– By Aecium
Disclaimers: First and foremost, I am NOT a medical professional and this article should not be construed in any way as medical advice. Second, all experiences are mine and what has worked for me may not work the same for you. In short, your mileage may vary. If you have not read part one of this series, the following will make more sense if you do.
After dealing with my anxiety ineffectively for many years, I finally took the first step toward better mental health, although at the time it felt more like a leap over an impossibly wide chasm. But still, I took that leap. I, rather casually, mentioned to my doctor that when I’m dealing with new situations or new people, or old friends in new situations, or large gatherings of any kind, or even just thinking about those things and an almost endless array of other situations, that I felt anxious and sometimes that anxiety could be extreme. Like wanting to run and hide extreme. Like not being able to make simple decisions because I was paralyzed by the thought of making the wrong decision extreme. And that prior to said situations I would spend a lot of time worrying about all the possible outcomes, good or bad (my anxious brain did not discriminate). And that I would be left exhausted after.
He asked some questions and we had a discussion about the benefits of medication and one-on-one therapy. “Ha!” I thought. “Me, one-on-one with someone I don’t know, laying on a couch spilling my guts about my childhood and what this or that inkblot reminds me of, while this therapist, this stranger, sits smugly scribbling notes on their notepad, all the while silently judging me. I think not!” So we went with the medication only route.
Over the course of several months, not much changed. We changed and fiddled with the medications and doses which led only to small improvements. I wanted more. That’s when my doctor referred me to a psychiatrist for further scrutiny (treatment). I was reluctant about seeing a psychiatrist. I thought, “Great, I’m so messed up that my regular doctor can’t fix me so he’s giving up and offloading me on to a crazy people doctor.” Not to mention this would mean rehashing everything I told my regular doctor to a new doctor. No, not just a new doctor. A stranger. At that point, my regular doctor had literally been my doctor since birth – he delivered me. I was comfortable with him. And now he was telling me to go see someone new. Not what I had been hoping for.
The day came. I – was going – to see – a psychiatrist. It was not a productive day. I was too preoccupied with what I felt for sure was my impending doom. The I best I could figure, one of two things would happen. He was either going to tell me I was completely nuts and should be committed (I pictured him pressing a inconspicuous button and guys in white shirts and pants bearing a straitjacket coming to collect me). Or he would read me the riot act and say I was just whining about what everyone deals with every day and that I just need to suck it up and deal with it, and to stop wasting their time.
To my surprise, however, nothing of the sort happened. Amazingly, I was not the first patient anxious about meeting him. From the way I was greeted to the way he explained his process and treatment options, he put me at ease. Mind you, part of our conversation did include the fact that being there made me want to crawl out of my skin and go hide. He completely understood and assured me this was not uncommon. He assured me I was not the only one struggling with anxiety of this kind. I found that rather comforting.
We had a conversation that was not unlike the one I had with my regular doctor, although longer and more detailed, and we formed a plan. My psychiatrist, like my doctor, explained the benefits and side effects of medication, and just like my doctor, he pointed out that seeing a therapist in combination with medication would be the most effective way to deal with my anxiety. With the way they were pushing a therapist on me I would swear they were getting kickbacks from the therapist union. Like before, I expressed my strong dislike of that course of action and he agreed to table the topic for the time being. When all was said and done, I walked out with a new prescription. And the confidence that all my problems would be solved.
After six months or so of regular visits with my psychiatrist and some more fiddling of my medications, we found the right dose. It was like a someone reached into my head and flipped a switch. Suddenly, my anxiety floodgates were not swinging wide open at the drop of a hat. It was amazing! And yet… And yet, after a short adjustment period, and more conversations with my psychiatrist, I knew it could be better. I saw marked improvement and I wanted more! With that progress I was finally able to tackle the next step – going to see a therapist. This is where the work really began for lasting change.
My first therapy appointment was still rather nerve wracking, even with the improvements from medication. And not at all like the chaise-lounge-laying, rorschach-test-taking, parent-blaming experience that pop culture had lead me to expect. While those methods are not complete Hollywood inventions, they were not what my therapist practiced. He practiced cognitive behavioral therapy (CBT), which focuses on changing thought patterns in order to change behavior. Which is not to say that you come out a brainwashed, ear-to-ear grinning, mindless-shell of your former self. It’s a method of helping you amplify positive thoughts and minimize negative thought patterns. Still, a few things were the same as Hollywood would have you believe: he did have a pad where he jotted notes during the session, and there were a few “How does that make you feel?” questions, but all and all it was more like a conversation than an inquest.
