Psychiatry & Psychotherapy Podcast - Red Face: Social Anxiety with Russell Norris

Episode Date: May 5, 2023

From childhood, Russell experienced intense social anxiety to the point that, on more than one occasion, he discontinued certain extracurricular activities and socially normal gatherings to avoid it. Red Face is a narrative of his struggles with this social anxiety, the accompanying idiopathic craniofacial erythema (uncontrollable blushing), and the many successful and unsuccessful coping mechanisms he has attempted over the years.  In today's episode, Russell shares his experience with social anxiety, which started at a young age and continued into adulthood. He will share what he does to overcome the often debilitating fear.  By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

All right, welcome to the podcast. I am joined today with Russell Norris. He is a writer, copywriter. He has written a book called Redface. It is a book on social anxiety and idiopathic, craniofacial erythema, and he writes it for a popular audience to help them potentially overcome similar issues and he tells his story. And so having recently done an episode on social anxiety with Dr. Cummings, I thought I would bring him on and hear his story and kind of have a just a dialogue on what that was like growing up and what's helped him overcome this. So welcome to the podcast. Hi, David. Nice to meet you and thanks for having me on the show. So you're hailing from England, from south of London or southern London. Yes, that's right. I live in

London on the edge of London, greater London, and I've pretty much lived in London my whole life, although I spent the first few years of my life in Oklahoma, in the US, believe it or not, because my mum's American, so I'm half American, spent my summers over there visiting cousins a lot. But yeah, I was spent most of my life growing up in in London, England, and that's where I live and work now. So, yeah, why don't you kind of like take us back to where you first remember having performance anxiety or anxiety or, you know, anxiety about blushing? Like, how old were you when that started? Yeah, so the big thing for me is the blushing. So I think it all began with blushing. I've asked myself this question several times, like, you know, did being socially anxious make me blush or did the fact that I started blushing make me socially anxious?

I've never really been able to answer that chicken and egg question. But for me, it was around the age of probably 12 or 13 years old when puberty began to hit. That's the first time I remember blushing and, you know, disliking the way it made me felt and disliking the way other people reacted to it. I guess it first started happening in school. It's most closely tied in my memory to, you know, being in classrooms or being around kids. You know, as kids generally are, are a bit unforgiving and cruel when someone in the group looks different or does something different or behaves differently. I remember, you know, some taunting at school, you know, you're red, why are you so red? You're always the one who goes red.

Those are kind of like my earliest memories, I guess, of it as being the kid who blushed more than other kids, usually in a school environment. So that's, I suppose, when I first remember it. But there are other things that stick out in my mind, like specific moments. I used to have piano lessons around that time when I was 12, 13. And I got to the point where I built up this fear inside myself. I was really scared of my piano teacher. She was a lady in her 50s, I guess, and she was very strict.

A real kind of disciplinary authoritarian style figure. You know, she'd get very angry if you made mistakes. She was from the old school world of, you know, shout at the kid till they get it right. She wasn't screaming and shouting, but she made me very nervous, and I didn't like going into those piano lessons. And I remember a big fear building up inside me of going into these lessons. and I used to start to worry about it in advance. And that sticks out very clearly in my mind as well as worrying about things more than other people seem to at a young age.

Yeah. So you talk about before, during, and after, you kind of had anxiety, three anxiety components. So before something you would feel like anticipatory anxiety and then during you would feel it. and then after what would and then you had to talk about that cycle of what you noticed there yeah i think i only managed to break it down into those three parts you know later in life looking back on things um as i was trying to sort through how i used to feel and how i still feel in anxious situations but there were these clear kind of three definitions for me there was the the anticipation which is before before the blushing happens or before the social anxiety kind of peaks um how

And that's often a long time before. So if you know something's going to happen, like you have to give a presentation in class at school, or even at work, or you're going to have a piano lesson once a week, I would start to worry about it a long time in advance. You know, we're talking, not just waking up that morning and being worried about it, but worrying about it the night before, the day before that,

almost like a week before that, already dreading something that's coming up on the horizon that I know is arriving and that I have to go to and can't escape. That anticipatory feeling of dread, building it up in my mind, worrying about the fact that this event's going to happen and I can't avoid it. So that's the before. And because all that's been kind of boiling up in the kettle beforehand, when the moment arrives, it kind of feels a hundred times worse because you've built it up to be so bad. in your head. And in that moment arrives and it will either be, you know, feeling so socially anxious in a situation that you can't perform or you feel paralyzed or you lose your train of thought. You can't speak to people or do what you were there to do. Or it's launching into a blush.

I find there are two kinds of blush. There's like an instantaneous blush, which happens very quickly and goes away very quickly. And then there's a long slow blush where you're very nervous for, let's say, a set period of time like an hour when you're in a room with lots of other people. And that blush just builds and builds and builds and it turns into a long lasting redness. It takes a long time to then subside. So that's the during. And in the third part, the after is when you finally managed to escape that situation that's been distressing you, you get away from the room or the meeting or the presentation you've been giving,

and you start to ruminate on it. You start to think what went wrong, what did everyone think of me when I went so red in the and you start to feel quite down about it and deflated. And that's the after where you think about it too much, blow it out of proportion, and then the whole cycle begins again because that meeting or piano lesson or whatever it is is going to come back again in a week's time.

So yeah, those are those three kind of chapters or pillars for me that it makes sense to break them into. And that's helped me kind of, I don't know, formalize some of the things that go on in my head. It's helped to put these things into blocks that I can kind of look at and try to isolate and understand. Yeah. And, you know, I think everyone kind of has this to some degree, but what you're talking about is like a much higher degree than most people, because I can even relate to this, like the before, during and after anxiety. You know, like when I used to, I remember when I used to wrestle freshman year in high school,

like I would have, like I would feel like throwing up before practice. I would feel like throwing up during practice because it was so hard. And then afterwards I would feel like throwing up because it was like just the, yeah, that internal critic of like, gosh. So I don't think I'm at the level that what you're saying. So I'm not like trying to compare. But I think it might be helpful for you to distinguish as you've kind of looked at this, like what is normal versus what is, you know, crippling and leads to avoidance.

