How to Interact Effectively with Individuals Facing Social Anxiety and Panic Disorders

How to properly interact with individuals who have social anxiety and panic disorder?

Dear Dr.
Chang,
I have a younger relative staying at my home for an extended period.
He is currently a PGY2 resident and is working alongside you.
However, there are some issues concerning him, and I am unsure how to interact with him correctly without revealing too much of his personal information, which could potentially harm him.
I can only provide general information.
I accidentally discovered that he is taking Xanax and Rofecoxib.
The prescription label for Rofecoxib indicates that it is for depression, social anxiety, and panic disorder.
I have not disclosed this information to anyone, including him.
Since my elderly mother is not tech-savvy, I assist with some daily needs.
He later added me on Line, and we use it as a communication tool because he sometimes needs to be on standby for work and cannot reach my mother.
Initially, our interactions were natural; I drew a welcome and blessing card for him and bought him some necessary items, attaching handwritten notes of encouragement.
I noticed that he keeps the card prominently displayed on his desk and has not removed the notes from the items I gave him.
However, I observed that when our interactions feel awkward, the card is laid flat or tilted on the desk.
Regarding our Line interactions, I respond to his messages, and sometimes he replies, while other times he does not.
I do not message him without reason; our interactions are based on necessity, such as my mother asking about him or checking if he will return home.
I remind him to be safe on his way home, especially since it is often late at night, and I inform him where the meals are prepared, trying not to add to his mental burden.
Sometimes he greets me, and sometimes he does not, but he often leaves quietly without anyone noticing.
His room windows are always closed, regardless of whether the air conditioning is on or if he is home.
When he is home, his door is always closed, but it is open when he leaves.
Initially, our conversations were natural and normal, as we were not very familiar with each other, so I listened more than I spoke.
He would share some thoughts, and I could sense his trust in me.
I have been careful to observe and adjust my interactions, avoiding casual remarks or prying into his personal matters, responding only to the topics he brings up, maintaining kindness and concern, and managing my expressions.
Occasionally, I would inquire about his surgical cases, and he would share some details.
A few days ago, he had to leave a meal several times due to being called back for surgery.
Understanding the stress of his work and not wanting my mother to stay up late, I prepared a late-night snack for him (my mother mentioned he only had a bite of dinner before being called away).
When he returned home, I asked if the surgery went well.
He replied that it seemed like they could not save the patient.
He appeared fatigued and not very talkative, so after a brief greeting, I returned to my room.
I later sent him a short Line message to encourage him, expressing that as long as he does his best to save lives, he should let go and bless the patients, helping them maintain a positive mindset in their final stages of life.
I also reminded him to take care of his health so he can continue to help others.
He did not reply immediately, but the next morning he briefly expressed his gratitude.
I forgot about it, but in subsequent encounters, I noticed a shift in his attitude toward me, which seemed to be a mix of respect and fear.
I observed this through his eyes, expressions, and body language, which made me feel sad.
I was concerned that excessive words or actions might exacerbate his situation, so in our later interactions, I kept my greetings brief, asked how he was, pretended to be busy, and shortened the time he needed to interact with me.
I also added emojis to my Line messages (which I usually do not do, but I noticed he occasionally uses them) to help alleviate his anxiety and refrained from discussing encouraging topics (in fact, we hardly spoke).
This morning, my alarm went off, and although I was awake, I did not get out of bed.
Shortly after, I heard him leave.
When I got up and checked his room, I saw that the card was once again prominently displayed on his desk.
Dr.
Chang, I am uncertain whether he has social anxiety disorder or panic disorder, and I can only judge based on his medication and behavior.
Based on the information provided, if he indeed has social anxiety or panic disorder, could you please advise on the following:
1.
What have I done right? What have I done wrong?
2.
What should I be aware of when interacting with someone with social anxiety or panic disorder to help them rather than cause distress?
3.
What are the symptoms of social anxiety disorder and panic disorder? How can one distinguish between personality issues and symptoms?
I apologize for the lengthy message and appreciate your time in responding.

Wishing you peace,
A hopeful learner seeking to help a junior in a correct and harmless way.

