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Useful therapies, treatments and strategies
We hope you find this information useful. This website has been compiled by fellow sufferers. We are not trained professionals, and are not qualified to offer specialist medical advice. COGNITIVE BEHAVIOURAL THERAPY (CBT)
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COGNITIVE BEHAVIORAL THERAPY (CBT) CBT is NOT the kind of therapy where you just talk to someone about the past - the focus is mainly on changing how you think, feel and act in the present. There are two main elements to CBT. The 'cognitive' side of it is about challenging overly negative or unjustified thoughts (for example 'People don't like me' or 'everyone is staring at me'), and 'retraining your brain' to interpret anxiety-causing situations more helpfully. The 'behavioural' side of CBT involves gradual, controlled exposure to more of the situations you fear, and trying to reduce 'safety behaviours' (e.g. avoiding eye contact) while in those situations. There may also be an element of social skills training if this is appropriate. CBT techniques take time, practice and commitment, but are probably ultimately the best way of getting to the real root causes of your SA. You can read a thorough overview of the principals behind, and history of CBT here: Your GP can refer you to a CBT therapist on the National Health Service, although there may be a long waiting list. You could also try finding a therapist independently (although you should try and seek out one with experience of dealing with social anxiety), via the website of the British Association of Behavioural and Cognitive Psychotherapists (BABCP): You may also be able to get help with finding a CBT therapist via the National Phobics Society: The NPS is a charitable organisation, which deals with all kinds of anxiety disorders/ phobias. They should be able to point you in the direction of a therapist in your area, and can offer reduced rates of therapy to their members.
Some people have had success overcoming blushing with the aid of medications such as beta blockers (for example, propananol), which are available via your GP. You would usually be recommended to take these now and again for specific or situational anxieties, although sometimes people take them on a regular basis to treat generalised anxiety. They work by blocking the signals in the body that lead to the anxiety/panic response and some sufferers have found that they help combat their blushing in this way as they remain calmer in what would otherwise be very stressful situations. There are other medications available from your GP, which work more directly on the brain and can help over the long-term with anxiety and phobia problems. These are usually a type of anti-depressant called SSRI's ('selective serotonin re-uptake inhibitor'), with three of the most popular brands of this type of drug being Seroxat (Paroxetine), Prozac (Fluoxetine) and Cipramil (Citalopram). This type of medication increases the amount of serotonin activity in the brain serotonin is a brain chemical that has been linked to mood and arousal. You may be prescribed these sorts of medications for periods ranging from months to years depending how well they work for you. Other anti-depressants like MAOI's (monoamine oxidase inhibitors) have also been shown to help with social anxiety (although they have worse side-effects), as have some newer types such as Effexor and others, which are similar to SSRI's. All these medications are available only on prescription in the UK and all have side effects. Your GP will be able to advise you further. Please do not try to purchase these medications over the internet.
ECT is available on the NHS in Britain (although the waiting list is very long) and is used to treat excessive blushing with permanent results. This option is usually considered to be a a last resort since there are many potential side effects. It is more appropriate for sufferers who have tried all the other non-invasive options with no success, or suffer from the associated medical condition of severe facial blushing (Idiopathic Craniofacial Erythema) in conjunction with their blushing phobia. This surgery should only ever be considered after seeking proper medical advice. The following websites provides further information and advice about the procedure and provides testimonials of those having had it, along with info on social anxiety related blushing:
Some sufferers find hypnotherapy beneficial in helping to reduce their worries surrounding social anxiety related blushing. A course of hypnotherapy can sometimes help individuals to keep calm in trigger situations and learn to adopt a more relaxed and positive mental attitude through the use of methods such as positive suggestion and visualisation. It is important to make sure however, that you seek the assistance of an accredited and reliable hypnotherapist – see the links below for searchable directories of accredited hynotherapists within the UK. Hypnotherapists will often be happy to compile a recorded hypnosis programme for you to use in conjunction with or in place of a course of face to face therapy should you prefer to explore that option. British Society of Clinical Hypnotherapists: The National Council of Hypnotherapists holds a register of independent hypnotherapists in the United Kingdom and seeks to maintain high standards among its members. List of hypnotherpists resident in the UK: You can also seek the services of an approved hynotherpist at a reduced rate by becoming a member of the National Phobics Society.
Although visiting a hynotherapist in an established practice or location suits the needs of many, this environment is not always suitable for social anxiety sufferers. Some therefore choose to control their own hypnosis, tailoring the suggestions used to their own specific wants and needs, or listening to pre-prepared hypnotherapy tapes in the comfort of their own home, where they find it easier to relax. Many hypnotherapists are happy to teach self-hypnosis skills and practices to clients. www.self-hypnosis.co.uk/ is a helpful and informative site, providing self-hypnosis information including downloadable hypnosis programmes, free email course and retail section. www.hypnospractice.demon.co.uk is a UK based site / therapist and gives an informative background of the therapist, his work and hypnosis in general. Tapes may be purchased directly and tailored to suit individual phobias including blushing and anxiety. Self-hypnosis and stress management workshops are also available via the site and its associated practice.