Yeah, I think there is a level of normality to this, as you say, especially when it comes to performance. So, you know, I think most people get a bit nervous before they do something, like participate in a sports game or, you know, go out on the stage to, to act in a play at school or as an adult on the stage. And people will say sometimes the nerves give them an extra boost and it helps their performance because it gave them some lift and put some fire in their belly.

And afterwards they're actually thankful that they were nervous because it showed that they cared and that they wanted to do well. But yeah, then there's the point where that becomes, I think, not normal or unnatural. when it kind of skews all out of proportion to what you're doing. So, you know, your body going, going into full-on fight or flight mode to the point where you can't accomplish what you're there to do anymore. So I used to swim.

I used to swim competitively when I was around that age when the social anxiety first hit, and around 13, 14. And I got to the point where I was so worried about going into swim races, swim gala that I was feeling physically sick just the smell of chlorine became a trigger for me it would make me physically shake

I wouldn't want to go out and you know participate in the race I would feel like once I was in the water I didn't want to hear the bang of the gun I developed this fear of the starters pistol and the fear of it going off because I didn't like loud noises they always made me jump

and just the anticipation of waiting for that would affect my performance so that when the gun went off, you know, the other swimmers would release and start swimming and I'd still be clinging on, almost paralysed. And then I'd remember I'm there to swim. And that puts you at a disadvantage, because they're already behind everyone else and you lose the race. But it started affecting me to the point when my dad noticed, and he was like, you don't seem to, you don't enjoy swimming, do you? It's kind of like making you physically nervous and physically, almost physically ill. And I think

I just said to him, yeah, I don't like it. I really worry about it now. And it's not funny. anymore. So we stopped doing it, and I stopped doing swimming. And I didn't do many competitive sports growing up, and it's one of my regrets, really. I kind of wish I had pushed through that a bit more and got more involved in sports, because

we'll probably touch on this as we talk. I think exercise is a very important component in trying to burn up a lot of that excess adrenaline and nervous energy that a lot of blushes and socially anxious people have. Yeah. Yeah. I

I'm hearing you that. So your father started a notice, and did he offer any potential steps that you could take? Or was there steps that you could take that started at that point? Not really, no. I mean, we stopped the swimming. And I think because that made me happier. And I had that,

that stressful event wasn't a regular part of my life anymore. I think that was just seen as a good thing. you know, he's stopped the swimming. He's not as anxious now. So that can only be a good thing. We've removed something that was bothering him. I think the same thing happened eventually with those piano lessons I was talking about. We stopped doing those as well just because I almost found it debilitating going in and facing my teacher each week to the point where I was pretending to be sick. You know, like I'm sick today. I can't go to school. I can't have my piano lesson. And again, that's a regret because I look back on that and I wish I had learned to play the piano.

I stopped at that point and never picked it up again. And it just felt like a missed opportunity to me. But I only have that, you know, that in hindsight. At the time, I was very glad to stop and remove it from my life because it was causing me, you know, regular distress. Yeah. Yeah. I think it's very common as a parent to want to avoid what is distressing.

And so a lot of parents pull their kids out further and further until they're homeschooled or, you know, completely not doing anything socially with peers. But you continued in school, it sounds like. Yeah, I continued in school. It never got to the point where I couldn't go into school. I mean, actually, it did get to that point, but I hid it from my parents because I was a bit older by then. So by then I was in secondary school, which is the equivalent of high school. and I'd say by around the age of 15 or 16,

I was old enough to kind of go out, leave the house for the day, convince my parents I was going to school, and then not go to school. Because I was old enough to be out on the streets alone. So it was easier to get away with skipping school without them knowing, although they eventually did find out, of course. There's only so long you can hide that kind of thing. But I, yeah, I wasn't homeschool. I stayed in the public school system, but I did reach a point in my mid-teens where I started not turning up at school because I felt like I couldn't face it being in an environment with so many other kids all day long.

I went to an all-boys school. I mean, by the time I reached the age 11 and I entered the secondary school system, it was a single-sex school, so it's full of boys from the age of 11 to 18. and I mean looking back on that as well I found that a bit difficult just being with with all the boys for for that many years it would have been perhaps more beneficial for me to have more yeah yeah I think that definitely contributed to things single sex schooling is not uncommon in the UK it happens a lot you know all girls schools all boys schools it's a bit old-fashioned and I think it goes back to like the Victorian era but it's still around with us in the UK. And, you know, some people see it as a good thing that you, you know, you stay focused on studies because you don't have to bring boys and girls into the equation and the troubles that can add in teenage years. But I think it comes with its drawbacks as well. In that kind of environment, you know, everyone's competing to be the alpha male at that age, I think. And if you're a bit more sensitive or you're prone to blushing,

you can be singled out and kind of find schooling a bit more difficult. Yeah. Yeah, I think sometimes men behave better if there's a couple women around. They're less, they're less cruel to each other, it seems. Yeah, I can believe that for sure. So, okay, in the book you talk about how it kind of progressed to some self-harm behaviors and suicidal thoughts. Yes. tell me about that so i guess at that point we're fast forwarding to me going to university so i've left school by then i'm at uni and by that point i'm pretty much master of my own destiny i can i've moved away from home i'm at university with with people i don't necessarily know it's up to me if i turn up to classes or not and it didn't take long for me to stop going to

seminars and lectures because I just I had developed that fear that we talk about. So I was already thinking about how hard it would be to sit in a small group of six people and in a seminar discussing and debating things. I found that kind of situation very hard to be in to speak up in a group without you know turning bright red for that hour while we spoke, you know, breaking out in a sweat, just feeling really uncomfortable, not knowing what to say. Built it up in my mind over and over. And of course, it was one of those regular events. There was a seminar every week. So every week I stopped going. And then then I had, you know, moments where I was like, you're going to keep doing this. You're going to get found out. You're going to get, you know,

you're going to fail all your exams and get, you're going to have to drop out of university and own up to your parents about what's been going on. So I then began drinking before I went onto the campus because that was the only thing that gave me enough courage to actually turn up and participate. So I would drink a bottle of wine, for example, before going into a seminar and somehow get through that seminar without everyone knowing I'd drunk a bottle of wine. I don't know if people did know and just decided not to act on it. But there were many occasions where I turned up to a seminar fairly drunk.

