The Key to Effective Social Anxiety Therapy for New Yorkers
Social confidence can be hard to achieve in New York City. In fact, it’s quite common for New Yorkers to grapple with periods of overwhelming social anxiety and stress in anticipation of relating to other people.
As a psychologist in private practice in NYC, I have come to understand what makes therapy for social anxiety effective. I’m going to share with you what I believe needs to be part of your therapy process in order to maximize your efforts to gain social confidence and reduce anxiety. That is, to feel highly prepared to manage the challenges that arise in social settings and in the time leading up to social events.
When we talk about social anxiety, a.k.a. ‘social phobia’, we’re referring to persistent fear of and intense worry about being judged and/or observed by others in social settings. This fear promotes avoidance behaviors and can be associated with depression, as isolation from the need to avoid promotes a lot of negativity directed toward the self, sometimes including a deep regret for failed or missed opportunities.
I’m going to talk about getting started in the process of improving your social anxiety, but most importantly, I’m going to discuss what actually makes therapy for social anxiety effective for New Yorkers. I’ve been doing this work for a long time as a psychologist, and I believe many people don’t realize what is needed to feel more socially prepared and adept.
Sometimes our social anxiety fears do come true. The very outcome we ruminated about can happen. CBT therapy prepares you for this situation.
CBT for social anxiety can help you identify hot thoughts that keep the vicious cycle of self-judgment and avoidance in motion. By learning to gain control of painful mental images, negative self-judgment and personal rules, you can work on creating small victories in social settings.
But there’s more to that’s required for social anxiety therapy to be effective.
Therapy Key #1: Managing Social Expectations
The very first step toward improving social anxiety is about managing your expectations. (In truth, it’s also about acknowledging that you’re going to need to go outside of your comfort zone to make any appreciable change, which includes a willingness to sit in the discomfort that comes up when facing the embarrassment, shame and self-defeating thoughts and behaviors associated with social anxiety, but more on this in a bit.)
Your expectations determine whether or not you feel pleased or dissatisfied with reality. They can promote avoidance behaviors or push you to try hard things. Expectations of social success in New York can be tainted by all of the influences that NYC throws at you.
For New Yorkers who are sensitive to social failure, models of social success may feel like they are everywhere they go. New York City, particularly Manhattan, bombards its inhabitants with massive exposure to material wealth goes hand in hand with feelings of intimidation, the need to “catch up.” This all starts with what you expect to happen when you aim to grow your professional network, make new friends, find love in the big city or all of the above.
Of course, it’s beautiful to aim for the stars and hope for an amazing social outcome. However, a having healthy social expectations involves being realistic about the time it takes to establish connections in the city and a deep understanding of the impact of who you choose for social comparison on how you view yourself and your chances.
When there is a constant discrepancy between social expectations and your social reality, it can create periods of social avoidance and despair. On the flip side, if you just assume that you’re going to fail and you use evidence of past failures to project into the future, your expectations are also messing with your chances of improving your social anxiety.
So the first step is all about expectations. Try to be open to the idea that what you define as social success might need to be adjusted. The illusion of massive social success is all around us. Social media makes this worse.
Then there are the select few who have amazing social success, but I promise you that you don’t know the whole story.
Ask Yourself These Questions About Your Expectations of Social Success
- Where does my benchmark for social success come from? Is this a realistic goal? Am I willing to look deeper into my standards in an effort to improve my social confidence?
- Does my model of social success match my personality style? (i.e., Extroversion/Introversion)
- Are there teenage experiences of social success or failure that I’m trying to repeat or correct for?
- Am I aware of the extent to which social media plays a role in feeling like a social failure? Which social media accounts make me feel the best/worst?
- Are my expectations for how I feel and act in social situations rarely being matched by reality?
- Are my expectations of social failure too high? Do I recognize the small social wins?
- Do I stay away from taking social chances because I assume I’ll fail?
These questions represent a small sample of what to start thinking about in any initiative to improve your social anxiety. Going into therapy with a keen eye on your expectations is a good first step, but real, appreciable change in therapy for social anxiety requires an understanding that your anxiety is not all that needs to be targeted in therapy. It will certainly be the primary focus, but to do social anxiety therapy the right way, you need to target “second level” emotions as well.
