0:01

Ted Audio Collective. This

0:15

is Ted Health. I'm Doctor

0:18

Shauna under later socializing. Is

0:20

a crucial part of our lives?

0:22

Yeah, it can be daunting and

0:25

anxiety provoking for many. In her

0:27

twenty twenty one text talk at

0:29

the University of South Florida license,

0:32

Clinical Psychologist Fallon Goodman sheds light

0:34

on the root causes of social

0:36

anxiety and offers practical tips to

0:39

manage it. Afterwards.

0:42

I'll talk to psychiatry and science journalist

0:44

Doctor Jesse Gold will discuss how we

0:46

can all do our best to ease

0:48

the burden of social anxiety for the

0:50

people that we care about. So stick

0:52

around. Each.

1:05

Person who answered are therapy clinic

1:07

answer stack of questions before beginning

1:10

treatment. And or years therapist

1:12

there. There was one question I always

1:14

reviewed before meeting with a new fire.

1:16

It as this: what is your purpose

1:18

in life Define as a central motivating

1:20

life? Ain't that the you're trying to

1:23

accomplish Now to be fair and says

1:25

difficult question. Identifying. A

1:27

Single Purpose in Life drills really

1:29

hard. It also feels consequential. Many

1:31

people spend years searching for and

1:33

developing their purposes, and some never

1:36

find it. But typically B C

1:38

responses like this. To

1:40

been engaged parent. To.

1:42

Make meaningful change in my community.

1:45

To. Builds a career I'm proud of.

1:48

To. Live for a long time, skip minutes

1:50

And but then there was the answer

1:52

of one young woman who I worked

1:54

with. before meeting with her as

1:56

i always did i flip to see how

1:58

she described her purpose And she wrote

2:00

this, to

2:03

avoid being noticed by other people.

2:06

This young woman, a bright, witty,

2:09

compassionate high schooler, decided that her

2:11

purpose in life was to make

2:13

sure that other people did not

2:16

know that she existed. This

2:18

is the power of social anxiety. At

2:21

its core, social anxiety is about the

2:23

fear of being rejected. When

2:25

we feel socially anxious, we become hyper-focused on

2:28

how we are appearing to others. We scan

2:30

the room, we'll keep the signs of threat

2:32

and disapproval, signs we might have slipped up

2:34

on our risk for rejection. And

2:37

then we seek comfort in signs of approval,

2:39

smiles, head nods, laughs, and so on. And

2:42

while social anxiety can be exhausting, it exists

2:45

for a reason. Social

2:47

anxiety tries to protect us from rejection.

2:49

And it does that by tuning us

2:51

into the nuances and norms and dynamics

2:53

of a social group so

2:55

we can match our behavior to fit in

2:58

with them and ultimately avoid being rejected. Now,

3:00

this is a good thing because humans are

3:02

social. We exist in social groups. We rely

3:04

on each other whether or not we like

3:06

that. But also more simply because rejection is

3:08

painful. Take a moment

3:11

to think about your own rejection experiences, however

3:13

cringe-worthy they all have them. Maybe

3:15

you were ghosted after a first date. Been there.

3:18

Maybe you were rejected from your dream job.

3:21

Maybe you were ousted from a friend group. Rejection

3:24

is unpleasant. And social anxiety tries to

3:26

protect us from it. But

3:29

social anxiety becomes problematic when it begins

3:31

to interfere with the life you want

3:34

to live. And this

3:36

happens when your fear of rejection becomes

3:38

intertwined with your view of yourself. When

3:41

you believe you will be rejected because you

3:43

think you have some inherent flaw, deficiency,

3:46

or failing of character. You

3:48

were ghosted after that first date. And you believe it's

3:50

because you are not or

3:53

attractive enough. You

3:55

were turned down from your dream job and

3:57

you believe it's because you are not intelligent.

3:59

Accompan... in enough. You're

4:02

out there from that friend group and you believe

4:04

it's because you're not interesting or funny enough. Our

4:07

fear of rejection is really a fear of

4:10

being less than. Less than we

4:12

want to be, less than we think we should

4:14

be, or less than we believe

4:16

society wants us to be. And over

4:18

time this belief system can develop

4:20

into social anxiety disorder. When

4:24

a person has social anxiety disorder they

4:26

become overly concerned by other

4:28

people, scrutinizing them, evaluating them

4:30

harshly, and ultimately rejecting them.

