CBT for Social Anxiety in New York City
We all have a need to connect with others. This basic human need can be a source of mental discomfort if we have obstacles preventing us from placing ourselves in opportunities to gain social fulfillment.
Social anxiety is a common experience, but for many New Yorkers, especially people who lean toward a high achievement/high control-type of personality, social anxiousness can reach incredibly uncomfortable levels that promote avoidance of potentially satisfying experiences and relationships. Social anxiety disorder (SAD), also referred to as social phobia, is a label that is given when the anxiety has a debilitating impact on your life. I’m not a huge fan of labels, but sometimes they are helpful for making distinctions and identifying the best course of treatment. Social phobia is sometimes used to refer to unrealistic fears regarding a specific social scenario.
The tricky part of social anxiety is that avoidance often becomes the default way of coping. Of course, mild avoidance of social situations can be helpful, as it allows for time to sit with one’s thoughts and recover from a stressful week or a particularly exhausting experience. However, more persistent avoidance of social situations leads to a vicious cycle of greater avoidance and self-loathing/self-criticism.
When you actively avoid social situations (or use significant amounts of alcohol to cope with social situations), you experience relief from the feared scenario of having to endure extreme discomfort, a panic attack, potential rejection or failure. However, for many people there is also an equally uncomfortable or even worse feeling of discomfort that comes with the failure to socialize.
People often judge themselves harshly and feel remorse about missing an opportunity. Taking away opportunities for social connection only reinforces negative beliefs about the self. In addition, I have found that chronic social avoidance caused by social anxiety also leads to varying amounts of depression, ranging from a mild case of the blues to more severe and debilitating depressive experiences that affect daily life in profound ways.
CBT Therapy for Social Anxiety
The good news is that therapy for social anxiety can be very effective. I find that clients seem to benefit more when I incorporate cognitive behavioral therapy (or CBT therapy for short) tools into my approach. Exposure therapy for social anxiety disorder is added to the treatment as needed.
Put another way, successful treatment of social anxiety via CBT therapy requires a few components:
- A cognitive approach that emphasizes altering thinking errors and unrealistic self-standards, and reduces self-criticism and rumination.
- A behavioral/coaching approach that focuses on reducing unhelpful emotional responses and increasing exposure to social situations, while using feedback gleaned from new social experiences to inform efforts to alter problematic beliefs and standards.
Managing Social Anxiety in NYC
New York City culture amplifies the importance of social success and performance. The most socially successful people are celebrated in real life and on social media, which creates pressure, shame, FOMO, fears of losing one’s job, and a lot of other uncomfortable thoughts for many people.
Frankly, it’s just a whole lot of pressure to be social in NYC.
Since the pandemic ended, I have seen a significant increase in the number of clients requesting CBT therapy for social anxiety/phobia. It seems as though the stakes are even higher in a post-pandemic NYC where many people are working remotely at least part of the workweek, which limits opportunities for true social connection and places people in their own heads for a greater portion of the day, as opposed to directing energy toward others.
This closed system of chewing on your own thoughts in place of in-person social exposure appears to make thoughts of self-doubt, rejection and avoidance run wild.
Effective Social Anxiety Treatment in NYC
I’m here to help you with your social anxiety. If you’re searching for a psychologist for yourself or for a loved one, an experienced CBT therapist can make a huge difference in helping to reduce social anxiety and avoidance.
Feel free to reach out with any questions regarding therapy for social anxiety. I love what I do and I am happy to work with you or your loved one.
All the best,
Greg Kushnick
Learn More
The Starting Point for Managing Anxiety
As a psychologist in New York City who has conducted thousands of sessions helping clients manage their anxiety, I have come to understand that there is one key to managing your worries. This key unlocks your ability to gain a sense of control over anxious moods and thought patterns. What I’m proposing also helps with an intense fear of something specific, such as a work presentation, medical test results or childbirth.
Just to clarify, when I use the term “anxiety,” I am referring to persistent worry and severe concern in response to an event that may or may not happen, the very uncomfortable anticipation of negative things to come. Anxiety involves a response to something in the future that is less likely to happen. Sometimes we feel anxious without any conscious awareness of what we’re anxious about.