I mean, I was taking steps to hide it, brushing my teeth, making sure I didn't stink of booze. But, you know, again, looking back on that, it must have been obvious to be. people that something was different because I was the quiet guy who didn't want to talk and then one day I would turn up able to talk and being a bit much more open and it's because I'd been drinking beforehand. But yeah, this just led to a few dark years at university where I questioned myself and what I was doing and how I was going to go out into the real world afterwards and function and I went to some dark places and I ended up self-harming. I got very low at one point and was contemplating suicide.

This was towards the end of my three years at university. And thankfully, I reached out to a friend of mine at that point, my best male friend from school, who managed to convince me to not do anything stupid and instead go and get some help from someone. And I'll be forever grateful to that guy because he's the one who kind of made me see light at a very dark moment. And it's very rare for male friends.

friends to genuinely tell each other what they're feeling. And this was one of those moments. And I'm really glad we had that conversation. I still remember it. And it was a very pivotal moment. What did you say? What do you remember? What exactly?

Was it how he said it or was the care of his concern? I think I was very unfair to him, actually. I think I called him up at two in the morning. And I essentially said to him, you know, give me one reason why I shouldn't kill myself right now. you know this was me 20 years old in despair I guess reaching out and I think the way I did it was quite unfair on him

but his answer back to me was you know the reason I shouldn't do it is because he would miss me I would really miss you that's what you said and you know I don't think a male friend has ever had ever had ever said that to me or has ever said it since

it's that kind of moment of opening up of complete honesty between two guys that just doesn't really happen unless you kind of, you know, put yourselves in a situation where it does. And for me, it worked. And it was after that that I went and spoke to my doctor for the first time. And I was about 20 years old at that point, about to turn 21. What was that? Well, first of all, how meaningful, you know, for someone to, authentically express that care, you know, and that touched you in that two o'clock phone call. Yeah, that's really meaningful. Yeah, it was, like I say, I think I put him in an unfair position looking back on things,

but it really helped, and it helped me take the next step, which was to acknowledge something was pretty wrong and I needed to try and do something to try and move forwards and that first step was to speak to my GP. Yeah, what was that conversation like with your GP?

So it was very, very hard because I didn't want to go and talk to him about it. I didn't want to talk to anyone about it. I was I guess one of the paradoxes of social anxiety is that to take that first step and tell someone about it and get help means not being socially anxious about it.

You have to go into a room and speak about it and put the attention on you, the spotlight on your problems, which is the last thing on earth you want to do because you're always trying to avoid putting the spotlight on yourself and drawing attention to yourself. So it's very hard to make that first step, because that is a big part of the fear.

That's the big part of the phobia of, you know, speaking to another person. You know, it's hard enough to speak to another person, let alone about your problem, your social phobia. So I found that step difficult. But I did it. I made the appointment. I went to see the doctor. And I think in the back of my mind, I also had a worry because our doctor was our family doctor. you know, he knew my parents.

And my brother was friends with their son. And I just couldn't get over this niggling worry that going to him meant it was all going to come back to my parents and to my family. And they'd know that I was cracking up at university and I'd gone to him for help. And I think I was vaguely aware of like the Hippocratic Oath and that there was patient, Dr. Patient confidentiality. And that he shouldn't and probably wouldn't tell anyone what. you know, it goes on between doctor and patient behind closed doors. But I was still worried about that. And that's part of the reason I think why I still didn't, you know,

I didn't immediately go to the doctor, I think. I waited and waited and then did go. So I was worried that he was going to, you know, tell people about it. Obviously that didn't happen. But anyway, he eventually got out of me what I was feeling and what was going on. And he managed to pin it down to, he called them intrusive thoughts. I was having a lot of intrusive thoughts. My symptoms sounded like they could be in line with anxiety

or social anxiety in particular, because I was telling him how hard I find it to go into rooms and be with other people and to just do ordinary things, like go into a shop and buy something. I was finding things like that difficult by that point. And I think he mentioned an overactive thyroid. He was going to test for that.

I think doctors have mentioned that to me several times. They always check for an overactive thyroid. I've never really understood what that is or why they always check for that. But that always comes back as a negative. He basically prescribed me antidepressants in the end. That's where my visit to the GP ended up. He prescribed me some antidepressants.

Do you remember which one? So this was over 20 years ago. But yeah, I do remember. It was called Syroxat. I don't know if it has a different name in the States. But yeah, syroxat with an X in the middle. Yeah. Syroxat, yeah, interesting.

Paroxetine. Okay, paroxetine. So, yeah, that's called something a little bit different in the U.S. Okay, so go ahead. Is that fairly common? Yeah, it's a fairly common one. Yeah. Okay. So yeah, he prescribed me a course of Syroxat. And this was to get me through my final year at university because I was about halfway through that third year and I had a lot of big intense exams coming up at the end of it. And this was enough to get me through the rest of the year. So I think it was like a six, six month course, six to eight months or it was a year's course. I forget because it was so long ago. But I started taking those antidepressants and, you know, nothing happened for two or three weeks.

as the instructions said they wouldn't. They said it's going to take time for this to kick in. And then I really did notice when they did start having an effect. I remember feeling physically nauseous a few times when it first kind of started kicking in. But as I then got further into the course, I didn't really enjoy the way antidepressants were making me feel. I felt like they were helping to reduce the anxiety.

So they were kind of chipping away at the anxiety, but I felt like they were chipping away at my personality as well. I felt like it was just dulling me as a person. So I remember being in the library and I'd have these moments where I felt like I zoned out where I just kind of started daydreaming. And the daydream, I'd look out the window and I'd daydream for about 40 minutes just staring out the window. and I wouldn't feel especially happy, but I wouldn't feel especially sad either. I'd just be kind of neutral. And I didn't really like that. I'd come out of that 40-minute kind of staring out of the window,

and I just felt kind of like at times I was becoming a bit of a zombie, and I didn't enjoy the way it made me feel. Like on balance, I almost preferred how I felt before, which I know sounds odd, but I just felt like I wasn't reacting to them in a great, way and I felt like I was walking around in a days a lot of the time. So I did take them until I finished uni. But then when I left university, I stopped taking them, came off them gradually, and I didn't go back on them again. You know, it sounds like, and I wonder, was it just

the, this medication that you started with the peroxatine? It is anticholinergic, and it does sometimes cause something of like a depersonalization, which is kind of a dissociative state, a little bit more dissociative, where you don't feel quite in your body. Yeah, and I didn't enjoy that. Yeah. And I think I told my GP that,

and we gradually came off them. But then I kind of just went back into avoidant patterns, and I didn't go back to see the doctor. I just went out into the world and got my first job and just tried to get on with things from there. I didn't, it was quite few and far between after that that I went back to the doctor. I almost felt like, because he gave me the antidepressants

and they didn't really work, I kind of felt like he didn't really understand and that I'd been misprescribed. I'm in my 20s then. I'm also thinking like, well, I don't, need this, I'll just go my own way and figure it out by myself. And yeah, I didn't really go back to the doctor for a long time during my 20s. I just tried to find my own way through.

