This is a draft of an article written by well known Sydney psychologist and author Sarah Edelman.  It basically tells the story of what my life was like with the anxiety condition known as Social Phobia, and how I overcame it using Cognitive Behavioral Therapy.  It is to be published shortly in an Australian magazine.  I have placed this on the internet in the hope that it might provide inspiration for those who suffer from this disorder.

If you have any comments you are welcome to email Andrew by clicking here

Andrew’s Story

by Sarah Edelman

When first you meet Andrew there is nothing to hint at the torment that has been his life for much of his 39 years. A handsome man of nearly six feet, his calm understated manner, his honest reflection and his articulate expression are characteristics one normally associates with social confidence and career success. So as his story unfolds it is utterly astonishing to discover how troubled and desperate his journey has been. 

For as long as he can remember life has been a struggle, although most of the time he had no idea exactly what was wrong with him. From his mid teens Andrew spent hours scouring through self-help sections of bookstores, trying to find some clues to the demons that tormented him, and how he could keep them at bay. All he knew was that he was different to others – being with people often made him nervous, and he worried too much about what others thought of him. While he felt secure in the small supportive environment of his primary school, going to high school was a totally alienating experience. He couldn’t relate to most other kids, and although he did have a small number of friends, he felt an outcast much of the time. “School was agony for me” he remembers.  “I was extremely self-conscious and suffered a lot of burning anxiety and tension headaches. .. I felt like an alien – like someone from another planet.” Each night Andrew spent hours lying awake in bed, dreading the thought of having to go the school the next day. 

At age 14 Andrew started seeing the school counsellor on a regular basis. From there followed a string of referrals to psychiatrists, psychologists and mental health specialists.  One of the psychiatrists diagnosed anxiety and prescribed Serapax – the wonder drug of the day. Although it made him feel better the effects quickly wore off, and Andrew found he needed more and more to give him any relief. Within a few weeks he was hooked – gripped by an addiction that further complicated his life for the next six years. By his 20^th birthday Andrew had a habit of eight pills a day, and still no respite.  

Once the calming effects of Serepax had proven ephemeral Andrew stumbled across another elixir at the age of 17. This one was not prescribed but discovered one night at a party, when Andrew became extremely drunk and noticed that his anxiety had disappeared. Getting plastered appeared to be a solution, so from then on the object of the game at any social event was to get drunk as quickly as possible. The relief from anxiety was a powerful motivator, and soon Andrew had developed a chronic binge drinking habit. The combined effects of Serapax and alcohol had a disinhibiting effect, and Andrew would often make a spectacle of himself. One evening while in a sober state he swallowed the remaining contents of his supply of Serapax and anti–depressant medication. He was rushed to hospital and spent two days at Northside Clinic. The overdose made him ill, but it was not lethal.  

A recent national survey suggests that between 2 and 3% of Australians suffer from social phobia. According to Stephanie Rosser, Senior Clinical Psychologist at St.Vincents Anxiety Disorders Clinic, the disorder usually develops during adolescence and becomes a chronic and disabling condition. The core fear is of being negatively evaluated by other people. Sufferers worry about doing or saying something that might be embarrassing, or being seen to be anxious by others. People with social phobia also very frequently suffer from depression. The condition affects most areas of their lives, and prevents them from achieving their full potential personally, socially and occupationally.  

For Andrew the disorder affected his ability to work, study, sleep, have normal relationships and sometimes even to walk down the street. “On bad days if there was someone walking towards me on the footpath I’d cross the road” he recalls. “I would be housebound for days at a time, totally crippled by fear”. The phobia also interfered with his ability to study, and at last count Andrew recalled seven separate courses that he started but did not complete because of the disorder. These included a Law degree, an Arts degree, two Masters courses in Information Science, a Masters of Public Policies and a Graduate Conversion course in Accounting. In each case it was never the studying that was the problem, but his inability to cope with the presence of other people. 

