Posted July 9, 2004
Case Study: JohnTaken from the St. Luke’s Institute website
[See link to St. Luke’s Institute on our Links page for further case studies.]
John is a 35 year-old seminarian who is in his first year of theology. Prior to entering the seminary he was a special education teacher in a Catholic high school. He enjoyed working with smaller groups of students even though he was always anxious about whether or not he was doing a good job. Since coming to the seminary, John spends most of his free time studying. When the other seminarians invite him to go out, he usually begs off saying that he has a paper due or is studying for a test. At times John seems to enjoy it when a small group of the seminarians convince him to go with them to a movie.
The other seminarians have noticed that John seems to be quite anxious most of the time and is usually very uptight when he has an upcoming class presentation. He either stays up late to prepare or if he does go to bed, he often has trouble sleeping. Although John manages to "get through" these times, he usually perspires profusely and at times his hands shake. When a few of the seminarians teased him about "the shakes," he became highly embarrassed and feared that they were judging him. Although John is a good student and has a real desire to be of service to others, the Rector is concerned about John's continual worrying about how well he is doing, about his avoidance of public presentations, and his increasing withdrawal from interaction with his classmates. When the Rector spoke with John about his anxiety, John said "I know I am more fearful than I need to be and I'm not sure why or what to do about it."
What is going on with John?
John is suffering from inordinate anxiety and potentially from social phobia, one of the more common anxiety disorders. Anxiety disorders are the number-one mental health problem among American women and are second only to alcohol and drug abuse among men. The essential feature of social phobia, one of the more common types of anxiety disorder, is a marked and persistent fear of social or performance situations in which embarrassment may occur. This fear is much stronger than the normal anxiety that non-phobic people experience in similar situations. This fear is so strong that it may produce a panic attack and most often leads the person to avoid social situations. However, if the situation cannot be avoided, it may be endured with intense anxiety or distress as we note in the case of John who perspires profusely while performing in front of his peers.
It is important to note that persons who suffer from social phobia recognize that their fear is excessive or unreasonable. They also recognize that the avoidance, anxious anticipation, or distress in the feared social or performance situation impacts their normal routine, occupational (academic) functioning, or social activities and they feel distress about having the phobia.
Typically people with social phobia worry that others will view them as "weak" or "crazy." It is especially difficult for men to acknowledge that they are suffering from social phobia. For some a frequent "remedy" is to have a drink or two to calm their nerves. Many an alcohol problem got started as a way to "medicate" anxiety or to ease or numb pain. Therefore, it is especially important to identify this problem and get proper treatment.
The most common social phobia is the fear of public speaking. Other common social phobias include fear of speaking to strangers, meeting new people, eating, drinking, or writing in public, using public toilets, writing or signing documents in the presence of others, being watched at work, and taking examinations. The common thread through all of these is that the phobic person worries about criticism, negative evaluation, or embarrassment. Awareness of this disorder is heightened today as we learn of public figures like singer Barbara Streisand who avoided public performances for 20 years due to her performance anxiety.
Social phobia is known to occur more frequently among first-degree biological relatives of those with the disorder as compared to the general population. There are varying theories as to whether the cause of the disorder is nature or nurture. Probably it is a little of both. Recent studies seem to indicate that what is inherited from parents is a general personality type that predisposes the phobic person to be overly anxious. Given the "right" circumstances and experiences, this reactive, excitable, volatile personality might develop a social phobia.
How to help John?
There are a variety of interventions that may help John. Because anxious people tend to breathe shallowly, it is very helpful for them to learn to do abdominal breathing to reduce anxiety. Learning relaxation techniques may also help to lower anxiety levels. Exercise is an excellent way to discharge excess anxiety. The practice of meditation is beneficial not only for the spiritual life but also helps to soothe an anxious mind.
Working with a therapist who is trained in cognitive-behavioral techniques may also help John to identify and challenge some of his anxious self-talk and faulty beliefs and expectations that fuel his anxiety. Many persons like John believe that if they make a mistake, they are failures. Such "all-or-nothing" thinking promotes the worry spiral that reinforces social phobia. Learning assertiveness skills may help anxious people grow in confidence in their interpersonal relationships. Medications may also be used to help a person with anxiety and can be of great benefit to help the client have sufficient control over the symptoms that he or she can utilize the skills mentioned above. However, a word of caution needs to be injected here because some of the drugs that calm anxiety also have high potential for addiction. It is best if the therapist and psychiatrist work collaboratively to help the client.
A wise therapist or pastoral counselor will help his/her anxious clients to apply the Serenity Prayer to life--the serenity to accept what cannot be changed (biological predisposition and hypersensitivity), the courage to change what can be changed (learn deep breathing, meditate, dispute irrational beliefs, set reasonable goals, reduce stress) and with the help of others acquire the wisdom to know the difference.
Anna Marie Ciarrocchi, MSW, LCSW-C
Diplomate in Clinical Social Work at SLI