And that ended up with me developing some pretty bad habits out in the workplace. Again, with the drinking. So I would often drink before going into work in the mornings because I found it very difficult to be in an open plan office. So many people around, so much. going on, so many meetings, constant interaction with other people. I found that difficult at times, some days worse than others. But that would happen. I would sometimes drink before going to work. I developed this very strange habit of not sleeping, deliberately not sleeping, because I noticed

one day after I'd been up very late because I'd had insomnia that the next day in the office, for whatever reason, I blushed less and I felt less anxious because I was so tired. I guess my blood pressure had dropped perhaps. But I was tired and I, you know, irritable, I guess and a bit kind of not with it. But at the same time, I didn't feel as nervous and less anxious. So I started staying up really late deliberately and not sleeping and going into work on like two hours of sleep. there were a couple of days where I didn't go to bed at all and just went into work the next day having not slept and for a while that worked but you know eventually everything starts to bite back you can't go on with lack of sleep forever

and eventually that just made the anxiety worse because I wasn't getting enough sleep and I had to you know stop doing that so I was always looking for ways out you know all ways around things I guess that typifies what avoidance is trying to avoid the things that distress you the most. I guess these were negative coping strategies. I think you were trying your best to cope, you know, and you were trying different things that creative, you know, not sleeping helped once, not sleeping helped twice. So you got creative like, oh, maybe this is the solution.

Yeah. So yeah, I think it's admirable to keep trying something new, you know, to try to come to a solution. Yeah. And then I tried anything I could find at the pharmacy that you didn't have to get, you know, a prescription for. So there are so many different herbal tablets out there that claim they can calm you down or, you know, help you feel relaxed. I tried everything that was there. I found none of these herbal remedies did anything for me. I probably took, you know, too many of those herbal supplements at one point,

but they didn't really calm me down. They didn't make me feel less anxious in any situation. So then eventually I realized you can't come to work drunk every day. You can't come to work half asleep every day. What are you going to do? You're going to need to find some kind of fix. So then healthier things came up. So exercise, for example.

I know that that might sound really obvious to a lot of people listening. But, you know, mind and body are so interconnected. It really is true that one affects the other. And I realized that if I went for very long runs, long jogs in the morning or evening, it really did help to reduce all of the nervous energy that I always. always felt running around and through my body. That was the only thing that ever genuinely made me feel relaxed was after a long period of physical activity. So I started to exercise strategically. If I knew I was going to have to, you know, contribute to a meeting the next day, I'd get up and do

a very long run on the morning of that day and it would really help. It wouldn't remove the anxiety, but it would take a big chunk of it off. And I really did know. it's a difference. So I started doing that a lot more, not just exercising, but doing it around my schedule so that I would always, you know,

have just exercised before a stressful event. Therefore, I'm going to react to it less stressfully. And that did help. It's not a silver bullet by any means, but it definitely did help. But then there were some days where, you know, I would do that and I would rely on it and I think I'm going to be less anxious

because I've gone for this long run and then I'll have a real bad episode at work. And then you start thinking, well, maybe exercise doesn't work. Maybe I can't rely on that. And it's always been maddening because I've never been able to get to the root of why some days are worse than others. But what specifically sparks anxiety for me and what takes it away? Because it is the obvious things like caffeine. If I have too much caffeine, I do feel more anxious.

If I eat spicy foods, I'm more likely to feel hot and to blush. But equally, there are some days where all of these factors have been removed, and there should be no reason why I should be more anxious or less, and yet I am. I've never really been able to understand the rhythms of it or get to the root of that. It seems to be random to me anyway. It would be nice if it wasn't random, because then you could have at least the expectation that this is going to be helpful. Yeah.

I mean, I guess I should have tried to keep like a diary or, you know, an anxiety diary or something to try and see if there were spikes in relation to different things going on. But I never took it that far to trying to diarize, you know, my anxiety. I never got that kind of granular with it. Yeah. Yeah. So, okay, so exercise, some help. What else did you find that was helpful? So I delayed for a long time learning how to drive because I was too anxious to drive a car.

I don't know, have you ever been to London, David, by any chance? Have you ever visited the UK? I wish. Hopefully someone will pay me enough to come out and speak to them out there someday. No, but I imagine the streets are pretty wild, right? Yeah, I only mention it because of that because the driving over here is quite a stress. You very rarely drive in a long straight line and the roads aren't wide and open. There's lots of traffic at all times.

Cars parked on both sides of the road, difficult to manoeuvre between large trucks and vehicles. It's quite stressful. And I was learning to drive stick. So it was like a stick shift. I was learning that. And I just found it too much. And I always felt like I was going to crash the car or I was going to crash into someone else and hurt them. And I just gave it up and I stopped trying to learn driving.

And then I, my driving instructor, I think when I was about to quit and say, I just can't do this, it's too much. You know, I'd get out of the car, covered in sweat, drenched. Oh, wow. Just like shaking because I couldn't take it. And he was like, have you ever heard of beta blockers? And I hadn't. I'd never heard of those. And he said, well, I teach someone else who gets very nervous.

And they take a beta blocker. And they're fine. It seems to really help. So I went to the doctor and said, I've heard beta blockers can help reduce the physical symptoms of anxiety. And they said, yes. Is there anything specifically that you're worrying about? And I was like, well, it's driving.

