Dr. Phil - AM818
AM818
00:00:00 Dr. Phil
I think it's a great time out and I have confidence in Dr. Manion and West Wind Recovery and Anger Management 818 is a great addition to this. I think you're wise to involve them.

Coming Soon....

[James Kennedy and Anita Avedian sit down for a therapy session at Anita's office.]
00:00:14 Anita Avedian
Hi, James.

00:00:15 James Kennedy
How are you? Good to see you.

00:00:16 Anita Avedian
I'm good. How are you? You too, how is it going?

00:00:20 James Kennedy
Things are going good. Things are going good.

00:00:22 Anita Avedian

Yeah?

00:00:23 James Kennedy
I've been really trying my best to keep my temper at controlled levels, but we were meant to all go on a vacation as a group to Mexico, and I didn't exactly take the news well that I wasn't invited, and I kind of blew up on the hosts of the trip.

00:00:42 Anita Avedian
Okay.

00:00:44 Flashback
[A 5 second flashback from the show Vanderpump Rules is shown. James is arguing with Tom Shwartz about Tom's wife Katie Maloney. Tom Sandoval and Lisa Vanderpump are standing alongside them in a restaurant.]

00:00:48 James Kennedy
I was really angry, you know, and I just don't understand the mentality of people that are really angry and just don't do anything about it.

00:00:55 Anita Avedian
Yeah. How's the drinking?

00:00:59 James Kennedy
I've had, like, couple beers at my friend's birthday party once and stuff like that, but never gotten drunk.

00:01:06 Anita Avedian
Was it two beers at the most?

00:01:09 James Kennedy
Two beers at the most. I'm more comfortable with that than just, like, trying to go to a party and be, like, the sober guy there. I hate that. I don't know what made me have that first beer. I kind of didn't even think about it, like, to be more James Kennedy, be more charismatic, I guess.

00:01:23 Anita Avedian
Let me ask you this. You don't think you would have been able to be that person without it?

00:01:27 James Kennedy
You know, sometimes I don't. Lisa always tells me that I don't need that, but I got self doubts. I'm human. It's just like I'm just like, what's one beer?

00:01:36 Anita Avedian
You tell me. What is one beer? How can one beer harm you?

00:01:39 James Kennedy
I don't know. Am I going to go cold turkey sober? Not right now. I feel like I'm just thinking so much when I'm sober, but, like, after a couple beers or a couple shots, you put yourself in the moment. I'm 26. I can make decisions for myself.

00:01:56 Anita Avedian
Try to focus more on what you do for you than trying to prove it to others.

00:02:01 James Kennedy
So, like, not worry about what they think too much.

00:02:03 Anita Avedian
Yeah.

00:02:04 James Kennedy
That's impossible to me.

00:02:06 Anita Avedian
The more power you give to someone else with how they look at you, the worse you start to feel like, is what I did not good enough?

00:02:15 James Kennedy
Just wish I could go back in time and said different things in different moments, and life would have been very different right now.

[James Kennedy and Anita Avedian sit down for a therapy session at Anita's office.]

00:00:00 James Kennedy
Hi.

00:00:00 Receptionist
Hi. [The receptionist directs James to the correct office down the hall.]

00:00:04 James Kennedy
Hi. How are you?

00:00:05 Anita Avedian
I'm good. How are you?

00:00:07 James Kennedy
Good to see you.

00:00:07 Anita Avedian
How have you been?

00:00:09 James Kennedy
Good, how have you been ?

00:00:10 Anita Avedian
Good. Thank you.

00:00:11 James Kennedy
I'm going to therapy because, you know, Lisa thinks it's gonna be a good idea for me to start talking to somebody.

00:00:16 Lisa Vanderpump
[Flashback of James Kennedy speaking with Lisa Vanderpump.] You need to be in some kind of therapy.

00:00:20 James Kennedy
I promise you I will. [End of flashback.]

00:00:21 James Kennedy
[James is speaking in a confessional/interview segment of the show.] In order for me to get back into Sur, I need to show Lisa that I really want this to show her that I'm trying.

00:00:26 James Kennedy
[James is now talking directly with Anita]
I'm kind of dealing with something right now with my parents. My mom called me saying, like, oh, your dad owes me this much, and blah, blah, blah. Puts it on me pretty much. My dad tells me he is looking for a job, but there is still a responsibility, like the car insurance and [censored] like that. And it's not for much, 200 here or there, which I'm sending to my mum every other day at this point.

00:00:50 Anita Avedian
So you're really supporting her.

00:00:51 James Kennedy
Yeah.

00:00:52 James Kennedy
[James is speaking in a confessional/interview segment of the show.]
Back in the day, when my dad was happily managing with George Michael and before my mum stopped modeling, they were living a very lavish lifestyle. And as I got older, the nice cars were going, the nice houses were going. And then before you know it, they are fighting about money twenty four seven.

00:01:09 James Kennedy
[James is now talking directly with Anita]
You know, it's like, in my normal head, like, a family is, like two incomes. A mum and dad, that was my life. And now it's just completely flip turned opposite. Right. And I'm the guy, like, making the only income. It's just like, for God's sakes.

00:01:25 Anita Avedian
James, that's too much. James, the expectations I'm hearing from you, you've put it upon yourself. I'm the one who's making the money, so it's on me.

00:01:34 Speaker 6
Sounds so stupid. When they're happy or we're having a good day. I mean, it's just, like, so good. And it's just, like, it turns so quickly.

00:01:44 Anita Avedian
Your mom, she has a lot of resentment towards your dad.

00:01:48 James Kennedy
A [censored] ton. She's still very angry. Very angry.

00:01:51 Anita Avedian
Set the boundary. Mom, you can't take it out on me.

00:01:54 James Kennedy
I'll say that. I'll tell her. I'll try that,

00:01:56 Anita Avedian
You know.

00:01:58 James Kennedy
Right.

00:02:00 James Kennedy
[James is speaking in the show's confessional/interview segment.]
It really is frustrating when I am financially helping my mom and my dad, and then I still get caught in the crossfire between them. I still get treated like a [censored] child when I'm the man of the family right now, keeping this whole thing together.

How Anita Avedian Collaborates with Amen Clinics to Level Up Her Practice 00:00:00 Fallon
Hi, Anita. Hi, Lisa.

00:00:03 Anita
Hi, Fallon. Hi, Lisa.

00:00:07 Fallon
Hi nice to meet you, Anita. I've heard so much about you, not just from Lisa, but from also Katie and some of the other people on the West Coast, and it sounds like you're doing some amazing work.

00:00:17 Anita
Thank you. Thank you. It's nice to meet you too. And thank you for having me here.

00:00:21 Fallon
Absolutely. So if you wouldn't mind sharing a little bit more about yourself, your practice, and then kind of where you first learned of Dr. Amen and then kind of your journey to where you are today with your practice.

00:00:34 Anita
Sure. So my name is Anita Avedian. I'm a licensed marriage and family therapist, and I've been practicing for more than 22 years. So hopefully it doesn't give my age away, but does with my experience. And I am a Certified Anger Management Specialist for so what I do is both. I have a therapy practice, and I have an anger management practice. And I think you asked, what else was it, how we met and how I got into this. So at every Evolution of Psychotherapy, we try to go have a booth and participate with my agency. And the last evolution of psychotherapy, where we had a booth, we had Amen clinics right next to us. And so we chatted it up and stayed connected with Katie. Amazing woman. And so it was really nice to not only get to know her better. I mean, obviously we knew about Dr. Daniel Amen and have watched a lot about him, but I know during that conference, my staff and myself, we all attended a lot of his talks and was really impressed by the material he has and the records of how many brain

00:01:47 Anita
scans he has. I think he has the most in the world. And just one thing really stood out about what he had shared, which is how come, of all physicians, of all doctors, why is it that psychiatrist is the one doctor who does not look at the organ that they're treating? And I thought, wow, of course, Right

00:02:10 Anita
I mean, that would totally make sense.

