Question: Dr. said he thinks it's anxiety, but I'm not sure. I've been foggy headed for over 3 yrs. I went limp 1st time sitting at table 3 yr. ago. All kind of test & all was good. 2 wks. ago driving down rd., out of nowhere I got real blurry eyed & felt like I was going to pass out. Pulled off rd. & called 911. After getting home I have to lay in bed 4 or 5 days except for being up 20- 30 min. at time. Next night I fell limp at table. Not as bad as 3 yr. ago, but had g-baby to call son to help me to bed. 2mg valium will help some after I've been scared to death. 2 wks. ago was 1st time I ever got blurry eyed & hands shaking bad to. In between the last 3 yrs., it's been foggy headed daily. Some days worst than others.

Dr. Richard Schultz Says...:

Hi Janice,

Thank you for addressing this question to me, and I apologize for the significantly delayed response.

Perhaps you now have a better understanding of the distressing symptoms you experienced back in 2017. For the benefit of others, I will reply to your original questions.

First, I want to support your decision to undergo a thorough medical exam and workup following emergence of these symptoms. It is crucial to identify any underlying pathology needing attention before ruling these out and focusing on the psychological and behavioral aspects.

Psychological disturbance can manifest physically in an almost infinite variety of ways. Psychogenic seizures, conversion symptoms, and functional neurological disorders can all result from, and/or be exacerbated by psychological and mental health difficulties. Even in cases where the initial symptoms are purely physiological, the cognitive, emotional, and behavioral reactions that follow will determines whether the problem will dissipate, persist, or even worsen.

The fact that some of your symptoms are helped with the use of diazepam (Valium) indicates that central nervous system arousal (anxiety) is centrally involved in their manifestation. By learning to think about and respond to these symptoms differently, you will find that your experience of the symptoms shift and reduce. Although the limpness, fogginess, blurred vision, and shakiness caused you significant concern and distress, they don't likely pose any actual threat to you. 

If you have not already done so, I therefore recommend that you consult a clinical psychologist grounded in cognitive-behavioral therapy, and who has particular experience in treating somatic difficulties. Such a provider will be best-suited to helping you understand the mind-body connection, and in devising a treatment plan to reduce the symptom burden.

Please feel free to update me on the evolution of your symptoms,and your response to them, since the time of your initial writing.

Sincerely,

Richard E. Schultz, Ph.D.

Question: So abt a month ago I took a shroombar with my friends and had a really bad trip. During the trip I was having what felt like a panic attack while my mind was thinking about the worse things possible. I was thinking about why people kill themselves, felt like I was going crazy and thought that all my friends thought I was crazy. Also felt to the public eye that I was going crazy so during all of this I tried to act normal. I couldn’t not sit still so I did my best to avoid all the negative thoughts by walking with a friend on the beach. It also made me think about my girlfriend and as well challenged my sexuality. That really scared me because I know I’m straight. Another thing was that during the trip I felt like I couldn’t tell what was real. Like I was doubting and second guessing everything, also felt like time wasn’t real. I had to have a friend near me at all times because they were pretty much my anchor. So after the trip ended I was able to calm down and felt relieved. Fast forward a couple days and I’m fine but I realize that my anxiety is a lot higher. And a week later I’m driving with my girl and she makes a joke about one of my friends liking me and that triggered like a anxiety attack. So I realized that when she said that I thought abt the horrible trip which then sent my body to panic. It doesn’t end there, I recently broke up with my girl and now I feel like my anxiety is higher than ever and I feel like im always in my head and never in the present. I feel like i am numb to life and like I am there but i am not there. At times I feel like I’m back but then I’m back to feeling weird. I really want to feel like I’m back to normal because this state scares the hell outa of me.

Dr. Richard Schultz Says...:

Hello Friend, and thank you for addressing this question to me. I am sorry for the distress you have been experiencing.

It is not at all uncommon for symptoms of anxiety to be triggered, or exacerbated, by the use of psychedelic compounds, in this case a non-specific variant of mushrooms.

What most likely occurred for you is that a pre-existing vulnerability to anxiety (with particular focus on feared negative or critical judgments of others, otherwise known as "social anxiety," as well as a fear of uncertainty about yourself) became activated during your trip, inducing some derealization (not in itself uncommon with psychedelics, or necessarily unpleasant) and panic symptoms (less common but unpleasant). Due to the unboundaried perceptions and mental activity which become available with the use of mushrooms, your anxious cognitions, feelings, and sensations assumed an even more distressing and traumatic form, and which are now impossible to forget. In effect, these are post-traumatic memories.

Subsequently, via classical conditioning, your brain has associated even mild symptoms of anxiety with the traumatic mushroom experience, thereby worsening them. Other painful concerns that arose during the trip (regarding your sexuality and others' view of you as crazy) are now also associated with mild anxiety.

The good news is that, if you seek appropriate psychological treatment, you will not only "come back," but will likely do so with even more confidence, self-acceptance, and peace, than you ever before enjoyed. I suggest beginning with an initial consultation, and adding additional sessions as needed.

If, on the other hand, you continue to focus closely and vigilantly on the content of your anxious thoughts and feelings, and attempt to eliminate, avoid, analyze, rationalize, control, or eliminate them, or work to avoid situations or people that trigger them, they WILL grow stronger. When relating to our selves, that which we resist will persist (and this brief video provides an excellent illustration of that process )

Regarding a treatment provider, I strongly suggest that you work with a clinical psychologist grounded in cognitive-behavioral methodology, and who can further inform this with acceptance-based "third wave" interventions.

Although you may have by now experienced a reduction in the anxiety, I suggest seeking consultation anyway, at least for check-up purposes, to ensure that you are not coping in maladaptive ways.

Finally, please know that, in order to receive therapeutic benefit from psychedelic compounds, they must be utilized within a specific context, and in accordance with a variety of conditions and procedures. If these procedures are not observed, significant and sustained negative mental health consequences may result. This is particularly true if one has a pre-existing vulnerability to psychological distress of any kind.  

Question: Hello Doctor, I think i’m having a though time with a new anxiety problem. In the past 3 years I tried mushrooms few times, I had a lot of fun and very profound experiences, but also a bad trip, then i tried mdma twice and had a bad trip the second time, i also am a heavy pot smoker and started way before «tripping ». Since I had those trips i think my way of seeing life is different, better in my opinion but there’s things that i can’t handle, like it’s too much and i have a sort of existential anxiety, i constantly analyze tons of things and sometimes it makes me feel bad, i get anxious for not much. Sometimes weed makes it even harder to handle and i had a few panic attacks (not very harsh but i really don’t like this feeling) since my trips, because tripping didn’t only change some of my perceptions of life, but also my way to deal with pot too, it can be more psychy in my mind sometimes. But weed isn’t the problem here because i also have those anxious thoughts when i’m sober. I get really anxious when i go out to see friends that i don’t see much (i don’t have problems with my 5-6 closest friends) if i have to get in a place fulled of people, or even just few « bad » or really « sad » people i just feel all the negativity and i feel bad. Thinking about my future can also get me really anxious, I think i have so much analized myself that i know my insecurities and thinking about them make bad loops in my head (girlfriend,money,work,find my real passion in life, practice more loving life and enjoying it because i don’t enjoy it enough i could be way better in my opinion etc..) Sometimes i have those thoughts alone also but i have no problem to deal with it if i’m in a good place (like places i know) I get really intense thoughts, but not only bad ones, i also feel all the possible love in the world and i can really love deeply (for what they are, not really falling in love) someone in a few moments or appreciate things about people i couldn’t before. I also learned a lot about mushrooms, the scientific side and i think know quit a lot (but i need to know much more and have even more to learn about it and a lot is still unknown). I feel like i learned a lot trough mushrooms and they made me a better person in this world. So by saying this, i am not sure if i have just a mild psychosis, an anxiety disorder, did my brain reprogrammed itself differently with mushrooms and made me even more sensitive than before..? i don’t know, i also think i am an empath, (i was before all this also, but even more now) But i am not sure 100% to have a kind of hppd. (maybe not at all and its just anxiety but more deep) I also tried Salvia, and had the weirdest experience of my life but challenging and interesting, but now with weed i feel depersonalization or derealisation (not sur about that either). It doesn’t bother me i enjoy it but maybe it’s also related to my anxiety because when i feel that state i think really deeply and with less of my ego, and i like it only in comfort zone.. i sometimes feel a lot through people’s eyes, i feel a lot by looking the sky or nature. And i can’t fight my anxiety, my discomfort zone is really hard to leave so here we are, i am having a bad time going out with all that and it’s not fun i really want to enjoy life at it maximum and this is a wall to truly loving life.. i feel i « know » too much and feel all the negativity around me...

Dr. Richard Schultz Says...:

Dear Nthrax,

Thank you very much for addressing your question to me. Or should I say predicament?

Based on your detailed adventures with substance use and experimentation, one thing is clear; you have very mixed feelings about your very mixed experiences. On the one hand, you enjoy pursuing a drug-facilitated sense of enlightenment, emotional attunement, and harmony with yourself and others, as well as the highly novel and stimulating sensory experiences that substances can afford. And at least some of the time, you seem to get what you’re after. The rest of the time, however, your drug experiences trigger worsened social and generalized anxiety, paranoid thoughts, depression, as well as possible social consequences. In addition, you worry about the possibility of longer-term psychological consequences of hallucinogen use, and there is no research or clinical data that can dispel these concerns.

