In part one of this two-part series, we discussed the experience of the Social Anxiety sufferer.  In part two, we examine how to treat this condition with Cognitive Behavioral Therapy (CBT), and how Social Anxiety relates to other Obsessive Compulsive Spectrum Disorders.

Treatment of Social Anxiety

Social Anxiety can be successfully treated with Cognitive Behavioral Therapy (CBT)

The most effective form of treatment for Social Anxiety is the same as in other Obsessive Compulsive Spectrum Disorders – Cognitive Behavioral Therapy (CBT).  This is because, like the other disorders in the spectrum, Social Anxiety involves an obsession and a series of compulsions which form a cycle.

The fundamental obsession in Social Anxiety is the fear of being evaluated negatively.  This generally includes fears of being rejected, as well as the fear of being singled out for humiliation and traumatized by emotional abuse from others.  The primary compulsion in Social Anxiety is the phobic avoidance of social situations in which one fears rejection and/or humiliation (thus its synonym, Social Phobia).

It is tempting to look at avoidance as the absence of engaging in social behavior.  However, avoidance is an overt physical and mental behavior, the primary goal of which is to reduce or eliminate anxiety.  For the individual with Social Anxiety, the act of choosing not to go to the party thus serves the same function as the act of choosing to wash one’s hands serves for the individual with OCD.  Further, those with Social Anxiety who are able to commit to a social interaction may find themselves escaping mentally in the process by spending their energy focusing on things other than the present situation.

The compulsion of avoiding a social situation is read by the brain as evidence that the avoided situation is dangerous.  This leads to the unwanted thoughts, feelings, or sensations being tagged with false information and presented as especially terrifying.  This leads to more avoidance and around and around we go.

Cognitive Therapy for Social Anxiety

The Cognitive Therapy element of Cognitive Behavioral Therapy (CBT) works by first identifying distorted cognitions which promote the anxiety, and then modifying them with more realistic and objectively true statements.

Here are some examples of common distorted beliefs that influence individuals with Social Anxiety:

• “All people must like me.  If one person does not like me, all people probably dislike me, and that would be catastrophic.”

• “I must behave in a certain way congruent with the environment.  If I am not feeling humorous when funny people are nearby, I am doing something wrong.”

• “I should always have something to say and it should always be the right thing to say.”

• “The people who say they care about me would not do so if not obligated.  People I work with are cordial with me because they have to be.”

• “If I allow a silence to become awkward, it is my responsibility to break it.  I am solely responsible for the flow of a conversation, which must be smooth, rhythmic, and without tangents.”

• “It is unacceptable for me to sweat, blush, or indicate in any way that I am uncomfortable in a social situation.”

Common cognitive distortions we see promoting these beliefs include mind reading (assuming you know what others are thinking), catastrophizing (predicting negative future outcomes), personalization (believing that the behavior of others must have something to do with you) and should/must statements (unrealistic expectations of one’s own behavior).  Working with a CBT therapist will mean learning how to pick out these distortions and re-write them both literally and internally.

Behavioral Therapy for Social Anxiety

The behavioral elements of CBT for Social Anxiety include Exposure with Response Prevention (ERP) and social skills training.  ERP for social anxiety involves identifying the feared situations and re-creating them (exposure) while at the same time resisting the urge to avoid the discomfort by escaping the situation (response prevention).

In part one of this series, we discussed the two main sub-types of Social Anxiety – “presentation” anxiety and “connection” anxiety.  When treating  “presentation” anxiety, it is possible to re-create feared situations in a number of ways, such as participating in an open-mic poetry reading, attending a public speaking class, or speaking in group therapy sessions.  For “connection” anxiety, exposure may involve calling old friends, starting up more personal conversations with co-workers, or interacting with strangers in daily life (security guards, barristas, mailmen, people in the elevator, etc.).

In part one of this series, we also discussed “The Cringe”, wherein the individual with Social Anxiety experiences a high degree of discomfort related to perceived social rejection.  To specifically address the problem of avoiding the “The Cringe”, some exposures may involve intentionally creating rejection situations.  This may mean voluntarily spilling a drink in a public place, asking a waiter for an item that does not exist on the menu, or starting random conversations with strangers.  Repeated exposure to the feeling of “The Cringe” not only reduces the intensity of the feeling, but increases the brain’s capacity to integrate that experience as a normal event.

