Social anxiety: Jerilyn Ross
Jerilyn Ross
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Monday, Oct. 2, 1 p.m. ET
Anxiety is the USA's No. 1 mental health problem and affects at least 19 million people ages 18 to 54 each year, according to an article about social anxiety in the Sept. 29 - Oct. 1 edition of USA WEEKEND. A study by the World Health Organization shows that the odds of developing an anxiety disorder have doubled in the past four decades.
Jerilyn Ross is director of The Ross Center, an outpatient multidisciplinary treatment center in Washington, D.C., and president of the Anxiety Disorders Association of America, a national nonprofit organization that promotes the welfare of people with anxiety disorders.
Scroll down to view all questions and responses.
Comment from USATODAY.com Host:
Welcome to today's chat with Jerilyn Ross. Send in your questions and comments about social anxiety.
Vero Beach Fl:
How do you know if you are suffering from anxiety disorder and does it require medication to control it?
Jerilyn Ross:
All of us have anxiety, and anxiety in general is not a disorder, it's an important part of life. However, if the anxiety seems irrational to you and if it changes your daily functioning -- at home, work, school, socially -- and if you find yourself either avoiding situations or manipulating people or situations to accommodate the anxiety, you may well indeed have an anxiety disorder, and you should seek professional help.
The two major proven effective treatments for all the anxiety disorders are a type of psychotherapy called cognative behavioral therapy and a variety of medications. Often times, the two are used together.
We can effectively treat up to 90 percent of most anxiety disorders, but we don't really know yet (pinpoint exactly) which treatment or combination of treatments is best for any one person. What's most important is that the person seeking treatment is with somebody who is open to both treatments.
While medication is helpful for many people, it's not the only way, and it's not for everybody.
Baltimore, MD:
What is the difference between panic attacks and social anxiety?
Jerilyn Ross:
A panic attack is a discreet episode where suddenly someone is flooded with intense feelings of terror. It usually last a few seconds to a minute or two, even though it seems like forever. And the person experiences both physical and psychological sensations, such as pounding heart, sweaty palms, tightness in chest, dizziness, nausea, trembling, shaking,sometimes feeling "spacy" and an overwhelming sense of dread. People can have panic attacks either spontaneously or in specific situations, like while driving a car, going through a tunnel, on a bridge or while giving a speech or in a social situation.
If someone has panic attacks just out of the blue -- spontaneously, for no apparent reason, and they're not avoiding anything because of them -- they have what we call panic disorder. If they're avoiding specific places or situations because they're afraid of panic attacks, they have what we call a phobia. If they're avoiding lots of things -- being away from home, in public situations and need to get to a safe person quickly -- they have what we call agoraphobia.
Some people have panic attacks only in social situations. Or they have such an extreme fear of situations where they're around people and fear they may be scrutinized by others or that they may embarrass themselves, and therefore they avoid social situations. They have what we call social phobia, or social anxiety disorder.
People with social anxiety disorder may or may not have panic attacks, and some may avoid specific social situations like public speaking, while others avoid many situations that involve interacting with people.
cheboygan,michigan:
Do you think caffein plays a big part in social anxiety?
Jerilyn Ross:
In general, caffeine is known to trigger panic attacks in people who are prone to having them. And there have been studies at the National Institute of Mental Health demonstrating this. So I strongly recommend that if someone is having panic attacks, whether they're spontaneous or specific, they should definitely cut back on their caffeine or avoid it altogether.
Lowville, NY:
How does a person overcome the feeling of embarrassment that it the anxiety is a defect in who they are? I have been hiding for all my adult life because of shame.
Jerilyn Ross:
The first thing you need to know is that embarrassment and shame and feelings of insecurity are all symptoms of your social anxiety disorder. This is a disorder that has biological and genetic as well as psychological roots. It's not your fault or a matter of weakness that you can't overcome it. As a matter of fact, social anxiety disorder is the third most common psychiatric disorder in the USA.
There are many excellent treatments available today. In my book, Triumph over Fear, I have several chapters specifically dealing with social phobia where I describe many different techniques that people can do both on your own as a self-help program or with the help of a therapist or friend or family member.
Burtonsville, MD:
Is it uncommon for social anxiety to develop as an adult and what is the prognosis for a full recovery without daily medication?
Jerilyn Ross:
Social anxiety disorder usually starts in childhood. However, this kind is more generalized -- more of a general fear and discomfort of being around people and social situations.
It's not uncommon for an adult to be in a situation like giving a speech, speaking up at a meeting, or giving a toast to have a panic attack for the first time. What happens is that the next time they're confronted with a similar situation, they become to develop anticipatory anxiety, thinking "what if" it happens again. They begin to either avoid social situations or endure them with dread. In such cases, the person should know that yes, this is treatable. Both cognitive behavioral therapy and a variety of new medications have been shown to be extremely effective.
