social anxiety help

September 27, 2007 4:03 PM

How can I help my teenage sister deal with her horrible social anxiety?

My 16-year-old sister has social anxiety pretty bad and feels like it's totally ruining her life and no one understands. I don't live with her, but I'd like to be able to help in some way, even if it's just pointing her to some good resources or buying her a book or whatnot. She'll be starting effexor soon, but ongoing therapy isn't really an option for her right now. Is there anything else that can help her? Or at least anything she can do to deal with the people (family included) who tell her just get over it already?

posted by logic vs love to human relations (19 comments total)

Christ, why do people need Effexor to be 16? It's a normal phase of life, especially if she's intelligent and a little more introverted than normal.

Everyone at 16 feels like something is totally ruining their life and no one understands. This is not news.

You can't do too much if you're not physically proximate to her; be someone she can talk to. Encourage her to do things and/or talk to the people she does enjoy being around, in one-on-one situations, or very small groups. She's not broken if she doesn't want to do massive group activities, some people just don't like them. If you're near enough to occasionally visit, do that sometimes, go out to coffee shops or whatever. You might want to suggest she do the same thing by herself if she feels up to it - just being out among people is a good way to slowly easy into the idea of dealing with people socially. Saying "hi, can I have a large earl grey tea, please" and having it not go horribly wrong (which it won't) is a good little thing to do every day, and generally the people working at a tea/coffee shop won't be like people that she doesn't like to be around (i.e. other 16 year olds.)
posted by blacklite at 4:12 PM on September 27, 2007 [2 favorites]

The thing is, she looooves social/group activities, loves hanging out with her friends and doing other fun, outgoing teenage things. But lately, just the thought of going to lunch with a couple close friends fills her with dread and makes her want to puke. She hates that she's missing out on all sorts of things she wants to be doing, and that's why it's a real problem for her.
posted by logic vs love at 4:15 PM on September 27, 2007

What changed between when she was outgoing and when she started being anxious?
Drugs aren't the answer if the problem can be traced back...
posted by PowerCat at 4:19 PM on September 27, 2007

I was definitely where she was when I was 16, 17, 18... it went into my early 20s. The difference from 16 to 18 was that I was aware of why I felt awkward and that it was totally normal. I don't know what her personal experience is, but I was picked on a lot, was the at the bottom rung a lot. I'm not entirely sure why. In the end... 4th year HS/college... I was thankful for the experience.

Blacklite probably is right about being intelligent and introverted. I didn't buy into a lot of the crap politics that teenagers subscribe to and as a result my life was hellish for a while. Being smart means you're unhappy quite frankly because it means you're aware of more than just your immediate situation. Especially at that age. There are a lot of factors, I now realize, that went into my unhappiness. Being part of a different culture was one of them. But..without going on a long winded rant about why this culture is especially difficult for teens... I'll just say she needs to know she's normal and that many other people can relate to her.
I went on Zoloft for maybe two weeks before I realized that drugs are not the answer... I didn't want to be medicated. I wanted to find my own solution. What helped for me was to really look at myself and realize that my problems were mostly mental.

The main difference for me is that I go through funks pretty regularly. Everyone does but I've noticed that mine swing harder than some. I suppose that is normal but I refuse to see a professional for it. No one can help like a peer unless she really has a chemical disorder that is endangering her safety.

Anyway, I wouldn't go about recommending books until I know what her tastes are. Lorrie Moore's Birds of America helped me, personally. They're generally about awkward women. they're heavy/funny but not really inspirational if that's what you're going for. Interaction helps. A lot of it. Even when you don't feel like it. Even when you feel like you're gonna puke. My suggestion is she somehow needs to understand that she needs to tough it out, force herself to see that it's no big deal. Hell, I'll talk even talk to her. Heh.
Anyway I hope that will help you.
posted by apfel at 4:37 PM on September 27, 2007

Why an anti-depressant for something that sounds more like an anxiety disorder? Why not an anti-anxiety medication?

And sure, it could be normal teenage angst, but maybe not -- people sometimes do develop such disorders early in life. If she's anxious about participating in activities that she genuinely enjoys, it sounds like it could be a genuine problem. [insert disclaimers here]
posted by sgass at 5:42 PM on September 27, 2007

WHOA.

HANG ON.

Effexor is not a good drug for many, many people. Google "Effexor withdrawal" or "brain shiver" for a good time - I can personally attest that it is not a drug that should be started lightly. Getting on it and getting off it is a bitch, and, for me, the side effects (Hi, I'm your closer personal friend, complete anorgasmia. And these are my pals, weight gain, lethargy, being sweaty all the time, and electric shock. We'll be hanging out with you.) profoundly outweighed any positive impact.

Yes, I'm just one person and this is just anecdotal, but if you google, you'll find that a ton of people just happened to have eerily similar experiences.

Your parents should really be giving it a lot of thought before blithely starting their daughter on this drug, is what I'm getting at.