Social skills training typically involves learning about and improving eye contact (for the record, people look more at each others’ faces, not eyes), hand shaking and other social greetings, as well as techniques for developing and managing conversations.

Mindfulness for Social Anxiety

Another key element in Cognitive Behavioral Therapy (CBT) for the treatment of Social Anxiety is Mindfulness.  As with other OC Spectrum Disorders, Social Anxiety is primarily a problem of inaccurately viewing thoughts, feelings, and sensations as intrinsically important events to which one must attend and respond.  But there is a tremendous difference between having a thought that someone disapproves of you, and believing that this thought is a piece of objective evidence that you are disapproved of.  Mindfulness training promotes the idea that one can observe thoughts, feelings, and sensation in social situations without weighing in on the value of those thoughts, feelings, and sensations.  In other words, we can separate the word “fire” from the actual pulling of the fire alarm.

Social Anxiety in the Obsessive Compulsive Spectrum

While not all Social Anxiety sufferers have Obsessive Compulsive Disorder (OCD), it is a common co-morbid diagnosis.  Typical OCD behaviors one might experience in relation to social anxiety include mental checking or retracing.  In this mental ritual, the sufferer replays events and conversations multiple times in an attempt to gain certainty that they did not commit some sort of social error that they find unacceptable.

There are some situations in which socially avoidant behaviors can actually be better explained by OCD, such as when a person avoids going to a party because being in a room full of people increases the likelihood that they may come in contact with some feared  contaminant.  In primarily obsessional forms of OCD (aka “Pure O”), a sufferer may avoid social situations for fear that certain people will trigger unwanted thoughts of a violent or sexual nature.

Another area in which OCD and Social Anxiety often collide is when an individual with OCD has an obsessive fear of being misunderstood, or not understanding another person, in a conversation.  This compulsive need-to-know makes it difficult to be “in the moment” with another person, and can cause extreme social discomfort.  It is also common to find a lot of reassurance seeking behaviors in both disorders.  For the individual with Social Anxiety, reassurance seeking often manifests as compulsive attempts to gain certainty that no embarrassing event took place or will take place.

Other OC Spectrum disorders we commonly see alongside Social Anxiety include:

• Body Dysmorphic Disorder (BDD) – In this condition, the primary obsession is with an imagined or overvalued defect in a one’s appearance.  Common compulsions seen in BDD include mirror checking, camouflaging, and multiple avoidant behaviors.  The line of thinking is, “If I am around people, they will see how ugly I am and they will be disgusted by me.”  The sufferer then infers that this disgust will be evident to them and will result in an internal feeling of being abused.

• Trichotillomania (compulsive hair pulling) and Dermatillomania (compulsive skin picking) – Like BDD sufferers, those struggling with hair pulling or skin picking may also be overvaluing the damage caused by their compulsive behavior, and may believe that other people are focusing on and judging this damage.  In addition to the BDD symptom, an individual with Trichotillomania and/or Dermatillomania may also feel that their perceived defects are especially unacceptable because of a belief that it is “their fault” they have the thinned hair or damaged skin.  So not only do they fear people are evaluating their appearance negatively, but they also fear people are evaluating the individual negatively (for example, believing that others are thinking “Why did they do that to themselves?  What a freak!”).  This then results in a lot of socially avoidant behavior, as well as intimacy challenges.

• Panic Disorder – One of the common behavioral symptoms of Panic Disorder is the avoidance of places or situations in which one fears a panic attack might occur.  This is frequently heightened by the fear of being in any environment where immediate exit may not be possible.  Since social interaction often involves places like theaters, restaurants, markets, and the transportation to get there, a person fearing panic is likely to become socially quite limited, even to the extent of being homebound.

• Olfactory Reference Syndrome (ORS) – This OC spectrum disorder focuses on the distorted belief that the sufferer emits a detectable and disgusting odor.  Social avoidance is among the first behavioral symptoms and usually involves particular avoidance of enclosed spaces where one fears an offending odor could be detected (for example, a social gathering in an apartment with closed windows, or any “close” social contact).

