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Posted on Mon, Apr 22, 2013 : 12:27 p.m.

Ann Arbor psychoanalysts pilot new program for treating social anxiety

By Amy Biolchini

Andrew Kukes graduated from his high school at the top of his class with an acceptance letter to Princeton University in his pocket.

Smart and athletic, Andrew went on to earn his degree from Columbia University. Upon leaving college, Andrew suddenly felt lost, said his father, Jeff Kukes, of Boca Raton, Fla

“It was almost as if he had lost his job,” Jeff Kukes said. “Once he graduated, he really didn’t know what to do with himself.”


Andrew Kukes in college.

Courtesy photo

The depression and sadness that ensued paralyzed Andrew. He eventually was diagnosed with social anxiety, but it was difficult for him to find treatment that helped, his father said.

Andrew moved to Santa Monica, Cal. with his brother. One month before his parents were set to visit in the summer of 2009, Andrew killed himself at the age of 30 years old.

In their son’s memory, the family started the Andrew Kukes Foundation for Social Anxiety.

The foundation is now partnering with the Michigan Psychoanalytic Institute -- which has offices in Ann Arbor and Farmington Hills -- to pilot a program to help people overcome their social anxiety.

“The mission is to really spread the word about social anxiety,” said Jeff. “To educate people that are sufferers, and people in the mental health community.”

The pilot program has been initiated by the Michigan Psychoanalytic Institute at the request of the Andrew Kukes Foundation.

Social anxiety is often a quite normal experience for many people, as it’s an individual’s response through physical sensations like blushing and sweating and anxious thoughts to interacting with other people or large groups.

Social anxiety becomes a problem when an individual is so paralyzed that it causes them to avoid social situations.

The program team consists of 15 clinical psychoanalysts. Dr. Dushyant Trivedi is the clinical director and Dr. Marvin Margolis is the project director.

“We felt we were a logical choice to provide care for these kinds of patients,” said Trivedi. “These patients are complex cases.”

The model of psychoanalysis now in which patients are analyzed for 20 to 30 minutes, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders and then prescribed a medication does not work for everyone, Trivedi said.

“It’s a pretty shoddy way of doing it,” Trivedi said. “When you label something as one particular disorder, it limits things -- and people think there’s a formula. We want to go beyond the formula.”

The program pairs one-on-one intensive psychotherapy to help individuals deal with the social anxiety in behavioral terms with medications in some cases, Trivedi said. Treatment will last for a period of several years.


Dr. Dushyant Trivedi

Courtesy of MPI

Trivedi said the initial program will treat 10 individuals and then evaluate its success. About three people have been accepted so far. Eventually, Trivedi said the intent is to train and consult physicians to be able to troubleshoot individuals with complex cases that include social anxiety symptoms.

“Most of our patients were in multiple treatments that failed them: A lot of these patients, because they are so paralyzed, they don’t have jobs,” Trivedi said. “Many of the people we run into are quite educated individuals: One is a musician, one is a college professor; they are quite otherwise accomplished people.”

Jeff Kukes described social anxiety as the feeling of fear that you get when you don’t want to stand up in front of an audience or large group of people - multiplied by 100.

“It’s a performance-based anxiety,” Jeff Kukes said. “When it gets to the point that it’s impacting your life; when you won’t take a certain job because you know that you’re going to interact with people, then it becomes a problem.”

Patients chronically paralyzed by social situations require more frequent appointments, more than one interventionist, longer treatment and more integrated care plans, Trivedi said.

“It can eat you up,” Jeff Kukes said. “Left untreated it keeps getting worse and worse … it takes about 10 years for people to seek help.”

Jeff Kukes said the biggest indicator of his son’s social anxiety that he retrospectively realizes was how shy Andy was.

“The classic response is that they’ll outgrow it,” Jeff Kukes said. “Shyness doesn’t create the concern that it should.”

Social anxiety is often the root of many other mental health problems, Trivedi said, and can stem from deeper issues including abuse, neglect and bullying.

“It’s a question of how to alleviate the damage that social anxiety has done to rehabilitate them,” Trivedi said. “It would be a process so it would last over a longer time, so these changes stick and social anxiety becomes a symptom that they have worked around.”

The partnership between the Andrew Kukes Foundation and Michigan Psychoanalytic Institute is a long-term project, said Lori Blumenstein-Bott, executive director of the foundation.

The Andrew Kukes Foundation is contributing about $27,000 in the first year of the partnership for the project.

“It’s mainly focused on the funding of the team approach to working in complicated cases,” Blumenstein-Bott said.

Blumenstein-Bott estimated the partnership would likely last about five years, after which they’ll analyze the data to develop best-practice guidelines to treating individuals with social anxiety.

Those interested in the Kukes Foundation project treating social anxiety patients should call the Michigan Psychoanalytic Institute at (248) 539-2223.

Amy Biolchini covers Washtenaw County, health and environmental issues for Reach her at (734) 623-2552, or on Twitter.


Steve Light

Wed, May 1, 2013 : 10:17 p.m.