Therapy Key #2: Embracing Second Level Emotions
Effective therapy for social anxiety will help you feel less in your own head when you’re socializing, networking or around strangers. You will be more in the moment and less preoccupied with how you think you’re being perceived. You’ll be more likely to feel self-expressed and vulnerable. In order to achieve these gains, you not only need to focus on anxiety reduction, but also on how you feel about your struggle with anxiety. I’m essentially referring to how you feel about how you feel.
Anxiety is considered a primary emotion. So is anger, disgust, surprise, happiness and sadness. Primary emotions are more brief and instinctive. Once they sweep in, they start to effect your thought process, which opens the door for secondary or “second level” emotions.
Second level emotions last longer. (I like the term “second level” as a metaphor because it makes me think of a cover or a ceiling that locks in the problem.) These emotions tend to have increasing influence over time and even may be operating out of awareness. While primary emotions are more universal, secondary emotions are specific to the individual. Examples of second level emotions are shame, guilt, embarrassment, frustration, withdrawal, regret and jealousy.
For people with moderate to severe social anxiety, I have found that second level emotions function as the mental glue that keeps social anxiety in place.
In my experience as a clinical psychologist in private practice in NYC, I have come to understand that effective therapy for social anxiety must include an examination of second level emotion. That is, you need to cultivate an awareness of how you feel about how feel.
Second level emotions make the experience of social avoidance much worse. If you decide to stay home and avoid a social situation, you might feel an initial sense of relief as you sit in the safety of your home because you avoided a potentially mentally dangerous situation. You succeeding in avoiding the potentially negative social experience, but this avoidance, if repeated, begets more avoidance. Before you know it, you’re making excuses on a consistent basis to avoid all kinds of social events.
It’s quite common for people to feel a painful sense of shame about their perceived social failures and avoidance. Some people judge themselves intensely for feeling socially anxious, even panicky, being too quiet or having nothing interesting to say.
For example, let’s say you attended a social event and felt so nervous that you could barely speak. You also questioned what you had to offer in various conversations. Maybe with one person you know well you felt fine, but you judge yourself for how you performed in other conversations. Maybe you felt hyperaware of having no hobbies or exciting topics to discuss. Following the event, you felt such negative self-loathing that any positive aspects of the event were canceled by your extremely negative evaluation of your social performance.
The shame you feel might compel you to mentally beat yourself up, question your character and your future. Depression might kick in because you’re grieving what you think you’ll never be able to accomplish.
This shame kind of seals the deal for your social anxiety to maintain control over your choices and self-evaluation. It is the mental glue that keeps your suffering in place because it contributes to a vicious cycle of negative self-evaluation and avoidance. The more you judge yourself about your social anxiety, the more you’re likely to avoid. The more you avoid social situations, the more likely you are to judge yourself negatively. This pattern limits your chances for social success, even little wins that could give you a sense of hope.
When shame and low self-worth are too easily accessible or too dominant relative to other emotions, your social anxiety cannot be fixed with exposure therapy alone.
Effective social anxiety therapy requires a focus on what is triggered in you as you judge yourself for having the anxiety.
Of course, social anxiety therapy does require some form of exposure, as well as the acquisition of new skills so you can feel prepared to handle social challenges. That sense of social readiness is crucial to the success of your social anxiety therapy.
Feel free to reach out with any questions you have about CBT therapy for anxiety. And please click on the link for FAQ about social anxiety therapy.
I wish you all the best!
Greg Kushnick
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10 Important Benefits of Cognitive Behavioral Therapy for New Yorkers
Living in New York City can be a challenging experience if you’re not invested in your mental health needs. Depending on how you’re faring here in the big city, cognitive behavioral therapy represents a wonderful option for helping you to get you through life in NYC. When you feel prepared to handle the emotional challenges that NYC presents, the city can be one of the most exciting and rewarding places to live.
Cognitive behavioral therapy’s focus on the here-and-now, as opposed to the emphasis on early childhood experiences in psychoanalysis, allows New Yorkers to experience a more solution-oriented therapeutic experience.
Here are seven reasons why CBT therapy is a wonderful choice for helping you make it in the Big Apple.
