How Can I Manage Social Anxiety? Three Tips From a Mount Sinai Psychologist

Aug 18, 2025 | Psychiatry, Your Health

Avoiding other people from time to time is normal. But if you isolate yourself out of fear of embarrassment or rejection, you may have social anxiety disorder.

Charissa Chamorro, PhD

In this Q&A, Charissa Chamorro, PhD, a Mount Sinai clinical psychologist, explains how to know if you might have social anxiety disorder and what you can do to be more confident around others.

“Treatment isn’t about getting rid of anxiety—it’s about learning you can feel anxious and still engage meaningfully. The more you approach instead of avoiding, the more confidence you build,” says Dr. Chamorro, Assistant Clinical Professor, Psychiatry, Icahn School of Medicine at Mount Sinai.

What is the difference between being shy and having social anxiety disorder?

Social anxiety disorder is a diagnosable mental health condition. Shyness is considered a personality trait that can be shaped by temperament and experiences. While shyness usually involves mild discomfort in social settings, social anxiety involves a persistent, intense fear of being judged, embarrassed, or rejected.

Unlike shyness, social anxiety interferes with your life. If you avoid situations you actually want to be part of or cancel plans because of discomfort, you may have social anxiety disorder.

What causes social anxiety disorder?

The causes are thought to be a combination of biological and environmental factors, but not necessarily due to bullying or poor parenting. Some people are more prone to anxiety, and experiences like negative social feedback can reinforce that.

What are signs I might have social anxiety disorder?

  • Avoiding social interactions: Not just avoiding parties, but isolating yourself at work or having a hard time starting conversations with co-workers.
  • Going blank in conversations: You may blame yourself—thinking, “Why can’t I think of something to say?”—but this can be part of your body’s fight, flight, or freeze response to anxiety.
  • Over-apologizing and deferring to others instead of stating your own preferences: People with social anxiety often seek social approval.
  • Rumination: Replaying past conversations, focusing on something you think went wrong, or feeling that you were really embarrassing. Thinking about social interactions is normal, but if it causes distress and is hard to control, you may have social anxiety.
  • Perfectionism: Feeling that you have to know the perfect thing to say before you can speak.
  • Hiding behind your phone in public: Not for work or enjoyment, but to avoid engaging with others.

How can I become more confident in social situations?

Here are three tips you might find useful:

  • Remind yourself that everyone feels awkward sometimes. That normalizes the experience and helps you feel less alone.
  • Vocalize your feelings. For example, if you’re giving a speech, you might say, “I’m feeling nervous because I really want this to go well.” Naming it can disarm others and help you feel more confident.
  • Reframing your thoughts can build confidence. Instead of telling yourself, “I’m so awkward,” tell yourself, “A part of me feels anxious, and that’s okay. I’m going to do my best.” Coaching yourself with more balanced, supportive thoughts can make a difference.

How can a mental health professional help me with social anxiety?

Social anxiety is highly treatable, and cognitive behavioral therapy (CBT) is the gold standard. CBT helps you identify thoughts contributing to anxiety and use cognitive restructuring to examine them.

How does a therapist use cognitive behavioral therapy to treat social anxiety?

I would ask you to recall positive social experiences to challenge self-critical thoughts, like “I can never connect with people.” Cognitive behavioral therapists work on helping you create more balanced thoughts—for example, “Sometimes I feel awkward, but I’ve also connected with others before.”

Therapists also assign gradual behavioral exposures—small tasks like ordering coffee and making eye contact with the cashier, then building up to things like attending a party. The goal is to break the cycle of avoidance and create opportunities to approach social situations.

Are there medications that treat social anxiety?

CBT is often very effective, but if symptoms remain or access is limited, medication may be a helpful additional support. Depending on how severe your anxiety is—especially if generalized anxiety is also present—we may refer you to a psychiatrist to discuss medication options.

What happens if I continue to avoid social situations?

Avoidance makes anxiety stronger. When you avoid a social situation, anxiety goes down short-term, but you don’t get the chance to learn that you can manage it.

Treatment isn’t about getting rid of anxiety—it’s about learning you can feel anxious and still engage meaningfully. The more you approach instead of avoiding, the more confidence you build.