Thank you for post Amy, I heard about Andrew Kukes from Jonathon Berent, it's such a sad story. The Andrew Kukes Foundation for Social Anxiety are doing some great work. I too suffered with quite severe social anxiety throughout my teens and early twenties. what got me through it was a combination of meeting others with similar issues, and slowly moving out of my comfort zone when I felt like avoiding things. I feel that being aware is a very important step in recovery as you can be mindful about what thought processes are coming up automatically and choose either to run or face the situation (fight or flight). What I wanted to know is, a) why is the treatment time a period of several years? and b) Why is it one to one? Surely that defeats the object of facing the situations that provoke anxiety? I know that one-to-one therapy has it's place, I run a support group myself and I know that due to the natural of the problem, many people cannot face coming to a group meeting due to anxiety and worry, but I feel it's essential to have a mix of both. Great post, thanks again, Steve


Wed, Apr 24, 2013 : 8:28 a.m.

yeah, we need lots of attention on this now more then ever. With all the terrorism and war, just makes it so much more intense. I think it has more to do with society and how we tend to judge and generalize people. Who wants to get caught up in all that mess? I know many folks who worry too much about what others think and how others judge. No one ever understands, as far as these victims are concerned. We as a society have to come back together and be a neighborhood, not a stranger-hood. I've been all over the USA, and the small towns are always the best ones.


Tue, Apr 23, 2013 : 7:31 a.m.

I am sorry to the family who lost their son. Anxiety is a very serious problem that can, in some cases, be very extreme. It can be debilitating, but so little is known about it's causes that the medical and psychiatric profession are still exploring various roots of this disorder. Thank you to the family who made the donation to help in this research -- it is generous that you are able to think of others and their suffering after such a terrible tragedy. Every bit of good and generosity that people can contribute to research into anxiety will help -- after all, it is THE MOST COMMON MENTAL DISORDER currently -- higher than depression and any other mental illness. My adult child also suffered from the same disorder as the young man in the story, and we eventually found, after alot of medical exploration, that she had extremely high copper levels in her bloodstream and tissues. Copper increases dopamine, a brain neurotransmitter that, if too high can cause over sensitivity to social cues, sounds, lights, and just the environment in general -- bordering on paranoia feelings. These people want to isolate so they can control their environments (reduce stimulation to a level that is more manageable for them). Social anxiety comes from the brain receiving too many inputs (not being able to filter out the dross), and overwhelming its capacity to make sense of all the input (putting the body in a fight or flight mode continuously). This is probably one form of anxiety, and I'm sure there are many others. People -- be sensitive to what you say. If you don't understand a topic, when you post something, just say "I don't really understand this, but I have a question or a comment that may stimulate the discussion" ... There are real sufferers out there, and they often suffer with shame, blame, and extremely low confidence from their disorder. Be kind, "be the change you wish to see in the world" (Ghandi).


Tue, Apr 23, 2013 : 12:22 p.m.

So well said. Thank you MotherofLove.


Tue, Apr 23, 2013 : 12:38 a.m.

I noticed that Dr. Trevedi's statement was not placed in quotes (The model of psychoanalysis now in which patients are analyzed for 20 to 30 minutes, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders and then prescribed a medication does not work for everyone) and I doubt this is an accurate presentation of what he said. He probably was talking about a model of "psychiatry," not "psychoanalysis," and the reporter did not know the difference between the two. Psychoanalysis is a branch of psychiatry, but some clinical psychologists have also been trained as psychoanalysists. In fact there is a division in the American Psychological Association called Psychoanalysis.


Tue, Apr 23, 2013 : 1:24 a.m.

something is off with the quotes and explanation. In some quotes Dr. Trivedi says that patients are so parallyzed by anxiety they cannot work, yet they are talented and bright and must have the income available to pay for this more extensive or longer treatment method. I clicked on the website to the foundation and it looks like it is a cognitive behavioral program with a staff from Wayne State University and the Psychoanalytic group is listed as a sponsor. If there is a treatment clinic for cognitive behavioral work at the psychoanalytic office in Detroit or Ann Arbor? Is there any information on the cost or program so people who might want to send a friend or family to the psychoanalysis team would know what the costs are or is it paid for by the foundation.


Mon, Apr 22, 2013 : 11:04 p.m.

@cibachrome - it is frustrating to see someone struggle and not get better. I had a friend whose young adult son went to the U-M anxiety disorders clinic and the family was really happy with the care there. I am confused by this new grant but think it's wonderful the family is contributing a grant to help someone who is struggling. I just don't understand what the treatment would be and why it would take so many years. This is the program my friend's son went to and he got better with a combination of a low dose of medication and cognitive behavioral therapy group. My friends were impressed with how well things went and maybe they were lucky to that they were assigned to staff members who were a good match for their son.

Mike D.

Mon, Apr 22, 2013 : 11:02 p.m.

I'm sure glad all the people commenting here know more about treating mental illness than the doctors whose careers it is to do so. *facepalm*


Mon, Apr 22, 2013 : 9:17 p.m.

Ah, the smell of blood and immense profits from untreatable disorders. I love the part where they say, "well. our time is up now, please come again next week for your appointment. Oh and would you sign the insurance form ? " Been all through this with a family member. A computer program responding to key words did a better job. "How long have you had these feelings? Have you been taking your [very expensive covered by insurance] medicine that I prescribed for you ? " "And tell me how you might have been abused by one of your parents". I'm sorry, my time is up.


Mon, Apr 22, 2013 : 8:53 p.m.

This is very generous of the family and sad they lost their son. Is it a typo in the story that the program they are proposing is one that takes several years of treatment? There are cognitive behavioral programs at the University of Michigan for social anxiety that involve more time than 20 or 30 minutes and can really help people learn specific tools for overcoming social anxiety. I don't understand what this program is offering that is different and is it really years of treatment or is the pilot program a shorter number of sessions and then patients could continue for years

Dog Guy

Mon, Apr 22, 2013 : 7:35 p.m.

Shy people are an immense and only slightly tapped resource for psychotherapists.