Anxiety and Me

Anxiety and Depression are seen as scary words. Mental illness is stigmatized. Seeing a therapist doesn’t seem like the norm. Taking medications instead of fixing a problem yourself seems weak.

These are the things I grew up thinking, that I think a lot of us grew up thinking. And what that meant was when I started experiencing anxiety myself, for a long time I suffered alone. I was ashamed to talk about my anxiety, to face it and to treat it.

But in the last five years, I’ve shifted. I’ve grown less afraid that people will view me as fragile and breakable if they know I struggle with anxiety, less concerned that employers will find me risky or unemployable because of it, less worried that people won’t want to be my friend if they know about it.

I’ve found that the more open I am about my anxiety, the medication i take to control it, and its symptoms, the more people open up to me. The less alone people feel in their own fears. The less alone I feel in mine. I’ve grown sure of the idea that if those of us who face anxiety speak up about it, society as a whole will grow to be much more accepting and kind towards those who struggle with it. The less stigmatized they will become.

So, with that in mind, here’s my anxiety story: how it grew, manifested, and took over, how I approached it, and how things are going now. I hope that my story helps those who don’t suffer from anxiety understand what the mental illness looks like. And I hope those that do suffer from it feel like I’ve done justice to what it can feel like.

Generalized anxiety disorder, defined as a disorder characterized by “persistent, excessive, and unrealistic worry about every day things,” is estimated to affect “6.8 million adults, or 3.1% of the U.S. population. Women are twice as likely to be affected. …And biological factors, family background and stressful life experiences can all play a role in anxiety affecting a person.”

People who experience anxiety often expect the worst, even when there’s no evidence telling them they should. They worry about money, health, family, work, and more.

You might say that this is called being human. Humans worry. And that’s true. But some humans worry a lot. And for some humans — like me — that worry causes extreme stress and physiological reactions on a daily basis.

(To be thorough, I should note that in addition to generalized anxiety disorder, I also have a panic disorder, which is “diagnosed in people who experience spontaneous seemingly out-of-the-blue panic attacks and are preoccupied with the fear of a recurring attack.” And at various times in my life, I’ve experienced depression. And finally, I have a specific phobia to bugs.)

Going way back to the beginning, I don’t remember being a worrier as a kid — elementary school, middle school. I had a lot of friends. I was not in the popular crowd, but I liked the people who liked me.

In high school, I started to unravel a bit after losing a bunch of weight swimming. I was always used to people not looking at me much, but when I lost weight, everyone started paying attention. Especially guys. This was unbelievably exciting, but it also really screwed with my head and my definition of worth. I ended up cheating on a boyfriend of mine and when I confessed, he responded by calling me all kinds of names. I went into a deep dive of depression that lasted several months after that. I wasn’t treated for depression at the time, but looking back at the things that happened at that time and the things I did to myself, I probably should have been. When I graduated, my parents were in the midst of a divorce and my relationships with them and my understanding of marriage and love were shifting.  Halfway through college, I started regularly experiencing what I now know were panic attacks.

When I started skydiving and spending my time outdoors before my senior year of college, my anxiety became a bit more noticeable. When camping, I worried about where the nearest hospital was (which wasn’t the worst idea, but I was positive I would need it). If I felt sick after having too much to drink, I panicked, “knowing” that I would need to go get my stomach pumped, fearing I might die. When hiking in the dark in Moab back to my campsite with flashlights, I became convinced I was about to walk off an edge into the abyss. After a bad landing skydiving, I became unable to remember the period of time between flaring and the ground on my future skydives. When I tried to imagine landing correctly, I couldn’t. I only saw the worst-case-scenario.

Nevertheless, in other areas of my life, I felt somewhat fearless. I moved halfway across the country to be with my new boyfriend, with no job and no prospects, and with no interest in getting a job in my degree field. That was in August of 2009.

Over time, that fearlessness unraveled. I didn’t have a full-time job, so I didn’t have health care through a company, and i didn’t have enough money to buy it independently. I lived in Massachusetts at the time, where health care was mandated, but I didn’t know that I could be eligible for subsidized plans. In August of 2010, Joe got in a massive BASE jumping accident and at the same time, our relationship faced one of its biggest tests. I became managing editor of the South End News, responsible for pages and pages of content about a community of people who really cared. Despite a total lack of experience, I worked day and night to create something worthwhile. I also finally got healthcare.

