiety not only fear negative evaluation from others, but also that others will see how nervous and anxious they are. As a result, such individuals typically avoid social interactions or engage in other safety behaviors, such as speaking softly, avoiding eye contact, or pre-planning questions and conversations.

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Image credit: Berger & Wyse

How does group CBT help social anxiety?

It may sound counter-intuitive to join group therapy if you deal with social anxiety. However, it is this group setting that contributes to the effectiveness and lasting results of treatment. Group therapy provides the opportunity to meet, interact, and relate to others with similar experiences. The social interactions that are built into the structure of the group provide ample opportunities to act out behavioral experiments, test out beliefs, and share constructive feedback in real-time.

Group sessions will be structured in a way that encourages participation from all members. Topics covered will include:

  • Changing perceptions and learning to identify the thoughts that contribute to your social anxiety

  • Mindfulness practice to help develop awareness of your distressing thoughts and turn your focus back to the present moment

  • Assertiveness and problem-solving skills to bounce back when social situations don’t go as intended

  • Experiments to test the skills learned in session and practice new behaviors in your daily life

Is group therapy right for me? What are the advantages of CBT groups for social anxiety?

  • Less expensive than individual treatment
  • Opportunity to identify with others who share similar experiences and problems and feel less alone
  • Provide support and be supported by others, which tends to feel good and help one another make more rapid progress 
  • Collaborate on in-session and homework experiments with other group members 
  • Make friends with people who share a common therapy experience, which is a good way to keep making progress after the group is over 
  • Groups serve as a safe “laboratory” to explore how we relate to others and to experiment here-and-now with new ways of relating in a safe setting
  • Changing underlying attitudes and beliefs about the self and the world in order to adjust perceptions of ourselves and others in social situations

When and how often will the group meet?

The social anxiety therapy group is a structured, intensive, 20-week CBT program. Groups are made up of 6-9 members who are at least 18 years of age. The groups meet weekly for 1.5 hour sessions on Monday evenings at 6:30pm, starting December 9th, 2019, for five months.

How do I join? 

If you would like more information or want to sign up for the group please e-mail Cara@nyccognitivetherapy.com and provide your name and telephone number. We will then get in contact with you to answer any questions.

Cost is $175 for the private intake session and $80 per group session, NYU insurance accepted.


How do you fix a shy bladder?


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  • Do you experience anxiety or fear using public restrooms when others are around?
  • Do you worry about what other people are thinking when you are trying to urinate?
  • Are you concerned about being humiliated or embarrassed by problems passing urine?
  • Has your doctor ruled out a physical cause for your difficulty urinating in public rest rooms?
Millions of Americans suffer from an anxiety problem that few know about and even discuss. This social phobia is paruresis, or shy bladder syndrome. At some point, almost everyone has difficulty urinating, most commonly as a result of a medication when recovering from a surgery, or when giving a urine sample at the doctor. But this temporary condition is not paruresis. People who suffer from paruresis almost always have trouble using the bathroom if other people are around, even in their own home. Paruretics experience a consistent pattern of “freezing up” and avoiding public restrooms. The condition often develops from a traumatic event. The triggering event can range from a simple remark (“Will you hurry up and go” spoken to a child going to the bathroom) to chronic bullying.