I can't drive without becoming a nervous wreck. So they gave me a course of beta blockers. And I took one before a lesson, and I found the effects of it were really, really beneficial for me. I suddenly I wasn't shaking, I wasn't sweating, I wasn't so uptight, and I could think about what I was doing, changing gears, you know, dodging in and out of traffic. I found it easier to focus on the performance instead of worrying about everything else. And that really worked.

And then I thought, well, what if I took a beta blocker before I gave a presentation in a meeting? Is that going to have the same effect? And I did that, and it did. and it helped me get through the presentation, and I got to the point where I was at work doing things that used to make me really uncomfortable, I could suddenly do if I took a beta blocker, which sounds great, right?

It sounds like, you know, all the problems are solved, but they aren't because it's a temporary fix. It helps you through that moment, but it's not going to help you through every moment for the rest of your life. I found, to basically cut a long story short, I found that I was becoming over-reliant on beta-blockers. I found that I'd become almost emotionally reliant on them.

I don't think they're physically addictive, so you can't get addicted to a beta-blocker, but you can emotionally get addicted, I think. And I started feeling like I was becoming a bit addictive around beta-blockers to the point where I would worry if I didn't have any on me, to the point where I was asking the doctor to put me on a repeat prescription

so I wouldn't have to keep coming back to him to get them. And it just started to show me a slightly nervous habit. Again, it felt like something that was taking away my nerves in itself was becoming a nervous habit. So I tried to start waning myself off of beta blockers and I eventually did. And we've gone quite far into my story now because I remember I was still taking beta blockers

just before the COVID-19 pandemic began. And then everyone started working from home. And all of a sudden, I had zero reason to take beta blockers anymore because I wasn't in the office with people. Everything was being done over Zoom through a screen. And all of a sudden, my anxiety was gone because I wasn't physically in the room with other people. So I found it much easier to do it all.

through, you know, a Zoom window than to be in there in a room physically with other people. So then I stopped taking the beta blockers all together. And I think these days I only take them very rarely if I'm going to need to stand up and give a quick speech, you know, to a family member at a family dinner, for example. If a moment like that comes up, I'll probably quietly take a beta blocker in the background to help me through it, but otherwise I've stopped relying on them and I feel better for knowing that I don't have to always have them in my pocket. So I don't know if that's a good story or a bad story, you know, that beta block has helped. I think I often prescribe them, especially

performance anxiety and social anxiety. It's a good, you know, propanol 20 milligrams, see how that goes. Some people take extended release once. a day in the morning. Yeah. To help decrease the anxiety. But I'm curious, like, what about, have ever done any therapy? No, is the answer to that. And I wish that I had because when I first spoke to my doctor, you know, when I was

at my most vulnerable and I was diagnosed antidepressants, the word therapy never came up. you know and even going back to that time 20 almost 25 years ago now even a phrase like mental health wasn't a phrase I had ever heard it wasn't I mean it might have been out there in the lexicon but I certainly wasn't hearing it being used and I think I felt there was still stigma attached to therapy you know like going into therapy was a true signify that you really were cracking up. That's how I used to think when I was in my mid-20s,

that that's the stigma I had attached to it in my head. And I mean, over here in the UK, we have the NHS, the National Health Service. So a portion of our taxes goes into maintaining a national health service that everyone has access to. And you can get therapy through the NHS, but the reality is the NHS is overworked and it's underfunded,

and there aren't enough people in the NHS working for it. So the waiting lists along if you want to get into therapy, meaning your only option is to go private, and private therapy is fairly expensive. So I think there are a lot of people who they reach out, they realize they can't get the help they need straight away, and so they give up, and they don't come back for help. I've always been aware.

I mean, at the time, I had heard of things like CBT, talking therapy, I think more recently, and it's probably through listening to your podcast that I heard about acceptance commitment therapy, which was new to me. I didn't know that term until just recently. But no, I have not had therapy and I wish I had younger in life. I'm still open to therapy now, but I've reached, I've got to a point in life where I'm fairly at peace with social anxiety and blushing. I think writing a book helped me with that. But I'm really interested in the acceptance side of something like acceptance commitment therapy, because for me, acceptance has been the key to getting past social anxiety and getting beyond

how distressing blushing has been for me throughout my life. So I think I got to the point where I realized just accepting it as being a part of who I am and trying to see it as a positive and not as a negative has made a big difference to me. And I think I've got a lot of that secondhand perhaps, but not going through direct therapy. Yeah. So as you listened to the episode, I know before we started, you told me you listened to the episode with me and Dr. Cummings, like did anything jump out as kind of a common experience or maybe something that might inspire you to, you know, start therapy or try, you know, try something.

Yeah, I think something that definitely stood out that I could really relate to was when it was either yourself or Dr. Cummings, he mentioned it. It was to try and think of social anxiety as a, as a buddy, as almost a sidekick. So someone who's next to you, almost looking out for you, because I've found that trying to reframe something in that way in my mind has been very useful in the past.

So I think I've come at it from a slightly different angle, but I think it means the same thing. I've always tried to think of, you know, turning a weakness into a strength and turning a curse into a blessing. or what you see as a curse, trying to find the blessing in it. And I think if you are socially anxious and you find it difficult being around people or you're highly sensitive, yes, there are perceived downfalls to that, but there are some good things that can come out of that as well.

And an example that comes into my head is that, you know, I'm a writer. I believe I became a writer, that's my profession, because I was the shy, kid who preferred his own company. I believe that helped me play to some strengths, and it helped cut me into a career that I love. And, you know, I work with a lot of software developers, guys who write code, really smart guys. And almost every single one of them is an introvert. You know, they all prefer to work alone. They all work with their headphones on. They might be socially anxious. They might not be, but they aren't the easiest people to sit down and have a conversation with. But some people might see those as weaknesses, but they're actually strengths because it's

turned them into excellent coders. You do need a certain sense of focus and deep flow to do that kind of work. And I think if you're happy in your own company and you're good at being alone, these can play to your strengths and help you find a career that's right for you and that's, you know, rewarding and gives back to the world. So it's kind of like trying to find the blessing inside the curse and not just seeing it as a, you know, something that's holding you back. It's also something that's helping you move forward as well if you choose to look at it

that way. Yeah. Yeah, I think, well, I appreciate you resonating with the thought that I put out about the sort of how do you see it as like a helper or a buddy. And I also appreciate you've naturally found something that I tried to help patients find as like, how do you see the strength in something, you know, like whether it's dyslexia and people with dyslexia often have a visual, spatial ability that most people don't have. Or like you're saying, strong introversion neurotic, being higher in introversion neuroticism in the Big Five, often those people make really good programmers or writers. because you read more than the average person who's extroverted and wants to spend all their time with other people.