1. New York City is the loneliest city in the world.
You may think that it’s easy to connect with lots of people in NYC, but it’s usually quite the opposite. For most New Yorkers, building a community is extremely hard. It is also assumed that it’s so easy to date because of all of the options. In reality, it can be a frustrating process involving painful trial and error and vulnerability. NYC’s culture does not lend itself to building a community that helps you feel valued and supported. Many of us have to do it from scratch. It takes a lot of mental resources to avoid feeling lonely, sometimes even in relationships.
CBT helps New Yorkers acquire tools to better manage social and dating disappointments. We look at troublesome belief systems, including core beliefs and rigid, conditional self-statements that promote social anxiety and a sense of fragility in response to perceived failure. CBT therapy also looks at problematic behaviors that exacerbate and reinforce negative cycles of thinking, such as social avoidance and addictive tendencies.
2. NYC can be unforgiving to people with social anxiety.
The pressure to be socially successful is one of the trademarks of New York City life. This is a terrible burden for many of its inhabitants. For those of us who grapple with social anxiety, NYC presents a constant flow of opportunities for brutally self-devaluing, social comparison. The shame that comes from perceived failure and judgment after a difficult social moment promotes social avoidance, panic and depression. Given how hard it is to socialize without the presence of alcohol (#5 on this list), many people with social anxiety also develop an unhealthy relationship with alcohol.
CBT therapy can work wonders for social anxiety. I’ve been doing this work for over 27 years and I’ve learned a thing or two about how to cater cognitive therapeutic techniques to alter a client’s self-concept and behavior patterns. CBT targets the vicious cycle built into social avoidance. It promotes an ability to cope with symptoms of Social Anxiety Disorder. It aims to achieve small wins with social success, self-acceptance and healthier thought and behavior patterns.
3. Too many options offered in NYC can affect your mental health.
The overwhelming number of possibilities baked into NYC life can effect your sense of what is “good enough,” it can alter your relationship with money, power, success and validation. Many of us are already over-scheduled and psychologically overtaxed. If you’re not careful, the NYC lifestyle will pressure you to overdo it with scheduling activities, which limits your ability to recharge or gain enough psychological distance from your troubles in order to reach a healthy perspective in your downtime.
My CBT approach aids in examining limiting beliefs and behaviors that get in the way of your commitment to important decisions. I help my clients to set goals and stick to commitments that align with personal values. My focus on values also offers a roadmap for navigating difficult choices and staying on course toward manifesting what you consider to be a life well lived.
4. NYC work culture views burnout as a badge of honor.
High-achieving people, especially those with perfectionistic tendencies will find many reasons to push themselves to their breaking point, recover and break again. New Yorkers who come from families that don’t value mental health as a safe topic of discussion often have to reach an extreme state of mental anguish in order to finally take care of their mental health. Many New Yorkers take on jobs with brutally long work hours. Many work cultures, especially in finance and law, promote sacrificing your mental health to reach your numbers and doing anything to avoid reprimand from your narcissistically-inclined boss. Most people are not built to sustain such pressure. Work burnout promotes depression, anxiety and addiction. It changes your priorities, which leads to relationship issues and neglect of one’s physical, mental and spiritual health.
CBT can help you cope with work burnout. The examination of belief systems that promote hopelessness, self-loathing, unrealistic standards and self-defeating behaviors can truly make a difference if you’re under a ton of consistent pressure at work. CBT can be highly effective for combating social withdrawal and motivational outages associated with depression. It also helps with the avoidance behaviors that go with anxiety and panic attacks.
5. Alcohol plays a role in so many social activities in NYC.
In NYC it can be a challenge to socialize with friends without the presence of alcohol. This becomes particularly problematic if you’re trying to limit your alcohol intake and you want to bond with friends. It often takes smart planning and well-developed habits to avoid social situations that center around drinking. What’s more–some jobs in finance promote an unhealthy relationship with alcohol when there’s an obligation to wine and dine clients at night. In addition, long term relationships/marriages (as well as your health) can suffer terribly when one partner doesn’t manage their drinking habits.
I help clients to navigate the social scene in NYC, while keeping track of which social habits create mental suffering and relationship issues. My CBT methods promote calming your mind and establishing your priorities, which can empower you to find alternative ways besides alcohol to quiet your mind and socialize effectively. I am highly passionate about my CBT work with clients who are grappling with social anxiety.
