Social Anxiety

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The following is an email from Jacob Towery, MD to my weekly training group at Stanford, describing his recent two-day intensive with a man who’s been struggling with performance anxiety and social anxiety. The patient gave permission to post this email on my website. We have disguised his identity to preserve patient confidentiality. The patient is hopeful that this case description will be inspiring and helpful to others who struggle with shyness and other forms of anxiety.

Jacob is one of the psychiatrists trained in TEAM-CBT. He is a superb therapist, as you’ll see below, and he also does volunteer teaching at Stanford.

David Burns, MD

Hi all,

David asked for more info about how my Intensive went last week so I thought I’d write a quick summary. Big thanks to David for sending this awesome client my way and also helping to make the Intensive very successful. The client was quite generous in saying that I can use his story but I have disguised his identity.

The client is a 32 year old rock star from Denmark. We’ll call him Sven. Sven has been very successful despite a challenging upbringing. He recently had the best selling album in Germany and he’s played to crowds of tens of thousands of adoring fans. Despite his success, he occasionally has stage fright, and feelings of intense insecurity, particularly when performing live on the radio. This has only happened a few times but he’s terrified that it might happen again, so he flew in to see me last week and we did a 3-day intensive, working several hours every day.

It was a joy working with Sven. We started right away by doing some exposure work. Exposure is only one of a large number of techniques we use in treating anxiety, but it’s crucial to successful therapy. When you use exposure, you confront your worst fear, rather than hiding or avoiding it. At first, you get really anxious, but if you persist, in nearly all cases the anxiety will eventually diminish and then disappear completely.

On day 1, we started out with one of Sven’s minor fears—getting his passport picture taken. He was afraid his face would tremble and he’d end up looking funny. He courageously disclosed this fear to many strangers in downtown Palo Alto and asked several of them to take pictures of him on his cell phone while he did various goofy facial poses. We all laughed we he tried to “tremble,” and also when he tried hard NOT to tremble. We collected dozens of pictures and Sven was pleasantly surprised to find that he looked good in all of them. But more importantly, he quickly got to a place where he didn’t care about the trembling.

For day 2, we couldn’t get an impromptu spot on any radio stations so he had his guitar flown in from Denmark and we took to the streets of Palo Alto for some jam sessions and more exposure therapy. We were joined by a local homeless man who did not recognize Sven and offered to rap for us while we provided the music and attempted to solicit money on the street. This added greatly to the low quality of the performance which was perfect because Sven’s goal was to face his fears of screwing up, playing the guitar incorrectly, or “freezing” in the middle of a set.

He bravely did all of those things on purpose and I added to the embarrassment by pointing out to passers-by how bad the music seemed to be, as this was another of his worst fears. Sven didn’t get any dollars that day but he was a great sport and was able to laugh a lot, and within about twenty minutes he was dramatically less worried about playing incorrectly or freezing, as nothing actually happened and no one really cared.

This is a discovery that many people make when they recover from anxiety disorder, especially shyness and social anxiety—you discover that you aren’t nearly as important as you thought. You may also discover that others are not nearly as judgmental as you thought.

After a brief phone chat with David to assess Sven’s progress and provide additional suggestions, we moved on to self-disclosure. This is another exposure technique that can be especially helpful, although it is usually terrifying for individuals struggling with social anxiety. Instead of trying to hide your shyness, you simply tell people that you often feel insecure or anxious in social situations.

This proved to the highlight of the Intensive for both Sven and me. As a very famous musician, he is used to women throwing themselves at him and it was an unusual experience for him to have to approach anyone, let alone reveal his inadequacies and insecurities. He put his all into it and approached at least ten strangers, disclosing that he’s embarrassed because he sometimes gets nervous when he performs on the radio. He even asked them what they might think of someone like that.

I couldn’t have scripted the responses better, as people were incredibly kind and sympathetic. He discovered that not only were people not bothered by his nervousness, they seemed to feel warmly toward him and closer to him when he was vulnerable. This was a huge realization. He left feeling more in touch with humanity and strongly motivated to continue this self-disclosure on the radio and in his life. He even let me film one of these self-disclosures on my phone to use for teaching purposes. Maybe he will give us permission to post it on this website, along with some links to his awesome U-Tube videos.

Sven was so excited and inspired that he’s even thinking about starting a website to encourage other celebrities (he knows many) to disclose some of their anxieties and emotional struggles to decrease the stigma around anxiety, shyness and low self-esteem. We are also hopeful to set up a string of radio tours in March (when his new album comes out) and I may accompany him to a few stations as he tells the world about his fears before playing on the radio. Let’s hope that happens as well!

It was really fun working with Sven. He was a courageous and kind guy. How privileged we are to get to do this kind of work! I feel so grateful.

I hope you are all well, and look forward to seeing you next week at David and Jill’s Tuesday evening training group at Stanford.