Yi ge xiang xuexi zhengque wuhai bangzhu houbei de, 50~59 year old female. Ask Date: 2024/06/30

Dr. Zhang Gengjia reply Psychiatry

From your letter, it is clear that you are experiencing discomfort and distress due to issues related to interpersonal sensitivity and interaction.
These concerns involve specialized treatment modalities, including pharmacotherapy and psychotherapy.
I strongly encourage you to seek medical attention in person to discuss your situation and seriously consider the recommendation for formal treatment.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
We have recently hired Dr.
Cheng-Jeh Shen, who has previously served as an attending physician and the head of the psychiatry department at Taipei Veterans General Hospital and Chiayi Branch of Taichung Veterans General Hospital.
He specializes in treating mental health issues in this area and possesses extensive clinical experience in psychopathology, supportive psychotherapy, and cognitive-behavioral therapy, along with interdisciplinary integration expertise.
Additionally, Dr.
Shen is known for his compassionate approach, earning the trust and recognition of patients and their families.
He is one of the recommended physicians for you.
I suggest you consider visiting our clinic for a face-to-face consultation with the doctor to collaboratively discuss the best decision for your well-being.
Wishing you good mental and physical health.

Reply Date: 2024/06/30

More Info

Interacting with individuals facing social anxiety and panic disorders can be challenging, but with the right approach, you can provide meaningful support. Based on your observations and interactions with the individual in question, here are some insights and recommendations.

Understanding Social Anxiety and Panic Disorders
Social anxiety disorder (SAD) is characterized by an intense fear of social situations where one may be judged, embarrassed, or scrutinized. Symptoms can include excessive worry about upcoming social interactions, physical symptoms like sweating or trembling, and avoidance of social situations altogether. Panic disorder, on the other hand, involves recurrent, unexpected panic attacks—sudden surges of intense fear or discomfort that peak within minutes. Symptoms may include heart palpitations, shortness of breath, dizziness, and feelings of unreality.

1. What You Did Right
- Respecting Privacy: You’ve done well to respect the individual’s privacy regarding their medication and mental health status. This is crucial, as individuals with social anxiety often feel vulnerable about their condition.

- Creating a Welcoming Environment: Your efforts to create a welcoming atmosphere, such as drawing a card and leaving encouraging notes, show thoughtfulness and care. These gestures can help the individual feel more at ease in their environment.

- Observing Non-Verbal Cues: Your attentiveness to the individual’s non-verbal cues, such as their body language and facial expressions, is commendable. This awareness can help you gauge their comfort level and adjust your interactions accordingly.

- Using Indirect Communication: Utilizing LINE for communication is a good strategy, as it allows the individual to respond at their own pace without the pressure of face-to-face interaction.

2. Areas for Improvement
- Avoid Over-Encouragement: While your intentions were good, the encouragement you provided may have inadvertently increased pressure on the individual. People with social anxiety often fear disappointing others, so it’s essential to balance encouragement with an understanding of their limits.

- Be Mindful of Your Presence: If you notice that the individual seems to withdraw or become anxious during interactions, it may be beneficial to give them space. Sometimes, less is more when it comes to engagement.

- Limit Direct Questions: Instead of asking direct questions about their feelings or experiences, which may feel overwhelming, consider making statements that allow them to share if they choose to. For example, “I’m here if you want to talk about anything,” can be less intimidating.

3. Key Considerations for Interaction
- Patience and Understanding: Individuals with social anxiety may take longer to respond or may not engage as actively in conversations. Patience is crucial; allow them to take the lead in interactions.

- Non-Verbal Communication: Pay attention to your body language and tone of voice. A calm demeanor can help create a safe space for the individual.

- Avoid Assumptions: It’s important not to assume that the individual’s behavior is a reflection of their feelings towards you. Their actions may stem from their anxiety rather than any personal feelings.

4. Distinguishing Between Personality and Symptoms
- Personality Traits vs. Symptoms: Personality traits are relatively stable characteristics that influence how a person interacts with the world, while symptoms of social anxiety and panic disorders are often situational and can fluctuate based on stressors. If the individual’s anxiety significantly interferes with their daily life or relationships, it may indicate a disorder rather than a personality trait.

Conclusion
Your approach to interacting with the individual demonstrates a genuine desire to support them. By continuing to be observant, patient, and respectful of their boundaries, you can foster a supportive environment that may help them feel more comfortable. If you notice that their anxiety is significantly impacting their daily life, encouraging them to seek professional help could also be beneficial. Remember, the journey to managing social anxiety and panic disorders is often gradual, and your understanding and support can make a positive difference.

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