Over the past few years, I began assessing for shy bladder with all my clients and discovered that many people struggled with it, but didn’t bring it up on their own either because they didn’t realize it could be helped with therapy, or felt too self-conscious to bring it up on. The good news is the treatment for paruresis is simple: Since some event, or series of events, triggered the inability to urinate in public, the method to overcome the disorder is to relearn how to urinate in a safe environment. The best evaluated treatment is referred to as graduated exposure therapy, essentially, doing what you fear in a step-by-step fashion and the exposures occur gradually, often, and for prolonged periods of time. For paruretics, since avoidance of urinating in public restrooms is the phobia, the “do what you fear,” involves gradually and repetively attempting to urinate in the presence of others, in situations ranging from those that are “safe” to more challenging situations.
Here’s an example of one of my patients who agreed to share his story. At the beginning of treatment he said, I am a 31 year old male who has had this problem for as long as I can remember. I can’t urinate if I have even the slightest idea that someone might come into the bathroom. I have severe anxiety about it…, it isn’t rational, but it seems to be the way things are right now.
Here’s a summary of some of the tools we used to help my client conquer his shy bladder:
1. We started with “fluid loading.” This means, drinking a lot of water until he felt like he was about to burst. (This idea of fluid loading goes against one of the main coping strategies that patients use, that is controlling the intake of fluids in order to control the “when” and “where” of needing to urinate – e.g., avoiding drinking fluids before going out to a restaurant).
2. Working with a therapist as a buddy. My role was simple. I would stand at various distances from the patient (whatever his comfort threshold would allow), in various bathroom environments, as he attempted to urinate. The patient would give me directions on where to stand, and we would always discuss the plan beforehand as a team to make it clear and specific; the patient was in charge of all plans.
3. Developing the behavioral plan. The goal was after loading up on fluid, for the client to allow the flow of urine for approximately 3 seconds and then stop the flow of urine. Then zip up, then go back and repeat. The reason for the 3 second limit is to save urine for repeated exposure attempts in the same session. When he was initially unsuccessful (which is normal and part of the process), we had him wait by the stall for 2 minutes; if he was still unable to go, we took a 3 minute break and tried again. If still unsuccessful, we would reduce the intensity of the exposure (e.g., I would stand outside the bathroom, instead of inside).
3. We worked on a range of exposure challenges, and repeated each one until it became easy for him, before moving on to the next one:
*Urinating at home alone, standing up, while imagining people are standing next to him.
*Urinate in a single person public restroom (a single commode with a locked door) with therapist standing outside the restroom.
*Urinate with therapist standing in the bathroom a few feet with patient.
*Urinate with therapist standing behind patient while therapist makes noise or impatient comments (this helps the patient feel more prepared for any rude behavior they might encounter in a public restroom).
Outcome:
After several successful trials in isolated public restrooms with me present, the client graduated to practice on his own. Attempting to urinate with others present at stalls and at other urinals, then a more crowded restroom. My client varied the context which helped build his confidence even further – urinating at the mall, a busy airport, a sporting event, a concert, and the theater.
After 12 weeks of intensive exposure practice, both in session, and between sessions, he sent me the following email, Dear Noah, I had the most incredible experience. Last night a friend and I went out to dinner. We went to a restaurant we have been to at least 100 times before. I had to go to the bathroom even before we got to the restaurant, which used to produce a lot of anxiety for me. However, not this time. The restaurant was very crowded, and I walked into the bathroom and went. When I got back to the table I realized something, that for as long as we have been going to this restaurant I had never even walked into the bathroom!

Improving sex & intimacy: What we know from research


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We all want to keep our relationship passionate and connected, and there are ways to both create and destroy your connection that all take place out of the bedroom. What’s most important is not to let sex become the last item on a very long to-do list, the final obligation you turn to when you’re both exhausted. There are concrete ways to ensure you have a great sex life.

 

In a study of 70,000 responses from 24 different countries, Christianne Northrup and Pepper Schwartz and James Witte, in their book, The Normal Bar, reported the results of their extensive study about love and sex. Couples who have a great sex life:

 

  • Say “I love you” to their partners every day, and mean it
  • Buy one another surprise romantic gifts
  • Compliment their partner often
  • Have romantic vacations
  • Give one another back rubs
  • Kiss one another passionately for no reason at all (85 percent who love sex also kiss passionately)
  • Show affection publicly (hold hands, caress, kiss)
  • Cuddle with one another every day (only 6 percent of the non-cuddlers had a great sex life)
  • Have a romantic date once a week that may include dressing up, dinner out, massage, and lovemaking
  • Make sex a priority and talk to one another about sex comfortably
  • Be open to a variety of sexual activities
  • Turn toward your partner’s attempt to connect with you

 

Furthermore, the more couples do these things, the better their sex life is. The champion countries were Spain and Italy. The bottom line: Great sex is not rocket science. It’s very doable, but you have to talk about it and you have to make it a priority in your relationship. CBT can help.

