Therapy in L.A.

  article of the month
August 1999
By Carol Boulware, Ph.D.

This month we complete our series on anxiety disorders with a cogent description of post-traumatic stress disorder and social anxiety. The psychbytes section offers some suggestions about what you can do to help yourself. However, if your anxiety is excessive and is interfering with your normal activities or is preventing you from doing things which most people have no trouble doing, psychotherapy is recommended. There are cognitive and behavioral techniques that have excellent success rates. You don't need to be condemned to a restricted life of fears and anxiety. Dr Boulware's complete article is archived in "previous articles". --Editor, Joyce Parker, Ph.D.


A person with PTSD has experienced an event involving actual or threatened death or injury to themselves or others. They have experienced intense fear, a sense of helplessness and horror.

Trauma can be a one-time experience such as rape, assault, mugging, robbery, fire, accident or a natural disaster such as a flood or an earthquake, or it can be a prolonged trauma as in the case of physical or sexual abuse, living in a prison or concentration camp, or being a refugee.

Our brains and nervous systems are intended to handle stress and trauma - to a point. When our system is overwhelmed by traumatic stimuli, it goes into an overload situation. The result is that the anxiety of these traumatic events stays "locked" in our nervous system, waiting to be released.

Possible Causes

PTSD can develop after a major traumatic event, either emotional or physical. This disorder is characterized by flashbacks and nightmares, and is commonly found in returning military personnel and in people who have experienced natural disasters or been victims crimes. Other causes can be serious accidents, violent attacks such as rape or torture, or witnessing violence in which they or other people are seriously injured.

It is estimated that about ten percent of the U.S. population has or has had symptoms of PTSD. It affects people of all ages who have experienced a trauma. More females than males suffer from this anxiety disorder. Some people can recover from a traumatic event with brief therapy and the support of loved ones. But for others, it persists, often for years.


Symptoms can appear within a few months of a traumatic event or much later, after an event that triggers symptoms. Typical symptoms of PTSD are:

-- reliving the trauma event as if it were happening - flashbacks -- intrusive thoughts, images, feelings and illusions -- re-experiencing the traumatic even in dreams or nightmares -- intense anxiety and physical distress when remembering the event -- attempts to avoid the situation, feelings or activities related to the event -- avoids conversations connected to the trauma -- changes in appetite -- feeling sadness, depression, hopelessness, and despair -- difficulty falling asleep or staying asleep -- anger, resentment, irritability or explosive outbursts -- feeling "numb" emotionally -- a sense of detachment; "spacing out" -- overwhelmed by normal situations -- love, sexuality or intimacy become restrictive -- frequent and excessive crying; moodiness -- trouble concentrating; poor memory -- Hypervigilance and scanning; being on guard -- easily startled, jumpiness -- pessimism; a sense of doom and dread of the future -- survivor guilt

It is important to diagnose and treat Post Traumatic Stress Disorder because if it is not treated, it could lead to more serious psychological illnesses, such as clinical depression or drug dependency.

Treatment for PTSD

There are a number of treatments available to mental health professionals that have good track records with helping PTSD sufferers deal successfully with their traumatic experiences. Treatment usually focuses on anxiety reduction and stress-coping techniques.

Self-hypnosis can help, as can be relaxation exercises. In many cases, cognitive psychotherapy is effective. By bringing their experience into the therapy setting, the trauma survivor usually finds it easier to discuss their trauma, and learn new ways of reacting to their memories.

Another effective therapy for PTSD is a relatively new but powerful technique called Eye Movement Desensitization and Reprocessing, or EMDR. Drug therapy can be helpful if there is notable depression, panic attacks or debilitating stress symptoms. There are also peer-counseling and other groups which can help sufferers deal with their symptoms.


Phobias are common in our society and are characterized by intense, irrational fears of things, situations, people or activities. Having high anxiety in social settings to the degree that it interferes with ordinary social interaction is called a Social Phobia.

Social Phobia is a major mental health disorder in the United States, affecting about eight percent of the population. However, it has only been taken seriously for about ten years. Fortunately, the body of research developed in that time has fostered numerous treatment modalities.


People with Social Anxiety Disorder or Social Phobia, or, are very fearful and anxious that other people will criticize them. In fact, they will go to any extreme to avoid a social gathering at which they might be stared at, and, in their mind, evaluated negatively. They are intimidated by every stranger they come across. They avoid eye contact with nearly everyone and feel that they will embarrass themselves if they do anything at all in public. Other typical symptoms are embarrassing easily, blushing, frequent swallowing and twitching.

"Trigger" Situations for Social Phobia

-- having to speak in front of other people -- being the center of attention -- dealing with people of authority -- looking other people in the eye -- being introduced to strangers -- being teased or confronted -- being in a public place -- interviews and meetings

Social Phobia is very distressing emotionally because it adversely affects a very important aspect of life - social interaction. To make matters worse, other people often perceive those with Social Phobia as being unfriendly, aloof, withdrawn or inhibited.


Social Anxiety is very prevalent in our society probably partly because of social pressure to live up to idealized social expectations and partly due to the emotional and psychological insecurity of the individual with this disorder. Add to this the tendency to analyze and evaluate everything. People with this disorder realize their negative thoughts and feeling are irrational, yet they cannot stop them. A cycle of negative thoughts and negative actions is set into play that can only be stopped with appropriate psychotherapy.

Cognitive-behavioral therapy highly effective in treating social anxiety. Behavioral Therapy in a Group setting is also helpful because they allow opportunities for reestablishing healthy relating skills.

© Copyright 1999 by Carol Boulware, Ph.D.

For more information, please call: Carol Boulware, Ph.D. (310) 395-3351

Offices: Santa Monica & Redondo Beach, CA

Dr. Boulware is a Cognative Behavior Therapist and has Advanced Level II training in EMDR. She practices in Redondo Beach and Santa Monica. She is a member of the Independent Psychotherapy Network.

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