With the help of my therapist, I tackled some of my most stressful problems, like catastrophizing. I gave a full example here in part one of this series, but to summarize, I was afraid to tell my coworkers about a personal project because, in my mind, it could lead to me losing my job, car and home. No really – that’s how I thought it would end. So in therapy we would start with something like “What do you think would happen if you shared one of your personal projects with a coworker?” and I would explain the whole convoluted way it could leave me homeless. Then he would help me work backwards from the worst point and we would discuss the true likelihood of ending up there. For example, I have a strong family safety net so when I got to the part about losing my car or house, he helped me realize I have family that would step in and help. Of course, once we reached that conclusion, I proposed “OK, but what if I have a falling out with my family?” and we talked about the likelihood of that happening. And in the unlikely case we did have a falling out, I still had a safety net of friends I could go to for help. Basically it went on in this manner: I would come up with what was to me a very plausible situation, and my therapist would help me work backward step-by-step and realize that, while possible, my dreaded scenarios were not very likely to come about. And that’s the way it went for a long while during my therapy sessions. Over time, it started to sink in that he was right. No matter how bad of a situation I dreamed up, it was not very plausible. And the strongest proof? None of my scenarios had come true. Ever. Rather damning evidence if I do say so.
After working with my therapist for a couple of years, and making very good progress, I got to a place where I felt I did not need any more therapy. I felt I had been provided the tools I needed, along with medication, to manage my anxiety. My therapist agreed that I had come a long way from where I started out at our first session. It was time to move on.
Life went on and was better after leaving therapy. For awhile. I went about two years using what I had learned in therapy and medication. However, this eventually devolved and I slipped back into old habits. I also relied on a less than ideal coping mechanism by drinking too much. Thankfully, my wife helped me see that how I was coping was not healthy and that it was time to go back to working with a therapist. At the time, I experienced a whole rush of emotions, most of them revolving around what I saw as my failure of not being able to make it on my own and that I couldn’t tell my choice’s were bad ones. I lost a lot of respect for and confidence in myself.
When I called my previous therapist to schedule an appointment, he informed me he was retiring and could no longer see me. My only choice was to see someone new. I was not happy about it, but I knew that I needed to get support from a professional to get back on, and stay on, track. My old therapist made some recommendations and I picked one that turned out to be perfect for my needs.
A lot of really great breakthroughs and progress came after starting therapy again. I really clicked with her style. She used CBT, the same as my first therapist, but she figured out ways to explain it to me that really made sense. We were able to not just chip away at my distorted thinking, but actually took out chunks at a time. While I had slipped back into the habit of creating complicated catastrophe scenarios, she helped quickly restore and re-enforce the work that had been done with my first therapist. From there, we dug in one-by-one to find my patterns of distorted thinking and find ways to challenge each of them.
One thing we worked on was my tendency to dread future events. By this point in working with her, I had re-learned enough to (mostly) stop building elaborate scenarios for things to go wrong but I still spent hours dreading it, especially if it was something I didn’t want to do. She helped me work through the numbers to see how much time I spent dreading. Let’s say there was a party I had to go to in 3 months. Initially, I might spend 3 hours a day dreading it. As the event neared, that time would increase and when the event was still 2 weeks away, I was spending 8 hours a day dreading it. The few days before the party I would be almost consumed with dread. Adding everything up, she helped me see that I easily could spend over 400 hours dreading an event that would last only a few hours. This blew my mind! That long? Really? Think of all the things I could have gotten done in that time. Think about all the extra energy I would have if I wasn’t spending it on dreading future events! Just that thought alone was exhausting.
It took a few times of running the “Time Spent Dreading” exercise before I really stopped dreading events so far in advance. What really helped this click for me was realizing that most of the things I worried about were not even in my control. Since I couldn’t do anything to change the situation, I didn’t need to waste my energy on dreading them. Now, when I notice I’m dreading something in the future, I step back and ask myself if there is anything (within reason), that I can do about it? If the answer is no, I challenge my thoughts about it and try to put it to rest. I say try because I still slip sometimes, and my therapist will still on occasion run the numbers with me. But not that often nowadays.