We can all relate to the looping repeat of uncomfortable thoughts that accompany anxiety. Anxious moods steal our ability to focus on work, relax, bond with loved ones and get sound sleep.
My success with helping clients who are grappling with anxiety has depended on establishing the proper starting point for gaining a sense of mental control. In essence, the stage must be set before the band can start playing a relaxing tune.
Managing Anxiety Starts Here
The key to managing anxiety is gaining a sense of hardiness, or faith in your ability to cope with the unknown. Having this faith allows you to know that you’ll be ok no matter what happens. Hardiness is not easy to achieve, but the presence of just a drop of faith goes a long way.
How do you build up your hardiness? It starts with telling yourself 50 times a day, “No matter what happens, I will be ok.” If fear of a specific event is overwhelming you, try gently picturing yourself in the feared scenario and then tell yourself this message 50 times as you look around experience the sights and sounds of this event.
See yourself as making it through the event if you can picture what you fear. Say to yourself, “I made it.”
If this kind of imaginary exposure feels like it’s too much for you, that’s ok! Just feed yourself the reassuring message without imagery.
Faith in your ability to cope can come from a variety of sources. There’s faith in your mind, which refers to a sense of being able to control your thoughts and a sense that you’ll be ok if you lose control of your mind. The chaos doesn’t last. It’s time limited.
You actually do have at least partial control over some things that make you anxious. For example, if you’re getting a procedure done in the hospital, can you decide which doctor will perform the procedure, or the music you listen to, or who will be with you when you’re recovering? Focus on the choices you actually CAN make. The ability to choose some of the minutia of the feared scenario really helps.
The other side of building hardiness is to accept that there are some things you can’t control, which necessitates even a mild commitment to letting go and trusting in yourself, even if you know you will suffer for a period of time. This is where faith comes in. Faith in doctors, faith in God, faith in your efforts to take care of yourself, faith in people to make good decisions and do what’s best for you.
Building Faith in Your Mind
Your ability to control stress and anxiety ultimately depends on how much you believe your mental health can absorb a difficult event.
Sometimes faith in your ability to cope has to do with recognizing what your body can do for you without conscious effort. You were built to cope and return to a comfortable baseline of body functioning. Your body always resets to achieve as close to a sense of balance and equilibrium as possible. For example, if your heart rate soars in anticipation of a catastrophe, you need to remind yourself of your body’s ability to return to a comfortable state. Mental suffering generally comes in waves or cycles, as opposed to a permanent, unrelenting negative experience.
A sense of hardiness is also connected to your immune system. If you tell yourself that you can handle something, your body can have a stronger immune response. Of course, this is not true in ALL scenarios, but feeling hardy certainly gives you a physical boost of strength. Feeling like you can’t handle something is likely to elevate your cortisol levels, which weakens your body’s healing response.
Tips for Managing Anxiety and Building Hardiness
Below are a few hardy suggestions for learning to manage your anxiety.
- Start by sharing your experience of anxiety more authentically with a trusted person in your life. Remind yourself that you have this person to lean on if needed.
- Make sure you go at least one step outside of your comfort zone. It’s ok to be a bit uncomfortable if your behavior is in the spirit of striving toward something.
- Spend time identifying what’s important to you. What are the values you live by? What kind of person are you striving to be for the world? Judge your behavior based on these commitments. Knowing your values and who you are striving to be serve as a guide for difficult choices and personal boundaries.
- Take time to evaluate your personal boundaries with others. Who makes you do things you don’t want to do? Who makes you feel badly about yourself? Consider reading the book Set Boundaries, Find Peace to get a wonderful introduction to setting healthier boundaries.
- Evaluate your expectations for how an anxiety-inducing situation is supposed to go. Do you need to spend time learning to be less perfectionistic? Do you expect too much of yourself or other people? Setting reasonable expectations promotes feeling less shocked by negative outcomes.
- Pay attention to how you use your phone to self soothe. Are you over-reliant on your phone or should you commit to bringing uncomfortable thoughts under control without a screen?