00:02:12 Fallon
Right

00:02:12 Anita
And how we were still using old school system of diagnostics of symptoms and experiences rather than also taking a look at what's happening. But that was a moment where I thought, he's really onto something and just being able to share a lot of the brain specs that they talked about whether someone was under the influence of marijuana or what a brain. Looks like when it's dehydrated versus under the influence of or having been damaged through so much drug use or alcohol use and so forth. And so just having seen all that, I was extremely inspired to learn more and was impressed by him and the clinic and what everyone had to offer. And so I think after

00:02:58 Anita
that Evolution of Psychotherapy, I was at a state CAMP Conference exhibiting again, and there was Katie exhibiting for Amen clinics, and I noticed that they had the brain health coaching certification. I said, oh, let me look into this. And so I started the process, I purchased it, and again, extremely impressive and was very intrigued by the material shared. And so since then, I've collaborated care with Amen clinics, quite often trying to refer clients to your center because I have a lot of clients who prefer not to be on medication but want to know what they can do, just doing things with the natural course and taking supplements. And so Dr. J. Faber is someone I work closely with in terms of making a lot of referrals to him and Dr. Melissa Quinn, both very great psychiatrists. And so that's kind of my history with them. I did also because I'm on the board for the California Association of Anger Management Providers, I thought it would be an excellent idea to bring Dr. J. Faber on to

00:04:06 Anita
provide a continuing education program. And so the board was very excited about that. So we invited him on and it was a great hit. He talked about the raging brain, and I thought that was a great training and a workshop, again, wonderful material that he shared about what happens to the brain when one is angrier and or one is raging. So I think I may have shared more than you asked, but that's kind.

00:04:31 Fallon
No like, oh, that's exactly what we want to know. And I love that Dr. Faber has been working with you so closely. He really does have a wonderful heart for helping the community and just opening people's perspective again, looking at the organ that you're having problems with and then real simple solutions that don't necessarily have to go straight to medication. So it's really cool.

00:04:54 Anita
Right, Definitely.

00:04:55 Lisa
And thank you so much, Anita, for being such a trusted partner and for doing that for us. Dr. Faber and Dr. Quinn appreciate you so much and we all appreciate you so much at the LA Clinic. You have been such a great asset to us and have sent so many professionals our way, and we really appreciate it.

00:05:14 Anita
Thank you. I'm happy to do that. It's really a two way street. You guys have helped me, and I've had a wonderful place to be able to collaborate with and send my clients to. And I will say, usually they're seen pretty quickly. They have a full report that gets to be shared with me, of course, upon the client's request and just that collaborative work to be able to connect with the two psychiatrists as needed with what else is needed and making sure the clients are following through with the recommendations. So all that has been really helpful for me and loving sending people your way too for that support. Yeah.

00:05:54 Fallon
That's awesome. Is there any patient or type of patient that you see where the scans really showed why they were having anger issues and why it was a biomedical issue and how much that helps with their healing.

00:06:07 Anita
There's been so many that I referred. I think one did the hyperbaric chamber. I think a few have done that. A few has really helped a lot. Some didn't need as much of treatment. Some are still using actively. So there's not much that can be done right now until they sober up. So it just really depends on each person what they're going through. But for the clients who are ready to do the work, it's just been absolutely amazing. And hopefully the other clients who will do the work later, that the resource is there and they know that even if they prefer not to take medicine, that there's an option, there's an alternative that whether it's the supplements or the hyperbaric chamber hyperbaric am I saying that right?

00:06:57 Fallon
Yeah.

00:06:57 Lisa
Yeah

00:06:59 Anita
Okay. For some reason it sounded wrong for a split second, but the hyperbaric chamber treatments have had, like their reports back about it have been really positive and wonderful. So I think through this past year or so with all these referrals and the positive feedback, I

00:07:18 Anita
think it's really been helpful. And of course, the ones, as mentioned, they're still using, so it's not going to and they know it, so it's not going to really be as helpful until they make lifestyle changes.

00:07:31 Fallon
That's why I love talking to counselors about the work that we do, because you really have to at least be a little bit open to getting information and then doing the work, like you said. So I think that's really cool that you have that healthy perspective, that you do so much for them, but you can't do everything for them.

00:07:49 Anita
And I will say what I also love, I think I've worked more with Dr. J. Faber, but they both do this, the psychiatrist, is that there's this full lengthy report with the recommendations on there and even recommendations of what books they would recommend for the client to read exercises, brain exercises. So as a therapist, to have that type of feedback from a psychiatrist so specific really helps me be better able to integrate some of that work with the client. And really to have it more like there's just more resources where I can help motivate the client to do some of that reading or I personally can be involved with some of that treatment too. I will say that that actually plays a huge role of support for therapists, because if you're just working with a client alone, there's only so much we can do. But when we have that second opinion and the recommendation from a psychiatrist and you're seeing the brain specs and what's happening and gaining a better understanding of how the brain is

00:08:58 Anita
involved in what areas of the brain is impacted and what to do to support that. So much of that collaborative work, really, I think helps me as a therapist to do a better job with my clients and to know that I have that extra support with. Collaborating with a psychiatrist is really golden. I think that really helps us do the job we really need to be doing.

00:09:18 Fallon
I love that. Yeah.

00:09:21 Fallon
Dr. Faber has always been so wonderful and very exceptional at making really personalized book recommendations. When he was in Atlanta helping us open for the first two years, I got to work with him, so I'm used to reading his reports between three and ten a day and going over him. Loved how he recommended things. And honestly, half the books on my bookshelf are things that he's told the patient. And I'm like, I kind of resonate with some of this patient has going on. I might read this book and I just always have found his information really helpful.

00:09:55 Anita
Yeah, definitely. Me too. I love seeing those.

00:09:58 Lisa
Fallon and I were saying that we think you and Dr. Faber ought to do a video together too.

00:10:03 Anita
I'd be happy to.

00:10:05 Lisa
Yeah, we'll put you all in touch. I think it would be a very powerful video since you guys collaborate so well together.

00:10:13 Anita
I'd love to. I'd be happy to.

00:10:16 Fallon
He comes alive on camera too.

00:10:19 Anita
And he was really well received with our California Association of Anger Management Providers. So when he did the talk, it was wonderful. Too. Yeah, I love that.

00:10:29 Fallon
That's so cool.

00:10:30 Anita
Yeah.

00:10:33 Lisa
Going for you too. Are you doing a lot of your services telehealth now, too?

00:10:37 Anita
Anita I went all telehealth for the last few months just because of everything that was going on. And this past week, literally two days ago was my first time back in the office. I decided to just with very select clients to meet with them at my office. My office is large enough to allow us to sit 9ft apart, so I think that's pretty safe. I think, of course, with coming in with masks and so forth and making sure we're taking proper measures, but with select few clients, I'm meeting them in person. I did this week. I'll continue to doing that, but most of my practice is still telehealth, just to keep it safer for now, until things feel better. But yeah, so I'm available for both. I have a whole staff at Avedian Counseling Center. We have a staff, I think about 15 of us. So twelve of who are therapists. So most of them are still doing telehealth, and a select few of my therapists are comfortable with meeting with some clients in person. But yeah, I think across board a lot of therapists

00:11:48 Anita
are trying to focus on telehealth right now. It's not the same for me. I really prefer in person. The connection, reading every queue is very different in person than it is doing telehealth. I mean, it's a good alternative instead of putting everyone at risk. But I think I'm more of an in person therapist and thrive more doing that, seeing clients in person. But both work just my own preference. Yeah.

00:12:20 Lisa
Wonderful. Well, you want to tell us a little bit about your business and give your information too? So when we do, put it on our website that you get some feedback and some people reaching out to you.

