Wednesday, September 10, 2008

Social Phobia: Pill or Hypoxia?

Social Phobia: Pill or Hypoxia?

Meds Vs. therapy, and it looks like therapy is gonna win this one!

Hypoxia means low oxygen. The mental health world has known, for a long time, that the detection of low oxygen, or even the fear of low oxygen, can start a panic attack. People with panic attacks “know” part of this problem all-too-well, but have to be convinced, by various means, of the other part of this problem: when, for whatever reason, the oxygen that you are breathing gets a bit low, it “triggers” a panic attack. If you start to get scared in some situation, and your body has a typical fear reaction including your chest tightening up AND your heart beating faster, the amount of “air” or oxygen getting in your body will be reduced. It is the same as if you were holding your breathe for a few moments. The feeling is light-headedness, as if you were spinning around a couple times, or dipping your head between your legs then raising back up a couple times, or breathing through a narrow soda straw, like a coffee stirrer.

The mental health world has also known, for a long time, that learning to handle this problem can drastically reduce panic attacks.

SIDEBAR: If you have panic attacks, get a self-help book on the topic, or find a decent therapist who acknowledges this established treatment, or check the youtube videos on panic attack, and get help! You have a strong possibility of greatly reducing panic attacks with modest, little or no professional cost or help, as long as you can grasp hold of the basics and train yourself accordingly, or get this done with the guidance of someone who knows the established science of this, and is skilled in helping you gain some control over panic attacks. And this includes the use of pills ONLY as a reassuring security-blanket backup plan, such as when traveling/flying. Now back to my blog.

A recent study published in the Journal of Psychiatric Research indicates that, along with people suffering from panic attacks, people suffering from social anxiety, but who do NOT have panic attacks, may also be sensitive to reduced oxygen.

The unhelpful thoughts and the body response that is part of social phobia may be triggered by low oxygen in the body.

So, you are about to do a job interview, or attend a work party, or give a public talk. The fearful thoughts - what if this, what if that - make your body tense up - this includes your muscles generally, including chest muscles. You all-of-a-sudden are breathing shallow, and your heart is going a little faster. After a few moments, your brain detects low oxygen. From this, your social phobia symptoms are on a roll. Off on their own, out of your control.

What is new is that the researchers in this new study have discovered that low oxygen in the body is part of this. Social phobia, and the problematic behaviors that follow from it, are not just from the off-base, unproductive thoughts, but also, somehow, low oxygen is part of this.

That’s good news! That is like discovering that Wellbutrin, supposedly effective for depression, might also help people quit smoking!

This suggests that a new avenue of treatment is available for social phobia!!!! And it totally already exists!! It just needs to be borrowed from panic attack treatment!!!!

Or, you could go to your physician, and they can start prescribing pills. Which pills? Antidepressants and or “anxiolytics,” also known as ant-anxiety drugs. Anxiolytics include “valium,” Klonopin, and other similar pills - that have side effects including dependence, withdrawal, and being unable to “operate heavy machinery” such as a job interview, public speaking, work holiday party, or an automobile.

Also, some pills that are primarily used for blood pressure -such as propanolol - will work, and do not have the addictive-type side effects except, possibly, eventually leading you to believe you cannot perform in certain situations without a pill, and the slight increase in risk of fainting from lowered blood pressure.

So, how do you treat this sensitivity to low oxygen? Low “air?” Well, it translates directly from what I said above, about the dizziness and feeling short-of-breath.

One: therapists, or self-help books, will train people to breathe deeply. This is why they always tell ya to breathe deeply.

Two: therapists, or self-help books, will train people to practice coping with slightly low oxygen so you can feel it, but not have it lead to a bunch of calamitous, disastrous thoughts in your head - those thoughts that crowd out what you really want to have in your head - like answering questions, keeping your balance, not dropping food on yourself in a social setting, etc.

The self-help books and the therapists can help anyone learn this, with fancy techniques such as: put your head between your knees, then raise it, then repeat, but keep breathing deeply, and keep telling yourself reassuring thoughts. Or breathe through a coffee stirrer (after managing to breathe through a soda straw). Etc.

There are lots of ways to conquer social phobia. All of this knowledge is widely known and widely available. The reason I am glad to see this study is because it holds the promise of even more strategies for treating social phobia -- these recognized therapies for panic attacks may also benefit people with social phobia but no panic attacks. That is cool.

At the same time, it is worth mentioning because, as this knowledge marches forward, the pharmaceutical companies are marching forward with the idea that pills will solve social phobia.

On the web, the power of cognitive/behavioral therapy, as I have alluded to, is widely recognized. However, some sources delve into the pharmaceutical aspect, such as this site:
http://www.socialanxietysupport.com/meds.php
It is bothersome that, rather than some in-depth discussion of the types of maladaptive thoughts addressed by cognitive therapy, or the many possibilities for behavioral, cognitive, and social-skill exercises to deal with social phobia, the discussion is centered on the various antidepressants and how one might be different from another.

The erroneous belief that various psychotherapeutic interventions are not “therapy” but are some other kind of help (I don’t know what kind, but my recent Phelps/ADHD post indicates that one term is “tips”) pops up on some websites:
The NIMH website shows this view:
http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml

“Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy.”

Uh, what? --Stress management and meditation is therapy, not something that might “help” or “enhance” therapy.

So, to wrap this little discussion up, it is cool to see some decent, organized study investigating social phobia, since it affects so many people. It is cool to see that, if sensitivity to being out-of-breath is part of social phobia as it is for panic attacks, then the treatments for panic attacks might also work for social phobia. Non-pill treatments. In the future, we may see meds vs. therapy for social phobia, and therapy will win this one.

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