Nevertheless, I began to worry all the time about my health. When I developed a cough, it was tuberculosis. When I saw a bruise, it was leukemia. When I felt a pain in my stomach, it was a tumor. When I laid in bed at night, I felt my throat start to close up and was convinced that if i fell asleep, I would asphyxiate and die. So I stayed up. Night after night I read WebMD, searching all my symptoms, discovering more things that my ailments could point to until exhausted, trying to prepare myself for the worst. Those nights, I would finally give in to sleep while still gripped with fear. I had many, many panic attacks, some of which occurred after arguments with Joe, and many of which occurred out of nowhere.

I told Joe about my health concerns and he was the first person to ever suggest going to see a doctor, a psychiatrist, about it. I thought he was crazy for suggesting it and freaked at him. These were normal, reasonable fears, I felt. I was preparing for the worst. That was what you were supposed to do. There was nothing wrong with me. I didn’t go see a doctor.

Then, my anxiety started progressing further. All day and all night, it felt like there was a lump in my throat that was growing, threatening to block my breathing. (This is called globus hystericus, I later learned, which is defined as “the sensation of having a lump in the throat when there is nothing there.” It is an intense feeling.) Soon, I was in a constant state of panic. My adrenaline was always pumping. My throat was always about to close up and block my airway and kill me. My thoughts screamed at me. I was on edge all the time, every single minute of every day.

In January of 2010, after talking with Joe and his mom (who is a psychiatrist), I finally made an appointment with a psychiatrist. Before I could make my way in, I had what I can only describe as a week-long panic attack and I needed to see someone, now. At my PCPs office, I told them what I was experiencing, sure that they would look in my throat and find the biggest tumor they’d ever seen. Instead, they told me that the sensations and feelings i was having were classic anxiety and panic symptoms – just what Joe’s mom had said. Knowing I was about to go see a psychiatrist, they prescribed a medication called Ativan — a teeny little pill they said would be a gap measure I could take while the medication the psychiatrist put me on started working.

I can’t quite describe how that first Ativan felt. It’s a controlled substance – which means its addictive – and I was scared to depend on it, to take it, to need it. But that night I took one of those teeny pills, and for the first time in such a long time I felt calm, like I could think and react normally, like I could breathe. I felt like me. It had been such a long time since I felt like me. It was such an incredible revelation, such an emotional moment, one that still makes me tear up. That night was my first real glimpse into the fact that my anxious thoughts were not truth and fact. They were manifestations, suggestions, ideas based on no evidence and made worse by the physical sensations.

Since that first night, I’ve seen a series of psychiatrists and therapists, and it’s been really difficult to learn to navigate that world. There was one guy whose method was silence; he didn’t ask questions or offer suggestions but instead just wanted me to talk at him. It didn’t take long to realize that this method did not work for me, but I stuck with him for a long time thinking that the problem was me, not his methods. I saw a therapist in Boston who helped me through Joe’s move to Providence and started working with me on my bug phobia, but I had to leave her once I headed to Providence. And then in Rhode Island, it took me a year to find a psychiatrist I liked — and to find her I had to experience (and pay for) sessions with one completely incompetent woman and one completely mean doctor. With this new psychiatrist, I found a daily medication that worked better than the one I’d been taking for years. I finally stopped taking Ativan on a daily basis. Then, a few months ago, the real game changer happened: I found a cognitive behavioral therapist I liked.

Since taking to Joe’s mom in 2010, I’ve been aiming to participate in cognitive behavioral therapy (CBT). CBT is a method of therapy in which you work to identify, understand and change your thinking (cognitive) and behavior patterns.

With my therapist we started with examining the scenarios that created anxiety, working to nail down what exactly about that scenario made me anxious. This is called Down Arrowing.

So, for example, if my boss wrote me an email in which they were shorter with me than normal and that made me anxious, the question I would ask myself is “Okay, they wrote a shorter email than normal, why does that make me anxious?”