Please feel free to reach out and ask a question or if any of this information feels like something you want to work on in therapy.
Good luck to you and your hardiness!
-Dr. Kushnick
Learn More
What Does a Psychologist Do for Anxiety? An NYC Doctor Answers
1. What does a psychologist do for anxiety?
A psychologist is trained in providing a variety of methods to alleviate your anxiety. As a Manhattan psychologist who works with ambitious New Yorkers, I offer a multi-pronged approach to alleviating anxiousness. I help clients identify triggers, discover thought patterns that exacerbate anxiety, focus on here-and-now techniques to manage flareups and ultimately gain a toolbox of available techniques to apply to difficult moments. In my experience, the fast-paced life of New Yorkers leads them to have to constantly juggle multiple stressors at once, so anxiety is almost an inevitable part of the NY experience, but there is a tipping point beyond which the anxiety can take over your life. This is where therapy can be immensely helpful.
2. How do psychologists test for anxiety?
A psychologist typically assesses through detailed questioning about your current symptoms and history, including any traumatic life events that may have played a role in your anxiety. Some psychologists offer questionnaires and other formal assessment tools to better understand the nature of your anxiety.
As your psychologist I am better able to help you if I understand many of the details related to the present and the past, but I don’t dwell in the past. I am much more focused on the here and now. The beginning of therapy involves me asking you lots of questions, and then the nature of the conversation shifts into a more collaborative conversation.
3. What type of psychologist should I see for anxiety?
A clinical psychologist is well trained to offer you tools to manage your anxiety. Some clinical psychologists are trained in multiple methods of treatment, such as cognitive behavioral therapy (CBT) or psychoanalysis. Clinical psychologists receive a doctorate in psychology and train in a variety of contexts, including hospitals, clinics and schools. Counseling psychologists represent another option, but they are less common in New York City. Please note that other mental health professionals, such as clinical social workers and mental health counselors can be just as (if not more) effective as a clinical psychologist, but Doctors of Psychology generally receive more formal training on the path to their doctoral degree. Other mental health professionals typically subject themselves to other forms of training after they receive their degree. Please note that there are many exceptions to the comments I made in this paragraph.
I am a clinical psychologist who has trained in just about every type of clinical setting. New York City has offered me so many opportunities to train with such a variety of people from diverse backgrounds and professions. Please do not hesitate to reach out with any questions. I love to talk shop!
4. Can a psychologist help with anxiety?
A psychologist can help with anxiety, but there are a lot of factors involved in determining the extent to which therapy will help. I have found that the following factors play a role in determine success with anxiety treatment for New Yorkers:
a. Timing – Success in therapy is connected to how ready you are and open to subjecting yourself to the therapeutic process. Some clients are in a place in their lives where therapy truly fits in with their life situation. Other clients are initially resistant and fearful, but slowly evolve into a state of readiness to change.
b. The presence of a Medical Condition – Sometimes medical issues slow down progress in talk therapy. Medication might be needed, but that should be determined by a psychiatrist.
c. Your investment in valuing your mental health – In my experience as a New York City psychologist, my clients who allocate a good amount of time to caring for their mental health, even outside of therapy, tend to fare much better than clients who barely make time for therapy and other wellness activities. I respect the extremely busy schedule of ambitious New Yorkers, but to truly manage your anxiety more effectively, you need to allocate time and energy.
5. Is it better to see a therapist or a psychologist?
It really depends on the amount of training of the mental health professional. Many therapists who are not clinical psychologists have undergone more training than psychologists. Look into the breath of experience and areas of expertise of the therapist to determine what works for you. Psychologists are considered one type of therapist.
6. How do I choose a psychologist for anxiety?
In the age of the pandemic, it is even harder to find a therapist because so many people are seeking mental health care. Start with the listing sites on the web, including psychologytoday.com and good therapy.org. Cross reference your findings with the list of in-network psychologists listed on your insurance company’s website. It is a frustrating process for many people to find a therapist. Plan to reach out to 10-20 therapists to find one who is available.