And yeah, you found contentment in that. Yeah. I think I challenge you, though, to see therapy as an investment and to find someone good in your area, I think it would help you beyond what you imagine it would help you. I think that sort of the exploration inside of your and the relationship. The exploration and the relationship, I think the combination of those things would be valuable. You know, even though you've come to a good place where you have a good job and family life, I understand family was important for you as well in your journey.

Yeah, family helped me take a lot of the focus off of me. off of my own thoughts, off of my own cyclical kind of narrative that would go around, around in my head and reinforce my anxiety. It just helped to push me out of that and realize that it's not about me anymore. It's about my wife and my kids. I just found that a really helpful natural shift in life to move towards thinking of others or focusing on the needs of others instead of overthinking everything inside my own head about myself. For me, that was a big kind of paradigm shift, which really helped. Yeah.

One thing that I think, which I would be curious, as you've kind of looked at your life somewhat on your own, do you find that you have a negative internal voice that comes from early developmental figures? in your life. Do you, that sort of negative critiquing voice is that, do you imagine that that's more personality, like you were born with that? Or that that was somehow internalized from someone else?

I don't know. I don't have a specific authority figure that stands out in my mind as being overly critical. I mean, neither of my parents were like that. they were encouraging but not critical. I mean, we all have those figures in life like teachers who are naturally there to push you and be critical, but there's no one teacher who stands out as, you know, being a bully or anything like that.

I wasn't bullied in school. You know, you'd think I would be. I was a prime target for bullying, but I managed to get through school without ever really being a victim of being bullied. So I'm not really sure. I mean, for me, it's always focused so much on the physical side of things. Like, I know social anxiety comes from the mind, but for me, it's not so much the internal negative voice.

It's the negativity of experiencing the sweat, the red face, the trembling. It's the physical side of things that I guess, I remember more and that I, you know, it's like so much that that's what reinforces the fear for me. I don't want to go, I don't want the shakes to come back, the sweats to come back, the redness to come back. I find it hard to pin that onto a specific personal figure. It always just seems to come from my own body, which I can't control. And it's that lack of control where it all begins. Because I can't control it, I fear it.

And that's where the cycle starts. But yeah, I struggle to attach it to one event or figure. I almost wish I could to make it simpler in a way. Yeah. At one point you describe the anxiety as like you get lightheaded or you feel a little bit disconnected from your body when the anxiety gets really high, right? Those words for things.

have you ever heard of the word a dissociation and thought that that might be like have you have you ever thought about how when fight and flight is not working right there's like almost like an unsuccessful state where then we start like entering into a dissociation has that ever term ever come to your mind or have you ever thought about that i've heard the term and i have i have felt that way, I suppose when social anxiety is at its absolute worst, when I feel cornered, I've often felt like I'm suddenly not part of it anymore, or I'm watching like a train wreck from a distance. That's happened to me before, but it doesn't last too long, and then I'm, you know, back in the room and back in the body that's blushing and sweating. Um,

we're probably talking a matter of seconds when it does occur, but it's something I have noticed in the past. I get that less now. I mean, I'm in my early 40s now. I think I got that a lot more when I was in my 20s and everything felt much more raw, less so these days. I find in general the older I get, the less of an edge my social anxiety has,

so it was very sharp and cutting when I was younger, and it's just dulling over time. I find a lot of people who I speak to, especially when they're younger, and they're going through the phase where it still feels very sharp and raw, they're all looking for a quick fix. They want something quick

that's going to stop this from happening to them. You know, what pill can I take? What method can I use to make this go away in a matter of weeks or months? And I never really have an answer because it's taken time for me and time itself has been a natural kind of healer.

The older I get, the less it affects me, therefore the less I care about it, therefore the less it happens. So it's kind of a gradual breaking down of that cycle, but for me it's taken years and getting older for it to happen.

And that's not what most younger people want to hear. They don't want to hear, they're going to have to wait 20 years for it to get better. So I often don't have an answer when someone says, you know, what can I do now, apart from speak to someone, consider medication, consider therapy. I am, you know, advising people to the best that I can because, you know, I'm not a specialist in anything related to this. I'm a layman who's just kind of giving my own life story, I guess. But yeah, I understand the desire.

for a quick fix, but I haven't found a quick fix. Yeah, well, even therapy, like, data shows it's going to be 50 sessions, maybe 100 sessions, to get, you know, 75, 85% response rate. So even with good therapy, I think it takes time. I think you've found a lot of the things that are helpful. and acceptance, not beating yourself up over things and seeing the positive and the strengths of being introverted. And also you've been successful, which is helpful.

Being successful in and of itself, you're good at something. And I think that has a positive sort of feedback. It's like you've had some behavioral deconditioning as you go on in life just because you have been successful. And despite maybe being fearful about work, it's like if you're doing good work, you know, and your boss is happy with you, then it kind of like is a behavioral deconditioning thing that happens over time. And the other thing you said was once it went to Zoom, that's when things, went, got really good, right? Yeah, I mean, personally, for me, it made a big difference. I've never enjoyed working in an open plan office,

and every office I've ever been in has been built around that model, you know, the open plan space, which is essentially built for extroverts. Yeah, totally. And I could never find a quiet place to go and do work. And, you know, day after day, I found it was, it raised my stress. I always felt like my character was going against its grain. being in a busy office. I was forcing it to do things

he didn't want to do every day. Whereas now it's completely different. And we're all working a lot of the time, if not the majority of the time, through our computer screens. And again, while that's great and it's made a big difference to me, I also don't want to start relying on that too much,

you know, because when I do have to go back to the office, I don't want it to become twice as hard to go back. So it's kind of like I recognize I still have muscles I need to flex and exercise so that I feel comfortable in social situations. I can't just disappear into one long Zoom meeting for the rest of my life. And I don't plan on doing that. And it's important to still get out and be social.