4:32

So much so

4:35

that they begin to construct their

4:37

lives around avoiding rejection. Because

4:39

if you can avoid being noticed by other

4:41

people, then those people

4:44

have fewer data points on which

4:46

to reject you. Now social

4:48

anxiety disorder is one of the most common

4:50

mental illnesses in the world. In the

4:52

United States alone more than 12% of

4:54

Americans at some point in their lives will

4:57

have diagnosable social anxiety disorder. That's

4:59

roughly 40 million people.

5:01

Now worldwide the estimates are lower,

5:03

they're 4%, which in and of

5:05

itself is interesting, but based on

5:07

current population estimates 4% of the

5:10

world's roughly 300 million people that

5:12

will potentially have social anxiety disorder

5:14

at some point in their lifetime.

5:16

And despite how prevalent it is, it's

5:19

widely misunderstood, widely

5:22

misdiagnosed, and often missed

5:24

entirely. This is because

5:26

several myths about social anxiety pervade our

5:28

culture. The first

5:31

myth is that people with social

5:33

anxiety are happier alone. The stereotype

5:35

of someone with social anxiety is a recluse

5:37

who'd rather be hiding away alone in their

5:40

bedroom than out interacting with the world. And

5:42

this is simply not true. In research

5:44

conducted in my lab we

5:47

find that people with social anxiety

5:49

disorder desire strong, healthy, intimate relationships

5:51

to the same degree as those

5:53

without mental illness. And they

5:55

do socialize, they're not robotic aliens. And

5:58

when they socialize they often and enjoy doing

6:00

so. In fact, when we

6:03

ask people with social anxiety how happy

6:05

they are, they report

6:07

feeling happier when they are with other

6:09

people than when they're alone. This

6:12

is because not all social interactions

6:14

are stressful. Maybe

6:17

someone feels socially anxious with friends, but

6:19

not the romantic partner. Or they feel

6:21

anxious with strangers and acquaintances, but

6:24

not people like their neighbors or coworkers.

6:28

Even though some interactions are

6:30

stressful, people with social anxiety

6:32

are not devoid of the basic desire

6:34

for human connection. They

6:36

just have trouble painting it in certain

6:38

situations with certain people. OK,

6:41

so maybe then people with social anxiety

6:43

do socialize, and when they do, they

6:45

enjoy it. But it's with a small,

6:47

tight-knit group of people. And

6:49

really, social anxiety is about avoiding the spotlight.

6:52

And this is the second myth. Social

6:55

anxiety is not necessarily about a fear

6:57

of public performance. While this is true

6:59

of some people, other people

7:01

with social anxiety find, performing in front

7:03

of others, less anxiety-provoking than

7:06

smaller, more intimate conversations, like

7:08

where they have to carry

7:10

a conversation one-on-one. Many

7:13

people with social anxiety excel in

7:15

careers that are intertwined with social

7:17

evaluation and social performance. Modeling,

7:22

acting, sports. In

7:24

May of 2021, Naomi Osaka declined

7:26

to participate in press conferences with

7:29

the French Open. She

7:31

courageously and preemptively shared that they

7:33

exacerbated her social anxiety. Shortly

7:36

thereafter, she received a wave of

7:38

public backlash and scrutiny. She

7:42

goes on to play her first match, of course

7:44

wins, and then she withdraws from the French Open.