00:12:33 Anita
I'd love to. So Avedian counseling center is our group practice. We are a number of therapists who focus and specialize in different areas. I personally work a lot with couples, a lot of relationship work. I work a lot with mood disorders, anxiety, and anger. And I'll talk about my anger management practice in a minute. And so we have a group of us, everyone has their own specialty. I also work a lot with addictions, and I think it's most of my addiction clients. I've been referring to Amen clinics, if I'm not mistaken.

00:13:08 Anita
Those are who I would normally work with. My personal clientele usually are either executives or in the entertainment industry or health industry. So a lot of physicians and surgeons. And then with our Anger Management 818 Center, we work a lot with court order clients and those who come in voluntarily. Normally we have over 20 groups a week in person, but now it's all on Zoom Telehealth. So we want to keep it safe for everybody. So we still do have those groups. And we also offer one on one anger management. I have authored my own program, so we have a book titled Anger Management Essentials. It's published on Amazon. We have a book for adults. The second edition is about to come out, and we also have a teens version, Anger Management Essentials for teens. And then the adult book has been translated into Armenian, Spanish, and Hebrew. And the teens book has been translated into Spanish. And we're currently finishing up the second edition. And we'll be focusing on the facilitator

00:14:11 Anita
manual. Hopefully that will be out in a few months as well. And then my other businesses, I offer a monthly anger management certification training for those interested in offering anger management services to help the community better deal with their aggressive regression. That's my other side gig that I do. So I do offer CES for those, which is what kind of got me into wanting to take the Brain Health Coaching certification, because I'm all about certification trainings and become specialized in areas and the websites. In case anyone's interested, for Avedian Counselingcenter, it is www.avediancounselingcenter.com. For angermanagement 818, it's angermanagement818.com. And then for the certification training, it's angermanagementessentials.com. So those are the three websites I have, and for anyone who would like to contact me directly, the number is 818-426-2495. I'd be happy to talk to anyone about any of our services.

00:15:21 Fallon
That's incredible. You're like superwoman.

00:15:24 Anita
Thank you. It's been 22 plus years, remember?

00:15:27 Fallon
I know. But still, 20 classes and a private practice, and you just wrote books.

00:15:35 Anita
Thank you.

00:15:35 Lisa
Also, how amazing she was.

00:15:37 Lisa
Fallon.

00:15:37 Lisa
And you're really plugged in with the Armenian community, right? Too.

00:15:41 Anita
Absolutely. Which I think I tried to speak to you about this. I'm a member and have been a member for some time of the Armenian American Medical Society and also of the Armenian American Mental Health Association. And so I know the Armenian American Medical Society, especially during these times, they were holding two to four webinars a week worldwide to help disseminate information about medical concerns, or we would have specialists come on to do talks to educate those who were interested in learning more about medical issues that were coming up, especially around COVID. And so they're a very supportive group, so I'm very involved with them.

00:16:25 Lisa
Love that. Now, what can we do to help? Is there anything that we could do to help give back to you? Because you've given us so much.

00:16:36 Anita
Yeah, I mean, this is amazing. What you guys are offering right now is this interview. And for me to be able to also share this with my contacts as well, literally, I'm not exaggerating, but just existing with the services you guys offer and to have that platform, for me to be able to be able to send my clients to as a resource so that they can get the proper support has been absolutely, very, very helpful. If you know of anyone who wants to be trained in anger management, feel free to send them my way. And absolutely anything with services around anger management or therapy, we offer those.

00:17:15 Fallon
Can you do that across state lines or virtually?

00:17:19 Anita
So the anger management certification training is actually international.

00:17:24 Fallon
What

00:17:28 Anita
I've done the training in Armenia. The last several trainings had people from Canada.

00:17:33 Fallon
Oh my gosh

00:17:33 Anita
Yeah, we have people from all over who attend because it's a NAMA approved program. So National Anger Management Association is really international, even though they're called national. But I'm an approved supervisor and trainer, and the program is approved. So anyone who goes to my training, they'll get the CE's for California and or if they're NASW nationwide, but whoever takes it can then be part of NAMA and receive their certification as well. So it's kind of a nice program in that way to be able to offer that. It is a three day training, and it is a live training, but on Zoom, and so it's kind of nice. Yeah.

00:18:15 Lisa
Awesome.

00:18:16 Fallon
Wow.

00:18:16 Lisa
I would love to do it.

00:18:18 Fallon
I know. Me too. Just sounds fun.

00:18:20 Anita
Yea

00:18:24 Lisa
Well, Fallon asks a great question at the end because I've watched all her videos. She's made some great videos with professionals. What's the question you ask Fallon?

00:18:33 Fallon
What else we can do to support you? I know that I'll be helping you with the course.

00:18:39 Anita
You got it. Thank you. You guys are really doing a lot of great for the community, and I really do appreciate that a lot.

00:18:50 Fallon
Of course. That's what we're here for.

00:18:52 Lisa
And is there anything else that you want the folks that are watching to know about you?

00:18:58 Anita
Let's see. I'm of Armenian descent. I can kind of speak Armenian. I can speak Armenian, but I cannot do therapy in Armenian. I think there's a difference between the two, but I am I'm passionate about cultures. I love traveling, mostly because I love to learn about the culture of the country. And in fact, right before COVID I was at the safari in Kenya and absolutely loved it.

00:19:25 Lisa
Wow.

00:19:26 Anita
Came back, I think it was early March, and I'm like, what's going on here? I was lucky. I was fortunate to have that experience. But I do love traveling and very proud of my background. Let's see. I started doing therapy at a younger age. I've been doing it for some time, and I think that's really it. I love working with couples, and anger management has been a big passion of mine, especially more recently, and I love to mentor. I think that's something to note. That the day I was allowed to have interns and supervise, I had interns. So I've always had several interns to supervise in my practice, and it's something that I just enjoy doing. It's giving back, mentoring and helping people know that there's someone there that can be supportive towards them. Just like you guys are asking me how you guys could be supportive. It feels good to give back. It feels good to guide. It feels good to be there for others as well, because I know a lot of people have been there for me.

00:20:30 Lisa
I bet you're an amazing mentor. I can imagine that you've helped a lot of people get into this industry and do wonderfully. You're a wonderful woman, and I feel so grateful that you spent some time with us today.

00:20:43 Anita
Thank you. Likewise. I appreciate this time spent and that you chose to highlight me as a therapist. I do appreciate that a lot.

00:20:52 Fallon
Easy choice to make.

00:20:54 Anita
Thank you.

00:20:56 Lisa
Thank you so much Anita.

00:20:58 Fallon
Thank you so much for everything that you're doing for the community and your clients, and I'm so grateful that we have this partnership together. And there's anything else that you need from me as a coach, let me know.

00:21:13 Anita
I will. Thank you so much, you guys.

00:21:15 Fallon
You're welcome.

00:21:16 Anita
Have a great one.

00:21:17 Fallon
You too. Bye

00:21:17 Anita
Bye

Interview with Dr. Sepilian - Anger Management
The interview is held at a recording studio, with Dr. Vicken Sepilian wearing black scrubs sitting on the left and Anita Avedian, LMFT, wearing a navy dress and sitting to the right. Both Dr. Sepilian and Ms. Avedian are sitting behind a gold-colored table with the television centered behind them.

00:00:02 Dr. Vicken Sepilian
Good day, ladies and gentlemen, and welcome to Stay Healthy TV. I'm Dr. Vicken Sepilian, your host. Today in the studio, we're going to focus on some mental health issues. We have a very special guest, Ms. Anita Avedian, who is a licensed marriage and family therapist. Anita practices in Southern California. She has multiple locations, including Sherman Oaks, Tarzana, Glendale, and Hollywood, and she's the director of Anger Management 818. Anita, welcome to our program.

00:00:35 Anita Avedian
Thank you so much, Dr. Sepilian.

00:00:37 Dr. Vicken Sepilian
So mental health is a very, very you know, important topic that I think oftentimes gets overlooked in health educational programs. And before we start and we're going to talk about anger management today, I want you to tell us a little bit about your field. I mean, you're a licensed marriage and family therapist. What is a licensed marriage and family therapist? What are some of the common things or common conditions that you work with? And tell us a little bit about your typical day for you.