Many social anxiety sufferers see significant improvement by adopting a number of self-help methods, whether it be by reading publications detailing self-help versions of proven psychological therapeutic practices, positive mental approaches and strategies or following self-help exercises tailored to learning to relax and cope with the physical manifestations of anxiety. www.self-confidence.co.uk has a free online self confidence course and self help articles. USEFUL PUBLICATIONS: The first one on this list - 'Coping with blushing' is the only one that deals specifically with the problem of blushing, while 'Overcoming Social Anxiety And Shyness' - is also recommended as it is based on Cognitive Behavioural Therapy (CBT) techniques you can work through in your own time. Prices below are correct on 1st November 2004 at www.amazon.co.uk 'Coping with Blushing' by Robert Edelmann (Sheldon Press, 1990) £6.39 ISBN: 0859699196 'Overcoming Social Anxiety and Shyness' by Gillian Butler (New York University Press, 2001) £6.39 ISBN: 1854877038 'Painfully Shy - How to overcome Social Anxiety and reclaim your life' by Barbara G. Markway & Gregory Markway (Thomas Dunne Books, 2001) £7.00 ISBN: 0312316232 A number of fact sheets including one about blushing are available from the National Phobics Society for a small fee.
HOLISTIC/COMPLEMENTARY APPROACHES: Many of our members/sufferers prefer to opt for more holistic and complimentary therapy approaches to deal with their social anxiety and related erythrophobia and indeed learning to relax and take a more positive mental attitude can be of tremendous help when dealing with anxiety. There are plenty of ways to learn to relax including relaxation tapes, yoga, breathing exercises, meditation, muscle relaxation techniques, reiki, reflexology, massage, and aromatherapy. www.chisuk.org.uk: The Complementary Healthcare Information Service provides information on alternative medicine & holistic health. It includes a retail section with suppliers of natural products and medicines, equipment, books, music tapes and videos- yoga/ relaxation techniques etc www.bcma.co.uk: The British Complementary Medicine Association Holistic approaches such as Reiki, Reflexology, Therapeutic Massage, Aromatherapy, Spiritual Healing, Acupuncture are also available at discounted rates for members through the National Phobics Society
EXERCISE/KEEPING BUSY ‘Physical activity reduces the risk of depression, and has positive benefits for mental health including reducing anxiety, and enhancing self-esteem. It can help you relax, sleep well and cope with stress. It can help you feel and look better’ - NHS steps to health scheme You should consult your GP before embarking on a new course of exercise. Many people find that physical exercise can be of value in helping to maintain good mental health. Those who suffer from depression, often resulting from some kind of social anxiety, sometimes find some relief by taking some brisk exercise, while those who are in the recovery process often find that exercise can help to speed it up. As well as having all round health benefits such as lowering blood pressure, maintaining good circulation and controlling weight, taking up a form of sport can be a very effective way of increasing social interaction, distracting ourselves from our anxieties and a good balance with other areas of our lives.. Anxiety in particular can be reduced significantly by a course of regular exercise as the stress reaction (i.e. the state we find ourselves in when tense and fearful at the prospect of blushing in front of others) encourages a state of high energy causing our bodies to stay in a tense state of arousal for hours at a time. Exercise can be a very effective way of dissipating this excess energy and encouraging a more otherwise relaxed and well-balanced attitude. Times when we experience insomnia are common times for worrying about future events or ‘self-prophesising’ about our social anxiety and blushing, and exercise can be a useful too in improving sleep and therefore reducing undue worries. Other health benefits of exercise include the reduction of headaches, increased feeling of well-being, concentration and stamina. This is due to the chemicals called endorphins, which are released into the brain during exercise, morphine-like in their effect; they promote a sense of positivity and happiness, which can last for some time after exercising. This somewhat ‘elated’ mental state or ‘improved mood’ can help you to maintain a well-balanced attitude when faced with stressful situations where you feel you may blush by improving your overall mental health. So its well worth considering taking up a regular programme of exercise to help cope with and manage your social anxiety, blushing, and possible related depression. The kind of physical exercise you choose to adopt is a matter for your own personal choice. However in order for exercise to be effective, it should be brisk rather than leisurely- brisk walking and cycling, even heavier types of gardening are ideal as out-door activities are particularly beneficial. At the very least, it is important to exercise three times per week for a minimum of 30 minutes each time. Other Aerobic activities like jogging, swimming, squash, football, aerobics classes and dancing are all suitable. Remember not to push yourself too hard in the beginning, to seek medical advice prior to taking up any new exercise programme and bear in mind that the body benefits more from short periods of regular exercise rather than infrequent bursts. Make sure to ease yourself into an exercise programme, as doing too much too soon could lead to physical exhaustion or injury. Many NHS local authorities now have a ‘Steps to health’ Scheme in place whereby patients, who would benefit, can be referred for courses of exercise at local establishments for free- see your GP for details of any such schemes in your area.
If you can recommend any self-help publications, tapes, strategies or practices that you have found beneficial in overcoming your problems with blushing, please let us know at contact@social-anxiety.org.uk
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