And yes, you are correct in that we can be impacted cognitively, behaviorally, and emotionally by drug experimentation, just as we can be from other internal and external stimuli. All such experiences constitute one’s “learning history,” which is a strong predictor of subsequent functioning. Further, although some recent clinical research has begun to identify true therapeutic value in psychedelic mushrooms, the “trips” in those studies are conducted under controlled conditions, and are supervised by mental health therapists in the event the “patient” experiences any distress during or after the drug experience. Finally, there is no research to support the value of ongoing, habitual, or leisure use of mushrooms or any other hallucinogen.

That said, I am wondering how I can be of help here. It sounds like you have a fairly realistic awareness of the potential risks (that we know about) and benefits of substance use/abuse. More importantly, you don’t appear to be considering moderation or sobriety at this time. Readiness for change is a highly fluid concept, however, and your stance will likely shift significantly across time. In regard to abstinence or harm reduction, I can only tell you that there is absolutely no downside to either, and your risk of any further psychological difficulties associated with your drug use would be reduced to zero.

As noted above, I do understand that you are now suffering from clinically significant symptoms of anxiety, primarily of the social and generalized varieties, with a little panic thrown in as well. Your substance use is certainly a confounding factor in evaluating these difficulties, however, as the symptoms are notably triggered and exacerbated by it. By reducing or discontinuing your substance use, the anxiety may very well cease to be a significant problem. If it does not, I would strongly recommend that you consult a clinical psychologist to discuss treatment. In particular, I recommend seeking out a mental health provider who practices from a cognitive-behavioral perspective.

Although drugs are likely increasing your feelings of vulnerability and symptoms of anxiety, the underlying challenge of managing the firehose of discursive, unpleasant, scary, or self-critical thoughts confronts all humans (and a few other mammals) in the 21st Century.

The most effective practices for learning how to cope with the multitude of thoughts (which number 70k per day!) are mindfulness, progressive muscle relaxation (PMR), diaphragmatic breathing (DB), and cognitive therapy.

Resources for learning the above techniques include “The Mindfulness Solution” by Dr. Ron Siegel, “The Feeling Good Handbook” by Dr. David Burns, and “Get Out Of Your Mind And Into Your Life” by Dr. Steven Hayes. You can find many instructional videos on PMR and DB on Youtube.

I hope that some of what I have written here is of use to you. Please do follow-up with me to let me know of your progress, as this will be of great interest to others who may be struggling with similar quandaries.

Sincerely,

Richard E. Schultz, Ph.D.

Question: As the sibling of a drug addict, I was against drugs for most of my life. My sibling was in rehabs and mental institutions for most of my teenage life. Mental illness runs in my family (drepression, personality disorder) More than half of my family is on some sort of anti depressant. I never battled with any of these illnesses until 2 years after leaving school where I began to feel mild anxiety and so I decided to go on a mild anti-anxiety/anti-depressant. Eventually, after coming out of my teen years, I decided to experiment a little with drug use. (This was not my first time trying drugs. I had tried drugs in high school before my sisters serious drug addiction started) I decided to stop taking my anxiety medication as I didn’t feel I needed it anymore. I stopped my medication the same day I decided to stop. I never consulted my doctor as I was told it was a mild pill that I could stop at any time. My partner, with whom I share a home, is an avid marijuana smoker and so it was only a matter of time before I became a regular marijuana smoker as well. I smoked everyday consistently for about +- 3 months. I decided to try other drugs as well. I’ve tried a few drugs and none of them have drastically affected me besides for shrooms. My first attempt at trying shrooms, I took a small dose and barely felt any different. On my second attempt I had a good amount. I had a normal trip for about 3 hours until I decided to smoke some marijuana afterwards so that I could relax, which was the worse decision that I have ever made, I regret it to this day. I had the worst trip. It took me to the darkest place I have ever been in. I felt like I was an inanimate object, like I was one with the bed I was laying on. When I did speak I couldn’t feel my mouth moving, I felt like I had no control of my body even though I was talking and walking completely fine. I had a huge panic attack. I felt completely disgusted with myself, I hated myself. I was so self conscious and kept telling myself that I was not good enough. In that moment I thought my families history of mental illness had finally caught up with me. I insisted that my partner drive me to the hospital as I legitimately thought I was going to die. While in the car driving to the hospital I was in and out of focus, I was boiling hot and then I was freezing. I kept yelling to my partner that I was going to die. At one point I felt as if my soul was leaving my body and I had accepted the fact that my life was ending. After being rejected help from hospitals, eventually the driving around for about an hour or two sobered me up. I went home that night and slept. The next morning I felt fine, just extremely embarrassed that I couldn’t handle my drugs. Since that night, I had smoked marijuana again a few times but every time that I smoked I got extreme social anxiety, to the point where I would lock myself in a room just to be away from people. I decided to stop all use of drugs straight away as I could see it was effecting my life in a huge negative way. These last few months after my bad trip I have not felt myself at all. I fell like a completely different person. I have extreme social anxiety to the point where going to work is a huge fear for me. The thought of being around people terrifies me. Communicating with people on a daily basis is a struggle for me. I feel like I have lost all social skills that I have developed over my life. I have forced myself to see friends and go out few times, sometimes I am completely fine but other times I have mild panic attack’s from having to communicate with people, I have no control of when I feel social anxiety. I used to be a loud, fun, outgoing person and now I would rather lie to my friends so that I don’t have to see them and sit at home doing nothing with my partner where I don’t feel anxiety. I was an English teacher in Thailand for one year, I lived by myself in a foreign country with no one I knew for one whole year and I never felt a second of social anxiety and now I can’t even handle having to have a casual conversation with my boss. All these symptoms I have mentioned above, I thought were just symptoms of me developing anxiety or depression but my partner keeps insisting that I have not been the same since the night of my bad trip on shrooms. I am currently back on my anti-anxiety medication. After the first two weeks of taking this medication again I felt like I was myself again as the medication was starting to work. Now I have been on it for more than a month and I feel my social anxiety is coming back again and it’s still as bad as it was before. I don’t know what to do anymore but I feel completely depressed that I am not the person I used to be. I feel like this is the person I am now and there’s no way for me to go back to normal. I really need any help or advice that I can get. I’m desperately trying to fix myself but don’t know how. I just want to be the person that I was before I made the wrong decision to experiment with drugs.

Dr. Richard Schultz Says...:

Hello and thank you for addressing your question to me.

Let me start with the good news. With proper psychological treatment, there is every reason to believe you can experience significant improvement in your current condition. Although going back to a place in time before these problems ever existed is impossible (damned time machine is broken again), you can likely attain an even greater sense of confidence, self-esteem, and peace than you previously enjoyed.

Based on your description, it appears that you are currently exhibiting symptoms consistent with Social Anxiety Disorder. This is defined as "a persistent fear of one or more social or performance situations in
which the person is exposed to unfamiliar people or to possible scrutiny
by others." Further, "the individual fears that he or she will act in a way (or
show anxiety symptoms) that will be embarrassing and humiliating." This explains your pronounced anxiety about, and avoidance of, going to work, and being around and communicating with others. In addition, you appear to also have developed significant signs of depression, based on your extreme self-criticism for having the anxiety problems, your feeling that you are not the person you used to be, and your hopelessness about ever recovering from these current struggles. Depression often follows anxiety because we naturally become quite discouraged (and often self-blaming) at seeing how narrow our range of of coping and behavior seems to have grown.

As you report a family history significant for various mental
health and addiction issues, and indicate that you yourself had
struggled with "mild anxiety" prior to the events you describe, pre-existing vulnerabilities to your current condition(s) clearly existed prior to your use of mushrooms and cannabis.

Your symptoms were exacerbated by drug use via a common behavioral learning paradigm called Classical Conditioning (remember Pavlov and his drooling dogs?). Your typical functioning, which had been largely "normal," was inadvertently paired with feeling out of control, acutely self-conscious, and fearing that you were about to die (which arose during the panic attack you suffered during your mushroom trip). This connection was further reinforced by the subsequent social anxiety-producing episodes in which you smoked only cannabis. As a result, normal functioning and extreme anxiety have been strongly paired, and the drugs need not even be present for the symptoms to emerge.

Another behavioral learning process, called Negative Reinforcement, easily explains the persistence and worsening of the anxiety symptoms even apart from any substance use at all. 

I therefore strongly recommend that you seek out an experienced psychologist with whom you can work. This practitioner will ideally have a strong grounding in cognitive-behavior therapy (CBT), which tends to be the "gold standard" for addressing most anxiety disorders. CBT is based on the idea that it is not the our experiences and circumstances that determine how we feel and behave, but how we INTERPRET the events that occur to use. Please ensure too that the therapist also has demonstrated experience treating social anxiety. Through a combination of in-session and extra-session techniques, the CBT-trained provider can help you to regain your social confidence and positive self concept. As I noted earlier, by directly confronting and addressing what you currently fear, you will probably find that you feel even more confident and grounded than you did before you experienced the traumatic events you described.

