To Dr. Chansky

[Guest guest]

>Hi Dr. Chansky,

Thanks so much for participating on our list. Have you successfully treated

many kids for social phobia? I would like any insight you can offer. My 7

yr old daughter Kelsey seems to be an interesting case. After two episodes

of OCD over a year and a half, OCD came on hard and fast last March. She

was very severe with contamination issues, wouldn't wear clothes or hardly

eat. We started CBT without any medication in April and after 10 weeks she

had mastered her item at the top of the hierarchy. Within days of that, OCD

had lost its grip on her nearly completely, and 30+ contaminated items fell

of the list. We've had occasional minor relapses since then but don't

really see much contamination these days. She has some scrupulosity issues

and trouble letting friends leave from time to time (extremely anxious,

holds on to them, doesn't want it to end) but quite minor to where we were.

As a result, we decided to focus on her excessive shyness, which has always

been with her but gotten worse over time. She does OK interacting with kids

(but has trouble maintaining friendships because of problems with social

awareness) but cannot make eye contact or talk to adults at all, even those

she knows quite well and is fairly comfortable with. So I've now been

coaching her with E & RP for 6 weeks, also imaginal exposures but we have

seen very little progress on this one. The problems: 1) a social

interaction is not as controlled as an OCD E & RP in the privacy of your home

2)she never failed at exposures for OCD and seemed to have an amazing sense

of what was doable, very accurate but fails about 50% of the time with our

social phobia exposures, tends to underestimate them. I don't understand

this so has not been able to build the confidence " bossing back " that she

did with OCD. 3) Is not as motivated as with OCD because I think she sees

the shyness as more integral to her personality than OCD because it's been

a behavior for her always. Plus she's kind of tired of CBT. 4) I always did

the OCD exposures with her but have asked her this summer to do one a day

while at day camp (i.e. assertiveness training: Can you think of one

question you can ask the counselor today?). She then forgets (too busy

playing) or decides it's too hard as I'm not there prodding her.

Do you have any suggestions for us? I understand CBT (and medication) are

treatment of choice for social phobia. Do you agree? If so, how can we be

more successful? People say that social phobia is much more treatable than

OCD but this hasn't proved to be true yet for her. She has become quite

comfortable with her therapist over past months, going from whispering in

my ear to having an in-depth 20-min conversation today on tough issues but

this hasn't transferred to others the way I'd hoped. The imaginal exposures

(paired with belly breathing) have also not transferred into a relaxed

response during anxiety-producing social situations as hoped. Phew..I

apologize for the length of this post! Thanks for any insight you can offer.

in San Diego