7:48

Many people were perplexed about how someone

7:50

could have social anxiety and also be

7:53

the number one ranked tennis player in the world, lead

7:56

a fashion campaign with Nike, new choice,

7:59

and done the cover. of Sports Illustrated in

8:01

a swimsuit. In an

8:03

interview the year prior in discussing her

8:05

social anxiety, Osaka explained, "'On

8:08

the court is completely different. "'I

8:10

love playing at Arthur Ashe "'because it's the

8:13

biggest stadium "'and you feel the rumble of

8:15

the crowd. "'You

8:17

kind of feel like a gladiator "'because it's

8:19

super big,' quote, "'and there are so

8:21

many people watching your match. "'But

8:24

off the court, if I was ever thrown into a

8:26

situation "'where I had to speak in front of 100

8:28

people, "'I feel like I

8:30

would start shaking.'" There

8:32

is no one-size-fits-all profile of

8:35

social anxiety. Just

8:37

like people who are depressed, have

8:39

different collections of symptoms at different times

8:41

for different reasons, social anxiety

8:43

looks different in different people. And

8:47

last, and maybe the most problematic myth, that

8:50

social anxiety is fleeting and harmless. Social

8:54

anxiety is not just something you grow out

8:56

of. It doesn't magically disappear when you graduate

8:58

middle school or high school. Without

9:01

intervention, many people struggle with social

9:03

anxiety for years, for decades. And

9:06

social anxiety can influence every aspect

9:08

of a person's life. It

9:11

can influence the hobbies they choose, maybe

9:13

opting for solo activities like reading, writing,

9:16

rather than things like team sports. It

9:19

can influence the careers people pursue, maybe

9:22

opting for careers with more individual, like

9:24

computer time, versus things like

9:26

sales or customer service. And

9:29

social anxiety can influence people's everyday

9:31

lives. Ricky Williams,

9:34

star NFL running back, Heisman

9:36

winning running back, dazzled

9:38

millions of people in the football

9:40

field every week. And yet

9:42

he shared that he struggled with social anxiety, and because

9:44

of it, he had difficulty

9:47

interacting with teammates, running everyday

9:49

errands where he'd have to interact with people,

9:52

and even interacting with his own daughter.

9:56

The real tragedy of social anxiety is

9:58

that it robs individuals of their

10:01

greatest resource, other people.

10:04

Other people help us overcome adversity, like

10:06

recovering from illness or after you bomb

10:08

a job interview. Other

10:10

people help us celebrate milestones like showing

10:13

up to the birth of our child

10:15

or a wedding or graduation. And other

10:17

people help us overcome loss, like

10:20

grieving the death of a loved one. Our

10:23

fear of rejection gets in the

10:25

way of obtaining and appreciating the

10:28

benefits of being accepted the benefits

10:30

of other people. And

10:34

in our modern world is harder than ever

10:36

to manage social anxiety. We

10:38

are more connected today than any time

10:41

in human history. And yet we are

10:43

lonelier, more depressed, and

10:45

more socially anxious than ever. We

10:47

have endless tools to socialize. And

10:50

yet we're seeing a decaying social

10:52

connection. In a

10:54

rapid amount of time, our social

10:56

structures have been upended and rewritten.

10:58

Technology and social media have created new standards

11:00

for social relationships and interactions. Do I post it?

11:02

Do I share it? Do I like it? Do

11:05

I love it? We

11:07

create these bizarre extensions of ourselves through

11:09

curated profiles and now avatars. We try

11:11

to make sense of unlimited feedback from

11:14

a massive and often invisible audience. And

11:16

the cost of social wonders are higher.

11:19

Things you do and things you say

11:22

can live online forever and subject you

11:24

to unforgiving scrutiny, reputation loss, and even

11:26

job loss. It is a tough time

11:28

to have social anxiety. But

11:30

the world will become more, not

11:33

less connected. And the influence of

11:35

technology and social media will grow,

11:37

not shrink. Now

11:39

is the time to address social anxiety. And

11:41

here's how. The

11:44

first and maybe easiest thing we can do

11:46

is identify early. Early

11:48

detection is critical because of those who

11:50

go on to develop social anxiety disorder.

11:53

More than half of them have developed it before

11:55

their 14th birthday, more than half. And

11:58

Social anxiety puts people at risk. developing

12:00

other mental illnesses later on. Of

12:03

adults who are diagnosed with both social

12:05

anxiety disorder and depression, Social

12:08

anxiety came first seventy percent

12:10

of the time. Of

12:13

adults who are diagnosed for both social

12:15

anxiety disorder and alcohol use disorder, Social.

12:18

Anxiety came first. it was developed

12:20

first approximately eighty percent of the

12:22

time. With this

12:24

data suggested that social anxiety starts early

12:26

and it puts people are at risk

12:29

for developing other mental illnesses. Refusing

12:31

around the park social anxiety can

12:33

be reliably in accurately flagged by

12:36

asking just a few simple question.

12:39

Seems like there's your fear rejection that

12:41

one up among one of your worst

12:43

fears and is your fear of rejection

12:45

get in the way of doing things

12:47

that you'd otherwise want to be or

12:49

enjoy doing. The costs

12:51

of asking these questions: Six thirty

12:53

seconds and Zero dollars. One.

12:55

Of the creative infrastructure his we

12:57

don't the up and existing ones.

13:00

We get bed early detection programs

13:02

into our existing structures like it's

13:04

schools. New Year. Orientation or

13:06

one cancer meetings. And

13:09

primary care settings because of it's out

13:11

there to screen for the person and

13:13

seguin off the screen for social anxiety.