Outside of the OC Spectrum, it is not uncommon for sufferers in the Autism spectrum to also experience many of the symptoms of Social Anxiety.  For these sufferers, the challenge appears to come more from an organic difficulty in “reading” other people and situations in their emotional context.  This can result in confusion over the intentions of others, as well as deficits in social behavior such as eye contact, or in failing to sense what another person is expecting from an interaction.  While Cognitive Behavioral Therapy can help an individual with Social Anxiety to confront triggering situations, it is also important for treatment to focus on social skills development.

In closing, it is probably safe to say that most people who live in social environments experience Social Anxiety from time to time.  The issue becomes clinical when the fear of negative evaluation pushes one into isolation.  But social anxiety is not simply about being shy or being “bad with people” as many have come to believe about themselves.  It is about having learned inaccurate  messages about the world and one’s ability to tolerate rejection and social discomfort.  Whether these inaccurate messages start from a traumatic past, a chemical imbalance, or just a misstep in piecing together a social philosophy, the message can be unlearned with the appropriate treatment.

•Jon Hershfield, MA, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD), Social Anxiety, and related conditions.  Jon can be contacted at jon@ocdla.com.

Many people mistakenly think of Social Anxiety as nothing more than shyness.  In this two-part series, Jon Hershfield of the OCD Center of Los Angeles discusses Social Anxiety, its treatment with Cognitive Behavioral Therapy (CBT), and its relationship to other OC Spectrum Disorders.

Social Anxiety, also known as Social Phobia, is more than just shyness.

When I first began treating people with Social Anxiety Disorder (also known as Social Phobia), it seemed to me that this condition was primarily a problem of interesting people not realizing that they are interesting.  While this is a significant element of the disorder, there is more going on than one might initially expect.

In reality,  Social Anxiety and Social Phobia are terms used to describe a cluster of symptoms that center around the fear of being negatively evaluated by others.  This is often confused with being shy or introverted, or even schizoid.  An introvert may genuinely prefer the quiet solitude of turning inwards to the self rather than outwards to other people, while someone with schizoid personality disorder may simply not find the presence of other people to be pleasing.  In either of these cases, the experience of isolation from others is essentially rooted in ego-syntonic thoughts, which simply means that the thoughts are consistent with the individual’s true beliefs and values.  In other words, those who are truly introverted or schizoid genuinely prefer to be alone.

Conversely, a person suffering from Social Anxiety is burdened by unwanted intrusive thoughts about being judged, rejected, and/or and humiliated by others. In some cases, these thoughts may be ego-syntonic, coinciding with the individual’s distorted core belief that they genuinely deserve negative judgment.  On the other hand, Social Anxiety may at times also be rooted in thoughts that are ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s beliefs and values.  To these people, their thoughts about negative evaluation appear strange and irrational.  They don’t see themselves as being worthy of negative evaluation, yet the thought repeatedly pops up anyway.

Ironically most of the people I treat with Social Anxiety are anything but shy.  All it takes is a sense of safety and permission to be themselves and they are eager to be social.   It is worth noting that the term “social” here does not mean casual.  For many, the symptoms of Social Anxiety are equally troubling in the work environment, where fear of disapproval from someone in a position of authority or fear of disrespect from a subordinate can greatly impair functioning.  It may also be prevalent in the classroom where overvalued thoughts of rejection by peers can consume daily life.  So the term social applies to any environment that involves one or more other people.

Presentation Anxiety vs. Connection Anxiety

Social Anxiety seems to fall into two main categories, which I call Presentation Anxiety and Connection Anxiety.  Presentation Anxiety focuses on an intense fear of being judged negatively while engaging in some sort of solitary interaction with a group of people.  This often manifests as a fear of public speaking, but it is equally debilitating for the person who fears being negatively evaluated in a small social gathering such as a party.

Conversely, people who suffer from Connection Anxiety may or may not feel comfortable in the spotlight in a group setting, but experience far more intense discomfort in one-on-one interactions.  This has unfortunate implications for establishing relationships with people in an unstructured environment.  Connection Anxiety appears to be less talked about because it is common to see those with this type of  anxiety actively and comfortably engaged in large social environments.  But in my clinical experience, it is equally prevalent and every bit as debilitating.