And I do. I make sure I try and keep that balance. But shifting to remote work and working from home, it did genuinely make quite a big difference for me. I suspect it has for other people who get anxious in the office. Yeah. Yeah. I think one thought that I have on exercise from the data is that it is predictable that if you consistently do it, it's going to help. It may not help as much as you want it to help. It's kind of like it's incremental improvement. You know, it's like, but if you continuously exercise and that cardio and stuff, like, I think that there's a payout that happens after a month or two months from the epigenetic changes. And you, you know, you're going to be able to exercise. And you, you know, your brain, you know, too. So if there's anyone listening who's like, needs that encouragement to

keep going, I think that's one of my thoughts on that. Do you still exercise? I do. I find that as I get older now, I've pushed the 40 mark. I'm tending to injure myself when I go out running. I'm more prone to injury. So that's slowing me down a bit sometimes. But I do. I try and keep an exercise regime. I've always been a runner. That's been my thing. So it's always running for me. And, you know, There's no better motivation because it's hard sometimes to go out and make yourself run if it's if it's cold and it's raining. But there's no better motivation than knowing it's going to help reduce one of your phobias. You know it's going to help you feel less anxious. And what, you know, what better reason is there to go out and run than that really?

So that's one reason why I've always kept it up. It has the added benefit obviously of keeping me fit, getting me outside. but it really helps to minimize something I've grappled with for years and years. And it's helped me along the way. I've been doing it for probably 20 plus years now, trying to run regularly. And it's helped me a lot. And I continue to be amazed at how much the body can affect the mind.

It's always had positive results for me, exercise, on my mood and on my, on my anxiety. So I'd like to think that's that's solid advice to give out as well. You should try some free water swimming especially in the cold. I think that that might be good for your

to have that variety plus then you get the cold treatment as well. Yeah, I might give that a try. We have people over here who swim over the English channel from England to France. that's a bit extreme but maybe i'll work my way to that in the future go go with a friend um yeah the other the other thought i had was on um your experience on the proxatine that medication

you tried i do think because it's very anticholinergic so imagine like benadry it's like taking an ssr i with a benedril benadry um you know has that strong anticholinergic effect and so And some people have genetic predispositions to not break down a medication in a normal way. So it could be four to ten times as high in you. Now there are other medications that don't involve those same P450 systems. So it's like for Paxil, peroxitine that you were on. You know, there are other options. and depersonalization is an awful, awful side effect.

If that's what you had, it sounds like that's what you had. But if someone's listening and they're like freaked out by that comment, I would want to put that out there as like, yeah, if that happens to you, definitely talk to your doctor. But if that happens to you as well, consider it might not take that whole class of medications off the table. It might say that there are other meds at lower doses in that class that could still be helpful. But with potential side effects.

So that's where I lean into therapy and exercise, unless the severity is at a level where someone is completely stuck. Yeah. I mean, I took what the doctor suggested, and afterwards I didn't try any other antidepressants. And I also think, looking back, was I even depressed? I don't know. You know, I came to the doctor talking about anxiety and blushing and I got given antidepressants. I'm not sure if it's the right thing.

If you look at the studies, I mean, antidepressants, SSRIs are helpful for anxiety. It takes six to eight weeks to really work. But just because they're called antidepressants doesn't mean that they aren't the medication of choice, so to speak. But, you know, in my episode with Cummings, I talk about how there is a placebo aspect to that as well. And so, you know, it's complicated. But, no, I'm not willing to give up on them altogether quite yet because they are. I see a lot of people get a lot of help from them. And, yeah, so my thought for you, if you were, so I used to run genetic tests on a lot of people and I don't anymore.

Just because I can kind of figure it out without running and they're expensive. But there's P450s like with Paxil, peroxatine. the um the there's a p450 called 2d6 which breaks down peroxatine and so if you don't have that in your you know your genes are set up in a way that you don't have 2d6 then you could have huge increases and it could cause lots of side effects right so just some nuance more for my audience than for and for you for thinking about like you know if you ever needed to go back to work and you ever needed to consider options so yeah any any other thoughts that are coming to your head as we sort of bring this to a close um one one thing i found heartwarming actually in your chat that you

had with dr cummings was towards the end when you both spoke about uh even therapists needing a beta blocker sometimes before they go and speak at a big event. You know, it's not too uncommon to take is it 10 milligrams or a small day's blocker? Yeah, 10 or 20. No, I think that, you know, the human experience is the human experience. I think there's a lot of people who have performance anxiety. a lot of people I know I invite on the podcast they're like I never would come on the podcast like are you kidding me I would just never do that so I think a lot of people where I have functioning have a lot of performance anxiety actually it's pretty it's pretty great that you were able to come on you know and talk about this and I'm wondering what was your anxiety level like coming

into it or on it yeah I mean I these days and especially since writing a book, you know, obviously that comes with talking about the book. I've had to do some radio interviews. I've done a few podcasts. I even went on TV when it first came out for like a 10-minute segment on a daytime talk show,

which I found very difficult, actually. I'm not going to lie, that was the hardest thing I've done for a while was to go in front of cameras for 10 minutes and talk about this, you know? but it felt like, you know, reaching a milestone, a big milestone, kind of conquering a mountain in a way, that's, I guess that would class as one of my number one fears is, you know, sitting in front of hot lights in a TV studio, not just talking about something, but talking about blushing

and anxiety. Oh, yeah. I found that very, very difficult, but got through it. And coming on a podcast like this, I, yeah, I think when I was. a lot younger. I probably would have been worrying days in advance, but I probably started getting a little bit anxious before coming on this show a few hours beforehand, but not to the point where I wouldn't, you know, give the podcast. So I feel like I'm in a very different place these days to where I used to be. And even coming out and talking about it has given me more reason

to expose myself in a way. You know, people talk about exposure therapy and gradually putting yourself in the situations that you fear over time. And I feel like even coming out about social anxiety and blushing has been in a way its own kind of exposure therapy for me because I have to keep talking about it. And it helps me to care less about it. And I've, I personally have found that opening up and talking to people and telling everyone that I have an issue with blushing

and that it worries me so much, it now makes me worry less because everyone knows about it. It's not a secret I'm trying to keep anymore. It's not something I'm trying to hide from. So I naturally worry less about it. So even just that honesty and speaking about it for me has made a big difference. So that's what I try and say to anyone else who blushes and hate the fact that they blush. If you can talk to someone about it, it's going to take some of the power away from that vicious cycle.

that makes you worry about blushing in front of other people, even if it's just to your doctor or to your a parent or a friend, you'll be amazed at the difference it makes once you speak to another person and it's no longer just a secret to carry on your own anymore, that's a big step forwards. But it's often the hardest one for people to take with social anxiety because as we touched on earlier,

that's the hardest thing is drawing attention, not just to yourself, but to your phobia. No one wants to do it, so they don't come forwards. And that's why I feel like there are more people out there with social anxiety than we realize, because they're too afraid to come out and put a spotlight on it. In the UK, I think the stat is around 10% of people are affected by social anxiety in varying degrees. But I personally, my hunch is that the number is higher because people don't step forwards to seek help, especially if they're men.