Another distorted thought pattern we challenged had to do with my low self-esteem and low self-confidence. This was heavily driven by my tendency to minimize my successes and maximize my failures. At work, I could do 100 things well but as soon as I did one thing wrong, that’s all I could focus on. Even if I had been praised for the 100 good things, I’d discount that as just lip service. I would convince myself that I was at risk of being fired. Clearly, I could not be trusted to do good work. Situations like this drove me to develop an almost paranoid attention to detail and extreme drive for perfection. Both of which did not serve me in a positive or productive way. It really just drove my stress and anxiety higher and for longer as I waited for someone to discover the problems in my work.
My therapist helped me work through challenging my thoughts of being a complete failure and being fired because of it. She pointed out the 100 things I got right, or the fact that I corrected the one thing I got wrong. She asked if my peers ever made mistakes? “Everyone does,” I said. She asked if I thought my co-workers worried about being fired because of making a few mistakes? “No.” She reminded me that there had been many company layoffs over the years and I was never a part of them.
I’ve gotten rather good at challenging these thoughts on my own now. If something happens that causes me to feel inadequate or like a failure, and I notice that I start to minimize the positives of the situation and just obsess over my mistakes, I step back, take a deep breath, and re-frame my thoughts on the situation.
One time during therapy, after going through an exercise similar to the one above, I had a very disturbing thought and a strong sense of panic. I became very certain that if we challenged and corrected my distorted thinking about obsessing over my mistakes, that I would lose my edge, I would start to slip. I thought if I was not being driven by my extreme anxiety to do better than my best that I would very quickly stop trying and end up not performing well enough to be kept around. I asked my therapist to keep an eye on signs of whether or not I was starting to slip in work ethic and performance. She assured me that was an unlikely outcome. And I can report that to this day the only effect thought challenging has had on my work ethic and performance is that now I can actually enjoy my successes. As for my failures – I now accept that mistakes are inevitable and I understand that I can learn from them.
Getting better at challenging my distorted thinking was not immediate and it still requires a lot of work to maintain. I work at it in the therapist office and I practice outside of it. I’ve found it important to be open and truly vulnerable with my therapist, which is scary and also takes time and practice. Being open and vulnerable can lead to some very intense sessions. For me this is part of the process and helps me let go of the bad and clear a path for a healthier and more resilient mindset.
What has surprised me the most is that with this new set of tools I have been able to stop daily medication for anxiety, something I had previously thought impossible. I have a prescription I can take for acute anxiety attacks, which still happen every now and again, but they are fewer and farther between. I know that anxiety will always be there, I’m not going to stamp it out completely. Anxiety is a natural and often useful emotion and getting rid of it would be bad. Right now, having the acute medication works for me. I understand that in the future it may make sense to go back on daily medication. I’m okay with that, because I don’t want those constant feelings and thoughts of dread, fear, and general anxiety to take hold again. I don’t want them to have a chance to hold me back again. I don’t want to turn down an opportunity because I’m afraid of irrational or illogical thoughts. I don’t want to be controlled by my anxiety to that extreme ever again.
I have come to realize that I don’t ever want to completely stop seeing a therapist. My appointments are farther apart than they used to be. At the moment I meet with her every 6-8 weeks and we might go longer than that at some point. But now I view seeing my therapist as part of good mental health maintenance, like getting a physical or going to the dentist. It’s just a normal part of my over health care regiment.
Looking back, I find it hard to believe that I once let myself be held back from things I wanted to do, but when I was in the thick of it there was no light at the end of the tunnel. I convinced myself that the activities and opportunities I avoided were ones that I did not want. I’m not ashamed of my anxiety or how I dealt with it. I did what I needed to cope and I survived the best way I knew how.
Now, armed with healthier and more appropriate ways to view and interact with the ever-changing world, I can look at situations that previously would have caused me paralyzing anxiety and see them as opportunities that I can chose to pursue or pass up. The difference is now I make the decision for the right reasons, not because of anxiety.
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