My boss sounds short in their email to me

V

It means my boss is annoyed with me

V

Which means my boss thinks I did a bad job

V

And that means my boss doesn’t like me

V

Which means that my boss will fire me

With down arrowing, you’re supposed to stop when you *feel* like you’ve hit the mother load, the real concern that makes you shake in your boots. Maybe the initial concern was that you thought the email was short, but the real worry is that you will be fired. The next step is to write down your fear/anxiety so that you can clearly see what initial and final thoughts you have.

“My boss sounds short in their email to me, so they will fire me.”

First of all, doing this can really put your anxiety in perspective and give you insight to why you’re getting all worked up: you may intellectually know that one short email doesn’t equal that they will fire you. Whether it’s this “obvious” or not (and it’s often not), the idea after getting to this place is to review the evidence. What’s the evidence for and against the phrase “My boss wrote me a short email”? What’s the evidence for and against the phrase “My boss will fire me”?

If the evidence for my boss writing a short email is that some past emails have been nicer and more “warm”, then the evidence against would be, or maybe they were in a hurry. or maybe they aren’t effusive in emails. or maybe they were distracted. Evidence against “my boss will fire me” might be, last week I got praise from them. or I got a raise this year. Or, they haven’t shared any concerns with me. or, even better, in the past they’ve written short emails like this that haven’t led to my firing.

The idea is to amass evidence for and against — evidence that you could (theoretically) use in the court of law and that aren’t colored by your perception of things — and examine what is real  instead of what your thoughts suggest. And the point isn’t to take all your anxious thoughts and tamp them down and say, “Don’t worry about it.” The point is to come up with a more realistic conclusion. In this case, maybe, “My boss was short in their email to me, so they may have a busy day today, and they’ve written emails in the past like this and it hasn’t meant anything bad.” Sure a short email might indicate annoyance with you and it might indicate they don’t think you’re doing a great job which might one day lead to you being fired. But does one short email likely mean you’re going to be fired? In this case, no, it doesn’t.

This might sound really simple to some people, but when you find something you’re worried about, it’s hard. It’s hard to look your thoughts in the face — things you truly, completely believe — and say that they’re not as real as you feel they are.

In addition to this kind of CBT, we’ve done work on controlling the panic emotions and the physical panic sensations that come with it. A physical sensation might be that my throat feels like it’s closing up, or my chest feels tight, or I can’t get enough breath. Fearing those sensations creates a kind of feedback loop. Because you’re afraid of those sensations and what they mean, your adrenaline and panic rises, creating stronger sensations. And so on. The work I’ve started to do with my therapist is to disconnect the feedback loop by removing the fear attached to those sensations. This is hard, uncomfortable work full of awkwardness. Like breathing through a little straw for as long as possible until I no longer feel panicked, or wrapping my chest with an ace bandage to simulate a tight chest and waiting through my panic until i feel normal again.

We’ve also worked on my bug phobia, which has been some of the most uncomfortable and upsetting work I’ve done, if you can believe it.

My initial interest in CBT was that it could fix my anxiety in such a way that I would no longer have to take medication. Instead, it’s given me a whole new lens with which to view the world. I’ve started to really understand and accept what it means that I can’t control anyone’s emotions or reactions but my own. I’ve started to really be able to understand myself, my thoughts, my fears, and my past, and I feel more capable of handling my stresses. It’s also humbled me. There’s nothing like having someone else succinctly (though kindly) lay out why what you fear or think isn’t reasonable, no matter how real it seems.

I’ve also let go of the idea of needing to stop my medications at some point. I used to think if I had to take medication my whole life to handle anxiety, I would be a failure. I know now that it’s possible that to live my life to its fullest, medication might be part of the package. And that that doesn’t mean I’ve failed. In fact, it doesn’t really mean anything. I know that my anxiety will not be cured or fixed, but that through CBT methods, I can increase my happiness and ability to interact with the world and my friends and family positively.

Over time, I’ve also learned not to be ashamed of myself, or of my anxiety, or of taking medications, or of seeing psychiatrists and therapists.

Instead, I’ve grown proud of myself. I’m proud of wading through the murky waters of anxiety and medications and therapists and psychiatrists to finally find a combination that works for me, that makes me me. I’m proud that I’ve looked my anxieties in the eye and wrestled with them, attempted to view them in a different light, and, ultimately, come out a happier, better human.

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