The kind of therapy you get shouldn't just be "talk therapy." At the Ross Center, we us a therapy where you're helped to get into social situations and you're taught specific skills such as breathing retraining, challenging negative thoughts, labeling and understanding your anxiety. Gradually you will be desensitized to your anxious feelings. And we use medication when appropriate.
Williamsburg, VA:
What can people do to help themselves cope with social anxiety? Is there a program you can recommend?
Jerilyn Ross:
I just recently completed a very comprehensive self-help program called Freedom from Anxiety. It includes 16 audio tapes, a one-hour video where I'm actually working with patients, a workbook with homework, etc.
It's designed for people to be able to help themselves recover from all the anxiety disorders as well as give resources for people to get professional help in their communities. For more information, visit www.rosscenter.com.
In addition you can contact the Anxiety Disorders Association of America at adaa.org. They have treatment center listings for the USA and Canada. They also have excellent publications, newsletters and general resources.
Reno, Nevada:
How do I find and contact a Doctor or Counselor in my area that specializes in anxiety?
Jerilyn Ross:
The best and most effective way to do that is to go to www.adaa.org.
You'll be prompted to enter your zip code and you'll find a list of doctors and other mental health professional in your city who have a special interest in helping people suffering from anxiety disorders.
Memphis, TN:
If a person has one or more non-social phobias, for example, heights and snakes, does this increase their risk of developing social anxiety disorder?
Jerilyn Ross:
If somebody develops a phobia because they are having panic attacks and associating particular places, objects or situations with those panic attacks and they don't get treatment, it is possible that they can develop panic attacks in other areas as well.
However, social phobia is more commonly associated with a fear of being scrutinized or judged by others and of acting in a way that is embarrassing or foolish. It's generally a distinct disorder onto itself.
While people that have one anxiety disorder may be more vulnerable for other anxiety disorders, as well as depression and substance abuse, what's most important is that if their anxiety disorder is diagnosed and treated early, chances of developing secondary disorders are significantly reduced.
sunnyvale, ca:
What are some suggestions fo dealing with day-to-day anxiety - sweatty palms, rapid and arrythmatic heart beats, nervousness, etc.
Thanks
Jerilyn Ross:
I think some very basic suggestions include:
1) eliminating caffeine
2) making sure you get at least 30 minutes of aerobic activity each day
3) be aware of breathing properly -- slow, deep breaths from your diaphragm
4) getting enough sleep
5) eating a balanced diet
6) communicating your feelings as openly and honestly as possible.
These all seem like obvious suggestions, but they absolutely work.
If you're feeling a constant worry and anxiety, you may have a generalized anxiety disorder, which affects about 5 percent of Americans.
ADAA is having a live chat on Thurs., Oct. 5, from 7-8 p.m. ET with Dr. Jack Gorman from Columbia University to talk specifically about general anxiety disorder and what can be done about it.
Laurel, MD:
Just a comment -- I experienced severe anxiety attacks earlier this year. I missed many days at work. It was so bad, I thought I may never be able to leave the house again. I always look toward medication to solve my problems. What finaly worked for me was a lifestyle change. I gave up the medications, started eating better and exercising, explained my condition to close friends and turned myself around in a matter of a couple weeks. One of my greatest fears was having an attack around co-workers. Explaining my condition to co-workers I felt closest to REALLY helped.
Jerilyn Ross:
I appreciate you're sharing this with us. There are many different ways of treating anxiety disorders. One of the most important things, which you demonstrate here, is not keeping it to yourself. Talk about it, don't feel ashamed, don't be afraid to ask for help.
We've found that in a study that ADAA did last year, anxiety disorders as a whole costs our nation more than $42 billion a year. About 10 percent of that money was spent on lost productivity at work and absenteeism. Many people who find themselves unable to go to work, either because of panic attacks or are plagued by obsessive thoughts or overwhelming general anxiety, can be helped like you. Sometimes do best with medication or without. But the important thing for you to know is that all anxiety disorders are real, they are serious, and they are treatable.
In my book, Triumph over Fear, I have developed a "dear friend" letter that is designed for people to give to their friends, family members and colleagues to help them understand what the person is going through. It's often difficult for people to understand what it's like. Many of my patients have found that this letter helps to break the ice and open up communication.
Ann Arbor, MI:
I do not have health insurance. Are there agencies, professionals, etc. who are either affordable or charitable?
Jerilyn Ross:
In general, if somebody has mental health benefits through their insurance company, then treatment for an anxiety disorder should be included the same way that treatment for any other mental health problem would be.
However, there still is a huge gap is what we believe should be covered versus what really is. And the ADAA along with many other mental health groups is fighting very hard for equal coverage for both mental and physical disorders.
A few things I suggest for people with no coverage or poor coverage is to contact your local university medical center or hospital (I include a list of these in the Freedom from Anxiety program and my book). Many times these places offer free or low-cost treatment for people participating in clinical trials, some testing medications but not all.
