Amy is a 35-year-old client who has agoraphobia and social anxiety disorder and is making tremendous progress getting well. When I first started working with Amy, she was unable to leave her house without her husband and then only to travel in an area very close to her home. She could not go into any businesses like grocery stores or even into her friend’s homes. Her life was lived in a very small area that felt safe to her, yet she still had panic attacks every day. Our beginning work was painfully slow but she really took to CBT, spending an hour or more every day on exposing herself to anxiety-generating situations and staying until her anxiety went down. One of her first goals was go to her doctor for a long-overdue physical and to start anti-depressant medicine.
Six months later, Amy is able to drive herself to the grocery store, shop, and return home on her own, and she was able to celebrate her best friend’s birthday with a visit and cake. These are significant improvements in her life, but she clearly has more she wants to do. Recognizing what anxiety has taken from her, Amy is filled with shame. She feels shame that she was home-bound for so many years, and shame that she is still unable to visit her sister who lives in another state.
Clearly the shame was a barrier to her continued improvement. Psychoeducation has been a big part of how this client got well – understanding why her brain was tricking her was key to her willingness to take those first, difficult steps months ago. So together we looked for articles to help her this time.
We found “Shame and Guilt in Social Anxiety Disorder: Effects of Cognitive Behavior Therapy and Association with Social Anxiety and Depressive Symptoms.” http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0061713 The authors explain that shame can be internal or external, and that people with Social Anxiety Disorder have higher levels than others. It also shows that CBT effectively reduces shame. This helped her realize she was not alone and there was hope!
We also found “Shame: The Other Emotion in Depression and Anxiety” from Esperanza magazine. https://www.hopetocope.com/blog/shame-the-other-emotion-in-depression-and-anxiety/ The author shares his personal experience with shame, and explains that he used cognitive restructuring to quiet his negative self-talk. Wonderful, since my client had already been using cognitive restructuring in other areas of her treatment!
Several weeks later, Amy is back on track with her improvement. Shame was just another mean trick anxiety used to keep her stuck. Through her hard work she is now able to manage those feelings and continue moving toward living life the way she chooses.