Schedule an appointment with a Mount Sinai mental health professional

Taking Supplements? Use This Guide to Make Smart Choices

Updated on Aug 20, 2025 | Diet and Nutrition, Your Health


From turmeric capsules to muscle-building powders like creatine, many people are turning to herbal and dietary supplements. While supplements are generally harmless when taken in moderation, some pose health risks, including unpredictable liver problems, especially when taken in large doses. For this reason, you should always talk to your doctor before taking them.

In this Q&A, Meena B. Bansal, MD, a Mount Sinai liver specialist, explains the risks of supplements, what to watch out for, and how to protect your liver while making informed choices about supplements.

We’ve been hearing more about supplements being linked to liver damage. What’s the connection?
This is a growing concern. Over the last 20 years, more people have started taking supplements like turmeric, curcumin, and ashwagandha. Because these are widely available online, more people use them than ever before. With that rise, doctors have seen more cases where these supplements cause liver injury.

Are supplements really that dangerous?
They can be. One big issue is that supplements aren’t regulated like medicines. The labels might say one thing, but there’s no guarantee the product is pure or safe. Some ingredients may be harmful in higher doses or when combined with other supplements.

Key Facts About Supplements

  • While mostly safe, some supplements can cause liver injury, especially in high doses.
  • Supplements aren’t regulated, and labels can’t guarantee safety or purity.
  • LiverTox® (NIH resource) is a trusted tool for checking if a supplement has been linked to liver problems.
  • Whole foods are safer sources of nutrients; supplements should ideally be taken with medical guidance.

Meena B. Bansal, MD

Does this mean something like turmeric, which is often praised for health benefits, could be harmful?
Using turmeric as a spice in food is safe and may have health benefits, but when it’s highly concentrated in pills, and the exact purity is unknown, it has the potential to cause liver injury.

What signs suggest a supplement might be harming your liver?
People usually find out from blood tests showing abnormal liver enzyme levels. These tests might have been normal months before. When doctors ask about new medications or supplements, many patients don’t realize supplements count as medicine and forget to mention them.

Are all liver injuries caused by supplements the same?
No. Some liver damage depends on the dose. One example is acetaminophen (such as Tylenol®), which is extremely safe when taken as directed but can harm your liver if taken in very large doses. Other cases are unpredictable and might happen because of a genetic predisposition. A thousand people may take a supplement without problems, but a few may have serious reactions.

Can liver damage from supplements be severe?
Yes. Mild cases show up as enzyme changes in blood tests. Severe cases can cause jaundice (yellowing of skin and eyes) and sometimes require a liver transplant, although this is rare. If you have symptoms, schedule an appointment with a Mount Sinai liver specialist: 212-241-7270.

Is there anything on supplement labels that can help me know if they’re safe?
Unfortunately, no. Supplements aren’t regulated, so companies can put whatever they want on labels. Even certifications from a “third party” agency or organization (companies that claim to check the purity of the ingredients) are not a full guarantee.

Is there an online resource that can help me identify whether a supplement is potentially harmful?
Yes—LiverTox®, a resource available through the National Institutes of Health, provides a trusted list of medications and supplements that are potentially harmful to your liver.

What if I want to keep taking supplements?
I discuss the risks and benefits with patients. If someone feels a supplement helps, I monitor their liver health closely. Sometimes we stop all supplements and add back just one or two, checking for any problems.

What about creatine, a popular muscle-building supplement?
While many use it without issues, I don’t recommend it. You get creatine naturally from eating meat and fish, which is safer. This may be challenging, however, for those on a vegan diet. There isn’t strong proof that creatine causes liver damage, but some people taking it have higher liver enzymes. Creatine can cause your serum creatinine, a marker of kidney function, to become elevated, but it does not necessarily reflect damage.  Those with pre-existing kidney disease should consult their doctor prior to use.

Therefore, overall, for healthy adults, standard doses of creatinine monohydrate (up to five grams daily) are probably safe, but people with liver and kidney problems should be cautious. Very high doses could be risky and should be avoided until more is known.

What other supplements are associated with liver problems?