Those with both forms of Social Anxiety may be adept at hiding their symptoms so long as they steer clear of their primary triggers.  For example, someone with Presentation Anxiety may be a social butterfly at parties but freeze in terror at the thought of giving a best man speech or asking a question in class.  Conversely, someone with Connection Anxiety may have no qualms about performing on stage, but may dread the interactions inherent in dating.  This may explain why some entertainers who have spent their careers on stage or on camera (Barbra Streisand, Carly Simon, Donny Osmond, Kim Basinger), have reported having Social Anxiety, despite their careers in the public eye.

Both Presentation and Connection Anxiety may converge in the presence of small groups.  A small group has both the critical mass necessary for one to feel ganged up on or out of place, as well as the intimacy in which one might feel suffocated.  This, among other reasons, is why group treatment is particularly effective for the Social Anxiety.

Social Anxiety and The Bully-in-the-Head Syndrome

While it is by no means a prerequisite for diagnosis, it does appear at least anecdotally that many sufferers of Social Anxiety have a history of being abused or bullied by others in one way or another.  Because Cognitive Behavioral Therapy (CBT) generally maintains a present/future orientation, comparatively little emphasis is placed on the relationship between past experiences and the development of a current psychological condition.  While the past may give us insight into how a sufferer developed faulty core beliefs about themselves, and how they learned to cope with stress, anxiety, and uncertainty, this knowledge often provides the therapist with little information that can be used to help bring about change in the present cognitions and behaviors that are causing the current symptoms.

This being said, it is difficult to ignore how often Social Anxiety sufferers report to me that they were bullied or abused before their symptoms surfaced.  For many with Social Anxiety, being judged in a present-day social context means suffering traumatic emotional flashbacks.  A failed attempt at eye contact or a sound that could be mistakenly interpreted as a judgmental chuckle from an audience can be experienced as a raised fist.

One way of understanding this is to consider how a person might respond to repeated bullying over time.  In the early stage of bullying, a person may develop a strong fighting instinct, an assumption that all people are bullies, but that “I am king bully and you better watch out”.  In fact, recent research suggests that many childhood bullies may actually have Social Anxiety Disorder.  However, if bullying continues to such an extent that a person’s “fight” instinct is exhausted, the brain’s only other option is to put itself in perpetual “flight” mode.  The same assumption develops, that all people are bullies, but an alternate rationale follows – “all people are threatening and stronger than me”.  The bully that was on the outside is thus born on the inside.

Imagine you went to a party and the first thing that happened to you was someone walked right up to your face and said, “You look weird.  Why did you come here?  Everyone here is more attractive and more interesting than you.  You are an eye-sore and a bore.”  You might laugh at the absurdity of the situation, punch the person in the face, or get terribly offended and leave.  Now imagine the same thing happens, but the person who comes up to you actually is you.  This bully-in-the-head syndrome is shared by many with Social Anxiety.  Since running from the party doesn’t shut the bully up, panic ensues.  This is followed by intense mental ritual aimed at quieting the bully and/or escaping the unwanted thoughts and feelings that arise.  In other words, leaving the party is only a preview of trying to leave the self.

The Cringe

As mentioned above, Social Anxiety involves an obsessive fear of being evaluated negatively by other people.  However, this does not offer a complete picture of the Social Anxiety experience.  In the course of treatment with Cognitive Behavioral Therapy (CBT), one common restructuring technique is to encourage the sufferer to rate (as a percentage score) the likelihood that a given social situation will go badly, as well as the likelihood (again, as a percentage) that they will be unable to tolerate this event occurring.  This is a good way to weed out catastrophizing distortions and the areas in which a Social Anxiety sufferer may be overestimating risks.

What’s interesting about this is that I have frequently found social anxiety sufferers will initially rate these concepts very high, such as an 80% likelihood that a person will notice if they are nervous and a 90% likelihood that this will be unbearably upsetting.  However, when the terms are reframed and I ask this same person if they really believe that 8 out of 10 times (80%) the feared event will occur, they are often quick to drop the estimate considerably.

On the other hand, the belief that the experience, if it were to occur, would be intolerable, remains the same.  They may concur that the embarrassment is not the end of the world, and that they won’t literally die, but they will often stick to the conviction that no matter how unlikely the feared event, experiencing that event must be avoided at any cost.  What this reveals is not just low self-confidence, but a fear of this specific form of discomfort.  Simply put, Social Anxiety is primarily about avoiding this discomfort.  “I don’t care what people think, I just don’t want to feel bad.  It’s not that I know for sure what they are thinking and it’s not that their opinion really even matters.  I just hate the way it feels when I even think about it!”