Google each therapist to see if they have a website and more information about their expertise and areas of interest.
If you are able to go out of network to find a therapist in New York City, you can probably find a psychologist who has tons of expertise in exactly the issues that you want to focus on. I purposely created my therapy practice website to give potential clients a lot of information about my approach to therapy and my thoughts about many topics in mental health so that people can get a sense of what I am like even before meeting me. See here for a list of articles I’ve written and expert input I’ve offered.
7. What are 3 coping skills or strategies for anxiety?
a. One coping skill for managing anxiety is to identify your triggers. When you are very aware of the exact stressor, you can work with a clinical psychologist to develop tools to take action.
b. Another coping skill is to become very aware of bodily sensations associated with anxious states. How does anxiety show up in your body? It’s different in everyone. When you have a keen understand of your physical symptoms, you’re less likely to be surprised by the way your body responds in the future. The goal is to be able to say, “Oh, my heart is racing not because I’m having a catastrophic medical issue, but because my anxiety has been triggered.
c. Distraction is king. Redirecting your attention away from your anxiety may also work to reduce symptoms.
(Disclaimer: These strategies are for informational purposes only. Please consult a medical or mental health help if you are experiencing significant anxiety.)
8. How do you calm down/ reduce anxiety?
Anxiety is reduced by developing tools to make you feel more prepared for future episodes of anxiety. It all comes down to what you tell yourself, so self-talk is crucial.
9. What triggers anxiety?
Many things can trigger anxiety, including specific environments, painful thoughts, or in some cases, medical issues.
10. Is anxiety a form of mental illness?
It’s tricky to define what constitutes mental illness. Anxiety is a mental health condition. The word “illness” is less clear to define. The DSMV-TR generally defines mental illness as emotional distress that significantly interferes with one or many aspects of your life, including social, occupational, relationship or school functioning.
11. What is anxiety?
Think of anxiety as the anticipation that a catastrophe is going to occur. Anxiety is the interpretation of an impending threat of some variety. Your mind and body react to the conscious or unconscious message that you won’t be able to handle the threat.
Learn More
A New York Psychologist Shares 18 Ways to Overcome Mask Anxiety
During this unique time we’ve had to adjust to life behind a face mask. The world outside your window has changed, which necessitates a shift in the way you protect our physical and mental health.
While casual use of a mask in open spaces is generally easier to manage, many of us are experiencing uncomfortable levels of anxiety, even panic, while wearing a mask around others, especially as we transition toward slightly increased exposure to more people and places.
Uncertain times like these demand increased confidence in our physical and psychological protection as we encounter real or imagined danger. Below you’ll find 18 great tips for overcoming mask anxiety.
18 Ways to Reduce Mask Anxiety
1. Take your self-talk to the next level.
Remind yourself 20 times during each outdoor journey that you’re going to be ok. Literally, say to yourself. “No matter what happens, I’m going to be ok.” This self-talk may boost your immune system by giving you an enhanced sense of control during this strange time.
2. Wear your mask at home for short periods of time.
Let the mask feel like it can be a part of you. Dance with your mask. Listen to music. Take selfies. Do whatever makes the mask feel like your mask is a part of you.
3. Remind yourself of your free will to choose.
If your anxiety spikes during a mask-wearing outing, keep telling yourself different choices you’re making in real time. Say, “I choose to…” For example, if you’re about to turn right on as you approach a perpendicular street, tell yourself, “I choose to turn right.” Repeat this for the smallest of choices. Consciously exercising your free will to make choices reduces a perception of powerlessness and increases a sense of personal agency.
4. Strive to better understand your triggers.
Pay attention to the situations that trigger your anxiety. Keep a log of each bout of mask anxiety. A note on your phone will suffice. For each occurrence, write down where it occurred, what you were thinking at the time, rate your anxiety from 1-10 and remind yourself of what you did to calm down. Read over your notes. Talk through your triggers with trusted loved ones and a mental health professional.