Known ones include:

  • Ashwagandha
  • Green tea extract
  • Turmeric (curcumin)
  • Garcinia cambogia
  • Kratom
  • Black cohosh
  • Red yeast rice
  • Chaparral
  • Ephedra
  • Germander
  • Kava
  • Polygonum multiflorum

Multi-ingredient supplements marketed for weight loss or bodybuilding are also associated with liver problems, but the specific toxic component is often unclear due to product variability and mislabeling. Always consult a physician before taking supplements.

Are any supplements considered safe?
Multivitamins and common vitamins like vitamin D and C from trusted stores are usually fine. Be wary of products promising quick fixes like “liver detox” or “rapid weight loss.”

Can I tell if a supplement has harmful contaminants like heavy metals?
No, not without lab testing. Even third-party certifications can’t guarantee a product is free from contaminants.

Is it ever necessary to take supplements?
Some people with certain medical conditions may benefit from supplements, but should check with their physician first. Healthy people are better off getting nutrients from whole foods. Supplements can be costly and sometimes harmful.

Schedule an appointment with a Mount Sinai Primary Care Doctor or Liver Specialist

How Can I Create Healthier Phone Habits? Three Tips From a Mount Sinai Psychologist

Updated on Aug 13, 2025 | Psychiatry, Your Health

Phones have become a necessary part of life, but if you find yourself mindlessly scrolling or constantly reaching for your phone out of boredom, you may have a phone addiction.

“Addiction isn’t just about substances—it can also be behavioral,” says Naomi Dambreville, PhD, a licensed clinical child and adult psychologist at The Mount Sinai Hospital. “Phone addiction is compulsive and excessive phone use, feeling out of control, or distressed when away from your phone. If you feel withdrawal when not online or fear missing content, you may have a problem.”

Naomi Dambreville, PhD

In this Q&A, Dr. Dambreville, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, explains how to know if you might have an unhealthy relationship with your phone, and tips for using it in healthier ways.

What are some signs that I spend too much time on my phone or social media?
We live in a digital society and rely on phones for many everyday activities. It can be hard to realize phone use is a problem because it’s so convenient, but signs include:

  • Everything revolves around your phone. You shop, socialize, get news, and do almost everything through your phone—and rarely engage in real-life alternatives.
  • You have an automatic relationship with your phone. Every notification prompts an instant reaction, you check every direct message, constantly scroll, or have FOMO (fear of missing out)—especially if being offline makes you feel sad or out of the loop.
  • Trouble focusing. If you’re multitasking—watching TV and scrolling, talking to someone but still on your phone—or always reaching for your phone at work or in class.
  • Low tolerance for boredom. Your instinct is to grab your phone the moment you have nothing to do. Scrolling becomes a default time filler with no real purpose.
  • Physical symptoms—headaches, fatigue, sleep disruption, eye strain, and “digital thumb” (thumb, hand, or wrist pain from holding your phone for long periods).
  • Phone-related conflicts. Your phone causes conflicts in your relationships because your loved ones feel ignored.

How can I use my phone in healthier ways?

Here are three ways to create healthier phone habits:

  • Train your social media algorithms: Block unwanted content, use filters, and control what you see. Choose not to view certain images or videos.
  • Create rules around phone use. No phones at dinner, during conversations, or bedtime. For families, agree on time limits, app access, and talk about uncomfortable content.
  • Use the phone for connection, but notice when it causes discomfort. Align phone use with your values and make space for real-world experiences.

How does phone addiction, including doom scrolling, affect mental health?
Doom scrolling refers to consuming large amounts of news, often bad—for example, catastrophic storms, conflicts, or negative political content. We grab our phones to search for updates and end up exposed to real-time traumatic or distressing information.

This behavior becomes mindless. You might scroll to stay informed but end up feeling worse. Bad moods lead to more scrolling, which worsens the mood further. It affects attention, mood, self-esteem, and can trigger irritability, anxiety, or anger.

Do “digital detoxes” reduce phone addiction? How?
A digital detox helps reduce or stop phone use. It’s about breaking the cycle of compulsive use. Detoxing gives your mind and body a break and allows space to build new habits. Here’s how:

  • Start by building awareness. Notice what you use your phone for—shopping, paying bills, etc. Try doing some of those activities in real life. Spend an hour off your phone, and see how it feels.
  • Notice withdrawal reactions—thinking about your phone, missing notifications, or feeling uncomfortable without it. Use app limits and be intentional: “I’m checking my bank app” vs. “I ended up scrolling Instagram.”
  • Replace phone time with real-life activities—reading a book, joining a club, socializing in person, or trying a new hobby.