6. The exposure to extreme wealth in NYC can promote an unhealthy relationship with money and success.
For the ambitious New Yorker, no matter what you have — the money you’ve earned or the job title you’ve achieved — the influence of other’s people’s money and achievements can make you feel not good enough. So many New Yorkers sacrifice their mental health to chase a dream, but the dream may not be grounded in the awareness of the price paid for striving to achieve a goal. In NYC, if you’re not careful, the goal hijacks the mind and the journey, which makes up the bulk of your time, is minimized. Many New Yorkers live in a state of self-imposed deprivation. “If I make Vice President, life will be good.” “When I can afford to buy this material good, people will notice me and see me as successful.”
I help clients to establish a healthier perspective with regard to their definition of “success.” People rarely stop to consider their “money wounds,” which promotes suffering and replicating unhealthy aspects of your relationship with money. Cognitive behavioral therapy can assist you in altering unhealthy patterns of behavior associated with irrational beliefs around money and success. Of course, you should chase your dreams, but you also need strong mental hygiene to enjoy the fruits of your labor.
7. NYC attracts people with narcissistic tendencies.
The reality that makes many people uncomfortable to talk about is that many highly successful people have narcissistic tendencies. NYC attracts ambitious people who have “made it” in their respective field. Chances are that at some point in your time working in NYC, you will have a narcissistic boss or romantic partner. One relationship with a narcissist has the power to gut your mental health.
I employ CBT to help my clients recover from narcissistic abuse. I am an expert in narcissism and narcissistic abuse. If you’ve been mistreated by a narcissist before, then you have some idea of the awful effects of their manipulation and controlling behaviors. Your sense of reality becomes altered, your sense of trust is shattered, your access to own personal value is reduced to nothingness. Cognitive behavioral strategies can be effective in helping you distance yourself from thought patterns that narcissistic abuse has instilled or exacerbated in you.
8. NYC can be a mental minefield for people grappling with panic attacks.
People who score high on measures of both achievement and control are more likely to suffer from panic attacks. NYC attracts this type of personality profile. The city is also full of common triggers for panic, such as theaters, crowded trains, and tight social spaces. Ambitious New Yorkers with Panic Disorder are likely to find themselves having anxiety and shame about the panic attacks they’ve endured in business or school presentations.
Since the presence of panic attacks usually includes the avoidance of settings that trigger panic, CBT with an exposure component to the treatment of panic attacks can be effective. As a Manhattan psychologist I do this work often. CBT targets the underlying issues promoting anxiety and shame about panicking. It helps people to feel more prepared in the face of panic.
9. Many New Yorkers are chronically overwhelmed and long term relationships suffer as a result.
Ambitious New Yorkers are chronically overwhelmed as a result of being constantly “on” at work or school with little time for relaxation. When there’s time to unwind, it’s often done by retreating into a their phones, which is ironically a very poor way to recharge. Because New Yorkers frequently find themselves in “survival mode,” it’s natural to choose disengagement and disconnection over engagement and connection with a partner.
My approach to CBT with an emphasis on values promote the establishment of healthy routines and communication patterns in long term relationships. CBT focuses on underlying issues that get in the way of healthy communication patterns. I also help clients to overcome resentment, judgment and pathological certainty to feel more connected in their relationships.
10. An unpleasant commute to and through New York increases stress levels.
Your patience may be tested if you have to deal with public transportation, which may add stress to your day. Finding peace of mind can be challenging. For people with less-developed anger management skills, NYC is a potential landmine of triggers that cause anger outbursts.
CBT can help you with stress and anger management so you can feel more prepared to cope with challenging moments in traffic, with strangers and other random, inevitable incidents. One key for sound mental health in NYC is to learn to stay connected to people, develop your empathy muscle and avoid stereotyping and snap judgments.
I offer CBT therapy as a clinical psychologist in New York City. I work with clients on a variety of personal, professional and family issues. Please feel free to reach out to me with any questions.
All the best!
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One of the Keys to Managing Depression
If I had 30 seconds to explain the key to getting over a bout of depression, I would offer one piece of advice that represents essential self-treatment for depression.