Effexor should particularly not be given to an adolescent without careful supervision. It has been shown to increase the risk of suicide.

Ugh! I get really pissed about this. (Sorry, I'm not yelling at you, I'm just grouchy.)

Effexor seems to have very effective doctor-outreach. That is, it's a strangely popular first-line drug for a lot of non-specialists. If your sister is seeing a psychiatrist who specializes in the treatment of adolescents, and this is what her doctor thinks is best, that's one thing. But I'm willing to bet you five bucks that this is what her family doctor - who may be a fine, fine person, but who does not have much specialized training in medicating social anxiety in adolescents - suggested. Right?

I'm not going to say she should just "get over it". But you know, 16-year-olds are notorious for being awkward and moody and prone to mood swings. If she's so upset about her perceived social anxiety that she's pondering medication, I think therapy should be an option. Your family should find a way to make it an option. There are sliding-scale therapy options available in every city. It does not need to be prohibitively expensive.

At minimum, please don't encourage your sister to take a drug that has been proven to cause a statistically significant increase in suicidal ideation in adolescents and young adults without really careful supervision.
posted by thehmsbeagle at 5:59 PM on September 27, 2007 [2 favorites]

The idea of prescription behavior-altering medicine without counseling screams, "Bad idea!" to me. I've been there and it made a not-so-great time of my life much, much worse. Effexor was my first and my worst prescription for those times.

At the very least, can she speak with a school guidance counselor or a teacher/mentor? Does her/your family's income inhibit psych counseling? Depending upon her local resources, she could get into a mental health group service that offers therapy to low-income people.

Thank you, logic vs love, for helping her.
posted by bonobo at 6:04 PM on September 27, 2007

Anecdotal: I have crazy social anxiety. They put me on Effexor. I can second thehmsbeagle's experience. If therapy isn't an option for her, and with severe social anxiety, I can attest that one often needs drugs before even thinking of visiting a therapist, there are a number of anxiety workbooks she can try. I've used Edmund Bourne's Anxiety and Phobia Workbook, but I see on Amazon that there's one especially for teens. Good luck to you and her.
posted by Ruki at 7:18 PM on September 27, 2007

My wife, who is a child/family therapist and sees some kids with social anxiety says ideally your sister should seek out group therapy for teens with social anxiety and a social skills group.

Since you say ongoing therapy isn't an option for your sister, anxieties.com might be a good resource for her, according to my wife. It can provide validation that social anxiety is real and provide other resources.

(My wife doesn't have a mefi account, so I'm posting for her. As usual, the standard disclaimers apply -- in order to get the best advice you or your sister should talk directly with a mental health professional. Also neither my wife or myself have any connection with Anxieties.com)
posted by cptspalding at 7:48 PM on September 27, 2007

Thanks for the answers so far. It wasn't too long ago that I was a moody, awkward teenager myself, so I remember what it's like, and what she's going through is definitely not normal. The decision to take effexor wasn't made lightly and isn't the first meds she has tried. I've shared my concerns about it, but it's ultimately between her, her doctor, and our parents, and I'm more concerned with things I can actually do to help her. To that end, the Anxiety and Phobia workbook looks good--thanks Ruki! Any other suggestion for helping her deal with this would be appreciated!
posted by logic vs love at 7:51 PM on September 27, 2007

Drugs should be the last resort, honestly.

There's a thing called cognitive therapy that they prescribe people suffering from 'anxiety disorders' should try before other more drastic measures are taken.

Backing up: are we so sure she's even got a disorder? People throw around disorders so lightly these days. Effexor sounds terrifying. Prescription drugs are meant to handle chemical disorders, not if someone is going through a funk. I agree with Bonobo on this one. How did she manage to get this kind of RX?

Anyway I commend you on trying to help her.
posted by apfel at 7:58 PM on September 27, 2007

oops you were quicker than i was. disregard the above.
posted by apfel at 8:01 PM on September 27, 2007

I had a lot of her same symptoms at 16 and it was definitely not normal. I refused treatment of any kind and withdrew more and more. By the age of 17, it had developed into full-blown agoraphobia and there was an eight month period where I did not leave my house. You're doing the right thing by being concerned. One of the best things you could say would be "I don't understand what you're going through," because I can guarantee she doesn't understand it herself, "but I will do what I can to make you feel comfortable."

Something you may want to try, my mother bought me a small piece of tiger eye at one of those rock and gem shops you find along the side of the highway in small towns. I kept it in my pocket and rubbed it whenever I started to feel anxious and it was a life-saver. It was from my mother so it meant something to me and helped me feel safe, and rubbing on the smooth surface during anxious situations was excellent self-soothing. Also, it was small enough to keep in my pocket so I could rub it without being worried that I was broadcasting my anxiety to everyone around me. Best of luck to you both.
posted by Ugh at 8:08 PM on September 27, 2007

I would recommend reading 10 Simple Solutions to Shyness by M. M. Anthony, if you haven't. The title is deceptive; it's actually a logical, well-researched little book that has a run-down of cognitive and behavioral therapies. It's not geared toward teens, so perhaps you should give it a read it beforehand.