How can a mental health professional help?
People often seek help for anxiety, low self-esteem, or conflict—and phone use may be a factor. Therapists can help with behavior changes, digital detox plans, and social skills. They can also address phone-related issues like gambling, shopping, and excessive social media use, helping reduce dependency and improve well-being.

Schedule an appointment with a Mount Sinai mental health professional

Do I Need a Midwife?

Updated on Aug 12, 2025 | Your Health

Some people might think that midwives are just for pregnant people, but that is not true. Midwives provide specialized care throughout the reproductive journey, from adolescence, through pregnancy, birth, postpartum, and menopause.

“We care for people across all stages of life, from adolescence through menopause. A big part of what we do is take time to talk, educate, and support our patients so they feel confident in their care,” said Grace Ferguson-Pell, CNM, WHNP, RN, a certified nurse-midwife at the Midwife Practice at Mount Sinai Doctors at Delancey Street, in Manhattan’s Lower East Side.

“Midwifery model care, typically, we really like to focus on education. We always say, most of our visits are talking, and I think it’s a way for people to feel more prepared and ready for birth,” said Johanna ”JJ” Monro, DNP, CNM, RN, also a certified nurse-midwife at the Delancey Street practice, which is part of the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at Mount Sinai.

In this Q&A, Grace and JJ explain the role of midwives, how their care differs from other providers, and what patients can expect when working with them.

Johanna “JJ” Monro, DNP, CNM, RN (left) and Grace Ferguson-Pell, CNM, WHNP, RN (right) are certified nurse-midwives at the Midwife Practice at Mount Sinai Doctors at Delancey Street.

What is a midwife and how is it different from an OB-GYN and a doula?

Grace: A midwife is an independent practitioner who focuses on reproductive health. This includes a wide range of care such as contraceptive counseling, menstrual cycle issues, prenatal care, helping with births, postpartum visits, and annual reproductive health exams like cervical cancer screening and STD testing. In addition to pregnancy care, midwives support patients through menopause and perimenopause, providing ongoing reproductive health services such as screenings, symptom management, and education. 

The main difference between a midwife and an OB-GYN is that midwives do not perform surgery and focus more on pregnancies that are low-risk or generally uncomplicated. People with certain conditions like diabetes or high blood pressure might need to see an OB-GYN instead. 

JJ: A midwife is a licensed professional in New York State. We are Certified Nurse Midwives (CNMs), which means we have nursing degrees and additional training in midwifery, with either at the master’s or doctorate level. We currently only attend hospital births at this time. 

A doula is different from a midwife because doulas provide emotional and physical support during labor and postpartum, though do not receive medical training and do not provide medical care. 

How might having a midwife’s support improve my pregnancy experience?

JJ: Midwives focus a lot on education and communication. Most visits involve talking through what to expect during labor, how to prepare for breastfeeding, and how to manage postpartum care. This approach helps people feel more prepared and confident.  

Grace: Midwives provide care that is personal and holistic, focusing not only on the medical aspects of pregnancy but also on emotional, mental, and social well-being. This approach means addressing a patient’s overall health, lifestyle, and support system throughout their reproductive journey. They manage pregnancies that are low-risk or generally uncomplicated and collaborate closely with OB-GYNs if any complications arise. Midwives also provide essential medical services such as ultrasounds and routine testing, blending medical expertise with individualized attention.  

Is it hard to access a midwife and integrate it into my care team?

Grace: In New York, midwifery care can be accessed through self-pay, private insurance, or public insurance. Midwives practice in a variety of settings, including hospital systems and private midwifery groups. Some private midwifery groups may not accept insurance or may provide care at out-of-network rates, so it’s important to check coverage details with your provider and insurer.  

Mount Sinai’s midwifery groups in New York City is in-network for many private insurances.  to make this care more accessible. Mount Sinai Hospital also has a midwifery service uptown that provides care for folks with public insurance. Patients do not need to pay out of pocket for reproductive health care.  

How does Mount Sinai approach midwifery care differently?