Depression can have so many manifestations ranging from mild and fleeting waves of melancholia to severe and debilitating months or years of suffering. With that said, among the many ways to combat depression, a commitment to practicing this one rule can speed up your recovery from any form of depression and catapult you toward happier days.
How do you overcome depressive experiences at a more rapid pace?
When you feel depressed, move toward people as opposed to withdrawing into your own world of social avoidance.
Strive to build a muscle of social approach within your depressive experience.
It will shorten the amount of time you suffer even if being around people seems to make you more depressed! For the best results, keep practicing social approach in between depressive phases.
You don’t have to love your time with your support network. Just allow yourself to be supported. Let your friends give you perspective, test your depressive reality and encourage you to think and behave in ways that pull you, even momentarily, from your depressive reality.
Your Social Approach and Depression
Your success with building a habit of social approach depends on two factors: (1) you how choose to design your time with friends and family, and (2) your willingness to talk about what your going through.
If socializing guarantees that you’ll drink or do drugs excessively, than you’re not going to help your cause. Alcohol and recreational drugs also lengthen the amount of time you will suffer, so try to create social situations that promote thoughtful, peaceful and sober bonding. Getting together with a friend to exercise, engage in a hobby or listen to music is gold in the fight against depression, especially if you agree to hold each other accountable to keep your shared commitment.
The maximum benefit can be gleaned when you’re willing to share what you’re going through. If opening up is hard for you, choose someone who seems less judgmental or who has experience with depression. Sometimes an in-person conversation about what you’re going through can make a dramatic difference in how you feel.
The social approach strategy means that you’ll have to fight the temptation to cancel plans. Everyone loves to cancel plans these days. It’s now become more socially acceptable to ghost your friends, but this is only the formula for unhappiness. Resist the desire to cancel plans if you want to overcome your depression, unless your low mood is extreme…I’m talking a 9 or 10 out of 10. When this happens, push yourself toward in-person support as soon as possible.
You might feel compelled to retreat into your own world of suffering when you’re depressed. This emotional cave certainly has its function when life feels overwhelming or when being around people feels intolerable. After a long and tiring day of pretending to go with the flow of work, school or parenting, I can understand why you’d would want to be left alone to watch your DVR in peace, but in most cases avoiding people will only elongate depression.
An introvert who is naturally inclined to withdraw from people (to stay in his or her comfort zone) might find it less helpful to move toward people when he or she is depressed. I work with a lot of introverts in my private practice and I’ve learned that even introverts with depression can greatly benefit from accessing their support system.
An uptick in social support will probably compel an introverted and depressed person to rapidly withdraw from people at certain points. That’s totally fine as long as people are seen as a source of strength, perspective and comfort in the battle against depression.
In this case, I would recommend a rapid oscillation plan. That is, you withdraw because you need to, but then get yourself in front of people and open up about what you’re going through.
If you have extroverted tendencies, you’ll probably have an easier time practicing social approach during a depressive phase. With that said, no matter how much you enjoy your social circles, depression compels most people to avoid social contact due to a decrease in motivation and energy.
The choice to move toward people and resist the muscle of withdrawal and avoidance can help you in so many ways, such as giving you a place to test your reality which depression tends to distort. Friends or family can offer alternative ways to view your problems, your relationships and your future. Social support also allows you to step outside of your suffering and have a neutral to enjoyable time. Most of all, the people who support you can make you find a tiny seed of hope and an ounce of meaning when depression makes you feel devoid of both.
So many people make the mistake of thinking that they can overcome their depression alone.
Just know that if you choose to avoid people when you’re depressed, you’re asking for a slow, uphill battle. Social avoidance creates a greater disconnect from purpose and hope. It distorts the way you view your relationships.
Your depression feeds off of social avoidance and an over–reliance on messaging as a source of support.
Please note that when I talk about accessing support, I’m not referring to messaging or emailing people more often. Digital communication can be helpful up to a point.
(Published on HuffPost)Dr. Gregory Kushnick is a licensed psychologist with a private practice in Manhattan’s Chelsea and FiDi neighborhoods. He strives to provide the most actionable tips on the web and in person for relieving emotional distress. He has successfully treated hundreds of people who struggle with depression, anxiety, trauma, panic, addiction and relationship issues.)