13:17

Early detection and then appropriately

13:19

intervening can significantly alter the

13:21

trajectory. Of young people. The

13:24

second thing we can do with Harness

13:27

are platforms. One of the benefits of

13:29

living in this hyper connected world is

13:31

that a single person can have a

13:34

ton of power. They can use their

13:36

platforms to create meaningful and lasting social

13:38

change. I mentioned Ricky

13:40

Williams and Osaka Us who abuse

13:42

their platforms to share about their

13:44

social anxiety. And just from these

13:46

two people, we've seen a effect.

13:49

In response to Soccer's announcer,

13:51

Viola Davis oscar any Tony

13:54

award winning actress assert that

13:56

she struggles with social anxiety.

13:59

A woman job it is as an

14:01

actress. To embody and express

14:03

the complexities of people in very

14:05

vulnerable and very public with. The

14:08

frankly be celebrities are not the

14:10

poster children for social anxiety. There's

14:13

three of the millions to suffer who are

14:15

brave enough to talk about it. And

14:18

we can do the same with our platforms,

14:20

however big or small. Schools.

14:24

In our workplaces, in our communities,

14:26

and in our homes. Because

14:29

regular, candid and forthcoming

14:31

conversations about mental illness

14:33

ultimately reduce Sigma. Correct.

14:36

Harmful myth. And. Get people to

14:38

help that they need. The

14:41

last thing that we can do is false or social

14:43

kurds. Addressing social

14:46

anxiety is not about preventing

14:48

are avoiding rejection. Addressing

14:51

social anxieties about fostering. Social.

14:53

Workers. Be

14:55

socially courageous means pursuing experiences and knowing

14:57

that your chances of rejection are not

14:59

zero. In fact, the chances are you

15:01

get rejected at some point in your

15:03

life as a way to here are

15:06

high. And worse, you

15:08

may be rejected as a function of who you

15:10

are. Things. About yourself that

15:12

you cannot change. Where. You come

15:14

from. What? You look like.

15:17

A We Love. Being.

15:21

Socially courageous means pursuing experiences because they

15:23

are important to you, and knowing that

15:25

the stresses of those pursues are not

15:28

contingent on your worth as a human

15:30

being. Being.

15:32

Socially create a sneeze, know you're

15:34

worth, and finding people and social

15:36

groups that was in excess. That

15:38

person. And

15:40

being socially courageous means asking their

15:43

personnel. Applying for that? Stop

15:45

speaking up without needing a party or

15:47

getting that big talk on that big

15:49

sees knowing that rejection works around the

15:52

corner. But.

15:54

The opportunity for growth. And.

15:56

For purpose shines brighter.

15:59

A purpose. Not defined by ensuring that

16:01

you go unnoticed in this world. A

16:05

purpose that makes you feel

16:07

most alive, most present, and

16:09

most authentically. You. Think

16:11

you. It's.

16:26

Social anxiety is a

16:28

medical diagnosis. It's something.

16:30

That's probably experienced by many the

16:32

people that you know. Maybe that

16:34

even includes you. Right

16:37

now we're also entering a time

16:39

of much greater awareness and openness

16:41

about discussing mental health, being led

16:43

in part by a younger generation.

16:46

I. Can't think of anyone in my

16:48

life who doesn't have a therapist and

16:50

that probably isn't new, but what's new

16:52

is that I know about. So

16:55

since we're more aware of metal, half mile

16:57

or more ready to make. Space. For it.

17:00

How can we set the tone or

17:02

set the table for others to help

17:04

ease their social anxiety? Assuming

17:06

that many, many people around us will

17:08

have it. To talk

17:10

about that, we have a special guest today. Doctor.

17:13

Jesse Gold as an assistant professor

17:15

in the Department of Psychiatry at

17:18

Washington University School of Medicine in

17:20

St. Louis, specializing in college mental

17:22

health, medical education, and physician wellness.

17:25

Think. So much for being here to see. And.

17:27

For having me. Jesse. Some estimates

17:30

suggest that up to thirteen percent

17:32

of people may experience some degree

17:34

of social anxiety symptoms at some

17:36

point in their lives, anywhere from

17:39

my olds all the way to

17:41

severe. So a social anxiety is

17:43

so common. Why does it off

17:45

and seem invisible? I.