00:01:15 Anita Avedian
So the licensed marriage and family therapist is a license which allows us to provide psychotherapy services, individually, to couples, to groups, to adults, to children. We can specialize in different areas. So most therapists have certain specialties they like to focus on. Several of my specialties include anger management, social anxiety, and couples therapy; so , relationship issues. With your other question around this was my typical day, what my typical day would look like?

00:01:47 Dr. Vicken Sepilian
I know one of your specialties is actually anger management. So I mean typically, what are the type of conditions or issues that you work with that you specifically specialize?

00:02:00 Anita Avedian
So with anger management, you're asking or just in general? In general. So my personal client load is going to be half my practice; I actually work individually with clients who are struggling with anger, some of those are court ordered, some of them are coming in. They're executives at the workplace, and they want to improve, realizing that they keep experiencing loss of work or setbacks, and they're getting into trouble. And the other half come in voluntarily. So some are ordered by the workplace or court, some are coming in voluntarily. And then in terms of my clinical practice and I say clinical, I try to separate the therapy and the anger management because in the clinical aspect, I'm going to work more providing therapy services to either couples or the individuals who come to me either have social anxiety or some form of anxiety, and I also work a lot with mood disorders such as bipolar.

00:02:56 Dr. Vicken Sepilian
Right. So that's great to know. And today, in this episode at least, we're going to focus on anger management. And this is one of your specialties. As we said, Anita is the director of Anger Management 818 throughout Southern California. So what is anger?

00:03:14 Anita Avedian
Anger is the feeling. It's the emotion that we experience. And I know a lot of people aren't realizing this, but when you experience anger, a lot of times there's another feeling that comes up right before it. So we call anger, we treat anger as a secondary emotion because a lot of times we're going to be hurt and it's difficult to stay in that hurt place. So instead, we quickly get into the anger place to give us some energy and control of doing something about it. And so anger is a secondary emotion according to one school of thought, which is a school of thought I prefer to belong to. And so it's something that it's a protective emotion. So you'll see this especially in parents, their child gets hurt and they go into the school and they start yelling at the school principal. So it's a protective emotion. Don't harm my kids, and of course, of ourselves. But it's a signal to us when we start getting upset. How wonderful is it that there's something that signals to us that, you know what, something's wrong with this situation.. trust my instincts, trust whatever comes up for you. And using that signal, we get to channel through and properly deal with situations that arise one on one or in a group setting at the workplace you get to communicate what's really bothering you.

00:04:35 Dr. Vicken Sepilian
Right. That's an important aspect. Now, what's the difference between anger, aggression and rage?

00:04:44 Anita Avedian
Great Question.

00:04:45 Dr. Vicken Sepilian
You know, like you said, anger is a secondary emotion. What's the difference between aggression and rage?

00:04:52 Anita Avedian
So what's interesting is our program, anger management, should really be called aggression management, because aggression is the actual behavior, it's the act. So if I'm yelling, if I'm hitting, that's the aggression. But if I'm just feeling the anger, I haven't done anything wrong. I have not violated anybody. I haven't broken any rules or laws. So it's okay to be angry, not to be scared of that, but what do I do with my anger? So some people, if they're not channeling it properly, like we just discussed, that signal, we communicate. That's a proper way of dealing with it. But for those people who have trouble with channeling it properly, sometimes can aggressively take it out on people. Either put someone down, the road rage we'll see, office rage we'll see, and so that's the aggression. Now, rage, rage is really this tough concept to really pull together. But the way I look at rage is someone is aggressive, but ten times as much, it's out of control. They cannot control it. I usually like to ask my clients, if the cop was there, if the policeman was there and you knew you were going to get arrested for what you were doing, would you have stopped? Now, the person who has control over that and they knew, they would have stopped. There's aggression, there's an intention. The person who's raging, there's no control. So those are the people who you see, they're fighting back with the police or there's still the physical fighting going on. It's too much has passed. So we're going to see people who rage in the prison system, mostly because they've really gone out of their way, they've violated. Right. And with people who rage, we see more shame associated because it's not what they want to be doing. They get triggered and they act out like really badly. And then there's a lot of regret and shame. Not always.

00:06:47 Dr. Vicken Sepilian
Eventually.

00:06:47 Anita Avedian
Usually, yeah. Versus someone who's aggressive, you're going to see the aggressive person, they have an intention to harm. They have the intention to "I'll show him, I'll show her." And they have a plan on what they're going to do. So it's not an out of control behavior. They know what they're doing. Makes sense. And there is a fine line. Some people say, well, at what point would you call that rage?

00:07:12 Dr. Vicken Sepilian
Right.

00:07:12 Anita Avedian
And there's not enough research on that necessarily, but in all honesty, our program should be called aggression management and then I'd let people know. I ask, do you know why it's called anger management? Because the anger is okay. They say, well, what are people going to Google search, anger management or aggression management? Leave it to anger management.

00:07:32 Dr. Vicken Sepilian
You should start to correct the terminology and eventually have the search engines catch up.

00:07:39 Anita Avedian
That's right.

00:07:40 Dr. Vicken Sepilian
Batter's intervention. How is that different from anger management? Or perhaps I should use the correct lingo and say aggression management.

00:07:49 Anita Avedian
Oh, there we go. So great question, because a lot of people confuse what domestic violence is, which would involve batters intervention versus why people come to anger management. And the best way of knowing this is if there's domestic violence, think of domestic as a home. The violence that occurs within the home, husband to wife, partner to partner, partner to child, that's all considered domestic violence. And there's a different dynamic that occurs there that's not necessarily occurring with someone who has issues around anger. For example, we're going to see people come home and there's like the cycle of violence that reoccurs at the home, but that same person, the perpetrator at the home, is not an angry person at the workplace necessarily. They're holding it together there. They're very charming to society and their surroundings. But at home, you see all the anger come out there. Vice versa, if I have people who are coming to our program for anger management, these are not people who have necessarily ever been aggressive at the home place it's more at road rage or office rage or bar fight or things of that nature and not necessarily what goes on at home. So your biggest difference with domestic violence or batter's intervention (that's the treatment for domestic violence) and the anger management, is that one is at the home, one is outside the home. Some people need both, that does happen, but typically in our anger management program we don't see as many perpetrators or people who need batter's intervention and you also have judges who sometimes will court order someone to take anger management instead of batter's intervention. I don't know if it's because they're not sure of the difference, but if I had to guess if someone's ordered to do batter's intervention, it's an automatic 52-week program. Versus anger management, since there's no legislation, they can have just one session or ten sessions and not the rest. But that's your main difference. There's a whole different thing.

00:09:50 Dr. Vicken Sepilian
So what are some with anger, with chronic anger, what are some potential deleterious health effects?

00:10:00 Anita Avedian
I love that you're asking this question, and especially for men. I think what helps to know is that, and research has reflected this, after two hours of having an explosion, angry/anger episode, let's call it, a person is eight and a half more times likely to have a heart attack and three times more likely to have a stroke. And when people get to hear this, and this is really more you'll see this occurring with chronic anger. What happens is if you think about it, when we're getting angry, yeah, our blood is boiling, we're getting heated, there's chemicals getting released to the body, but how does the body pick up that energy? It takes the energy from the glucose getting released. So it needs the sugar, it needs the fat, and eventually when it keeps using all that sugar and fat, it starts to clog up the arteries and there you have your risk increasing with heart attacks and strokes,

00:10:52 Dr. Vicken Sepilian
Right. Indeed. In fact, spasm vasospasm, where the blood vessels may go into a spasm, could occur as well and these are all things that could ultimately contribute to a heart attack or a stroke, which have a similar mechanism at the end of the day. When a person is angry, what are some things that you would recommend to sort of calm themselves down? What are some tips?