Grace: Mount Sinai allows midwives to lead how they provide care. As the first private midwifery practice at Mount Sinai, the team has been given a lot of trust and support.  

JJ: Being part of a large hospital system also means midwives have easy access to other specialists and services when needed. Mount Sinai’s midwives provide a small practice feel while being backed by the resources of a large health system. Another important difference is that patients are guaranteed to have a midwife present at their birth with 24/7 coverage. 

What else should we know about midwifery care?

JJ: Many people think you have to be pregnant to see a midwife, but that is not true. Midwives care for patients at all stages of reproductive life. This includes general reproductive health visits, menstrual concerns, and gynecological care like Pap smears.  

Grace: Midwives also provide care for menopause and perimenopause, which can often be confusing topics. The care model is similar to seeing a nurse practitioner, but focused on reproductive health.

Learn more about the Midwife Practice at Delancey Street

Why Are Vaccines Important?

Updated on Aug 13, 2025 | Featured, Your Health

Vaccines strengthen your body’s natural defenses. They are the safest and most effective way to protect yourself and your family from many preventable diseases, according to the U.S. Centers for Disease Control and Prevention (CDC).

Vaccines are one of the few ways we have to eliminate—or mostly eliminate—certain diseases. But often, for this approach to be effective, almost everyone needs to get vaccinated, according to Jennifer Duchon, MD, MPH, DrPH, a pediatrician and an expert in infectious diseases. In this Q&A, Dr. Duchon, who is Hospital Epidemiologist and Director of Antimicrobial Stewardship at the Mount Sinai Kravis Children’s Hospital and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, discusses why vaccines are important, especially for young children, and why you should talk with your doctor or health care provider if you have any questions about them.

Jennifer Duchon, MD, MPH, DrPH

Why are vaccines important? Vaccines help keep us healthy on several levels. On a personal level, getting vaccinated prevents you from getting sick or from developing the worst complications of a vaccine preventable disease, such as hospitalization or death. On a community level, getting vaccinated keeps your family and friends safe. Some people cannot get vaccines; they may be too young or may have a compromised immune system or some other health issue that makes them unable to receive a vaccine. But if you’re vaccinated, your risk of transmitting the disease is usually much lower. Which means you help others near you avoid getting the disease.

How does that work? In a particular population, we need a percentage of people vaccinated to prevent the spread of certain diseases. For example, for measles, which we consider to be eliminated in the United States due to an effective vaccine, we need about 95 percent of the local population to be vaccinated to prevent spread. Even a small outbreak can spread farther and faster than you’d think, and as fewer people are vaccinated, epidemic spread of a disease is possible. Remember, we’re all citizens of the world, and we have a responsibility to protect people who can’t protect themselves from vaccine-preventable diseases.

What vaccines do children need? We recommend several vaccines for children. Some start at birth; others we administer later. Some are single vaccines, while others require multiple doses to build up immunity, or yearly vaccination  to combat emerging disease mutations. For the exact vaccination schedule, check out the American Academy of Pediatrics (AAP) vaccine schedule and the CDC website. These vaccines include:

  • During a child’s first year, we administer vaccines to protect against hepatitis, Streptococcus pneumoniae; Haemophilus influenzae (which are bacteria that cause meningitis, blood stream infections and ear infections); tetanus, diphtheria, and pertussis; and RSV (respiratory syncytial virus).
  • At one year of age of older, children receive one vaccine against measles, mumps, and rubella, known as the MMR vaccine, as well as for varicella (chickenpox) . When they reach 4 to 6 years of age (typically school age), they need a booster shot for some of these diseases, including the MMR and varicella vaccines.
  • Booster shots for tetanus, diphtheria, and pertussis are also needed after the primary series.
  • We also recommend certain vaccines for older school age kids, to protect against diseases such as Human Papillomavirus (HPV) and meningococcal disease.

There are also some vaccines available for people with certain medical conditions as well as boosters for pregnant and elderly people. In addition, there are vaccines adults and children need annually, such as flu and COVID-19.

If I have any questions or concerns about vaccines, what should I do?

