Case study: lifelong social anxiety shifts to out and functioning, after EMDR therapy
For as far as he could remember, Jim (not his real name) had suffered from social anxiety. Because of his anxiety, he found it hard to go to new places and socialize. Most days he found it extremely difficult to even leave the house.
When his friends got tired of listening to his “excuses” (their word)—they stopped calling him. The isolation made Jim depressed, which made it even harder for him to be in social situations. This cycle of social anxiety dominated his life.
Social anxiety is NOT permanent, NOT who you are
Like many who suffer from social anxiety, Jim believed that it was simply a part of who he was—his personality. (Not true.) He had tried therapy before but always got temporary and mediocre results. “It must,” he concluded, “just be me.” (It was the therapy.)
He took medications for anxiety, which helped in the short term. (Neither antidepressant nor anti-anxiety medications are usually helpful long-term.) Anxiety doesn’t get cured by anti-anxiety meds, either. These meds helped reduce Jim’s symptoms, but the moment he ran out of meds, he went back into panic mode.
Though Jim was in his mid-20s, his anxiety and depression were so distressing that he had started thinking about suicide. While his friends were getting into serious romantic relationships, Jim spent most of his time at home, alone, playing video games. By the time he came to see me, his thoughts about suicide had gotten worse; he just didn’t see a way out of his struggles.
Until he started EMDR therapy.
It took Jim just 11 sessions of EMDR therapy to turn his life around. At that point, he was able to get out and socialize. He stopped isolating himself and spent more time with friends. Occasionally he would still feel anxious, but it wasn’t the awful, paralyzing anxiety he had endured in the past.
Social anxiety starts early
According to the Anxiety and Depression Association of America, Social Anxiety Disorder affects 15 million adults or 6.8% of the population in the US. Like Jim, millions of people with social anxiety live with the belief that something is wrong with them. While an understandable conclusion, it is simply not true. Social anxiety can be helped by reprocessing the memories at the root of it.
Over the years, the power of repetition had allowed Jim to believe the stories that were constantly running in his head. “You are such a loser,” he would often say to himself. He also believed that he would never get better.
But repeating a story doesn’t make it true. When I first asked Jim how old these thoughts were, he couldn’t even remember. He said what many people with social anxiety say: “I have felt like this since I can remember.” Many socially anxious people describe themselves as shy kids who became socially anxious adults.
Today, the medical paradigm asserts that all psychological problems are caused by a chemical imbalance. But, in my experience, anxiety—any kind of anxiety—is never just “a chemical imbalance in your brain.” Anxiety started at some point in your life, even if you don’t remember it. It has an origin. To resolve it, you have to go back to where it started.
When you can target and change the root cause of your anxiety, symptoms typically decrease or disappear. This is exactly what we do in EMDR therapy.
Coping skills don’t cure anxiety: reprocessing does
If you have anxiety, you may have tried talk-therapy before. Your therapist may have told you to do something like focus on your breath and then shift your attention from your stressful thoughts to your breath. That technique helps. I suggest it to my clients all the time. This technique is designed to help you cope with stress in that moment.
But it doesn’t solve the problem. It does not remove the initial trauma and put you back together again. It does not reprocess your memories and help your symptoms to go away permanently. It just helps you cope in that moment.
Once you’re done focusing on your breath and have to walk into the supermarket, you may fall back into panic mode again. You might need to pop a benzo, even to be able to remember your therapist telling you, “remember: your automatic thoughts affect your anxiety.” What therapists mean when they say this is this: what you are experiencing is not reality—it’s YOUR reality.
What your therapist told you is logical, but in the moment of panic, the logical part of your brain doesn’t work very well, if at all. Your brain becomes one big mess of emotions (managed by the limbic system). The rest of your brain is still there, but it’s not active. Logic fails. Emotions win.
And it becomes very difficult to logically manage your situation. In my experience, there is a better way to handle this situation over the long term.
EMDR therapy can help with social anxiety
In EMDR, we don’t just treat the symptoms. We target the problem, the thing that started the anxiety in the first place. As I mentioned, anxiety is never just a chemical imbalance in your brain. Anxiety started when you experienced or learned something that made you feel anxious.
Jim was very young when he learned that the world is not safe. As a kid, he didn’t have the big-picture view that we have as adults, the tool we need to put things in perspective. Jim was too young, for instance, to process the physical abuse he witnessed at home, on almost a daily basis.
As you can imagine, when a very young Jim saw his father beating his mother, the world felt extremely unsafe. Our parents are supposed to care for us and be strong and loving, not hurt each other. Jim’s brain shifted into panic mode. Decades later, he still lived with the underlying fear and belief that the world is unsafe.
As an adult, Jim wasn’t able to explain his anxiety like this. When the limbic (emotional) system of his brain took over, the language center of the brain went offline, so there was no explaining.
As happens to many people with anxiety who have been anxious for as long as they can remember, Jim’s anxiety started before he developed the ability to speak or understand language. Therapists call this preverbal trauma. The anxiety was stuck deep inside the brain, not accessible through language. Hence the mediocre results he had gotten with talk therapy.
In EMDR therapy, in addition to processing Jim’s erroneously self-negative thoughts and beliefs, we processed the sensations he felt in his body, the emotions he felt, and other sensations (visual, auditory) as well. Working on many levels like this allowed us to target his early memories, from before Jim was able to speak or understand language.
Traumatic memories can be reprocessed
Traumatic memories are stored differently in the brain than “regular” memories. It doesn’t matter if it was a “big Trauma” (war, natural disaster, torture) or “little trauma” (humiliation, embarrassment, witnessing trauma). Because it is stored wrong, a traumatic memory causes unpleasant symptoms.
Let me say this again: Traumatic memories are always stored differently in the brain than regular memories.
The traumatic memory needs an outside intervention. In EMDR, we help the brain transfer the traumatic memory to where or how it should have been stored in the first place: with the other (“regular”) memories. This process transforms the trauma into simply a story with a narrative. One that does not trigger panic. A story that belongs in the past.
Shortly after Jim turned 2, his abusive father left the house, so Jim did not have any memories of his father that he could think of. Deep inside, his memories did not come to consciousness. When memories are not accessible through language, the body remembers. Thus, with Jim, our EMDR work focused mostly on what he was feeling in his body. EMDR helped Jim both access and process his preverbal memories, the ones that were below his level of awareness.
This ability to reach—and treat—those hidden memories was what led to his successful results and could not have been done with talk therapy.
Social anxiety is not permanent
If you suffer from social anxiety, you don’t have to keep living your life feeling like there is something wrong with you. There is nothing wrong with you! Anxiety doesn’t make you defective. It’s never caused only by a chemical imbalance. Your anxiety started somewhere and it can (and should!) be treated successfully.
WIth EMDR therapy, your therapist will help you process what wasn’t handled at the time of the trauma. EMDR helps your brain to file the old memory in the past. What belongs in the past will become simply a fact, a part of your history, and stop affecting your life in the present.
When memories are transformed, the vicious cycle of anxiety will stop, and you will be able to be more attentive to what’s in front of you. You can be less anxious and more present.
What happened to you was a part of your journey. You may remember your past, but you don’t have to live it. This is what Jim told me after 11 sessions of EMDR therapy.
Yes, it is possible to feel “normal” again after social anxiety, and EMDR therapy is one of the tools that can help you achieve this goal.
Rotem Brayer is a certified EMDR therapist and an EMDR consultant in training practicing in Denver, Colorado. He divides his time between helping refugees to improve their mental health and maintaining a private practice.