Sincerely,

Richard E. Schultz, Ph.D.

Question: My 27 year old son has been diagnosed with anxiety and depression. He lives with me so I see first hand how he is not getting better. He feels hopeless, wishes he was never born, has pains in his mouth from the anxiety that causes him to lose control. I don't know what to do. The Dr.'s prescribed ativan to help with his symptoms, but he has to take it too often. He's convinced that he has diseases and won't accept that the pain is a symptom of his anxiety. Earlier today, I called a hotline at Kaiser because he was so bad. They wanted him to do a web visit with a therapist, but he declined. He won't take advice from me or anyone. He's really in a dark place. He says he doesn't have plans to harm himself or anyone, but I'm still so afraid for him.

Dr. Richard Schultz Says...:

Hello and thank you for addressing your question to me.

I sympathize greatly with this challenging situation, for both
you and your son. As a parent, I can imagine how painful it is to see your son
struggle and suffer, and to find that there are such significant limitations in
what you can do for him. For those who suffer from anxiety and depression,
reassurance tends to be of limited value, and suggested solutions are often met
with resistance.

From your son’s perspective, the daily terror of believing
that his body is under siege from a variety of medical concerns and symptoms,
and his feeling of helplessness to combat such maladies, is truly a living
hell. With other forms of anxiety, such as those that focus on the fear of
other people or external situations, avoidance of these stimuli, although
harmful in the long run, can at least offer the afflicted individual temporary
relief from the object of their distress.

With health and medical anxiety, however, the source of the
concerns is primarily internal, providing the sufferer with no ability to escape
the feared stimulus. Imagine having a phobia of snakes wherein the snakes live
inside your body! Seeking unnecessary medical interventions and performing research
into the nature of the feared illnesses or symptoms can sometimes bring relief
in the form of momentarily felt control, however the worry and anxiety typically
return quickly, and usually stronger. Also, insight into the fact that anxiety
may be responsible for even some portion of the perceived symptoms tends to be
lower among individuals afflicted with health anxiety than it is among those
with, say, panic disorder, generalized anxiety disorder, or most phobias.

To best assist you and your son, I offer the following suggestions:

First, if your son has not already undergone a complete
medical exam, with a focus on his current symptoms, it is recommended that he
do so. This will demonstrate appropriate respect and validation for your son’s feelings,
reduce his resistance, and identify any actual conditions in need of treatment.
It will also in help him understand the degree to which there is a medical
basis for his symptoms.

Second, you can explain to your son that individuals with a
wide variety of medical conditions can benefit from psychotherapy and
counseling in addition to medical treatment. Indeed, anxiety can exacerbate most
medical conditions by weakening immune functioning, and by increasing the
levels of stress hormone circulating within the body. Working with a therapist
does not therefore mean “it is all in his head,” but will assist him in
reducing his stress level and promoting adaptive self-care, thereby providing
an ideal internal environment in which physical healing can take place. In
addition, attention to nutrition, physical exercise, social involvements, and
spiritual pursuits can all be quite useful in this regard.

Finally, it is important for you to know that people seek
help on their own schedule, based on their personal level of motivation to make
change, and their perceived cost-benefit of suffering versus seeking
assistance. Your son may not be ready to accept treatment today, but he might
be in a day, in a week, or in a year. You can continue to let him know that you
will assist him in accessing treatment when he is ready, but that you will
respect his judgment and not force the issue in the meantime. You will also
find it useful to refrain from challenging him about his concerns and symptoms,
or trying to disprove his beliefs, as doing so may unintentionally strengthen
his anxious position.

I hope that some of what I have written is of use to you.
Please do write again if you have any additional questions, or to keep me
abreast of the situation. Hearing how you have navigated this challenging
situation may be of great help to other readers.

Sincerely,

Richard E. Schultz, Ph.D.

www.drschultz.org

Question: Hi Dr. Schultz, I don't know if you're still answering questions on this site, but I ran across an excellent and empathetic response you wrote to someone three years ago and thought I might as well try... life is difficult for me right now, and I am seeking help wherever I can find it. I am a 34-year-old woman who has suffered from occasional bouts of depression and low-grade anxiety my whole life. However, besides a year or so on Prozac after a close friend passed away, I've been able to lead a successful, healthy life without medication. That all changed when I took mushrooms with my friends this past March. I had done shrooms at least four, possibly five, times before, and had had either pleasant or negligible experiences. This time was different. I had extreme anxiety to the point where I feared I was losing my mind, and ever since then, I have suffered debilitating panic attacks and anxiety. I had to deplane an aircraft - I've never had a fear of flying - and see a psychiatrist, who prescribed me Gabapentin. However, while the Gaba does help if I feel a panic attack coming on, it ironically increases my anxiety since I fear long-term side effects and don't want to be reliant on a medication to (barely) get through my day-to-day life. Everything has changed for me. I've always been a bit of a hypochondriac, but now I am devastated by any negative change in my health. For example, last night I went dancing with friends, and my ears have been ringing ever since, and I am currently battling panic over the possibility that I sustained permanent hearing loss (the ringing has never lasted this long in the past). I get anxiety before social events and have a very hard time motivating myself to get up and get ready in the mornings. Things that used to give me pleasure no longer do, which I know is a sign of depression (when I'm not battling high anxiety, I often feel empty inside). I went on a retreat to Guatemala this summer and bought some herbal pills with valerian root in them, and I now have to take them almost every night to sleep. I hate that I've gotten to a point in life where I am taking something or a combination of somethings every day just to survive. And when I DO feel normal, the mere thought, "Hey, I feel normal!" makes me panicky because I remember that most of the time, I'm battling anxiety. It's a vicious cycle. The election has made everything ten times worse. At least in the past, my issues were my issues, but I felt confident that our country was moving in the direction of progress. Now I feel like my security blanket has been yanked away; not only do I not trust myself, I don't trust the world I live in. I used to be a very upbeat, trusting, and generally optimistic person, but now I feel this underlying gloom and doom that dominates my waking hours. I don't know where to turn for comfort. Talking about it with my friends and family often makes the anxiety worse. Do you think it's possible I suffered permanent neurobiological damage on my mushrooms "trip" and that I will never return to my old self? If so, or even if not, do you have advice for how I can manage my debilitating anxiety without having to be drugged for the rest of my life? I feel like I've lost myself. Thanks so much, and happy holidays, Sabrina

Dr. Richard Schultz Says...: Hello Sabrina, and thank you very much for your question.

After an extended hiatus from Choose Help, I just recently
returned and found your inquiry waiting for me. I do apologize for this
extremely delayed reply, and am quite curious to know how things progressed for
you in regard to the symptoms of depression and anxiety you were experiencing
in December of 2016.

Coincidentally, that was the precise point in history when a
GREAT many of us in the United States, and around the globe, “lost our security
blanket.” Understandably, it sounds like for you the administration change compounded
an already waning sense of general safety and security in the world. It challenged
and violated many of your deeply held beliefs and expectations about yourself,
your life, and your future. This is the way trauma may impact and shape us, and
it may take the form of a great many different direct and vicarious experiences.

From your description, it seems as if your most recent
mushroom trip played a similar role in your life. The experience shocked and
terrified you, as psychedelic journeys have the potential to do, and it seemingly
triggered a severe panic attack. You did not mention any history of such acute
episodes, so I will assume it was your first of that magnitude. The feeling of “going
crazy,” combined with many other distressing physiological and cognitive
phenomena, all hallmarks of panic, is likely to have awakened and/or redefined,
at least temporarily, your previous repertoire of distressing symptoms.

Thereafter, it is not surprising that you became
increasingly vigilant to changes in your anxiety level, and your functioning, with
a particular focus on physiological effects (given the nature of panic and your
own prior vulnerability to health-related anxiety). As vigilance and increased
focus on symptoms tends to intensify the subjective experience of those
symptoms, and movement away from distress-inducing stimuli is negatively
reinforcing (meaning that avoidance will continue and broaden), your anxiety
worsened.

In addition, your pre-existing beliefs, judgments and fears
about the potential risks of medication were heightened when your condition
necessitated that you actually engage in such treatment. This step may have
also eroded your self-confidence as you came to see yourself as now “reliant”
on such medication. This is not to say that you somehow erred in taking
psychotropic medication. On the contrary, it sounds like a smart decision.
Doing so, however, consequently triggered anxious beliefs and further
heightened your vigilance to physiological and/or psychological shifts.

In summary, the unpleasant unfolding of your symptoms across
time perfectly illustrates the “vicious cycle” of anxiety. As is quite common,
the narrowing of your activities caused by the negative reinforcement loop of
avoidance can have easily triggered depressive beliefs about yourself and your
life. You saw how your behavior repertoire had narrowed, perhaps compared this
to your previous functioning, and became highly self-critical and despondent.
This is often how depression arises and worsens as a counterpart to anxiety.

Although research has offered many compelling models of
epigenetic, neuroanatomical, and neurobiological bases and correlates for panic
disorder and anxiety, none have thus far yielded results which suggest causal
damage in any of these areas. The same is true for psilocybin. In fact, increasing
clinical and scientific attention is being paid to the potentially therapeutic
effects of mushrooms in treating depression and anxiety.