Andrew finally managed to complete an Arts degree in 1993, and promptly got a job driving taxis.  This suited him as in spite of the close physical proximity of his passengers, he didn’t have to look at them – he could look ahead at the traffic. And, as his alcohol problem was now out of control, the flexibility of contract work meant that he could stay sober whilst driving taxis for a couple of weeks, and then stop for up to 10 days while he went on a drinking binge.  

In 1997 Andrew achieved a second major feat when he completed a Diploma of Computer Programming and subsequently started a job as a computer programmer.  Once again the most gruelling aspect was having to deal with people, and after six months the job became unbearable and Andrew fled. His next job at the Commonwealth Bank was even harder. The large open plan office design provided little opportunity for seclusion, and at times when he felt someone approaching Andrew would make a tactical escape to the toilet.  “I was worried that they might say ‘hi’ and I wouldn’t know what to say” he recalls. To avoid the anxiety of having to pass people on the way to and from his desk Andrew would arrive at work before anyone else, and stay back late until they had gone.  

When he looks back at the pivotal factors that led to his recovery, a key event occurred in 1990, when he first read an article in a Sunday newspaper about social phobia. It was a term that he had never heard of before, but the symptoms they described matched his exactly. Suddenly he understood what was wrong with him and it had a name. It was a huge relief to discover that he was not just weird, but that he had a known psychological disorder. And he was not alone. This discovery led him to the first of many searches for more information on “Social Phobia”. Through the internet Andrew discovered a news group (alt.support.social-phobia)* that subsequently proved an invaluable source of information and emotional support. It was through this group that Andrew first came across Cognitive Behaviour Therapy (CBT) as a recommended treatment for social phobia. According to Andrew “people with social phobia usually live isolated lives, so many of them turn to the internet for support. There is actually a huge social phobia support network on the internet”. 

Excited by his discovery Andrew went to see a psychologist at a nearby counselling centre.  He came armed with his newspaper clipping and described how his symptoms matched those in the article. The psychologist was unimpressed.  She was skeptical of his diagnosis and didn’t seem to understand the extent of the suffering. In retrospect Andrew reflects that she didn’t have a clue about social phobia or how to treat it.  She interpreted his problem as shyness and referred him to a confidence building course. This, like many other “therapies” that he had tried was a dismal failure. “The program had nothing to do with social phobia and it didn’t address my problems. The other people in the course weren’t like me – I couldn’t relate to them at all”.  In the end Andrew found the experience totally alienating and dropped out after a few sessions.  “People don’t seem to understand that social phobia is not just shyness or lack of confidence” he stresses. “It is a pervasive negative view of yourself, and the assumption that people always think the worst about you. You’re constantly thinking, ‘there is something very different about me.  Whatever I say is dumb.  Everyone can see how nervous I am. They think I’m weird, pathetic and a loser.  They’re only talking to me because they feel sorry for me…”.  It is this sense of shame and defectiveness that makes the condition so painful. “Not only are you totally debilitated by the phobia, but you believe you have to hide it from the world. … It was my darkest secret. .. You feel like such a freak, and you’re terrified that people will find out”. As one of his fellow sufferers once put it “I’d rather step on a landmine than tell anyone about it”.    

In the final days of his job at the Commonwealth Bank Andrew was physically and emotionally exhausted.  His anxiety was out of control and he was barely sleeping. His vision had become blurred, to the point where he could no longer read the screen.  The increasing pressure of work and his inability to deal with the social environment became overwhelming, and Andrew was starting to think about suicide again. Finally, he broke down in front of his parents and told them the whole story. Although surprised, his parents were extremely supportive, and like Andrew years before, were relieved to discover that his malaise actually had a name. His mother encouraged Andrew to see a psychiatrist who was also a family acquaintance. This time Andrew’s problem was taken seriously, and the psychiatrist referred him to the Anxiety Disorders Clinic at St.Vincents Hospital (www.crufad.com)*.

