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Re: School shy, fear rejection Budgie

Posted by JonW on August 19, 2003, at 10:28:17

In reply to Re: School shy, fear rejection, posted by Budgie on August 19, 2003, at 0:42:59

> Have any of you combined CBT with medication?

Yes. I find CBT + meds to be highly synergistic. I take moclobemide, but in general, it's not a very potent drug for SAD. It's very helpful for me in combination, though.

>I've found meds that have helped me so much that it seems almost silly to also do these CBT exercises (not that I've tried), because the fear and paranoia is magically gone.

Some people with SAD get remission with medication alone. If you are one of these people, why not just take the meds?

>And it's strange- the SA has come and gone in waves (always concurrent with depression) over the years so much that I've had many, many exposures already to the situations that I fear the most.

Exposure alone is not CBT. In fact, exposure alone can make SAD and other anxiety disorders worse. This is not the case with phobias, but social anxiety disorder is not a phobia.

>Sometimes I even do splendidly. I guess my point is that I'm not exactly starting from square one. I know exactly what it's like to be be social and friendly, just like I know exactly what it's like to not feel depressed.

Having social skills and having experienced social success is one thing. The question is how big of a problem social anxiety is in your life. Social anxiety, in of itself, is a normal part of life. Does it prevent you from achieving what you want?

> For me, stress, depression, and SA are just so intertwined, it's hard to seperate them. But that's exactly what I want to do with them so I can understand and deal with them. They all just seem to happen when things start to go wrong. And it's so frustrating, because I'll find myself in a social situation, with people with whom I've got along wonderfully in the past, but these reactions and impulses just happen, and next thing I know, I'm a nervous wreak. I know I'm not scared, but yet I am!

You may not be open to CBT right now, and that's fine, but CBT is all about separating interconnected experiences. And it gives you the tools to learn from that knowledge.

> It seems more of a biological response to stress than anything, but of course I know there's something driving that response down deep in my subcoscious, or so I imagine.

Social anxiety definitely has a biological component, but that doesn't mean medication alone is the only solution or even the best solution. I don't understand, though. If medication alone works for you, what's the problem?

> I was thinking more along the lines of true psychotherapy. Has anyone had positive experiences with that?

Anyone can respond to any treatment, but the only psychological therapy that's demonstrated efficacy for SAD is CBT. Therapy with a CBT therapist is not a cold, clinical experience. It offers understanding, insight, friendship, and is at least as effective as Nardil for SAD. Obviously, combining medication with therapy is the best of both worlds.

CBT may not be for you, but as people with social anxiety disorder are experts at avoiding things, you may want to ask yourself if any reluctance to pursue this avenue isn't just another form of avoidance. If you are not getting what you want from medication alone, don't rule this out.





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