I'm going to add that thought at the end. because another stat I have, I can only speak for the UK again, but 75% of all suicides over here are men, and the biggest cause of death for men under 50 in the UK is suicide. Obviously, this is a much bigger conversation than just social anxiety, but social anxiety is one of the conditions that about 10% of the population suffer from, and they aren't coming forward to get the help needed. And I guess me talking about it on podcasts like this

is my way of trying to get other people to step forwards and acknowledge their social anxiety and try to speak to someone about it instead of just quietly living with it for the rest of their lives. If they can speak to someone, they really, really should. And that's an important first step on the road to things getting better. So you're advocating for therapy. Is that what you're saying?

Yeah, yeah. I am. Okay. There's no one more qualified to be speaking to than a therapist. No, I think you're going to have to do like a year of therapy and then you're going to have to come back on my podcast, okay, and talk about the experience of it. Yeah, sure.

I'd love to do that. And if you're one of my listeners and you're a therapist and you want to therapist and you want to therapist, Russell Norris, let me know. So maybe we'll find one for you, okay. Okay, sounds good to me. But that's what I wanted to close with, really. It was just some of those stats.

And one other stat in England that is worth noting is that of people who actually complete suicides, they have not seen anyone for it in the last six months. The majority of them have not seen anyone. So no doctor, no mental health professional. And so that stat was pretty significant to me as well. I think it's important to, yeah, it's like there's the anxiety keeps you from reaching out, right? The anxiety keeps you from getting help. But I think you have found kind of creative ways of deconditioning your fear by, yeah,

by getting on podcasts and putting yourself out there. it's like you're doing fear deconditioning every time you do that, which is good. It's part of my recommended treatment for you. It's just kidding. Personalized time. Just running on from what you just said about in the UK, people are not seeing anyone for the last, you know, six months prior to suicide.

I do think sadly in this country, it's quite easy to fall through the cracks. If you do go, well, first of all, not going for help is obviously the first crack that you slip down. But the second crack is once you do go for help, there is no help readily available unless you pay for it. And a lot of people aren't going to pay for it, especially in the current climate over here,

we have a cost of living crisis. A lot of people can't afford to turn on their heating, for example. So if it's a choice between staying warm and seeking therapy, I think everyone knows they're going to choose to turn the radiator on and stay at home. So it's not ideal. And I think getting to a therapist in the UK has a number of obstacles before you get there, which is why not everyone ends up where they need to be.

I hope that changes over time. But at the moment, it's not the easiest path to get to. Yeah. I remember taking the first step for me. It took months. I had that phone number on speed dial. I looked at it, I would call it and then hang up. You know, so I like, I have a personal experience of how hard it is.

It's like, sometimes, like, I think it's better to almost like get your ego out of it. Like, okay, I'm doing this professional development, you know. I'm going to be a better, more creative writer if I can get into therapy. It's like, that's true, right? We know that. But maybe that's that ego sort of stabilizer that allows you to get into initially. that's what it was for me. I was like, I'm going to be a better therapist someday

because I've done therapy. And then somewhere in seeing my third therapist after a couple years, I was like, oh, maybe there's a... Maybe I really needed this a lot more that I realized. You know, it's like, there was a whole lot there that I, like, completely had compartmentalized

for decades, right? And just been... Especially if you're high-functioning, like you seem like, I think, I think the higher the functioning, the person, the better you are at compartmentalizing. One of my attendees who was on one of my episodes talking about her depression, she was like suicidal and walking around and doing her job as a physician, full steam ahead, you know, 60 hours a week while she's like struggling with suicidal thoughts all day long.

during a so it's like people can people can when I say high functioning I mean like they're functioning at a high level while they're struggling at a very high level as well yeah

and I've heard that a lot you know like um for example a suicide happens and no one saw it coming because everything seemed fine and you know the person was performing so well at work in life um

I've definitely heard that that story before I think a lot of people, in terms of awareness of therapy, I think a lot of people might not be as aware as they should be about what's available to them. They're possibly also lacking that reasonable voice that urges them to go into therapy or to understand the benefits of therapy. I think if there was more awareness of what's available, people might be more willing to take that first step.

But at least, wait, you know, over here, you'd need to go and speak to your doctor. and then I guess the doctor would make you aware of the option of therapy and then you'd have to decide to go to that therapy. But I grew up at the tail end of the 90s going into the medium. The word therapy never came up. Yeah. If I wasn't in this field, it wouldn't have come up for me either, I think. And I think I would be in a very, well, you know,

I would struggle in different ways, but I would still be struggling. more than I would have otherwise. So, yeah, I think that the climate has changed, the stigma around it has changed. And I think books like yours decreases the stigma to talking about what's going on inside ourselves and getting, you know, and getting help, whether it be from our friends or family or, you know, just our creative journey. And I think that's great. So thank you for coming on.

Appreciate it. Thanks for having me. Yeah, have a great week. Well, hopefully, if you've heard this conversation and you are curious about Russell Norris, Russell, what's like the best way? Are you on Twitter, Instagram? Yeah, I think the best place to find me is on Twitter. So I'm on there as at Beyond the Blush.

That's my handle on Twitter. and I try and put relevant content out through that channel around anxiety and blushing. So that's probably the best place to connect. Okay. Great. I'll put that in mind to show notes. Great. Thanks for coming on. Yeah, thanks so much for talking through this with me. It's been great.