17:48

Think people just assume it's their personality,

17:50

like they're shy or their introverted. and

17:52

I think if you're introverted, a really

17:54

good book to read on that as

17:56

quiet by seizing team but. It's

17:59

very different. being shy and introverted,

18:01

but we kind of just assume if we

18:03

don't want to hang out with people, it's

18:05

our problem, or there's something wrong with us,

18:07

or that's just how we've always been. And

18:09

it makes it really hard to go, okay,

18:11

that's something I should get help with. And

18:13

it's true because it isn't just like, I

18:16

can't hang out with people. It's when I hang

18:18

out with people, I worry all the time about

18:21

what they're thinking about me. I'm fearful of hanging

18:23

out with people. So I don't want to hang

18:25

out with people. And I avoid them to that

18:27

extent. People get really severe symptoms from it. And

18:29

you kind of mentioned the spectrum of it. And

18:32

I think when you're on the more mild end,

18:34

it's really easy to just be like, that's who

18:36

I am. I'm just a person who doesn't

18:38

like people. But I think people

18:41

tend not to get help as a result.

18:43

And there's like a lot of data about

18:45

social anxiety, and people not actually seeking help

18:47

for it, only about 5% of people

18:49

actually do, and about a third wait

18:51

10 years. And that's really a long

18:54

time waiting 10 years to get help.

18:56

So because our society sort of normalizes

18:58

that as introversion or shyness, we tend

19:00

to then wait till we need help

19:02

until we have really severe symptoms or

19:04

just not get help at all. So

19:08

so many people are sort of suffering in

19:10

silence with this. Absolutely.

19:12

As a psychiatrist, you take care

19:15

of college and grad school age

19:17

students. So how does social anxiety

19:19

manifest for people in that age

19:21

group? College

19:23

is a really interesting time. So you're

19:26

basically thrown into extreme socializing. You don't

19:28

get away from people at all, right?

19:30

So you might have lived at home

19:33

with no siblings. You might not really

19:35

interact with people if you don't play

19:37

group sports or group activities. But all

19:40

of a sudden, classes are with people.

19:43

Eating is with people. You sleep

19:45

in the same rooms as people.

19:47

You literally can't get away from

19:49

people. And that's a big difference.

19:51

So sometimes you might have been

19:53

okay at home in high school or

19:55

even before in elementary school, but college

19:57

is like being flooded with people

20:00

as a person with social anxiety. And

20:02

what you'll see is kind of like

20:05

a constellation of like three categories of

20:07

symptoms. So people have

20:09

physical symptoms, where in social situations, it

20:11

kind of looks like panic, having

20:14

their heart rate go up, feeling

20:16

dizzy, feeling muscle tension, sometimes their

20:18

stomach hurts, sometimes they blush, that

20:20

sort of thing. There's a

20:22

lot of physical reactions because the brain and

20:24

the body are connected. And it's not necessarily

20:26

always to the level of a panic attack,

20:28

but it could be. Then there's

20:31

sort of like the emotional reaction, which

20:33

is social situations make you scared or

20:35

anxious, not just a little worried or

20:38

a little scared to the point where

20:40

we actually call social anxiety, social phobia,

20:42

like you actually are that scared

20:45

of being around people. And

20:48

when you're around people, you have these

20:50

like thoughts in your head that everybody's

20:52

watching you, and everybody's judging you. And

20:54

whatever you do, somebody's going to comment

20:56

on, and it can feel like negative

20:58

self esteem. But it's much more than

21:01

that. It's it almost like I've had

21:03

patients say they feel paranoid that everybody

21:05

is watching them. That word is used

21:08

kind of colloquially, but also to mean

21:10

like an extreme sense of just worry

21:12

about what everyone else is thinking. So

21:14

those are like the emotions that are

21:16

typical. And then I'd say behaviorally, we

21:20

see that people either really avoid

21:22

social situations, or when they go

21:24

into social situations, like in college,

21:26

you really can't avoid it, right?

21:28

You're feel horrible, like you just

21:31

have those physical feelings, those

21:33

emotional feelings, and it Is

21:35

really uncomfortable. So Then when you have

21:37

the chance, you're going to avoid them.

21:39

If you can, you're going to be

21:41

socially isolated if you can. Or we

21:43

see a lot of substance use in

21:46

college kids for this reason, too, right?

21:48

Like, I Want to be in this

21:50

situation. So I'm going to drink because

21:52

drinking lets me be in this situation

21:54

without worrying what everybody's thinking. But Social

21:57

anxiety, apparently quadruples the risk of developing

21:59

an alcohol. Are you disorder in their

22:01

studies in college students were it's really

22:03

related to a motion sell. They drink

22:05

more if they're feeling really sad or

22:07

angry and the situation or if it

22:09

feels really personal. our intimate but like

22:11

maybe not in the bigger situations where

22:13

they can kind of put on a

22:15

show and not have to. Be.