If you have any questions, don’t hesitate to ask your doctor or your child’s doctor. It’s important to know that all the vaccines listed on the AAP and CDC schedules have been studied extensively for safety and efficacy. Even the newest vaccines have been researched very carefully. The CDC continues to collect information about the safety of all vaccines; there are mechanisms in place for anyone—the public, a health care provider, or a health department—to report adverse reactions. The CDC studies these results, looking for trends. I recommend speaking to your primary care pediatrician, your family doctor, your obstetrician, or whomever you see regularly, have a long-term relationship with, and trust. You know these doctors—and you know they have your and your child’s best interests at heart. I always recommend asking as many questions as you want.

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The Benefits of Social Skills Groups for Autistic Individuals: Improving Communication and Relationships

Aug 7, 2025 | Seaver Autism Center, Your Health

For the last three years, the Seaver Autism Center has offered clinical social skills groups at The Mount Sinai Hospital. These groups are free of charge to families, thanks to generous grant donations from RVC Blue Speaks.   

The Seaver Center provides hundreds of free autism-focused diagnostic evaluations each year in the context of research studies.  In many cases, Seaver Center clinicians recommend social skills interventions to families.  

Jessica Zweifach, PhD

“We are proud to be able to offer this critical support within our own Center,” says Jessica Zweifach, PhD, the social skills group therapist. 

“Social skills groups are a place for children on the spectrum to learn and practice social skills with peers.”  

In a Q&A, Dr. Zweifach, licensed clinical psychologist, Seaver Autism Center for Research and Treatment, Assistant Clinical Professor, Psychiatry, Icahn School of Medicine at Mount Sinai, explains what a social skills curriculum offers and how these help families, including beyond the clinic setting. 

“In addition to learning social communication skills, families involved in our group have told us that they have made lasting connections with the other participating families, which have continued outside of the group,” she says. 

 

She adds, “We want all families of children on the spectrum to have access to excellent care, and we feel lucky to get to work with so many amazing families.” 

 

What is the social skills curriculum? 

Seaver clinicians host Seaver NETT (Nonverbal communication, Emotion recognition, and Theory of mind Training) social skills groups. Seaver NETT is a 12-week cognitive-behavioral intervention, which was developed by clinicians at the Seaver Autism Center.  The program has evidence that shows improvement in the presenting challenges of those who participate in this manualized social skills protocol;: A randomized comparative trial showed participants who received the NETT intervention displayed significant improvements in social behavior outcomes, including nonverbal communication, empathic responding, and social relations. We also recently added an extension to the NETT group, so that families could continue learning together. 

 

What happens in the Seaver NETT Social Skills Group?

The Seaver Autism Center recruits small groups of children and their parents to engage in the Seaver NETT social skills program annually. Children and parents meet in separate groups, with overlapping intervention goals.  Topics include, conversational skills; how to pick up and read social cues; perspective-taking skills; ways to engage and develop friendships with peers; and other relevant skills to enhance social understanding and skills.  

 

How have the Seaver NETT social skills groups helped families?   

The Center has received very positive feedback from families who participated in the Seaver NETT groups. Many families expressed interest in continuing to come to the Seaver Center for social skills groups at the conclusion of the intervention.   

To continue working with these families, past and current clinicians at the Seaver Center developed additional social skills lessons—guided directly by family feedback—and extended the program to meet the specific needs of these children and families who wanted to continue in the group. The families were thrilled for this opportunity. One mother said her child has been waiting to join the Social Skills group at the Seaver Center again. She said her child felt understood and validated and that the curriculum in the groups was comprehensive, organized, and allowed the child to learn regulation skills.    

 

Review from participating autistic child: “Can we extend the time? Because it is really fun!” 

Review from participating parent: “The curriculum and practice exercises from this group should be implemented in schools because it helps our children regulate their emotions, understand themselves and others and find better ways of communicating”  

 

Clinicians at the Seaver Center are very grateful to have funding for social skills groups, so they can provide interventions for autistic individuals in the community regardless of whether they are able to pay for services. 

 Being able to lead social skills groups that are free of charge to families has been incredibly meaningful to all of us at Seaver.  

 

If you and your family are interested in learning more about the Seaver NETT Socials Skills Group, or are interested in joining a group, please contact the Seaver Autism Center: TheSeaverCenter@mssm.edu.

 

Read more about the Seaver Autism Center for Research and Treatment at Mount Sinai
Learn more about the Seaver Autism Center for Research and Treatment