Elizabeth’s Social Anxiety Disorder

An attractive woman in her forties walked into my office and sat down. Her expression was serious and nervous. Her sister was with her offering her support and encouragement. After her sister left, Elisabeth introduced herself and began speaking.

“About ten years ago I started feeling anxious for no good reason.”

“What precisely does anxiety mean to you?” I asked.

“I get nervous in front of strangers. My hands shake when I’m doing normal and routine task, like writing the address on an envelope at the post office. I don’t dare have a cup of coffee on my own because I get too anxious.”

She explained that once she had had an anxiety attack in a bank. To feel less embarrassed about it, she had pretended that she was feeling dizzy and asked for a chair to sit down. Recently her anxiety had increased to the point that she had stopped going to work. By profession she was a dental hygienist but her trembling hands made it impossible to carry out her work.

In order to get better she had tried Tai Chi, yoga and other relaxation techniques. She also had been going to psychotherapy for four years. In her own words, the therapy sessions were about ‘me talking and the psychotherapist listening’. She was avoiding everything and every situation that could cause possibly cause her anxiety. When she couldn’t avoid it, she would try to calm herself down by convincing herself that ‘there is no danger’ and that she could handle it.

I talked to her about her coping strategies. I managed to scare her about the terrible consequences of avoiding those situations that stoked her anxiety.

“Avoided ghosts grow stronger”, I said, “When you run away or try to hide yourself from demons, they simply chase after you.”

I also explained to her that even the most courageous people in history felt fear. Bravery is not the absence of fear. The Nobel Peace prize winner Nelson Mandela who fought apartheid and was imprisoned for 27 years, explains it this way:

I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.

I asked her perform two exercises for a week. She agreed and we arranged an appointment for the following week. Seven days later, Elisabeth reported that she had managed to avoid less than before.

“One day I parked my car in the garage all by myself”, she said proudly. This might seem trivial to you but she had been afraid of driving her car into the garage by herself and that now she overcome this self-inflicted limitation.

During the following weeks, Elisabeth started doing many small and no so small things that she couldn’t do before. She began feeling calm and even enjoyed going out to eat at a nice big restaurant. She started to have coffee on her own and even attended a very crowded fashion show that she was interested in.