Also, contact the ADAA. The ADAA newsletter, The Reporter, summer 2000 issue has a special issue about clinical trials. This would be a helpful resource. You can also search for clinical trials on specific anxiety disorders through the National Institute for Mental Health program. Click on www.ClinicalTrials.gov. This site provides the current recruiting status of both government- and private-sponsored trial, organized by anxiety disorder, as well as links to other resource sites on clinical trials.
cincinnati, OH:
Is there tests that can diagnose a patient with anxiety, depression or panic disorder? If so, how is it done?
Jerilyn Ross:
Unfortunately, at this point in time, we don't have any x-ray or blood tests or scans that can pinpoint an anxiety disorder. Although I think we're heading closer to that in the future.
There are excellent psychological screening tests that most psychiatrists, psychologists and social workers use that are quite effective in identifying specific disorders. Also, on my Web site, www.rosscenter.com, I have a series of quizzes that you can take to help you identify which, if any, anxiety disorders you have.
ADAA also has an excellent list of books and self-help material that can also be very helpful in assisting you to identify your specific problem.
It's important for you to see a primary care doctor for a full checkup to be on the safe side and rule out any physical illness. Many of the symptoms of an anxiety disorder mimic symptoms of physical illnesses. And in most cases turn out simply to be the symptoms of an anxiety disorder; however, as a precaution, whenever a patient comes to see me for treatment, I always make sure that they've had a full physical exam in the last 6 months or they schedule one prior to treatment.
Comment from USATODAY.com Host:
We have a lot of questions coming through, and we're almost out of time. But Jerilyn Ross has agreed to stay online to answer a few more questions...
Dyer, Indiana:
Do anxiety disorders have any link to causing irritable bowel syndrome, or weight loss due to persitant worrying and nervousness?
Jerilyn Ross:
There does seem to be a link between anxiety disorders (particularly panic disorders) and irritable bowel syndrome. Although, we don't always know which is the cause and which is the effect.
What we believe is that often people become so afraid of the consequences of irritable bowel -- i.e., not be able to get to a restroom immediately -- that they begin to develop avoidance behavior and intense anxiety feelings (even panic attacks) in response to that dread.
Fortunately, through both cognative behavioral therapy and medications, both the anxiety disorder and the irritable bowel can be eased.
Cincinnati Ohio:
Has hypnosis ever been used to treat panic attacks? If so what sort of success rate does it have?
Jerilyn Ross:
There are many alternative treatments, including hypnosis, that people have used in treating anxiety disorders. To date, there are no clinical trials proving its effectiveness. I would not suggest it as the only treatment one is getting, but as part of an overall treatment program, it can be helpful. As can stress-management training, meditation and other forms of deep relaxation.
Americus, GA:
What is the first and second most common psychiatric illnesses in the USA?
Jerilyn Ross:
Anxiety disorders as a group -- which includes panic disorder, phobias (specific phobia, agoragphobia and social phobia), generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder -- are the most common, or frequently occurring, mental disorders.
But if we break them down by specific disorders, then it's depression (No.1), substance abuse (No. 2) and social anxiety disorder (No. 3).
San Francisco, CA:
What exactly is cognitive behavioural therapy and how long does it usually last?
Jerilyn Ross:
Cognitive behavioral therapy is a short-term, targeted therapy that usually lasts an average of 12 sessions.
The hallmarks of cognitive behavioral therapies are evaluating apparent cause-and-effect relationships between thoughts, feelings and behaviors, as well as implementing relatively straight-forward strategies to lessen symptoms and reduce avoidant behavior.
A critical element of therapy is to gradually increase exposure to the objects, places or situations that provoke anxiety. A good part of my day as a therapist is going with patients in cars, trains, restaurants, shopping malls or whatever situation is causing them anxiety and giving them the tools an techniques they need to bring their anxiety down while they're in the situations they've been avoiding or dreading. During the session, I'm continuously providing reassurance that although the feelings are frightening, they're not dangerous. Along with the patient, I develop a plan to enhance mastery.
Comment from Jerilyn Ross:
It's important to know that many people have suffered silently with an anxiety disorder because they don't know what's wrong with them or that help is available.
An average person has seen an average of 10 doctors thinking that they have a terrible disease. And when nothing shows up on a blood test or x-ray, often feel alone, embarrassed and like they're a hypochondriac when in fact they may have an anxiety disorder that is both real and serious.
The good news is that it's highly treatable. The only people we can't help are those who don't ask for help.
So, if you or a loved one have been suffering from extreme anxiety or avoiding places, objects or situations that pose no real threat of danger, then I urge you to contact ADAA and use their resources to find help in your community.
Comment from USATODAY.com Host:
That's all the time we have for today's chat. Unfortunately we weren't able to get to all your questions and comments.
Thank you for participating, and a special thank you to Jerilyn Ross for joining us today. Check the Talk Live schedule at talk.usatoday.com for next week's health chat.
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