In terms of “getting your life back,” I am guessing that
there is a very good chance you have already done so by now, given the
significant interval between your writing to me, and this reply. If so, please
do write back and let me know what you have done to effect this change. I am
sure that a great many Choose Help readers will be very grateful for your explanation,
as will I. If you have not yet fully recovered from this distressing episode,
Sabrina, I would highly recommend that you seek out an excellent therapist with
whom to consult. This professional would ideally have a significant grounding
in the treatment of panic and other anxiety disorders, and will also have a
strong grounding in cognitive-behavioral therapeutic technique. As you have
clearly read other of my opinions on this site, you will find more detailed
criteria for finding a qualified therapist among those responses. You will also
find some guidance on how to begin to reverse the constricting effects anxiety
and depression have had on your life. I wish you strength and peace on this
journey, Sabrina.

Sincerely,

Richard E. Schultz, Ph.D.

Question: Hello. I have social anxiety disorder and I've just changed my therapist, because I moved to a different city. I already had 3 sessions with my new therapist, but he's really different than my old one. I liked the old one more mostly because, when I told him that I‘m afraid of not knowing what people actually think of the things I say or do, he understood what I wanted from him and he‘d never (or at least almost never) beat around the bush. And even though I told this one the same thing, it still feels like sometimes he hides something that he‘d otherwise say just to not "insult“ me, I guess. He just makes the confused look for a second and says something really non-straightforward, which is pretty hard for me to understand. I talked about this thing with my friend and he didn‘t really agree that the old therapist was better, he said that he wasn‘t acting professional, because I should understand things myself and he shouldn‘t say his opinion and I feel like I really don‘t agree with her. It wasn‘t like the old therapist would just say his opinion and present it like a fact or made me do the things that he suggested me, he just said what he thought about the situation and suggested what could be the best solution for me, when I couldn't figure it out myself and I really appreciated that. I really want the new one to not be so overly nice, because I feel like it's not going to get me anywhere. But I‘m not sure how to talk with him about that.

Dr. Richard Schultz Says...:

Hello, and thank you so very much for addressing this question to me.

I find your question valuable for two reasons. First, it regards the treatment of Anxiety, of the Social variety, which is a specialty of mine. Second, it portrays the type of care NOT usually effective in such treatment, and third, your question is about the issue of communicating effectively with your therapist in order to yield the best outcome possible. Important issues all.

You may not have known this before, but you sure know it now; the "fit" between client and therapist, particularly from the perspective of the client, is a very significant predictor of therapeutic outcome. So, all in all, it is best to work with a therapist by whom you feel understood, valued, and whom you feel you can trust (trust that they are working with your best interests in mind and that they are highly skilled).

So, it seems we have a little dilemma here.
Technically, and purely based on your description ("he understood what I wanted and never hesitated to give it to me"), your former therapist was treating your social anxiety by
"giving you fish." In this case, "reassurance" is the fish. Perhaps you had a negative thought about how you might be seen
at an upcoming social event, or perhaps you thought your therapist was critical of your sounding a bit scattered in session; in both scenarious, it sounds like the good old therapist was quick to correct your fortune telling and mind reading, and to
promptly REASSURE you.

What's wrong with reassurance? In general, nothing. However, when it is elicited or sought in order to reduce anxiety, REASSURANCE ACTUALLY LEADS TO THE PERSISTENCE AND WORSENING OF ANXIETY! (based on the principle of "Negative Reinforcement" - Google it). Because although reassurance for an anxious person may yield a slight reduction in distress, it's really like a hit of "crack." It might feel great for a minute or two, or even 30 minutes or an hour, depending on how much reassurance/crack you can get, but the effects of both are terribly short-lived.
They are like "temporaries stays of execution." But with each new day, the
firing squad appears to line up yet again, and the anxiety is off and
running, once again.

The problem with being given nice, fresh fish every day, is that never actually learn to bait a hook, drop it in the water, and try
to catch a fish! And once you learn, you won't feel NEARLY so dependent on others for reassurance (which they don't ALWAYS give, right?). You will no longer have to worry about "whether or not there will be fish,"
or whether your therapist will give you any. The solution to this dilemma is to NOT seek fish, but to learn to fish. And indeed, as in leanring any new skill, there will be hits and misses on your way to a new set of skills. When someone hands you a fish, that all seems completely unnecessary, BUT IT DOESN'T LEAD TO CHANGE! Besides, most of us like to see ourselves as having a strong sense of agency and will and mastery in life, not as waiting for crumbs of crack to get through the day.

Ultimately, I suppose I would ask you how long you worked with the previous therapist, and during that time, by what percentage did your symptoms of social anxiety reduce? Approximately, of course. By 10%? 20%? 30%? Was the symptom severity ever measured and tracked from session to session? Were you given assignments to complete outside of session? Readings? Thought records? Exposures? These latter tools are DE RIGEUR when it comes to treating social anxiety.

So, what happens when you can't get
reassurance from your therapist? Or from anyone else? THAT is precisely
the right question to be asking in the treatment of social anxiety,
because the answer to it is your only real long term, "inside job"
solution. You learn a variety of VERY DIFFERENT ways of "greeting"
anxiety (after all, it comes from inside you, so it's best to treat it as a
friend and not an enemy).

My guess is that the new therapist MIGHT
be trying indeed to teach you to fish, versus simply serving them up,
but it is also clear that the rational for the new therapist's approach
has NOT been made adequately clear to you. It is therefore quite understandable
for you to feel disconnected from your therapist when you are not sure
what he is saying, or why he is saying it. Anyone else in your shoes would likely have a similar reaction, especially given what you had been accustomed to.

How to deal with this? Easy! My number one recommendation to you is that you
bring your original letter to me, and my response to you, with you to your very
next session. Put your cards on the table and express your concerns, your
disappointments, your confusion about what he's really thinking, etc.
Whether or not you like the answer, you will be treating the anxiety
SIMPLY by being willing to have the uncomfortable conversation. Its YOUR therapy, and YOUR LIFE that is being burdened by anxiety. It's also YOUR MONEY and YOUR TIME. Don't you think you deserve to use it as you wish? Perhaps not, and if so, this needs to go on the list of automatic thoughts ("I don't deserve to disagree with professionals, even if I'm paying; that is wrong, disrespectful, and could lead to an uncomfortable conflict or discussion"). That belief will then be subject to evaluation, and YOU will lead the charge!

Ideally, you will ultimately want to work with a
psychologist well-trained and experienced with the treatment of anxiety
in general, and of social anxiety in particular. They should have a
strong grounding in cognitive-behavioral therapy, which is the most
effective approach for this condition. Your new therapist may very well be coming from this perspective, and that may come out in the discussion I am proposing you initiate at YOUR VERY NEXT SESSION.

Your primary challenge is to relate to
anxiety as a friend or as an assistant; it is not your master although
you treat it as such. With self-acceptance, you need no reassurance, and
without it, all of the reassurance in the world won't help you.

Please feel free to review my replies to
many other questions about social anxiety, and my guess is that you will
benefit from doing so.

Please do also let me know if I can be of further assistance to you, and updates on your progress would be so very welcome.

Sincerely,

Richard E. Schultz, Ph.D.