22:18

Around people in this really intimate

22:20

way where they know are trying

22:22

to have these severe conversations with

22:24

them or something. But we see

22:26

substance use a lot in college

22:28

kids, obviously, but much more in

22:30

the social anxiety because it lets

22:32

them be the person they think

22:34

they're supposed to be around other

22:36

people as that makes sense. Yeah,

22:39

absolutely. Let's talk about another potential

22:41

generator of social anxiety that young

22:43

people are being bombarded by social

22:45

media. There's some evidence suggests that

22:47

social media use. Can really contribute

22:49

to social anxiety. What are you seeing?

22:52

So. Is a really interesting question. I

22:54

am a big believer that the social

22:56

media data is very confusing and mixed

22:59

anyway, and it tends to have people

23:01

can ago one side or the other.

23:03

And it's not really fair because it's

23:05

very mixed and so you can't say

23:08

all social media bad or also me

23:10

as good, especially for people with preexisting

23:12

conditions. But for social anxiety, you can

23:14

imagine that interacting with others through a

23:16

computer is easier for them interacting in

23:19

person. Anybody might say that I'm an

23:21

extrovert. I like humans. I get

23:23

energy from humans but sometimes I just

23:25

wanna talk to be on social media

23:28

is there is that distance and it

23:30

feels nice Sell It might be a

23:32

way that they feel they can interact

23:34

with people easier, but as a result

23:37

they might spend more time on social

23:39

media and the time spent on social

23:41

media could be related to increase in

23:44

anxiety, increase depression, increase in problems with

23:46

self esteem because of comparison to other

23:48

people and trouble concentrating, trouble with sleep.

23:51

Those are things that are related. To

23:53

social media use And some people, if

23:55

you're using it a lot because that's

23:57

where you're getting your social interactions, that

24:00

can be problem that. Plus, they might

24:02

also choose not to socialize and person

24:04

because they think they're getting enough socializing

24:06

online and that's problematic to because we

24:08

all need at least one friend and

24:11

person we can rely on In if

24:13

you're only relying on internet people that

24:15

can be pretty complicated. Jesse So what

24:17

are Listers Feel like they have some

24:20

degree of social anxiety or not? What

24:22

are the ways that we can all

24:24

so up and really support people that

24:26

we care about who are facing this.

24:30

We really bad at open communication,

24:32

period. Nobody taught us how to

24:35

have conversations. Social anxiety means a

24:37

lot of people are having thoughts

24:39

about you and what you're thinking

24:41

without you actually necessarily having those

24:43

thoughts. Anything you can speak out loud

24:46

to clarify that that's not what you're thinking

24:48

or like that facial expression I made wasn't

24:50

about you can make them feel better. I

24:52

know that feels really weird and we don't

24:54

speak a lot of those things out loud

24:56

because no one told us. feel I do

24:58

as a psychiatrist may more than some people

25:00

deal but like. Bear gonna make

25:03

assumptions about your body language, your interaction

25:05

you not responding to them and being

25:07

aware that that's going on in their

25:09

brain and trying your best to speak

25:11

openly to listen to be empathetic, not

25:13

to be like hey, something's wrong, why

25:15

don't you just come out And why

25:17

is it still hard? Feel like it

25:19

is hard and you have to understand

25:21

that. I think we also can be

25:24

really helpful by planning activities that don't

25:26

require actually talk it cel. Seems.

25:29

Full. Length Going for a walk?

25:31

Anything where the person can do

25:33

something else and still be interacting

25:35

with you. Sometimes we call that

25:37

parallel play when people are like

25:40

kid right? And I would say

25:42

third, that people with social anxiety

25:44

need. By the gradual. Steps

25:46

in. The things I mention that college

25:48

feel something to be getting thrown into

25:50

the deep end. sort of a socializing.

25:53

Like. what we would you ideally with

25:55

some omelets social anxiety is somewhat what

25:57

we would be with somebody with other

25:59

phobia let's say you were scared of a

26:01

spider. Like we wouldn't go, I'm going

26:03

to throw you in a cage of spiders like they

26:05

used to do on Fear Factor because that sounds

26:07

actually horrible. And that's like flooding

26:10

of emotions is what we would call that.