 

Practice exercise #1:Re-read the list above and identify 2-3 items you could do for your partner. Set an intention to do them this week.

 

Practice exercise #2:Pick 2-3 items you would like your partner to do for you. Share the list, and ask them.

Noah Clyman, LCSW-R, ACT

Academy of Cognitive Therapy (ACT) Diplomate & Fellow
Certified Trainer/Consultant & Credentialing Committee Member
Clinical Director, NYC Cognitive Therapy
347-470-8870, x700
Fax: 347-470-8870

Improve your love relationship by talking about sex


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Noah Clyman LCSW-R & Drs. Julie & John Gottman

I recently had the pleasure of attending a 3 day workshop with couples’ therapy experts Drs. Julie & John Gottman who are world renowned for their work on marital stability and divorce predictions. You may recognize them as the authors of the New York Times bestseller, The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert. I learned their innovative theory about how to make relationships work, along with research based skills for a great sex life, improving friendship, and resolving conflict. There are so many pearls of wisdom and this blog post will touch on the importance of talking about sex.

According to Drs. Gottman, there is no more stable and replicated result in the sex field than this: being able to talk comfortably about sex is strong related to satisfaction. Not just with sex, but with the whole relationship. And the results are not weak, they are dramatic. Quantity as well as the quality of the talking about sex, are strongly correlated with a couples’ happiness. Statistically speaking, only 9% of couples who can’t comfortably talk with one another about sex say that they are satisfied sexually, as well as satisfied in general with their relationships. On the other hand, over 50% of couples who can (and do) talk with one another openly about sex are satisfied sexually and are satisfied in general with their relationships. That’s a difference of forty-one percent! Amazing.

Research on sexuality strongly points to the importance of being able to talk intimately with one’s partner to enhance the quality of sex in your relationship. Yet having these conversations is very difficult for American couples from an African, Anglo-Saxon, or East European cultural background. Drs. Gottman–who have been analyzing videotapes of couples talking about their sex life in their “Love Lab” for decades–found that most couples have a great deal of trouble being clear and specific about what they want and don’t want in the bedroom. There’s an enormous fear of rejection which comes from a lack of trust and openness with each other.

Interestingly, this isn’t true of many heterosexual couples who are Latino and haven’t been made to feel guilty by strict religion. In some ways, these cultures support direct and frank non-defensive conversations with one’s partner about sex, romance, and passion. (This is not to say that all Latino couples are comfortable talking about sex. Many are not). Drs. Gottman discovered these facts about Latino cultures in America during a national survey they designed for Readers Digest. They also found that the same was true of gay and lesbian committed couples, in a 12-year study they did with Robert Levenson. Generally, Latino and same-sex couples didn’t make assumptions about eroticism. They considered it their responsibility as lovers to know what their partner did and didn’t find erotic.

To facilitate the process of conversation about sex, romance, and passion for couples who may feel uncomfortable with these intimate topics, it is important for couples to learn how to how their partner basic questions about sexual preferences, and then remember the answers. Remember: if you know your partner’s preferences, you will be able to create more excitement and pleasure for your partner. I look forward to helping couples improve their relationships from resolving conflict, to deepening friendship, to having great sex.