00:11:21 Anita Avedian
Great. I usually love focusing on preventive tips, what they can do. Most of the clients who come through our program, we really focus on prevention such as communicating, which we'll talk about soon. But clients say just tell me what to do Anita, I'm about to blow up just tell me what to do and so here are my go-to suggestions in these situations. First, get out of that situation. If you're in the same room and you can't leave the home, try to leave that room, at the very least to another room because if that person who is upsetting you is still in front of you you're still activated, the chemicals are still being released in your body and you need that break away from that person. My preferred element around this is go outside, take a walk, because not only are you leaving the situation, you're walking and we know with walking you're in nature. You have the right left movement, which relaxes us, you have the breathing, which is relaxing us, you have endorphins being released if you're walking fast enough to relax us. There's a lot more benefit to be able to do something like that, but I get it not everyone's in the type of neighborhood that they were going to want to that's easily accessible to do and so at the very least, to be able to excuse yourself to be in another room. The other suggestion we typically will have is count, I know it's been said so many times, but count one to ten. And the reason for this is, if you think about it, we have our right hemisphere which regulates the emotion so when you're angry you're predominantly in your right hemisphere, and when you're counting you're predominantly in your left hemisphere. So you're almost distracting the left hemisphere to not be as angry. When you stop counting, the anger is going to come back, but temporarily, you're kind of calming yourself down as much as you can. The breathing exercises, I know a lot of people will say, take some deep breaths. I'll caution people around how to do the breathing because we have certain breathing we can do that will activate the sympathetic nervous system. Which is not what we're wanting, because anger is going to be in that in that sympathetic nervous system. What we do want is how do you relax the body with breathing so that you're activating the parasympathetic nervous system? And that is, you count in, if we had to count, count in 4 seconds, hold 4 seconds and then exhale 4 seconds. Or inhale 4 seconds, exhale 8 seconds.

00:13:45 Dr. Vicken Sepilian
(Takes deep breathe)

00:13:46 Anita Avedian
Is it only counting for us? No. (Laughs)

00:13:53 Anita Avedian
This is how easily this works.

00:13:54 Dr. Vicken Sepilian
I wasn't angry to begin with.

00:13:58 Anita Avedian
But yeah, that's an important one to know.

00:14:00 Dr. Vicken Sepilian
We're going to take a short break. We'll be back with Anita Avedian, who's a licensed marriage and family therapist, stay with us. [There is a 30-second advertisement in Armenian for Dr. Vicken Sepilian's fertility practice.]

00:14:46 Dr. Vicken Sepilian
Welcome back ladies and gentlemen to Stay Healthy TV, our guest today is Anita Avedian and we're talking about anger management. Anita, again, welcome to the program.

00:14:50 Anita Avedian
Thank you.

00:14:51 Dr. Vicken Sepilian
And now, understanding and setting boundaries is an important aspect of anger management. What can you say about that?

00:15:01 Anita Avedian
Good. Great. So with boundaries, we have so many different types of boundaries. We have the physical boundaries, emotional boundaries. So if someone is in my physical space, of course I'm going to start getting a little aggravated. And the reason why we want to set boundaries is not only to let people know, here's my comfort level and at this point I'm not that comfortable anymore. So we're trying to communicate to people what's comfortable for me and what's not comfortable for me. What we find in people who typically get angry are they're pretty generous people. They give a lot. People ask them for favors, they'll say, sure, no problem. People ask for money, they'll say, sure, no problem, but what happens is now there's some sort of expectation built where they've been there for this other person. And so that moment where they're asking you for the favor and you say no and they feel taken advantage of at that point or they've been wronged at that point, they may turn and blow up at the person. And so what we try to teach clients is, first of all identify what are your boundaries? Physical, emotional? Meaning if I share something with you and I ask you, please don't share with anybody else, otherwise you're not going to know not to share. Perhaps my financial boundaries. If I lend you money, my expectation is you're going to pay back. Well, not everyone agrees with that. Some people just say if you lend money, that means you've given it. And so we're just trying to communicate on what the understanding is and where my comfort zone is. And so I really try to get my clients to start to see that it's okay to say no. It's okay to not give them, not give others whatever they're asking for, or give, but don't expect anything in return. Just make the assumption that they may not be there for you when you're needing them.

00:16:51 Dr. Vicken Sepilian
Right. And that's important, I guess, to communicate what your boundaries are because it removes any type of a preconceived notion or an expectation that if and when not met, then could be a source of anger.

00:17:06 Anita Avedian
And I think what we start seeing, culturally speaking, is you know in different cultures, boundaries mean different things. If you and I grew up in a culture where it was okay for me to take food off your plate without asking you because that was our closeness growing up as siblings, let's say, then now I'm dating someone who that's a huge no no, but I'm feeling close and I tried to grab it. So now we're going to be in a conflict, so that's where it's important. Culturally, we have very different upbringings and it's important to let people in and let people know, here's my comfort level and here's not and please respect this.

00:17:42 Dr. Vicken Sepilian
Of course. Now, drinking and drugs, of course, oftentimes do play a role. You know. How does that impact anger?

00:17:52 Anita Avedian
When someone first comes to our anger management program, during our intake, we try to rule out if their anger is existing primarily when they're drinking or using. What I notice is if someone is passive and they don't typically express themselves and what's bothering them that same person, when they're drinking, this is when they start either getting into a rage fit almost, or they get aggressive and start yelling and taking everything out on that person. It's because they haven't been able to share much. So under the influence, their inhibitions are lowered and they're more impulsive, so they're more likely to speak up and how they're speaking up isn't in the best way possible. So what we start seeing is, okay, drinking or the drug use has become a problem because they're holding things in and then when they're using, they're letting everything out at that point. If there's a drinking or drug use problem, I tell them, you can learn all the skills here you want, but unless you start treating the alcohol consumption or the drug use, this is not going to be helpful because it's a skill based program. And so we try to rule that out and we try to get them into the right programs necessary. If they're court order, there's not much we can do outside of making recommendations to the courts that this is what we're also recommending.

00:19:12 Dr. Vicken Sepilian
But if you do see that where issues of anger or the emotions of anger begin to manifest themselves, whether if it's expressing, or aggression, or rage, then I suppose in one sense it at least gives you some information that you can work with.

00:19:37 Anita Avedian
Absolutely, and a good point that you're bringing up. So if that same person is able to start asserting themselves during times when they're sober and they're not under the influence, that may actually help them during the times when, let's say now they are drunk because they've kind of let it out in a healthy way, but they're still using. We kind of hope that that helps if a person is deciding to continue to drink and we'll see that sometimes happening. The other relationship I see with this is with marijuana use. I've noticed that the day after, if someone is a chronic marijuana user and the day that they're not using, sometimes they're like the angriest people I've seen when they're not using. And I don't mean social using and the next day, that's not what I'm talking about. And so I realized that sometimes these drugs or alcohol is what they're relying on to calm themselves down. So when you remove that substance and a person doesn't have the skill set to really identify and know what to do differently to calm themselves down, you'll start seeing them get into rage fits or become aggressive.

00:20:41 Dr. Vicken Sepilian
More aggressive, yeah. Now, how are some ways we could improve our communication when we are angry? You touched on they don't have the skill set or whatever, have you, but what are some of these skill sets?

00:20:57 Anita Avedian
One of my favorite worksheets that we talk about is assertive communication skills. For one, there's so many words, trigger words and phrases we have. For example, if I start saying you did this, you did that, I'm attacking you. Of course you're going to attack me back and of course that's going to become a conflict and it's going to escalate. We also ask why questions. Why did you do this? Why did you do that? Well, that's accusatory. Whoever I'm asking is going to attack me back and blame me or the conflict gets worse. And so what we recommend is when you do something specific, when you don't put away the glasses after you're done with them, right. It's very specific. It's not an attack on your character, but it's talking about a specific behavior that you're doing and how that impacts me. So, you know, I can get into that I feel bothered or I feel alone in this in the household chores, right. So I'm expressing how it's affecting me when you don't do a specific piece rather than attack on the character, so it's so important not to get into attacking on the character. You're lazy. No. it's to try and stay away from the judging and such. And we have an entire skill set, I won't go through all the details, but I think it's just as important to be aware of what not to use. Such as words such as "always", "never" those absolute words that we just try to make our statement more powerful when really what it's doing, it's negating what we're trying to say and so just be very specific. I would like for you to do this more, I don't like it when you do this, rather than you always do that or you never do that. So those are the big tips when it comes to certain communication.