Question: I recently tripped on mushrooms for the second time about 2 months ago. I had eaten maybe 2 grams of them soaked in orange juice and maybe 15 minutes later started to feel the effects. At this point I was in the car with 5 friends, 2 of which had eaten mushrooms as well. The other 2 were just there to watch over us. As I started to feel my body react to the mushrooms I asked my friend to take me home to get some cigarettes because I started to feel a little anxious. In the car my friend pulled out a joint and we all smoked it, after we smoked I started tripping very intensely. We got to my house and I had gone inside to get my things, by the time I had come out of my house my friend who was tripping as well was tearing up and just started on walking down my street. At that moment I knew I was in for a really bad time. We followed my friend and her boyfriend both of whom were tripping and got them in the car. My friend had pleaded to go home and I had no choice but to continue my trip at her house where both of her parents would be. When we got to her house everything was overwhelming. I had felt psychically I'll, nauseous, shaky, and nervous. I had had these disturbing thoughts of vomiting in my head (I'm an emetophobic) it was almost like a movie playing over and over of me being sick and vomiting on myself and being out of control. At this point I was fluttering and walking around just waiting the trip to end. My visuals were wavy and intense and I couldn't see straight. I had sat outside quietly with my eyes closed clinging to one of my sober friends in fear. I did this for about an hour just trying to calm down. While I had swirly intense closed eye visuals. I kept on thinking that we are all one and we are all connected and some part of my mind considered death as a positive thing. I was convinced that it wouldn't matter if I was dead and that nothing really mattered at all because we are all connected. After that I stopped feeling my body. I felt as if I was blowing in the wind, I kept on saying that I was going to blow away. I couldn't feel my body at all. Maybe 3 hours in I started to grasp reality a little better but my mind was still anxious and I was pacing back and forth laughing and then crying and so forth. One of my older friends showed up and at that point I was ready to go home so I called my mother and told her what was going on. She was furious with me. Then my sober friends drove me home. I went home and watched a movie and finally fell asleep. I woke up fine and was glad that my trip was over. The next weekend the same friend I had tripped with invited me to the beach. As we were there she pulled out some mushrooms and suggested we try again just eating maybe one or two. So we did. At first the trip was minor I only felt a little euphoria and that was all. By the time we had driven home maybe 2 hours after eating them the car lights started to become brighter and I felt like I was in a space ship. I started to panic a little and asked my friend to take me home, she did and she stayed at my house and fell asleep. I went outside because I started to have the anxious feeling again. Pacing around not knowing what to do or how to take my mind off of it. I just waited it out. Maybe 2 weeks later I was in the car on the way to pick up some weed with my sister, we were both heavy smokers. In the car I started to get a little anxious. Then I started to think about the shroom trip I had at my friends house. My fingers and hands started tingling and I started to almost feel as if I was tripping again. Embarrassed, I didn't tell my sister as she went into the shop. I waited for 10 minutes during which I had a full blown panic attack and called my mother. I had never had a panic attack that strong before, I had been diagnosed with anxiety and the age of 9 but only had minor anxiety attacks when I felt sick or nauseous. After the car ride I had several panic attacks. Maybe 1 or 2 every hour. Mostly because I was terrified of having another one i ended up giving them to myself. A week or two later I started breathing and learning how to cope with these attacks and at the first sign of one I could control it. I could not smoke weed anymore since it was make me feel some similar effects to the mushrooms and triggered panic. I started to isolate myself and started to have major depression and anxiety. Not panic attacks but more of a lingering anxiety. The moment I woke up it was as if I had a whole day ahead of me just to try and fight my way through hours of despair. Time started to become a fear of mine. I started to dread it, since I was just sitting on my couch waiting for the hours to pass by which went very slowly. I started to worry about the future and how much time I had on my hands. As if every hour was a day that I had to try to fight. The bought of tomorrow and a whole new day to fight was unbearable. I never left the house and found it hard to have relationships and friendships. I had even broke up with my boyfriend of four years because I had not felt the same towards him. I had these intrusive thoughts that I could not control. If something made me anxious or worry, it became a trigger and therefore I could not be around that thing or person in fear of having an anxiety attack. (My boyfriend became one of those things along with tv shows and foods). My thoughts were very irrational and I could not think straight at all. Sleep became an issue and I found myself awake till 5 in the morning watching tv. Which became one of the only things that could distract me and make me feel better for the time being. I was afraid to go outside and communicate, I feel a derealization as if I was in a constant dream state. Everything almost looked different and felt different like I was on a different planet. I became suicidal and even started threatening my mother not to leave for work because I would die if she wasn't with me 24/7. She was a good distraction for my mind and helped me with a lot. When she wasn't around I would constantly think and I would give myself panic attacks. I felt worthless, like a baby that needed someone to hold my hand or else I would have a mental break down. My family, scared and worried, told me I had to take medication (though I had a bad experience with taking lexapro a few nights earlier which gave me a panic attack instantly after I took it) so I forced myself to take lexapro every night right before I fell asleep. I would go through period maybe weeks of being anxious and not being able to leave the house. Then maybe a week or two of feeling normal and I could see my friends again. Then another week I was back in bed again feeling worthless. I don't understand what happens with me or how I can fix it or if I ever can.

Dr. Richard Schultz Says...:

Hello and thank you for addressing this inquiry to me.

I understand that you now find yourself in a place of greater confusion, insecurity, self-doubt, and worry than ever before in your life; I sympathize greatly with the distress you are experiencing, although it makes complete sense to me that you now feel as you do.

You did not specify your age, but I am guessing that you are in your late teens or early twenties. If so, I would expect that your confusion about yourself is only that much more pronounced, given that you are still in the process of really figuring out who you are for the first time in your life. So, as your brain is just getting to know you, you have have been bewildering the hell out of it with your behavior.

You may not have known this, but our human brains rely primarily upon the observations they make of our BEHAVIOR when calculating our most important feelings and thoughts about ourselves.

So. It sounds like you have quite a combo-platter going there for yourself; on the non-substance side is a pre-existing case of emetophobia (which, for those who are not aware of it, is an often debilitating fear of vomiting or being around someone else who is vomiting, or even just talking about it). Emetophobia rarely presents by itself, and so I will assume you do also experience some degree of other types of anxiety (even when sober), such as panic disorder, generalized anxiety disorder, or social anxiety disorder. On top of this, you are a young adult, facing a variety of perfectly normal but nonetheless challenging life tasks, such as individuating from your family, establishing your own adult persona, choosing a professional or creative or educational path to pursue, exploring your sexual identity, and perhaps discovering your spiritual self.

And all of that is for sure enough to keep you darn busy for a while, and can prove to be, on its own, a somewhat intense path, with lots of ups and downs, trials and errors, hits and misses.

But several other potentially destabilizing events have also been introduced into the cocktail that is your life. You have been using hallucinogens on a recurrent (and it sounds more like frequent..3 times in 2 months?) basis. You also use marijuana, alcohol, and nicotine to modulate your experience. With the addition of these substances, your already quite changeable daily life has become dominated by a set of extremely powerful thoughts, feelings, images, memories, and behaviors. By taking the reins off of your frontal lobe and cerebral cortex, you have turned your brain from a helpful servant into a cross between a cruel taskmaster, and a 110 pound toddler! As we have 70,000 thoughts a day, and as the majority of them are negative, you have practically let your brain loose to tell you anything it wants, no matter how true or outrageously false it is, and you are far more vulnerable to actually believing it! Yeah, it's nice when you have the thought about being connected to everyone, however the notion that being dead really wouldn't matter much, or that something is very wrong with you mentally or physically, are cognitive experiences that are NOT intended to be given free rein to run wild in your psyche, completely unchecked. When these kinds of odd or negative experiences occur to us while sober, we typically have the resources to shrug them off as "silly," however the dysmodulated brain has no such ability, and thus the tail starts wagging the dog. In short, you were initially playing the game, and now the game appears to be playing you. I infer this, in part, from your closing line, "I don't understand what happens with me or how I can fix it or if I ever can." In this way, the "cure" for your problems has done far more damage than the underlying "disease."

In your account, you describe several signs of behavioral and psychological dysfunction, the majority of which seem to flow, not from your basic life circumstances, or your moderate degree of underlying anxiety, but from the act of adding drugs and alcohol to the mix. You have subsequently experienced recurrent suicidal ideation and imagery, desperate attempts to avoid being alone, aggressive, threatening, and perhaps even violent behavior (toward your own mother) in an effort to prevent such feared abandonment. Your basic life functioning has been notably disrupted, with prolonged periods of social isolation, avoidance of friends and others, and a reluctance to even leave the "safety" of your bed (I use quotes around safety because it just doesn't sound like it feels all that safe for you there).

Perhaps what I most want to tell you is that I am very concerned about you. Your willingness to take repeated risks with your physical and mental health, and lack of adaptive self-care, suggest that your judgment has gotten a bit bent by your choices and their consequences.

Give all of the above, I URGE you to immediately speak with a TRUSTED and TRUSTWORTHY adult caregiver, family member, teacher, spiritual advisor (priest, rabbi, youth minister, what have you), or friend about these difficulties. The goal in taking this step is to garner understanding and support for what you have gone through, and for what you must do to heal. Whether or not you take that first step, I also URGE you to consult a medical or mental health care professional as soon as possible so that you can be thoroughly evaluated, provided guidance in how to begin understanding the drivers and effects of your recent behavior, and to assess for the presence of any other underlying or accompanying medical or mental health conditions that may be relevant. I say this because the most common age of onset for schizophrenia is in the late teens and early 20's, and it often begins to emerge in the context of depression, unusual sensory and cognitive experiences, and accompanied by alcohol and substance abuse. In this regard, drugs and alcohol abuse is common among those beginning to experience prodromal symptoms of psychosis, as a direct attempt to neutralize or muffle the emerging disorder. Unfortunately, masking of the underlying disorder may indeed occur, preventing early diagnosis or treatment. And, of course, the substances themselves, and the incredibly challenging internal and external consequences to which they give rise, can also hasten the onset of another mental disorder (in addition to addiction).

Did I write this to scare you? In part, my answer is yes. Did I need to distort any facts of science in order to do so? Not at all. I know I probably have only one shot with you, my young friend, so I am making the most of it.

As difficult as things may be for you today, or even at this very moment, the fluid, impermanent nature of life, and the resilience and plasticity of our amazingly high tech brains, are solid proof of your ability to get to higher ground, and to a happier, more peaceful, and productive life. You had the freedom and ability to get from where you were before to where you are now, and you likewise have the built-in mobility to navigate to a far better place (None of us can ever get back to where we WERE, as that would require time travel, but we do have the ability to move into an even better future.

To quote "The Shawshank Redemption," an amazing film about internal and external imprisonment, we humans are faced daily with the option to "get busy living or get busy dying." And we have to remake that important decision every day of our lives.

I hope that some of what I have written here is of use to you, and I strongly encourage you to write back and provide an update on how you are doing. That will be of great help to others traveling the same difficult path, and it will also assist me in understanding what may have worked for you and what did not.