8 tools to defeat your ‘workaholic’ ways


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I am a workaholic. While on vacation last week, I became cognizant of the benefits of r&r and was inspired to write a blog that might help my fellow workaholics to address this issue. Do you find it difficult to disengage from work? An imbalance between your work life and your personal life may be behind of myriad of other problems, such as anxiety, depression, or insomnia. Are you obsessed with working to the exclusion of other things in your life? Some people work as though they were addicted to working. Have you convinced yourself that you have to work harder than everyone else? At your place of work, are you always the first to arrive and the last to leave? Has anyone ever accused you of being a workaholic or a perfectionist? Do you feel as if you are addicted to work? Work and your professional identity may be overly tied to your self-esteem so that you over-allocate time to work pursuits. Do you feel badly about yourself when you are not doing work? Do you view non-work activities as a waste of time? Do you believe that any idle time should be filled with some useful activity towards a goal? Have you come to devalue activities done for the sake of leisure or rest? If so, here are some cognitive and behavioral therapy techniques for you to try:

 

  • Ask yourself, Why am I the exception to the rule that human beings need rest and relaxation? In other words, challenge the idea that you do not require rest or pleasure in your life—all human beings do.
  • Imagine what would happen at work if you were incapacitated in some way. Would the business cease to exist, or would it find some way to make up for your absence? Challenge your tendency to overestimate your importance at work. Paradoxically, people who take breaks and recharge are often more productive at work.
  • Experiment with putting some rest and pleasure into your life and taking away some of the time currently allotted to work. For example, if you are working more than eight hours a day, commit to leaving work at an earlier time this week. Spend extra time doing something enjoyable.
  • Shorten your to-do list this week to essentials only.
  • In your own personal currency (i.e., in your mind), consider increasing the value of moments of pleasure and decreasing the value of accomplishments.
  • Create a “Buffer zone:” about an hour before getting ready for bed, begin to transition away from your “active self” by restricting your activities to those that are relaxing and enjoyable to you.
  • Say no to at least one request this week.
  • Think of the needs of people who currently depend on you. Now think of your own needs. Is your list of needs shorter? If so, why? How are your needs different from theirs? Why are you an exception? What is missing from your list of needs? Add to your list of needs and make time to de-stress and unwind every single day.

 

In summary, like any other human being, you need time for rest and relaxation. Far from being wasted time, making a conscious and consistent investment in “self-care” will help you be happier, more self-aware, calmer, and more productive throughout your days.

 

 

 


Online Hair Loss Study


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A PSYCHOLOGICAL STUDY OF HAIR LOSS, SELF-COMPASSION AND SHAME IN ADULTS
The aim of this online study is to understand whether and how feelings of shame and self-compassion affect people with hair pulling and other hair loss conditions.
This study is open to adults aged 18 years or over who have, or have had, trichotillomania (trich), alopecia, and/or other hair loss conditions.
This study will contribute to what we know about the psychological impact of hair pulling and other types of hair loss.
The website www.myhairlossstudy.com will ask for your consent, should you decide to participate. The whole process is currently taking 10-15 minutes on average, from start to finish.
Participation in this study is entirely voluntary.
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https://sites.google.com/view/myhairlossstudy


MEDITATION 101


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Author: NYC-NYC staff therapist, Mike Comparetto, LMSW.


CBT Therapists have lots of tools to teach our clients. But I often think, what if I had to pick just one to share with people? My answer, without hesitation, would be mindfulness meditation. It is the most powerful and transformative tool that I have ever come across, and these days we have ample studies to prove it. If you are a skeptic (as you should be), just Google “medical research on meditation” and you will find results from Harvard Medical School, Time Magazine, Mayo Clinic, the CDC, etc. showing a vast array of benefits both mental and physical. Here is just one article from the APA listing many of them.

What is Meditation?

This question is simultaneously very simple and very complex. Let’s start with the simple, and we can save the complex discussions for another day. There are many types of meditation, but for this article I will only be referring to Mindfulness Meditation. The officially accepted definition of mindfulness, penned by Jon Kabat-Zinn, is “…awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.” Mindfulness can be practiced while doing just about anything, but when we say meditation, this usually refers to practicing mindfulness in a seated position. There are ways to do walking meditation, standing meditation, and other forms of moving meditation, but seated meditation is the most common, and that’s what we will be focusing on here.

What is the Aim of Meditation?