26:12

Sometimes it just extinguishes them because

26:14

you're like, oh, wow, that was as much

26:17

as I could possibly feel. I'll never feel

26:19

anything again. But that's not how we would

26:21

like ideally help someone. We would be like,

26:23

let's imagine you're near a spider. OK, let's

26:25

look at a picture of a spider. OK,

26:27

let's play with a fake spider. OK, let's

26:30

go to a place where there is a spider, right?

26:32

Like you kind of keep going until it's more

26:34

time and a closer exposure. You have to

26:36

think about social anxiety that way with your

26:39

friends. So if you know your friend has

26:41

social anxiety or it seems like they really

26:43

don't like interacting with other people in the

26:45

same way you do, the answer is not

26:47

to go like, let's go in a group

26:49

of 10 people and go on a weekend

26:51

trip and enjoy that. The answer is to

26:53

be like, let's start somewhere small. And maybe

26:55

that's having a conversation with them about what

26:58

is small and what are they comfortable with?

27:00

And then sort of build them up and

27:02

make it easier for them to interact because

27:04

they feel more comfortable and safer with you.

27:07

Yeah, baby steps makes really good sense to

27:09

me. So I want to build on something

27:11

that you mentioned before. Are

27:13

there things that we can do

27:15

to make, for example, workplaces and

27:17

social spaces that we inhabit more

27:19

approachable for people with social anxiety,

27:21

whether we know someone has it

27:23

or not? So

27:26

a really interesting thing that has come out

27:29

over COVID I think is this idea that we

27:32

don't all need to be in-person places. And

27:34

that has been really nice for people with

27:36

social anxiety. I would say out of all

27:38

of the groups of people that I see,

27:41

even early on in the pandemic, people

27:44

with social anxiety were the most often going,

27:46

this is, I

27:48

don't really know what people are complaining about.

27:50

Like I like school from home and games

27:52

from home and socializing from home, whatever. It

27:55

takes the pressure off of also preparing to

27:57

go to class and be around people. takes

28:00

the pressure off of having to act

28:02

a certain way around people and I'm

28:04

just at home. Because we kind of

28:06

have a normal version of school and

28:08

work in our heads, we kind of

28:11

throw people into in-person jobs, in-person schooling,

28:13

that sort of thing, and assume it's

28:15

right for everybody. And nothing's right for

28:17

everybody. So being aware that maybe your

28:19

kid would do better with college at

28:21

home, being aware that maybe some employees

28:24

would do better working from home. And

28:26

they're not just saying that because it's

28:28

like laziness or something, which

28:30

I think is the way employers would

28:32

go. But it's because it's actually their

28:35

best way of working. And they're more efficient

28:37

that way, more productive that way. And I

28:39

think it's important that we have workplaces where

28:41

we can have open conversations like that. I

28:43

don't like when everybody has to explain themselves.