In the meantime, please review the several posts I have written in response to other young people with strikingly similar difficulties. You will know by reading the title of each post how relevant it may be to you. I point you to those posts because many of them flesh out more fully the mechanisms underlying the way substances and anxiety can interact and exacerbate one another, and what treatment for such difficulties would look like. You are of course welcome to follow me on Twitter (@mindsetdoc) or IG (@mindsetdude), or by subscribing to my blog (mindsetdoc.com).

Sincerely,

Richard E. Schultz, Ph.D.

Question: Dr Schultz, I've been trying to get help, first I have to apologize for the English, it's not my first language. I moved to other countries for two years now, about 1 month ago, I'm having a presentation in class, I'm well prepared, but when it was my turn, I got really panic and can't speak, I still get upset by thinking about it, I feel like everyone remembers it and secretly making fun of me. At first I thought it was because English is not my first language that's why I get nervous, but I still remember before I moved, I was like this too. In every presentation I would sweat and blush, my palms are cold and sweaty sometime I even got upset stomach before or during a presentation, my face would be hot and red to the point that steam would form on my glasses , which makes me more nervous because everyone will see how nervous I'm. Not only a presentation, I would blush when I'm talking to strangers,but only when I messed up, I'm usually ok in a 1 on 1 conversation. I'm afraid to tell my parents, especially my mother, I haven't seen her for 5 years, and she wasn't around me too much when I'm younger, I asked her why and she said because she doesn't like babies, I always feel nervous and stressed infront of her because she always judge my behavior, for example how I dress, the way I walk and the way I speak, I was never a loud person or get excited easily and my mother hates it and tell me no one would like me and I will never get married, She often asked me why she have a child like me, I try not to cry infront of her because she hates when I cry and she always said I deserve it, sometimes I get depressed because I have no one to talk to, my family is too complicated and I don't want any of my friends to know. When I was in kindergarten, I lived at neighbors house, I've been at 2 different neighbors house, when I'm 6 my father and mother divorced, than my mother got herself a boyfriend, so all three of us lived together, my mother usually come home late. When I'm 11 she left to and go to other country, so I was living with her boyfriend for 4 years, it was fine but I just don't like it. Now I moved and living with my mother and her new boyfriend i don't know is it because all the changes or what causes me to behave this way today, I'm not able to go to mall by myself, I can't speak loud and my voice is always like mumble, I have few friends in school and I'm keeping contact with my friends that are in my back home, even now, my hands are cold because I'm afraid to send my problem to someone, I haven't go to a professional doctor to diagnose any mental problems, I get nervous when I have to make a phone call, I don't know what to do. I just want to know what can make me feel better, I still laugh when I'm with friends, but get sad when I was alone. My concern are, base on what I describe, should I go find a doctor or it is completely normal?I don't know why I have such a hard time and behave this way, I've been worrying bout this for a while and I still avoid going to parties or mall, but thanks for taking your time to read this .

Dr. Richard Schultz Says...:

Hello, and thank you very much for consulting me about your struggles with anxiety.

Although you may not be aware of this, the symptoms and challenges you have described are quite common within the human population.

In the United States, we refer to this syndrome as "social anxiety disorder," and it is typically characterized by a fearful preoccupation with others' critical or negative evaluations, judgments, or disapproval. I understand that, in your situation, the condition was exacerbated once you moved to a new country, yet it is also clear that the condition existed prior to that. It is quite common for signs of the condition to be present in childhood, manifesting as shyness, social ambivalence, or attachment problems. So, these symptoms begin as a temperamentally driven tendency toward shyness. Thereafter, any challenging social or interpersonal situations come to be avoided because they are experienced as somehow unpleasant. This avoidance behavior becomes quite instrumental in the further worsening and persistence of the anxiety.  The relief one experiences after avoiding a fear triggering situation is part of the process of "Negative Reinforcement;" the behavior leads to very short term reduction of anxiety, and is therefore repeated, however, continued avoidance prevents one from improving their ability to cope with the aversive stimulus. Thus, the condition worsens, as the sequence of symptomatic behaviors is repeated and strengthened in a cyclical and habitual manner.

Further, as anxiety is a typically progressive condition, and via the process of generalization, more and more people, feelings, and situations will come to be avoided across time, due to their paired association with the worry about experiencing anxiety. This illustrates the true definition of anxiety as "fear of fear." During this process, the anxious person is quite aware that they are "on the run" from their fears, and this observation of one's own avoidance leads one to make negative judgments about the self. This is a common pathway for the development of symptoms of depression.

As you noted, physiological symptoms of panic can also exacerbate social anxiety in a variety of ways. It can manifest as gastrointestinal distress, hot or cold sweats, blushing, or muscular tension, as many of these symptoms are common reactions of the central nervous system to the possibility of danger. So, the fact that these symptoms are occurring actually means that your equipment is working correctly.

Another aspect of what you described that is common among individuals with social anxiety, is that you were frequently exposed to a caregiver (your mother) who was herself averse to, and critical of, the idea of expressing or showing emotions in front of others, or feeling or appearing out of control in front of anyone. You may have not only learned to adopt your mother's perspective, via modelling, but you may also have developed a strong motivation to suppress or hide your own vulnerable or overtly emotional feelings or behaviors, given that any manifestation of them was not likely to bring your mother closer to you.

I hope the preceding material has provided you with a good basic explanation of how you got to where you are. Now, let us address the issue of healing and growth.

You will be glad to know that the pathway to change in your situation will not be
particularly complicated or difficult. It will, however, require that you
agree to tolerate the distress that will naturally result from implementing your choice to leave the comfort
zone. If you are willing to face, and even embrace the frightened parts of you, and to do so with a strong motivation, you'll find that your distress will dissipate rather quickly
as you learn to live with an expanded repertoire of social behaviors, coping abilities, and confidence.

Although I note that the method of
change here will not be all that complex, it will be much easier and
more efficient if you employ the resources of a qualified therapist who
can guide you through the process.  In addition to providing basic
support and encouragement, a mental health professional trained in
cognitive-behavioral technique will be able to help you better
understand the mechanisms underlying your current state, and help you
develop a cohesive plan for making change. This will involve
re-evaluating some of your well-established patterns of thinking and
behaving, learning how to increase your ability to master your
physiological and emotional discomfort, and executing a series of graded
behavioral experiments, also known as "exposures."  The therapist will
focus on the interpersonal and intrapersonal challenges you face across
all settings in your life, and help you develop an even better
understanding of the environmental or developmental factors that led to
your developing these protective techniques in the first place. CBT for
social anxiety is time-limited, carries no side effects, and will lead
to a greater sense of overall well-being and confidence.

If you would like to try and take a few steps on your own before
seeing a therapist, you can certainly do so, however, as Albert Einstein
wrote, "It is impossible to solve a problem with the same thinking that
created it."  That is why having an objective and trained professional
at your side will optimize this process.  A few non-therapy activities
that might steer you in the right direction are reading and working your
way through a good book on social anxiety, or joining an organization
designed to help individuals build their social confidence.

As far as reading, I recommend you consult
"Managing Social Anxiety" By Heimburg and Turk. As far as groups go,
"Toastmasters" is an international organization that has been helping
improve their social confidence since 1924. Find out more about them at
www.toastmasters.org.

I hope this reply has been of some use to you, and I invite you to
let me know of your progress and to direct any further questions to me.

Sincerely,

Richard E. Schultz, Ph.D.