5. Practice breathing techniques with and without your mask on.
The more you practice bringing your breathing under control, the easier it will be to self-soothe when you’re feeling anxious with a mask on. Do relaxation exercises at home with your mask on. Here’s an example of a anxiety-reducing relaxation exercise you can try.
6. Practice visualization exercises to simulate wearing a mask in real life.
Picture yourself wearing a mask in different environments that represent varying levels of stress. Begin with the least stressful environment you can imagine encountering and rehearse relaxation exercises to calm your breath. See yourself as relaxed in your mind’s eye. Then move on to visualize more stressful places where a mask may be a challenge.
7. Give your mask a name.
Build a nice relationship with your mask by naming it. Talk to it. Reason with it. Laugh at it and with it. Relate to it as a friend. “Buddy, I gotta loosen you. You’re too uptight.”
8. Consciously send healing vibes to people you see.
Focus your thoughts on how your mask is protecting the people around you. Wish each person well as they pass you by. Transmit thoughts of love and healing. We’re all struggling these days. Bringing your attention to other people’s well-being can get you outside of your own anxiety. Tell them in your mind that you’re protecting them. The world desperately needs your good vibes and sense of social responsibility to heal.
9. Think of the children.
Remind yourself of the children you’re potentially saving by wearing a mask. Imagine kids thanking you in their cute little voices. Step outside of your suffering by picturing their smiles of gratitude. You’re making a sacrifice by being so uncomfortable.
10. Embrace the anonymity.
Your mask offers you a level of public anonymity that you’ve probably never experienced before. A teenager told me he likes to think of himself as a ninja when he wears his mask. Find a fascinating angle on mask anonymity. Embrace temporary hiding out. Enlist your imagination.
11. Get angry at your anxiety.
This is not my first choice compared to the other anxiety reduction techniques, but some people find it effective. Anger is the flip side of anxiety. You can’t feel both at the same time. Focus on how annoying your anxiety can be. Talk back to your anxiety. Yell at it in your mind. Tell it that it can’t control you.
12. Try name calling. That is, give your anxiety a name.
Naming your anxiety reminds you that anxiety is not all of you: rather, it’s a part of you. This anxiety reduction technique represents another way to increase your sense of control in the face of uncertainty, similar to my recommendation to get angry about your anxiety. Call your anxiety a person’s name and let it know how you feel. There’s something comical in this, but it can work if you buy into this technique. “Herbert, you suck! Go away!”
13. Find the humor in your situation.
I know that there’s nothing funny about all of the tragedy that the Covid-19 virus has inflicted on the world, but for survival’s sake, look for what funny about a given situation. Laughter can be neutralizer of mask anxiety. I think about the inevitably awkward moments that this pandemic has created. How would Larry David respond to a scenario you find yourself in? George Costanza? Kramer? The Modern Family characters? What about your favorite comedic characters?
14. Wear a funny, protective mask.
There are plenty of masks for sale with slogans that will give you and strangers a good chuckle. Knowing that you’re delivering humor to the world may help you feel less anxious with your mask on.
15. Make your mask a fashion statement.
If a humorous mask isn’t your thing, then can you make it about fashion? A few masks that match your clothing can go a long way. I wouldn’t make this recommendation if we weren’t in the midst of a global pandemic, but a little style can go a long way for easing your mask anxiety.
16. Online therapy = an anxiety game changer.
Seeking out an online therapist in a global pandemic is a sign of massive strength. Work on lowering your anxiety from the comfort of your own home with an online therapist. This experience can improve more than mask anxiety. Online therapy for anxiety with the right mental health professional can give you the perspective you need to understand and control your triggers, as well as the less obvious influences on your anxiety.
17. Imagine a light around you that protects you.
Imagine a blue light protecting you from all danger. Focus your energy on this force field. Picture a round aura protecting you. Send love to it. Repeat to yourself in a loving and confident voice, “I am protected.” This exercise is no joke. Creating a reminder of your safety can reduce your anxiety.
18. Start a creative, mask-related phone or video project.
Talk to yourself on camera about what you’re going through. Document this time in your life so that future generations can see what you endured. Share your wisdom from lessons learned. Creative projects lower anxiety.
Learn More