It is this feeling, the Cringe, the stabbing sense of shame that compels the person with Social Anxiety to engage in socially avoidant behaviors again and again.  Treatment therefore relies not solely on convincing oneself that there is nothing to be afraid of, but on mastering your ability to accept and integrate this feeling as a normal, tolerable event.

In Part Two of this blog post, we will examine how Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Behavioral Therapy approach treatment for Social Anxiety.

•Jon Hershfield, MA, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD), Social Anxiety, and related conditions.  Jon can be contacted at jon@ocdla.com.

This is part one of a two part series on anxiety disorders in sports.

This past week marked the arrival of the 2010 Major League baseball season.  And as with last year, this season already has three developing stories of athletes dealing with Social Anxiety.

During the 2009 season, infielder Khalil Greene, then of the St. Louis Cardinals, missed 46 games during two stretches on the disabled list due to Social Anxiety.  During the off-season, Greene signed a one-year contract worth $750,000 with the Texas Rangers.  Unfortunately, Greene’s Social Anxiety continues to be a significant issue, and reportedly was the reason for his failure to report to spring training camp in Arizona.  As a result, the Rangers have voided his contract, though they reportedly are leaving the door open for him to return to the team.

Meanwhile, an apparently happier story is unfolding in Detroit, where former all star and rookie of the year Dontrelle Willis is attempting to make a comeback.  After a 2009 season in which he too had a couple of stints on the disabled list due to Social Anxiety, Willis appeared strong in his first start of the season last Thursday.  After struggling in the first inning, during which he walked two batters, he went on to complete six innings in the Tigers 7-3 victory over the Kansas City Royals.

Of course, Kansas City is the baseball home of Zack Greinke, last season’s big Social Anxiety story.  Even casual baseball fans were delighted by his spectacular turnaround in 2009.  After nearly abandoning baseball in 2006 due to his Social Anxiety, Greinke went 16-8 in 2009, with a 2.16 ERA.  He then spent his off-season collecting the 2009 Cy Young award and marrying Emily Kuchar, a former Miss Daytona Beach and Dallas Cowboy cheerleader.  In two starts thus far in 2010, he is 0-1, with a 3.55 ERA.

All of this points to the ongoing issue of how baseball and other professional sports have never taken the issue of mental health very seriously.  It seems that teams (and fans) expect players to have an innate ability to withstand the huge pressures of performing at the professional level.

As we noted here previously (July 2, 2009), huge salaries and 24 hour-a-day sports coverage on cable channels are stressors that athletes in previous generations didn’t have.  Another factor may be that many baseball players (and other athletes) turn pro at a very young age, and as such, don’t have the opportunity to fully develop emotionally before suddenly being faced with the pressures of professional sports.

For more on this topic, I strongly recommend Roy Johnson’s op-ed piece that ran last week on the ESPN website in which he notes that “baseball and other sports must learn to do as good a job of diagnosing and treating “mind” injuries as they do when the body breaks down”.  Let’s hope leagues and owners are listening.

Next week – anxiety disorders in other sports.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. He can be contacted director@ocdla.com.

Baseball’s best story of 2009 just got better.

As reported in a previous entry here (July 2, 2009), major league baseball has in recent years seen a spike in the number of players reporting symptoms of Social Anxiety.  Perhaps the most noteworthy example of this trend is Zack Greinke of the Kansas City Royals, who missed much of the 2006 season due to his struggles with the condition.

What a difference a few years makes.

This year, Greinke was the dominant pitcher in the American League, going 16-8 with an ERA of just 2.16.  He started the season with six straight victories, with a remarkable 0.40 ERA over that span.  He was selected to the American League all-star team, and pitched a perfect inning in the summer classic.  He came back after the break and went 6-1 in August, and had a 1.75 ERA in his final 11 starts.  Imagine what he could have done on a good team!

Greinke was honored for his spectacular season by being named the best pitcher in the American League by both the Sporting News and the MLB Players Association.  His incredible turnaround year was capped this week when it was announced that he was the American League Cy Young Award winner, the highest honor a pitcher can receive.