00:22:37 Dr. Vicken Sepilian
And that's very very important. Now let me ask you, if somebody, if or when somebody is seeking for an anger management provider, what should they know? What questions should they ask? If you can give us some tips on that.

00:22:51 Anita Avedian
Of course, currently there is no legislation actually in any state in the United States, so my focus is trying to get legislation in California. But right now, anybody can teach anger management. So you don't need to go through any course, you don't need a degree. So it's a little bit scary of what's going on out there. So what I would ask, highly recommend for you to ask, is one, are they a clinician? Even though they don't have to be a clinician to offer the services, but if they are a clinician, it's an added benefit if they're also certified in anger management. So they have the skill set of what they're teaching you to help improve what you're there to work towards. Some people go to a certified anger management counselor and they're not necessarily clinician and they're great. So kind of look for both if you can, but at least go to someone who is at least certified and hopefully has been doing it for some time so they have some experience under their belt.

00:23:47 Dr. Vicken Sepilian
Right, of course, experience is always a plus. Now, when it comes to programs, I mean, we did touch on batter's intervention where it's a 52 week program. What's the typical anger management program and at least what do you recommend?

00:24:07 Anita Avedian
26 weeks, six months is my recommendation, and I'll say why. It takes three months for people to normally have that behavioral change. So all of a sudden they're incorporating all the skills we've been teaching and now it's become more natural, and we say six months because that's the amount of time it takes normally after trying to practice all the skills, that you're actually going to maintain it. Otherwise, if someone comes through a three-month program, there's a great chance a year later they're court ordered again or they're coming back again. And so we see that six month as a magic number, 1 hour once a week not to rush through it, because you need time to practice those skills. Is such a great number in terms of the term to incorporate the skill set and to learn. We also notice in that second or third month, a lot of times, clients will come to us and will say, "you know what, Anita? I was about to do dot dot dot, but I didn't I stopped myself." And really, part of this program is to have that cognitive behavioral approach to get people to have their prefrontal cortex to connect to the amygdala more quickly to stop themselves from otherwise acting out as to why they even got to the program.

00:25:17 Dr. Vicken Sepilian
Right, but that's great tips. Six month program. It takes about three months for us to even begin to change our habits and any other three months to maintain. Unfortunately, we're out of time. We have to close the program. But I also wanted to mention that Anita is a published author, has a book on anger management. If we can just show that, fundamentals.

00:25:45 Anita Avedian
This one's the teens book, I co-authored with Ingrid Caswell. This is the adult version and then we also have it translated in Armenian and it's called Anger Management Essentials. It's also been translated and published in Spanish, and the Hebrew version will be out in a few weeks from now.

00:26:03 Dr. Vicken Sepilian
Great. Thank you very much, Anita, and we'll have you back on our program very soon.

00:26:07 Anita Avedian
Thank you.

00:26:08 Dr. Vicken Sepilian
Thank you very much, ladies and gentlemen. We'll see you on the next episode. Until then, stay healthy.

Interview with Dr. Sepilian - Social Anxiety
The interview is held at a recording studio, with Dr. Vicken Sepilian wearing black scrubs sitting on the left and Anita Avedian, LMFT, wearing a navy dress and sitting to the right. Both Dr. Sepilian and Ms. Avedian are sitting behind a gold-colored table with the television centered behind them.

00:00:34 Dr. Vicken Sepilian
[There is a 34-second advertisement in Armenian for Dr. Vicken Sepilian's fertility practice.] Welcome to Stay Healthy TV. I'm Dr. Vicken Sepilian, your host. Today we have in the studio Ms. Anita Avedian, who's a licensed marriage and family therapist. Anita, welcome to our program.

00:00:48 Anita Avedian
Thank you very much, Dr. Sepilian.

00:00:50 Dr. Vicken Sepilian
So Anita specializes in anger management, and one of her specialties as well is social anxiety and disorders related to that. Previously on this program, we've had Anita talk about anger management. She does practice here in Southern California, and is the director of Anger Management 818, with multiple locations throughout the area. But today we wanted to focus on social anxiety. Now, what is social anxiety?

00:01:23 Anita Avedian
Social anxiety disorder is when a person really fears going into social situations. They worry about someone judging them, perhaps judging them that they're stupid or not good enough or what they're saying is very boring. So there's a lot of fears around social situations. It can involve performance. It can involve eating in front of people. Are they judging with how I'm eating or how I'm chewing? So there's a lot of fear of judgment or being humiliated or embarrassing themselves. And so it keeps them, even though they're interested in making friends and having a support system, so they definitely have the interest in going out there, but they have so much fear around what can go wrong in those interactions. And therefore it keeps them from making friends. It keeps them from a lot of things, which we'll get into. But it's, it's a pretty serious you know, it's a pretty serious disorder when it comes to support systems and having people around you.

00:02:22 Dr. Vicken Sepilian
Now, let me ask you, how prevalent is it?

00:02:26 Anita Avedian
Currently in the United States statistically it's about 8%, or sorry, 6.8% of people right now in this year have it. But in someone's lifespan, there's a 13% chance people will have it. It's the third-highest mental health disorder. I once read fourth, but most of the statistics read as the third-highest. So the leading causes of mental health are depression and the alcohol addiction. But this is your third highest prevalent in the United States. It's a pretty serious and common.

00:03:04 Dr. Vicken Sepilian
And is there any differences in the genders?

00:03:09 Anita Avedian
So we see that there are twice as many women as men who experience social anxiety, but there are actually twice as many men than women who actually seek treatment. And it makes sense because you have men who are wanting to be promoted at the workplace and they're realizing why they're not able to speak up. And so it's impacting them getting promoted at the workplace. It's impacting them asking for women out or men out. So it keeps them from dating and speaking up, and so they realize how badly it's impacting them. And so in my social anxiety group that I hold weekly, we have mostly men, even though there's twice as many women who suffer from it.

00:03:52 Dr. Vicken Sepilian
That's true and those are great points that you brought up. A man may be less assertive in asking for a promotion they deserve or a raise. Or dating, asking somebody a woman out on a date or a man out on a date. So essentially, these are ways that social anxiety can truly interfere in one's ability to grow as a person,

00:04:20 Anita Avedian
Right.

00:04:21 Dr. Vicken Sepilian
Yeah. So what's the difference between someone being shy versus them having social anxiety?

00:04:30 Anita Avedian
I think it's so interesting where a lot of people end up confusing or mixing shyness with social anxiety. Shyness is a personality trait. People could be shy, but not have social anxiety. Versus social anxiety is an actual disorder, it's keeping someone from going to that social function, from making friends, from interacting. But someone who's shy can go to those parties they're just a little bit shy. It doesn't keep them from doing those things, and so the main thing to know is if you take all the shy people, only 12% of those people will say, yeah, I suffer with social anxiety. So you see that some people who have shyness also have social anxiety, and then you see some people with social anxiety who don't have shyness. So I've seen both where you see shyness, no social anxiety, social anxiety, no shyness. And then those who have both, who suffer with both. But really, one's a personality trait and the other is an actual disorder that we can treat and work with tourists.

00:05:30 Dr. Vicken Sepilian
Now, in terms of, you know, the actual symptoms, when does it typically present?