28:46

So a lot of my patients really don't

28:48

like having to go to an employer and

28:50

say like, Listen, I have social anxiety. That's

28:52

why I need this. But

28:54

I do think we need to understand

28:56

that when people are asking for those

28:59

things, there are often reasons and be

29:01

more open to the flexibility in the

29:03

workplace. I didn't mention but performance anxiety

29:05

is a component of social anxiety. So

29:08

taking tests, giving presentations,

29:10

that sort of thing can sometimes

29:12

be a different version and only

29:14

around tests I have that test

29:16

taking anxiety. So I think it's

29:19

important to note that not everybody

29:21

can do those things. So flexible

29:23

workplaces, giving people the opportunity

29:25

to work from home if they want,

29:27

realizing that they might not like speaking

29:29

in front of other people and giving

29:31

people people breaks and breaks as important

29:33

too. It

29:35

feels like we've reached a tipping point in

29:38

people's willingness to talk about mental health in

29:40

general. And almost

29:42

everyone I know has a therapist, including

29:44

me. And that may

29:46

have always been true. But now I

29:49

know about it, meaning that people

29:51

are much more willing to discuss

29:53

it openly. Can you talk about

29:55

the ways that greater awareness and

29:57

openness about discussing mental health in

29:59

general? is helpful? It

30:03

is so incredibly important that we talk

30:05

about this stuff out loud. Otherwise you

30:08

feel super alone in what you're dealing

30:10

with and you don't identify with signs

30:12

and symptoms. So if you've never seen

30:14

someone like you say like, oh that's

30:16

social anxiety, you can't say that's what's

30:18

going on with you, that's the problem

30:20

with portrayals in the media or only

30:22

white celebrities talking about things, right, is

30:24

that other groups can't go, that's how

30:26

I identify. Like turns out that's what's

30:29

happening to me. So we have to

30:31

have diverse voices of people saying these

30:33

things so that people can notice that they're

30:35

not alone, notice that it's not a weakness,

30:37

notice that it's not a problem if they're

30:39

experiencing it and be able to at all

30:42

identify it in themselves because you can't ask

30:44

for help if you can't identify it. Then

30:46

I think it is important for people

30:48

to realize that just because we're talking

30:51

about it more doesn't mean we're actually

30:53

getting more help for it. So I

30:55

still think there's a lot of stigma

30:57

around mental illness especially medication and I

30:59

think it's important for people to realize

31:01

that yes maybe especially college students and

31:03

this comes up all the time for

31:06

me as people are like college students

31:08

are so open about their mental health.

31:10

Maybe they are but they probably just

31:12

are with their friend group or a

31:14

friend and they're not gonna be the

31:16

same about their family or their teachers

31:19

or even getting help in the first

31:21

place because that step is like an

31:23

added thing. Asking for help from a

31:25

friend or talking to a friend sometimes

31:27

is easier which is why it's important

31:30

for friends and family to listen, be

31:32

empathetic, know signs and symptoms and help

31:34

as they can right but it's also

31:36

important that we know that just because

31:39

we go I identify with those signs

31:41

and symptoms doesn't mean that if they're

31:43

impacting our life we shouldn't ask for

31:45

help for them. I mentioned social anxiety

31:47

has a long time before people On

31:50

average people with mental illness wait 11 years

31:53

before they get help for something from

31:55

the first signs of symptoms that doesn't

31:57

mean they recognized them 11 years ago.

32:00

that just means if I were to go back

32:02

and ask them a history, I would get symptoms

32:04

11 years ago. That's a really long time and

32:06

what that usually means is by the time someone

32:08

goes and gets help 11 years later, they're pretty

32:11

sick and the things that we can do to

32:13

help them are much more limited. If you came

32:15

to me or you came to a therapist 11

32:18

years ago, we probably would have been

32:20

able to help a lot easier. Dr.

32:22

Patrick Seeler Jesse, you've done something that few

32:24

physicians, at least that I know about,

32:26

have ever done publicly, which is speak

32:28

openly about your own mental health journey.

32:31

Why was this important for you? Dr.

32:53

Patrick Seeler Now, I

32:55

also fervently believe you owe no on

32:57

your story and you don't have to

32:59

tell the parts you don't want to

33:01

tell. And if you're never ready to

33:03

tell, that's also okay. But as a

33:05

healthcare worker who sees healthcare workers, and

33:08

all day every day tells healthcare workers,

33:10

it's okay. I was like, what's

33:12

up with that? And I brought that

33:14

to my own therapist and realized like in

33:16

my head, medicine had made me believe the

33:19

same stuff that I told patients like was

33:21

not true, which is if I'm

33:23

on meds, I'm worse. If I'm on meds,

33:25

people might not want me as a doctor.

33:27

If I'm on meds, they're going to see

33:29

me differently, etc, etc. And I have to

33:31

work through that and be like, just kidding.

33:33

Like, what am I doing? Like I don't

33:35

believe that. And so when I

33:37

wrote about it and have talked about it,

33:39

I really wanted to write about that conversation

33:41

and not just say, I'm on meds, I've

33:43

been on meds, meds are great, because I

33:45

don't think that's helpful for people. I think

33:48

it's helpful for people to realize that like,

33:50

I'm so in it, and still,

33:52

I Stigmatize it. So We

33:54

have a long way to go. And So

33:57

it was really important for me to have

33:59

that conversation. Open me because I

34:01

realize, like turns out, I'm.

34:03

Not practicing at all. what I preach and

34:06

not needs to change and a lot of

34:08

health care workers aren't and not needs to

34:10

change in may be as they see me

34:12

more openly. Talk about it will feel ok

34:14

to and I kind of wanted to just

34:16

say it out loud. The sense that. Doctor

34:20

Jesse Gold Thank you so much for

34:22

having this conversation with me and really

34:24

for all that you do in the.

34:26

World's I'm I'm grateful. Think

34:29

in. Today's

34:36

episode. Thank you so much

34:38

for listen This episode was

34:40

to do a few dozen

34:42

on Vanessa. Garcia Woodward special

34:44

thanks to her religious faith

34:47

Rubenstein Thera date runs to

34:49

me, Gutierrez on us feel

34:52

I'm. Michelle Quinn said pollen. And

34:55

nectar of. The A.