Just three years ago, many in baseball were concerned that Greinke, then a struggling 23-year old, would never live up to his potential in the big leagues.  His Social Anxiety was severe enough that he missed two months of the season and sought out treatment with a sports psychologist.  He came back the hard way, returning to the minors and eventually earning his way back to the Royals, and into their starting rotation.

As Greinke stands at the top of his profession, it is worth repeating that he has accomplished all this while battling Social Anxiety.  It’s hard enough for anyone to challenge this potentially disabling disorder.  Now imagine challenging it in front of tens of thousands of screaming fans and on national television.  Greinke is testimony to the fact that Social Anxiety can be managed and overcome if a person seeks help and dedicates themselves to facing their fears head on.  He deserves all the accolades he is receiving, and is an inspiration for people everywhere struggling with Social Anxiety.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  He can be contacted director@ocdla.com.

Anyone who has ever been socially rejected or had their heart broken knows that it really hurts.  And now, researchers at UCLA have discovered evidence of a biological basis for this pain.  It appears that people with a variation of a specific gene are not just more sensitive to physical pain, but also more sensitive to social pain.

Researchers already knew from previous studies that the gene, called OPRM1, regulates the body’s internal painkillers, known as mu-opioids.  In layman’s terms, the presence of this gene variation results in people actually feeling more pain in response to being physically hurt. What is so interesting about the new study is that researchers discovered this same gene variation also appears to regulate the level of distress felt if one is socially hurt.

And this finding is not just supported by people’s subjective reports of experiencing distress when being rejected.  The researchers also performed functional MRIs of the brains of those with this gene while exposing them to a computer program that simulated social rejection.  What they found was that those with the gene variation reported higher levels of distress in response to social rejection, and also exhibited more activity in the social pain–related regions of the brain – specifically the dorsal anterior cingulate cortex and anterior insula.  In other words, those with this gene variation not only had the subjective experience of heightened “rejection sensitivity”, but they also had more objectively measurable activity in the parts of the brain associated with social pain.

This research supports and furthers previous research done at UCLA in 2003.  That study found that the anterior cingulate cortex is more active when those with rejection sensitivity feel socially hurt.  The new study takes that discovery one step further in highlighting how this part of the brain is not just more active in the socially sensitive, but also how this activity is mediated by a specific gene.

Taken together, these two studies provide the most advanced clues yet as to how and why some people experience social rejection with such force.  And for those with Social Anxiety / Social Phobia, these studies not only provide evidence that their suffering is real, but also provide hopeful avenues for future research that may one day lead to better treatments for this condition.

•Stacey Kuhl-Wochner, LCSW, is a Licensed Clinical Social Worker at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  She can be contacted stacey@ocdla.com.

Anyone who reads the sports page of their local newspaper knows that there have recently been a number of professional baseball players who have been sidelined due to being diagnosed with Social Anxiety Disorder.  Just this past week, Khalil Greene of the St. Louis Cardinals was placed on the disabled list (DL) for the second time this season due to Social Anxiety.  He had previously been listed on the 15 day DL starting on May 29th of this year.  When he first came off the DL and returned to play in mid-June, he appeared to have responded well to the time off, as he hit home runs in his first three games.  Unfortunately, he soon started to experience batting problems, and was returned to the DL after going 1 for 17 in his next five games.

Greene’s story has been accompanied by two other high-profile Social Anxiety stories getting lots of coverage by the sports media.  Dontrelle Willis, a pitcher with the Detroit Tigers, has been on the DL twice this season as well, both times reportedly due to Social Anxiety.  And Zack Greinke, a pitcher for the Kansas City Royals, missed much of the 2006 season due to his combined diagnoses of Social Anxiety and Depression.  He took seven months off and sought treatment with a sports psychologist and has returned to great success.  He is having a career year in 2009, going 9-3 thus far, with an ERA of 0.96.

The question arises whether these cases represent a growing sensitivity within professional sports’ regarding psychiatric issues, or whether the pressures of being a professional athlete have become so intense as to lead to an increase in these problems. Some believe that huge salaries, multiple 24 hour-a-day sports channels, and even the internet may be contributing to athletes being under far more social stress than athletes experienced in earlier, less-demanding times.  In either case, it seems that these cases are bringing Social Anxiety into the consciousness of the American public, and hopefully encouraging an open discussion of this often debilitating condition.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  He can be contacted director@ocdla.com.