00:05:36 Anita Avedian
The median is at age 13. So for 75% of the people, it can start around age eight, all the way to 15. That's 75% of your population. Some children will experience it when they're younger and some in the adulthood. What's interesting is I end up seeing the clients who come to me, for example, for this social anxiety group I have during the intakes, I realize either they stopped drinking, they stopped using, and then all of a sudden they realize, wait a minute, I don't know how to talk to people. I'm actually very uncomfortable. And there's all this fear of judgment occurring. And that's when they realize they have social anxiety. So they've had it this whole time, but they didn't know it because they're at these parties drinking constantly, not realizing.

00:06:22 Dr. Vicken Sepilian
It got unmasked somehow.

00:06:24 Anita Avedian
Exactly. There's also ones where just during those college years, they went from high school with having a group of friends, and now they're in college. Well, wait a minute, they have to make new friends now. And that's when they start realizing, how do you approach someone? How do you make new friends? And that fear starts to kick in about the being judged, the rejection. There's a huge fear of rejection. What happens then? And so I see a lot of people coming to treatment in their early 20s, sometimes in their forty s and fifty s. And I've noticed the people who come in later in life is because they still haven't dated or they're struggling with the dating life and because they stopped using and all of a sudden they're realizing..

00:07:05 Dr. Vicken Sepilian
It's unmasked.

00:07:05 Anita Avedian
..it's unmasked right.

00:07:07 Dr. Vicken Sepilian
Now, is there a genetic component to this?

00:07:10 Anita Avedian
There definitely is. So there is a genetic component in that, I think, one third of the underlying causes of social anxiety is genetic. They haven't found the actual chromosome, as they have in panic disorder and agoraphobia. But that's to be coming, I would imagine, because they have very similar symptoms. But they have found that those who have a first degree family member, mom, dad, sibling, who also has social anxiety, that person is two or three times more likely to have social anxiety. So they're more prone to it. It's in the genes, but they haven't found the details yet. But that seemed to be coming.

00:07:47 Dr. Vicken Sepilian
That contributes to it. Now, in terms of other than genetics. Gender, we talked about the onset of age and the various clustering within age groups. What else contributes to social anxiety?

00:08:03 Anita Avedian
So there's several different things and we'll try to cover the different elements. So the family history we kind of talked about, part of it has to do with the genes. The other component is that they have negative experiences. So think about all the bullying that goes on, that child who gets bullied or teased or humiliated and there are people laughing at them. That's going to contribute to the social anxiety. Even if there's a lot of moving around as a child. So for those people who move schools and move cities and locations and the family kind of has to move around, let's say. That person is more prone to having social anxiety because they're constantly having to get into a new circle, loss of friends, making new friends, and it's not always easy to do that. And at some point, a person starts to feel more uncomfortable and trying to figure out how to get through in that scenario. So those are the negative experiences. We also want to look at temperament. So we see that children, when the temperament is, for example, shy or timid or withdrawn, especially when they're meeting new people, there's new situations. That person may be more prone to having social anxiety later in life. New social or work demands. All of a sudden you're hired at this workplace and this company is saying, Dr. Sepilian, we would like for you to make all these presentations. Now, you would have no problem with this at all. We know this. But there are a lot of people who they may not show up to work the next day because they're not going to love to do that, and so that becomes a big threat. So that same person didn't realize they ever had social anxiety, and they may have never had it, but all of a sudden there's these requests. We want you to go and speak in front of all these people or sell this thing to these people, and they start to realize, oh, boy, this is getting really uncomfortable. And so much so, they can't sleep. The anxiety is so strong, they can't function properly, and they want to avoid going back to work and eventually lose their work.

00:10:04 Dr. Vicken Sepilian
Right.

00:10:05 Anita Avedian
There's one more that I do want to cover, and that is for those who have a health condition that draws people's attention to them. So for someone who, let's say, may have skin burns on their face, something that's very visible of facial disfiguration of the face, someone who stutters, where they get embarrassed of, are people judging me? Can they understand what I'm saying? So it can be someone who didn't have social anxiety, but all of a sudden..

00:10:34 Dr. Vicken Sepilian
Acquires it.

00:10:35 Anita Avedian
Yeah, they can acquire that because of that. And so we want to just notice if there's anything around that that may be happening. Because, of course, there's also the fear of being judged. And even when we talk about the public speaking, the fear of people noticing that they're anxious. A person who blushes easily, not everyone blushes, but the person who blushes easily, that's a huge fear for them because it's an obvious everyone's going to know, right? And so the more obvious that becomes, the scary that feels for them.

00:11:08 Dr. Vicken Sepilian
I think I'm blushing [Dr. Vicken Sepilian and Anita Avedian laugh briefly] ..and environment as well.

00:11:16 Anita Avedian
Yeah. So environment. Thank you for that. Environment also definitely plays a role for some, we say it's a learned behavior. So if we have a parent who has social anxiety or someone is modeling like the peers are modeling for them, that there's social anxiety, they're scared to approach people. All of a sudden you start thinking, oh, maybe it's scary to approach people. I shouldn't approach them. And so you kind of start learning that same behavior from peers that otherwise you wouldn't have had. And so some part of it can be learned among the Armenian [Anita Avedian says a word in Armenian that translates to shameful]. It's shameful, it's shameful. Don't do this, don't do that. And eventually it's, oh, wait, people are going to think, this is embarrassing. This is shameful, I shouldn't do this.

00:11:56 Dr. Vicken Sepilian
So essentially, that was something that was imprinted on that individual by their surroundings, whether it be friends or family members or whatever have you.

00:12:08 Anita Avedian
And I think there's also one more point around this is sometimes when we see parents be controlling over their children or being overly protective. We start seeing that those same kids who've had those overly protective parents, end up developing social anxiety because the parents have kind of done the work for them.

00:12:26 Dr. Vicken Sepilian
Right.

00:12:26 Anita Avedian
Think about it again. Something happens at school, someone teased them. The parent comes in, does all the work. Well, now, this child hasn't learned.

00:12:34 Dr. Vicken Sepilian
Didn't learn the skills that it's necessary for them to actually do that. That's a great point. Ladies and gentlemen, please stay with us. We're going to take a short break, and we'll be back with Anita Avedian.

00:12:49 Advertisement in Armenian
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00:13:16 Dr. Vicken Sepilian
Welcome back to our program, Stay Healthy TV. I'm Dr. Sepilian, your host. Today with us is Anita Avedian, who's a licensed marriage and family therapist. Anita, welcome back. We are talking about social anxiety, and we had talked about some of the causes. Some of it can be genetic, environmental, and whatever have you. Can this disorder go away by itself or does it go away by itself?

00:13:52 Anita Avedian
It's rare, it can but it's really rare. Because when you say, does it go away by itself.. if a person is exposing themselves to situations, chances are they'll probably work through it pretty well. Most of what we see is when someone has social anxiety, they start avoiding they'll avoid the situation to not experience the anxiety. And then the more you avoid it, the more fearful you become of it and the less you're able to go and seek support or have a support system. And so we highly recommend to get some form of help. There's self-help programs as well. There's one on one therapy. My preferred approach is a group therapy because how much better can that be where you have a group of people, you can work through, its exposure therapy, where you can work through some of your discomfort and share in common with other people what you are concerned with and your fears. So you don't feel alone in this disorder that so many people experience.

00:14:49 Dr. Vicken Sepilian
Right, now if it goes untreated, what are some of the consequences?

00:14:56 Anita Avedian
What we start seeing? I mean, at worst at worst, people do attempt or commit suicide, and that's when it gets pretty bad because they feel hopeless and helpless, that they're not going to get a job or they're not ever going to be able to date. But generally we'll start seeing that there's low self esteem. They may have trouble being assertive, so they're not approaching people, or they're not asking for a promotion at the workplace. There's a lot of negative self-talk which eventually can then get into not just anxiety, but then depression. Hypersensitivity to criticism. They personalize what is being said to them because it's so difficult to hear something negative about them. Poor social skills. Isolation in difficult social relationships. And a main one for students to know is a lot of times we'll see the grades. They suffer in grades because even going to school, they're too scared to ask a question to the professor or to the teacher. And then they're not really understanding what the school lesson plan is, and we see that they start suffering with the grades because of it. Or projects that involve a group of people, team projects or public speaking projects, forget it. They'll probably avoid that. And so we start seeing them suffer in those areas.