Question: Dear Dr Schultz, Thank you for offering your advice on the internet. Sometimes it's much easier to seek help this way, especially when some experiences are embarrassing to share. I have an ongoing fear of home invasion that started 14 years ago. It has got worse, and I have been experiencing ghastly nightmares and panic attacks for the last five years. My home has been broken into several times, in fact this is what embarrasses me the most. I can't talk about it because not only do I see disbelief in the eyes of others, but I feel that the sheer number of times must indicate that something is wrong with me. Yet I don't know what I could have done to prevent any of these events. The first time, I was 19 years old, and studying in a town away from my parents. My father was (and is) emotionally abusive, controlling, and incredibly frightening. That day he decided to turn up unannounced, but I wasn't home. He was paying my rent, so he believed it was his right to break into my little one room flat by kicking a hole through the front door. When I got back that evening I felt such fear and shock that I called my mother, who told me they had "visited". Strangely enough, that didn't help at all. It nearly felt worse. I got the door fixed, but I had no idea how to fix myself. I felt awful, and angry, and guilty for the anger, because they were paying for my rent, after all. The second time, I was 26, and I had my own place. A large flat I rented in a rather nice part of town. It was the middle of the afternoon on my day off from work, and I was spending the day in pyjamas, expecting no one, lying on my bed reading Jane Austen with a cup of tea. I heard a loud knock on the front door, and was suddenly caught in a moment of indecision. Do I answer or just let it go? I wasn't dressed adequately, and besides, I was expecting no one. But before I'd even made up my mind, I heard more noises. Someone was prying the door open with a crow bar. I froze, then got up, but it was so quick, that he was inside my home in an instant. Luckily, the corridor led straight to my living room, and he walked past my bedroom door to get there first. I didn't know what to do. I knew the police wouldn't get there in time, but I knew my friend and neighbour was home. I hid behind the bedroom door and dialed his number. Whispering as quietly as I have ever whispered, but panicking too, I asked him to come round. At first he couldn't even hear me... then he wouldn't believe me... that was the worst. I wasn't speaking normally... I was deliberately skipping superficial words because I was afraid I'd be heard, so I sounded like an old fashioned telegraph. At last he felt it in my “voice”. Less than a minute later, he got to the building and the burglar heard him open the door downstairs. All the while the intruder had been making muffled noises in the living room and I could hear heavy footsteps. I thought I was going to die because I hadn't dared make my presence known... I was literally in a weird frozen state, like calm and panicked at the same time. I don't know how to explain. All these thoughts were rushing through my mind, such as, when he opens the bedroom door he's going to be surprised, his reaction will be unpredictable, he might panic too and kill me. Apart from that phone call, I couldn't move. I wasn't breathing normally, because I feared he'd hear my breath. My heart was pounding so hard I thought it would give me away. I was afraid my phone would ring, but I couldn't turn it off, because it wasn't on silent mode and he would have heard the "off" jingle. I wanted to break it. Even removing the battery was more noise than I could afford. When the intruder heard my friend on the stairs, he walked out, fast. I heard him walk past my bedroom and out the front door. My friend started shouting at one point, he told me it was after they'd walked past each other on the stairs, and he actually realized what had happened. He saw my door broken in, the lock was on the floor, and there were wood chips everywhere. I still couldn't come out of hiding. He had to come and get me where I was. That's when I collapsed, shaking, as if the frozen state had kept me up, and then it snapped, leaving me drained of all my energy and I just cried and cried and kept shaking with violent spasms. We called the police but nothing had been stolen so they did nothing. A few months later, two detectives did show up at my friend's place, because he was an eye witness, and admitted the procedure hadn't been respected, because they'd forgotten to show him photographs of potential suspects. Four months later, I got back from a sleepover to find the door broken in again. This time my laptop had gone, and the cables of my desktop were partially unplugged, which makes me think whoever it was must have been interrupted. I waited for the police to get there before I dared go inside, because I was afraid the burglar might still be there. The police were horrible about it. They were brutal, and dishonest. I don't know why. Maybe they were fed up because I was sobbing. I don't know. They just wanted to know what was missing, but they wouldn't let me check properly. I only noticed my laptop was missing after they left. One of them said to another in front of me "if there's nothing missing, we'll say nothing happened". I couldn't believe it. My door had a gaping hole in it, where the "new" and supposedly "secure" lock had been, with wood chips everywhere again. My friend's theory is that they were worried about not having followed the procedure the first time. I had gone straight back to work the first time, but I wasn't myself. This was too much, and my GP told me to take a month off. I was working in a bank, and I needed to be efficient. So I didn't take the medical advice... and burned out. I lost my job. I hate myself so much. That job was so important to me... banks were no longer recruiting where I lived, they were firing people left and right, and I desperately needed to hang on, but I wasn't strong enough. I was weak. I was a bit dead. I'm so ashamed. I decided to move out of my flat. I didn't feel safe there. Without a job, I was living on my savings. I didn't feel up to going to any interviews, because something was just wrong. I wasn't "me" anymore. So I got a small room and went back to school. I had to do something, but I didn't want to "betray" an employer. So I chose to study law. It was nice, because I could go to class and just learn. It was so much easier than going to a job, because I didn't have to pretend, or smile too much, or be criticized for looking like an empty shell. I actually did very well. I passed the first year with excellent grades. And then the second year, during the midterm exams, it happened again. I ran home exceptionally between two sessions for lunch and a 20 minute nap (I wasn't sleeping well). Just as I lay my head down, I heard someone try to insert a key in my lock. I froze again. Being a coward was becoming a habit! It wouldn't turn, because my own key was in the lock. Then I heard the knob shake and rattle angrily, and my landlord's voice yelling "I can't get in! Something's stuck". I ran to the door then, in anger and disbelief. I never missed a month's rent in my life and it's absolutely illegal for a landlord to enter a tenant's flat. When I opened the door, his jaw dropped. He didn't expect to see me! He mumbled an angry excuse, and then his wife turned up behind him, just as surprised as her husband, with my mail in her hands. I asked how long they'd been doing this. They wouldn't answer. I told them this was unacceptable. But I had an exam to go to. It was the hardest exam I ever took in my life. My brain was in a state of trauma. I wanted to press charges, but I couldn't bring myself to go back to the French police. (All this happened in France. My handbag had been stolen off my shoulder since the burglary, and they refused to take my deposition because I’m English, not French… I no longer trust the police in this country, I’m afraid). I started closing the blinds and putting toothpaste on the light switch, to make sure no one had visited my room in my absence! It sounds like madness... I found the toothpaste smeared on the wall THREE times before I actually dared to do something. I was a ghost. I felt completely naked all the time. Exposed. Lifeless. I felt like I had no intimacy anymore. I started staying home to defend it from intrusion and dropped out of school. I felt like an animal. As though I had no control over anything. Then I did the opposite. I left home for long periods of time, staying at my boyfriend's instead. My friend, who is a social worker, tried to help. He called the landlord, and told him we were taking him to court, and stated my rights. In France, where I live, home intrusion is a criminal offense, whether you're the landlord or not. But the result was not what I expected. The landlord got angry. He changed the locks and stole and destroyed all my belongings. Everything I owned. I was so broken by then that I couldn't do anything. I still haven't, and it happened two years ago. It's too late now. I hate myself for not reacting, being so inefficient, and pathetic. Letting him get away with it is awful. Now I'm dead inside. I still feel naked and exposed. My diaries, all my papers, photographs, everything is gone, and it's all been taken by a man I fear and loathe. I feel dirty, and ashamed. My deepest secrets, my dreams, my silly teenage thoughts were in those diaries. He was a nosey, disgusting landlord, who enjoyed letting himself into his tenant's flats, so I know he combed through everything I ever owned and probably read all my stuff. Now I have lost everything. My belongings, and my soul. I'm living with my boyfriend and haven't been able to work. I'm especially ashamed of that. I have a fear of doors... it's not agoraphobia. I can go out. But I keep having nightmares about doors. I lock them, and they open, or turn into flimsy useless little things, people walk through them, keys don't work, I wake up in sweat and cry. If someone knocks or rings the door bell I freeze, it's like receiving a physical blow in the chest. I start shaking uncontrollably, every time. And I cry. A lot. Now I feel like nut case. I don't know what's wrong with me. People have experienced much worse and they get over it. I would be ever so grateful for any advice. I cannot afford therapy at all. We hardly make ends meet as it is, because I'm such a useless burden. It's like I'm drowning, and you're my last resort. Sorry for such a long and boring question. Thank you so much for reading it.

Dr. Richard Schultz Says...:

Hello, and thank you for writing to me. I am so very
sorry to hear of your longstanding distress, and am glad to hear that you are
now motivated to heal.

Further, in sharing your experience with me (via Choose
Help), you are indirectly assisting others who have suffered from anxiety in
similar ways. 

I know that you have felt a great deal of shame,
embarrassment and self-criticism as a result of your traumatic past. I also
know that a significant portion of your pain has stemmed from the belief/fear
that others will not believe you or sympathize with you, and that they might
even somehow blame you for these experiences.

Therefore, in addition to the upsetting experiences
themselves, you have also learned to internalize a view of yourself as weak,
shameful, and untrustworthy, and have come to criticize yourself harshly for
having these difficulties in the first place. I call this set of painful
self-appraisals “Level 2” of the problem, “Level 1” being the simple facts of
the traumatic episodes, and the impact they have had on you.

So, before I proceed, I would like to tell you that
EVERYTHING YOU HAVE DESCRIBED MAKES COMPLETE SENSE TO ME. Based on the path you
have traveled, these recurrent and upsetting thoughts, feelings, and behaviors
are very logical consequences to what you have undergone, and they have sadly
gotten significantly worse over time.

Despite the entrenched place in which you now find yourself,
however, YOU CAN HEAL FULLY FROM YOUR ANXIETY. In fact, if you pursue a solid
path of recovery, it is likely that you will emerge from treatment feeling even
stronger and more confident than you ever have before. I make these positive
statements because they are empirically supported facts, and because I know
that being optimistic about recovery will be one of your greatest tools of
recovery. So too will be compassion, for yourself.

Okay, so how to make sense of the ways in which the past
has led you to where you now find yourself? Well, I think you’ll be glad to be
reminded that you were not born this way, and that you never intentionally
CHOSE to live this way. Experience has been your teacher, and it accounts for
why you behave and think and feel as you do now.

I am now going to review what you told me, and point out
some of the phenomena that have likely been responsible for the majority of
your difficulties. My goal here is to help you understand yourself, and to also
illuminate these concepts so that others can understand them as well. These
principles play a primary role in the development and exacerbation of all
anxiety disorders, whether one fears a home invasion or being confronted by a
terrifying snake.

The first concept at work here is "Classical
Conditioning" (CC). In CC, a previously conditioned stimulus (in this case,
your difficult relationship with your parents) is paired with the previously
neutral stimulus of being robbed. Yes, it might seem a stretch to describe
having one’s home broken into as a “neutral” stimulus, since it would be
extremely unpleasant for anybody. However, the majority of people who undergo
such an experience will not go on to develop an anxiety disorder, such as post-traumatic
stress disorder, and memories of the negative event will dissipate naturally
over time.