If I could boil the aim of meditation down to one thing, it would be switching our frame of mind from conceptual to experiential. Meditation allows us to tap in to our lived experience, and let go of the stories we tell ourselves about it. These stories often magnify (or in some cases manufacture) the pain and difficulty in our lives. Mindfulness also reminds us that we never have to endure our experience for more than one moment at a time, which is quite freeing. All experiences are impermanent, and meditation brings this into direct focus.

If you learn how to effectively manage your mind, your thoughts and actions start to lead you away from suffering and towards happiness. This is why we practice meditation- to end suffering.

“Mindfulness helps us get better at seeing the difference between what’s happening and the stories we tell ourselves about what’s happening, stories that get in the way of direct experience. Often such stories treat a fleeting state of mind as if it were our entire and permanent self.” –Sharon Salzberg

How to Meditate

There are so many different ways to meditate that it can be overwhelming. A Google search on “how to meditate” returns 258,000,000 results. I think when you are starting out, it is important to just find a style that is accessible to you and do it. Later on, if you find that that particular style or tradition doesn’t really resonate with you, you can do your research and find the one that does. In the beginning though, any meditation is better than no meditation.

Since this article is about the bare basics, let’s establish some guidelines for just about all types of meditation:

1) Meditating for 5 minutes every day is better than meditating for 1 hour once a week. Developing the discipline to cultivate a daily practice is extremely important, and doing it every day creates the momentum needed to get results. If that means starting with only 5 minutes, then do what you can.

2) Try not to judge your meditation. You may have some meditations that leave you feeling great, some that leave you feeling tired, discouraged, or indifferent. They are all equally valuable. Nobody is bad at meditation- it is a constant practice. Each time you redirect your mind, you are building new neural pathways in your brain.

3) Don’t seek out particular states of mind or experiences. As a beginning meditator, you will most likely not have the ability to sit down and immediately cultivate the exact mind-state you are looking for (if you can, let me know your secret!). Meditation is about observing what is arising in the present moment- it is not about creating an alternate reality to dwell in. Remember that mindfulness is meant to cultivate a non-judgemental mind. That is absolutely critical. The goal of meditation (you will not always achieve this goal and that’s ok) is to meet each moment without adding your own commentary, opinion, interpretation, or sense of like or dislike to it. Yes, it’s as hard as it sounds, but that’s why we call it a meditation practice.

4) Have compassion for yourself. You will quickly find that the mind can sometimes be, well, kind of a jerk. The last thing you ever want to do is make things worse by beating yourself up when you can’t focus for more than half a second, or when your mind won’t stop repeating the same thoughts over and over. This is all a part of meditating, and even advanced meditators experience a mind that is uncooperative at times. It’s all about how you relate to those experiences. Try to use it as an opportunity to observe what it’s like to be in a busy mind (or an angry mind, a sad mind, etc).

5) Develop patience. I don’t know how to break this to you, but you are not going to achieve enlightenment after your first meditation. You will most likely see some immediate results, but the real benefits come weeks, months, years, and decades into the practice. As a bonus, you can use your meditation to observe the mind’s compulsion to want instant gratification.

6) Don’t worry what anyone thinks about it. If your friends think you are weird for meditating, or you fear that your co-workers will never speak to you again, just let it go. Nothing is more important than finding true peace and happiness. Be yourself, be free, and do what makes you happy.

Keeping those guidelines in mind, use the resources I have provided at the end of this blog to try meditation. If you are absolutely brand new to meditation I suggest starting with the Headspace app, or this guided meditation.

I hope meditation can be as powerful and transformative for you as it has been, and continues to be, for me. Supposedly the last words the Buddha ever spoke were, “Strive on with diligence.” May you strive on towards liberation and well-being.

-Mike

Resources

Get in touch with us to book a session:

info@nyccognitivetherapy.com

Apps:

Headspace

Insight Timer

Webpages:

Simple Guided Meditation

Kristin Neff – Self Compassion Exercises

Tara Brach – Guided Meditations

Books:

Meditation for Beginners – Jack Kornfield

How to Meditate – Pema Chodron

Real Happiness: The Power of Meditation – Sharon Salzberg

Against the Stream – Noah Levine