00:16:18 Dr. Vicken Sepilian
I see. Now, we touched on this earlier, but when do you see people come and seek help?

00:16:26 Anita Avedian
So usually when a person just transitions into college, or they leave college and now there's no place for them to start making friends unless they really put themselves out there. So a lot of times I'll see people around ages 18 to 23, 24, seeking for help. So most of my clients who seek for my help are in that age range. Or someone who's been using and all of a sudden they stopped using and they realize they're having difficulty in social situations. So they start realizing, I'm not comfortable talking to people. I don't even know what to talk about. What do you talk about where it's not going to be boring? Anita, I don't know what I can share that would be even of interest. And so there's a lot of that self-doubt. So what we start seeing is people realizing they're at home every day watching TV after work. When they're at the workplace, by the way, and there's a meeting, they'll do their best to show up exactly on time because if they come a few minutes early, that means they have to talk to people. If they come a few minutes late, that means everyone's going to stare at them. Right. So the people who show up, doesn't mean you have social anxiety because you show up on time, but the people who show up on time are usually trying to work around not being judged some way or another.

00:17:45 Dr. Vicken Sepilian
Right. Well, those are such cues that probably most people wouldn't recognize, but now I'll keep that in mind. Now, what's been found to be effective in the treatment of social anxiety? I know we touched on this, and I happen to know that you're the only group therapist where you do treatment for this in a group setting, in all of Los Angeles.

00:18:11 Anita Avedian
Yeah, in Los Angeles area. I have been facilitating social anxiety groups for over twelve years. I finally found a person out in Orange County who does a group out there and her and I met up, I forget, somewhere in the midpoint to kind of share notes on what works, what doesn't work, to improve. Because usually this type of specialty, yeah, people may work with them individually, but here's the oxymoron. How do you start a group for social anxiety for people who are too anxious to be around people?

00:18:41 Dr. Vicken Sepilian
Right.

00:18:41 Anita Avedian
It is the most challenging group to start, I will tell you. So I've noticed on the average, from when a person seeks out for help, which is usually ten years after experiencing symptoms, they'll seek out for help, on the average, that's 36% of people. They seek out for help, four months later they'll step foot into that office. And sometimes I've had it where we had to meet someone at the lobby to escort them up into the room because that was such a scary concept. So in Los Angeles, my preferred treatment is a group setup where you have the exposure in a comfortable and safe environment with a therapist who understands social anxiety and who can help through the skill building around it. And it's a place where you can practice through some of those learned skills. Now, one on one therapy will help as well, but I think that exposure to a group is what takes it to a next level. I think sometimes at UCLA, I've seen a group randomly kind of start and end, but really I seek for therapists who provide this service because it's so unserved, and I could see why because it is very tough to start a group. I'm fortunate enough because I've been doing it for some time where people make the referrals, but it's a very tough group to get started and to maintain.

00:20:02 Dr. Vicken Sepilian
Of course, I can just imagine.

00:20:05 Anita Avedian
You know, people are too scared to be around people.

00:20:07 Dr. Vicken Sepilian
Right.

00:20:08 Anita Avedian
But it's a beautiful thing to be in a group setting to provide cognitive behavioral skills. And the behavioral part, what I do once a month is we go out to a mall or an outing where there's a lot of people and I actually have clients try out, approaching people to try actually there's a thing called rejection therapy to ask for something that they know most likely they're going to get rejected for. And then we process what that was like for them, for them to realize, not a big deal, it's not as bad as I thought it was.

00:20:37 Dr. Vicken Sepilian
That's right.
00:20:37 Anita Avedian
And when they start realizing that, they start taking more steps and more steps. So I've seen clients join Toastmasters, which is very scary to do for somewhat social anxiety. And it's been great.

00:20:47 Dr. Vicken Sepilian
So cognitive behavioral therapy that's when you try to explain or have somebody understand the root of the process and then have them act on it.

00:20:58 Anita Avedian
The cognitive part is going to be, for example, if my thought is, they're going to laugh at me or I'm going to be boring, they're going to think I'm boring. So now the countering thought may be something like, wait a minute, I have things of interest to say. If they are bored of me, so what? Right? They'll just walk away. So it's dealing with the rejection. So it's what we tell ourselves to help us through that process, to push us to be able to start taking those risks. Because without taking those risks, you're still kind of stuck in that same outcome of staying at home and not really having the support system that we need. We need connection, we need to have friends, we need to have someone to talk to.

00:21:38 Dr. Vicken Sepilian
And there are medicines that can be used to treat this.

00:21:42 Anita Avedian
Yeah, because there's neurotransmitters that play a big role. So what happens with people with anxiety, especially with social anxiety, is that the amygdala is just it's hypersensitive, it's overly acting. So what you and I may perceive as it's okay, it's just a social situation and it's okay if someone doesn't like what I said; for a person with social anxiety, that is the biggest I can't handle if someone says they don't like something or look at me a certain way that they may not like it. And so they don't think as rationally, it's not proportionate to what the real, it's not really dangerous for us but for them it's a real danger. So that's where we start seeing the amygdala acting in ways that it's not going to be that way in other people. But so the neurotransmitters, the four neurotransmitters that play a role, which is why we look into medicine as an option, is Norepinephrine, Dopamine, Serotonin, and GABA. So typically when one is treated with, sometimes they'll prescribe Paxill or.. I don't want to talk about medicine, because I'm not a psychiatrist, but there's medicine that's provided to help out with those situations. And I think when a client is taking that medicine and they're trying out different behavioral things, then they start realizing this isn't as dangerous as I thought it was. So when they get off the medication, they're able to function.

00:23:06 Dr. Vicken Sepilian
To cope better and ultimately the result being better. Yeah. This is a very important thing. I'm glad that we had the opportunity to talk. As Anita said, social anxiety disorders is the third most prevalent mental health disorder after depression and alcoholism, affecting approximately 13% of the population at some point in their life.

00:23:33 Anita Avedian
Exactly.

00:23:33 Dr. Vicken Sepilian
And more prevalent in women by two to one, you said. However, men seek treatment at a rate of two to one, probably due to professional reasons. There are number of contributing factors. Part of it is genetic, environmental, and our surroundings that may impact this. Most of the time it does not go away. So some sort of an intervention is necessary. And those interventions, as we talked about, could be seeing a therapist, you're being an expert in the field, an authority in the field, you recommend group therapy.

00:24:15 Anita Avedian
My recommendation, but I will say this because I know it's a big deal. A lot of people are too scared to step out of their home. So Dr. Thomas Richards and I'll show his book, he actually has an entire I think it's an online group. So for those who are too scared to come in person with someone, he has a wonderful program online. He's created a lot of peer groups internationally for it's not necessarily therapy facilitated, therapist facilitated, but peer to peer. And there's an entire online program with videos and books. So I'm not trying to sell him, but this is something that I have found. A lot of my clients tell me that it is helpful.

00:24:56 Dr. Vicken Sepilian
That they have that is effective and that could be a self help approach as well. And the point being here is that regardless of the approach, that something should be done because in and by itself, it does not resolve and can lead to some pretty significant consequences, including suicide or suicide attempts.

00:25:18 Dr. Vicken Sepilian
Anita, thank you very much for coming. Anita Avedian, again, director of Anger Management Eight One Eight practices licensed marriage and family therapists and practices throughout California. You can look her up online. And again, thank you very much for being on our show.

00:25:38 Anita Avedian
Thank you for having me here Dr. Sepilian

00:25:39 Dr. Vicken Sepilian
We look forward for future episodes. All right, thank you very much. We'll see you soon. Until we see you, stay healthy.