In your case, however, the pairing of the conditioned
stimulus (relationship with parents) and the neutral stimulus (experiencing a
home invasion) led to the development of a powerfully negative higher order
relationship, and this newly conditioned stimulus (the idea of being
burglarized) and has taken on a life of its own.

Once this pairing occurred, at the time of the initial
break-in, all of the negative aspects of your relationship with your parents
came also to be associated with home invasion, making the latter so much more
powerfully upsetting and influential for you. For clarity, here are several
negative aspects of the pre-existing relationship with your parents (the
conditioned stimulus):

1. You have long experienced your father as emotionally
abusive, intrusive, controlling, and frightening.

2. You described feeling financially dependent on your
father.

3. You described feeling “awful and angry and guilty”
about your anger at your parents, due to your financial dependency on them.

4. You felt self-critical after your parents initially
forced their way into your apartment, because you believed that you were unable
“to fix yourself.” This suggests that you have long expected yourself to
sustain the hurt from that relationship but not let it bother you (yet another
example of Level 1 and Level 2 thinking).

5. You described your mother as someone you could not rely
upon as an ally in the conflict with your father, perhaps because of her own
anxiety.

6. You have a history of tiptoeing around your parents’
personalities.

7. You learned to take your parents’ power over you very
seriously.

8. You had already learned to be vigilant to risk and
possible danger.

At the time of the second invasion, 7 years later, the
following beliefs, feelings and behaviors also became associated with your
reaction to being burglarized.

                “I
won't be heard.”

                “I
won't be understood.”

                “I
won’t be believed.”

                “I will
be frozen in terror, and unable to speak out.”

                “I will
be killed.”

                “Symptoms
of panic will prevent me from protecting myself.”

                “Law
enforcement will fail to help me because of their own errors.”

With the subsequent break-in and robbery,four months later,
the following thoughts and feelings also emerged:

                “Law
enforcement (by now, a proxy for male authority figures, such as your father),
are                               “horrible,
brutal, and dishonest.”

                “Authority
figures are fed up with my sobbing.”

                “Authority
figures care only about my tangible losses, not my emotional ones.”

                “Authority
figures are more concerned about covering their errors than they are about
the losses
I have sustained.”

Following that episode, you were advised by your physician
to take some time off of work so that you could recover from the emotional
trauma you had undergone. This suggestion did not sit well with you, as it
seemed to trigger a view of yourself as “weak, inefficient, a bit dead,
ashamed, and not strong enough.” You were therefore motivated to relieve these
unpleasant thoughts.

At that point in time, it appears that another fundamental
psychological concept came into play, this being “Negative Reinforcement.”
Based on principles of operant conditioning, the law of negative reinforcement states that “any behavior which leads to the
termination or avoidance of an unpleasant stimulus will be repeated.” In this
case, the unpleasant stimulus was the view of yourself as “weak and
inefficient,” and the avoidance behavior (also known as a “safety behavior”)
was to force yourself back to work.

Although this action may have very temporarily reduced your
discomfort of feeling weak, the truth is that you simply were not ready to
return to your job (and that you were badly in need of psychological
treatment). Thus, the decision to promptly return to work actually set you back
in the mid to long term, because you ended up losing the job. This unpleasant
outcome then strengthened the following beliefs, feelings, and behaviors:

                “I
desperately needed to hang on and I failed.”

                “I hate
myself so much.”

                “I am
so ashamed.”

                “I am
obviously unable to master my difficult emotions and thoughts.”

At that point, you elected to move out of your flat. Again,
Negative Reinforcement came into play, as “feeling unsafe” was temporarily
reduced by the safety behavior of moving, although the ongoing, underlying
anxiety-driven beliefs remained unaddressed. So, the engagement in safety or
avoidance behaviors, which allow for the temporary reduction of distress, are
actually the very behaviors that facilitate the perpetuation of the difficult
thoughts, feelings, and additional avoidance behaviors. This is the vicious,
downward spiral present in almost all anxiety disorders.

“We get better at whatever we practice and we are always
practicing something.”

By then, several new painful thoughts and feelings had also
been added to the scenario:

                “My
symptoms of anxiety prevent me from going on job interviews.”

                “Anxiety
is severely limiting my functioning. I am powerless against it.”

                “I am
not ‘me’ anymore, and am thus unemployable.”

At this point, things became a bit more complicated, and the
idea of returning to work had itself become an aversive stimulus. Perhaps
because it was associated with the previous return to work, or perhaps due to
the fear of “betraying” a potential employer (I am assuming you believed it
would be dishonest to present yourself as a “capable worker”?). As you felt you
“had to do something” (either because you needed to occupy your anxious mind,
or because you were feeling unproductive), the re-enrollment in school had now
become a safety behavior designed to reduce the power of these unpleasant
thoughts and anxiety-driven needs.

As the model would predict, your return to school did indeed
provide a temporary, safe-haven “bump” from the previously negative thoughts
and feelings. Although you effectively reduced your comfort zone ongoing, you
were able to briefly increase a sense of control over yourself and your
environment. In addition, as a student, you saw yourself as a bit more
anonymous, in a desirable way, and believed that you would not be as closely
focused upon, evaluated interpersonally, or criticized for the being the “empty
shell” you actually felt like.

Note that the relief in this case came NOT from feeling
particularly confident about yourself, but from believing that your negative
internal experiences and struggles would not be VISIBLE to others. As predicted
by your baseline intellectually ability, in the relative absence of anxiety,
you performed unsurprisingly well. You were probably also beginning to have a
little hope that life might actually be getting better, and that your condition
was improving.

Unfortunately, as noted, none of the underlying
trauma-driven beliefs had ever been directly addressed. They were simply
avoided. So, while the “house” appeared to be getting stronger, its foundation
was actually continuing to weaken.

Then you get to your second year of school, and the worst
happens. You are shocked by a surprise visit from an “old friend,” a home
invasion. It happens while you are napping and “expecting no one,” similar to
the occasion on which you were invaded while reading Jane Austen.

This time, it is reportedly the landlord’s doing, and not a
burglar, per se, or your father. Thus, the already negative view of male
authority figures as “unsafe” was strengthened further, as was the belief that:

                “Being a
coward has become a habit for me.”

It may also be important to note the similarity of this
landlord situation to the very first invasion, by your father and mother. Just
like then, an air of anger emanated from the man, while “the wife/mother” served
as an idle accomplice. These similarities further explain how trauma of the
past can be triggered by specific events of the present.

Although you were at that time quite strongly motivated to
again contact the authorities, you had also come to believe they were not
trustworthy. You were therefore negatively reinforced for AVOIDING the police.
As expected, this also further fueled your unsafe feelings, and the
manifestation of other safety behaviors such as keeping the blinds closed, and
applying toothpaste to the lighting switchplates. As for your view of yourself,
witnessing this behavior, you began thinking:

                “I’ve gone
mad.”

Again, please notice the internal consistency of your
thoughts, feelings and behavior as they cluster around an intense focus on
potential threats. More and more, the triggers are everywhere, within and
without, and there is no safe haven. They are all aligned to paint a very
scary, malevolent and dangerous picture of the world in general, and a very
inefficient, “weak,” and “mad” view of yourself. It’s impossible to imagine
that being in a place such as this would feel anything other than scary and
depressing, and that there would also be much anger, toward self and others.

Your behavior had become virtually ruled by your fear, to
the point at which you elected not to even act in response to actual signs of
intrusion (toothpaste smears). My guess is that you had become increasingly
self-doubting by that point, which of course goes along with “feeling mad,” and
that you would have also commonly ruminated about your judgment and decisions,
and been very careful about disclosing it to others. This would have only
increased your sense of social isolation.

At this point, your self-image was notably and negatively
distorted, described by the word “lifeless.” Yet the anxiety cycle continued.
To ease the unpleasant thought of feeling “exposed” and “completely naked all
the time,” you withdrew from the world even further, to stand guard over your
apartment. You dropped out of school, believed you had no control over anything
(except MAYBE a home invasion), and you felt like an animal.

Then a shift occurred, and you begin avoiding your own
apartment in favor of your boyfriend’s place. Another negatively reinforced
bump. Although the assistance of a social worker friend temporarily promised to
get you justice, the angry landlord just got even angrier and then suddenly and
forcibly evicted you and your possessions.

At last, you described seeing yourself as a pathetic,
ashamed, dirty, inefficient, soulless, dead, naked and exposed woman who has
been violated and defeated by one or more disgusting, sadistic men.

And with that recount of your saga, and an attempt to
explain the progression of your symptoms, from a cognitive-behavioral
psychological perspective, I will pause in my reply to you. I will provide the
rest of my reply in an edited addition to this post.

I am doing this so that you can take a little time to
understand and digest what I have written thus far, and so that I too can
continue to refine my formulation of this case. In the next installment, I will
describe the ideal treatment approach suited to your recovery.

Of course, should you wish to provide me with any additional
detail, or even interim feedback on my accuracy in understanding your story,
please do comment upon this post. I thank you again for your amazing openness,
and for your willingness to reach out for assistance.

Sincerely,

Richard E. Schultz, Ph.D.

www.drschultz.org

www.mindsetdoc.com

@mindsetdoc