I also recommend Dale Carnegie's famed How to Win Friends and Influence People, not because sis doesn't have a shining attractive personality, but because the book is a fairly good tool for gaining a bit of perspective on how people think. It's also nice and positive.

The best thing you can do for your sister is reinforce that she is not crazy, and that she has it in her to be OK. Don't underestimate the healing value of hearing "I love you" or even "I like you." I bet there are some great things to like about your sister, and I bet she could stand for someone to point one or two out to her every so often. Even without knowing her I can admire her for facing this problem as well as any human being can-- imperfectly, but deliberately.

There may be nothing she can say to make people understand; they may think she's just being stubborn. Sometimes I wish I had a normal phobia, like a fear of spiders, or cats, or water, because at least those things are visible and somewhat recognizable. Social anxiety is a bit too much like being haunted by a bunch of stick-in-the-mud ghosts.
posted by zennie at 11:12 PM on September 27, 2007

There seems to be a lot of good advice being given. I have had social anxiety most of my life. It started by high school. By then I had no close friends and pretty much spoke to no one unless I had to. It has usually affected every decision in my life from job choice on down. I did whatever meant the least social interaction. I have been homeless before. I happened to read recently in a genealogical report that some cousin made, that one of my ancestors, over a hundred years ago in Canada, "died of pneumonia because, while travelling, he was too shy to go into an inn and get warm and dry after a storm". I thought to myself, "Yep, that would have been me."
I'm sure your sister is not like me. I have other problems like depression. I'm just trying to say that, thinking about it now, I wonder maybe if someone had insisted that I got therapy early in my life, if it would have been different. Also, I was prescribed Effexor a few years ago. I think it is for both depression and anxiety. I had no serious problems with it until I retired. Then I decided that I probably didn't need the medication because I didn't have the stress of going out to work anymore. So I quit cold turkey. That is a mistake I won't be making again. Many bizarre withdrawal problems. (This is the only problem I had with it. Since then I've actually gone back to the doctor and gone back on Effexor.)
I'm glad to hear you want to help her because I also feel that, if she has a serious problem, she should have someone close who can convince her to go to therapy and read those books and help her get out there. Not just the medication.
posted by dorkwad at 4:39 AM on September 28, 2007

In my experience with anxiety, no amount of talk therapy (individual and group) or self-help material ever helped in the slightest. Neither did antidepressants. What finally did work for me was a small dose of Xanax, taken as needed.

That said, I think the best thing you can do for her is to simply continue being supportive. Make sure she knows that you know it's not just a phase, and be her advocate when dealing with those who believe she can just get over it.

I'd say that the people she really needs to be talking to are her friends. Anxiety feeds on itself. If she's anxious about being around her friends, the very best medicine she could get would be their support. Yes, for a teenager, this approach is risky, but if her friends are real friends the benefit could be enormous.

I'm glad she has you.
posted by sgass at 4:49 AM on September 28, 2007

It's always been a shock to me to read that. on many occasions that in the US, giving teenagers who arent in hospital, anti-depressants or anti-anxiety meds in any circumstance whatsover is considered 'normal'. (or replace 'normal' with 'at all').

Growing up in the UK, having known many teenagers, and people with teenagers, not one of whom didnt have the usual teenager issues, I've never heard of it. I'm fairly sure that its a cultural thing, it just wouldnt cross most peoples minds to think "oh little jenny is being a bit moody, lets give her some drugs". In the OP, the phrase "She'll be starting effexor soon" sounds like 'she'll be having a bar mitzvah' or '16th birthday party', as if starting insert-some-med-here is an everyday thing you do for your kids.

So, ok, bit of a thread hijack but, christ, unless she has bonefide, quantifiable and a diagnosed psychiatric disorder, why would you even consider drugs? And the issue isnt 'which drug' either.

You seem to have answered your own question though possibly - recently she was fine, but changed. *Something* happened, and, it being a teenager, it was probably embarrassing.
posted by daveyt at 5:04 AM on September 28, 2007

If sis uses the Internet at all, you both may find it helpful to browse the "Social Anxiety Support" site. I can't figure out who runs it at a glance, but they don't appear to be selling anything, and they have a nice forum.

"bonefide, quantifiable and a diagnosed psychiatric disorder"

Ah, but there's nothing wrong with me. I'm just "shy." How could that interfere with your life so much as to warrant medication?
posted by zennie at 9:48 AM on September 28, 2007

Recovery Inc. Cannot vouch for it personally, but I've heard good things. My understanding is that all ages are welcome, but I don't know how many people your sister's age would be there.
posted by hannahq at 10:29 AM on September 28, 2007