After a two-month wait, Andrew commenced a six-week program that was to change his life forever.  The first week involved 3 days, and the subsequent sessions were held one day a week over the next five weeks. The program was based on Cognitive Behaviour Therapy (CBT) – an evidence–based psychological therapy that is increasingly used in the treatment of many psychological disorders. It involves teaching people to identify and challenge their irrational thinking patterns, and to modify some of the self–defeating behaviours that perpetuate their problems. Participants learn to challenge faulty thinking such as “mind reading” – making assumptions about other people’s thoughts. For example, “they think that I’m weird  … they can see how awkward I am … they obviously think I’m a loser”. Another common faulty thinking pattern amongst social phobics is “personalising”  – assuming that other people’s behaviours are always directed at us.  For instance, when a work colleague doesn’t look up and smile, a rational response might be “she’s busy – she probably didn’t see me”; a personalising response would be “she’s snubbing me – she obviously doesn’t like me”.  

In reflecting back on the program, Andrew cites the group format as one of its most valuable aspects. Meeting other people who reported being crippled by social phobia in terms no less dramatic than his own was very reassuring, especially because they all looked so normal. Even though they described feeling overwhelmed by fear, they didn’t look like they were dying inside. For a brief instance an intriguing idea started to dawn on him: “could it be that maybe I also appear normal to the rest of the world?”  

The big breakthrough came in week two of the program when each participant had to give an impromptu one-minute talk to the group that would be video–taped and then played back to them.  “I nearly threw up at the thought.  It was one of the most frightening things that I have ever done” he recalls.  Each participant had to predict on a scale of 0 to 100 how nervous they would look. Like everyone else Andrew predicted that his terror would be obvious – about 85% on the nervousness scale.  Yet when they came to watching each other’s talks it became clear that each person had highly over-estimated the visibility of their discomfort. Upon seeing Andrew’s presentation the group estimated that his nervousness looked 15%, and upon watching himself on the video Andrew could only but agree. His earlier suspicion now turned into an exciting prospect. “It started to dawn on me that the way I feel inside is not the way I project myself to the world. For years I had believed that everyone could see how nervous I am and that they thought I was weird; suddenly I realised that all this time I had mistaken the way I feel for the way I look.  This was a “Eureka!” moment for me.  

On the last session of the course the group members were asked to bring along guests, in order to make the situation more challenging. Here was the ultimate test: participants were required to give a five minute presentation in a lecture theatre in front of a wider audience – not just fellow social phobics, but friends, acquaintances, and other psychologists. To add to the challenge Andrew chose to do an impromptu presentation – no preparation. “I enjoyed myself” he confesses. “I think I actually love being the centre of attention, and once I was no longer terrified I was having fun”.  

By the time he finished the program Andrew knew that he was cured, even though he occasionally experienced brief periods of relapse when he was tired or anxious. “One thing I learned from the clinic was that as soon as those feelings start, you have to jump on them – snuff them out”.  To maintain the momentum Andrew set himself a personal challenge: to find a job that forced him to keep pushing the boundaries.  He chose door-to-door sales.  Amazingly, this was not something that he dreaded – now he actually liked the idea of knocking on people’s doors.  Andrew reflects that the selling itself wasn’t difficult. “The most difficult aspect of the job was being in an environment with pumped up ‘sales types’”. He started fitting in. The thought of going into a room full of sales people was no longer frightening – in fact, when he was feeling confident Andrew could be quite gregarious. Soon he became the team leader, which involved among other things, giving motivational talks and presentations to sales staff.  “It was no longer terrifying – I enjoyed it”.  

This could be the happy end of the story, but for one outstanding issue – Andrew still had a major drinking problem. Although he was now cured of the social phobia his drinking was out of control.  Alcohol had become his salve for dealing with any uncomfortable emotion – boredom, anxiety, guilt, frustration – the answer was always in a bottle. About once very three weeks Andrew went on a binge that could last for a week or more.   

On 29 April 2002 Andrew had his last drink. He spent a week at a detox clinic and then another month doing a live–in rehabilitation program. “It was a fantastic experience” he recalls. “They helped me to get in touch with my emotions. I learned to acknowledge how I was feeling without trying to distract myself or escape through drinking, smoking or eating”. Although the program was extremely useful some aspects of their philosophy didn’t sit well with him.  “It was based on the 12 step program used by AA, and they kept pushing the idea that we had a disease and would never be able overcome it. You were supposed to acknowledge that you are powerless, but something inside of me kept saying “hang on, I got over my social phobia in six weeks, I can get over this one as well. …  In a way, it became a challenge to prove them wrong”.  

After completing the rehab program Andrew continued to attend regular AA meetings, which he found very helpful. However in the end, it was the strategies that he had learned at the social phobia program that proved most useful in overcoming his alcohol dependency. “When I found myself feeling uncomfortable, I started to challenge my thoughts, and to work through my emotions. Realising that my thoughts create my feelings, and that I can change the way I think has been a radical shift for me.  These days I live and breathe CBT – it’s become my philosophy of life”. Andrew stresses that this doesn’t mean that he always feels good: “I don’t always feel the way I would like to feel, but I know that my emotions are always created by my thoughts – they come from the story that I tell myself.”  

Andrew quotes Albert Ellis, one of the pioneers of the cognitive psychology movement: “instead of saying I’m feeling anxious or angry or upset, I tell myself “I am ‘anxietising’ myself or I am ‘angering’ myself. Then I think about what I am saying to myself that makes me feel that way and I start to challenge it”. According to Andrew, it works for him. “I haven’t had the desire to drink since my detox.  AA would say that it’s a dangerous place to be – that I’m in denial, but I know that I am over it. I don’t have the urge to drink any more”.  

These days Andrew’s life is radically changed. He has released some of his earlier friendships that were sustained by drinking and drug taking and has established a broader social network. He is no longer terrified of talking to people, and for the first time in his life he has embarked on a healthy love relationship. The ability to self–disclose and to feel loved and accepted in spite of revealing his darkest secrets has been extremely liberating “I don’t have to keep secrets any more”. His girlfriend has been extremely understanding and supportive. Ironically, she has told Andrew that she has never had a relationship with someone so open.  

If there are any lessons to be learned from Andrew’s experience, one of the most powerful is the importance of evidence based psychological therapies. In seeking treatment for his disorder Andrew saw countless therapists and underwent an array of treatments, including “Rogerian” supportive counselling, Freudian psychoanalytic therapy, psychodynamic therapy, Serapax, anti–depressant medication, and some very weird alternative therapy that involved being spun in a hammock. He has been an in–patient in two psychiatric institutions, attempted suicide on one occasion, lost thousands of hours of sleep and read numerous self–help books. In addition to the personal suffering, there has been a huge cost in terms of time and money.  And yet, for at least the last 10 years, there has existed a brief, well-evaluated treatment for social phobia that has been repeatedly shown in clinical trials to be effective. Andrew’s experience highlights the importance of evidence-based therapies and of providing consumers with good information about what is out there – what has been shown to work and what hasn’t.    

Of course, not every person who presents for treatment with CBT makes a recovery as dramatic as Andrew’s. According to Stephanie Rosser, the majority of participants who do the St.Vincents Social Phobia program improve, but the extent of their recovery is often related to the severity of their symptoms. Those with mild to moderate social phobia are more likely to make a full recovery than those who enter the program with very severe symptoms. Stephanie points out that given the extent of Andrew’s symptoms when he entered the program he has done exceptionally well. “I think that choosing a job in sales would have helped him to maintain and consolidate the gains from the program” she says. “I suspect that’s one of the reasons why he has done so well”.   

When I asked Andrew if he is still receiving counselling, he said that he doesn’t need it any more. In fact, he is currently doing a Graduate Diploma in Counselling, with the aim of one day helping people with social phobia and alcohol related problems.  “I feel content now,” he says.  “I can go to a social function and talk to people and enjoy myself without using alcohol. The last eight months have been fantastic. I never knew that life could be so good”. Recently Andrew started a new job in sales. A substantial part of his role involves cold calling potential customers, a prospect that is not the slightest bit daunting.  “I enjoy it … I’ve got the ball rolling now, I’m happy to keep it rolling”. 

End.  

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*These are my additions.