Anxiety

[nonsequitur]

Hi, I did a preliminary google search of anxiety on this forum and was surprised when it didn't turn up anything, considering that it's such a common condition.

If you don't know me, hello. I lurk more often than I post, though I do have a blog that I update every so often. In that blog, I've been detailing my struggles with my anxiety, which is co-morbid with clinical depression. Both of them play significant roles in my life, and I've been trying unsuccessfully to overcome both of them this year.

I'm currently on Effexor, 150mg. I'm not sure that it has much of an effect, but I didn't notice anything positive with my previous antidepressants either. Before that, I was on Mirtazapine (it completely knocked me out, was drowsy all the time) and then Lexapro (it made me exhausted after a while). Most of the problem with "not knowing if it works" stems from the fact that I don't know how I feel most of the time (typical INTJ problem). In fact, I didn't even realise that I had a problem and had to seek help till I became suicidal in January this year.

I've asked my psychiatrist a few things, but have never really gotten satisfactory or practical answers because he tends to go off on long, rambling tangents. I'm hoping that people who have experience with this will be able to provide practical advice and help.

These questions include:
1) Do suicidal and self-harming thoughts go away with medication? (They don't for me, and fighting myself and the urges is really tiring.)
2) What can I do to overcome my paralysis by analysis/worry?
3) How do you "stop worrying"? (My psychiatrist told me to 'just stop worrying', which wasn't helpful.)
4) How do you "brainwash" yourself into becoming positive?
5) How do you "force" yourself to communicate how you're feeling?
6) How do you stop the shame that comes with being unable to control how you feel?
7) How do you "know" how you feel anyway?

My anxiety tends to feed into my depression, and vice versa. Often, I feel too afraid to leave the house or deal with reality. My fears (irrational as they are) stop me from communicating with people, or even having them see me around. As such, I avoid crowds and people at work, and feel resentful when people want to talk to me because it means that I have to work up enough energy to suppress that fear. I also hate that I cannot resolve an issue within myself by myself. That makes me feel useless and further feeds the depression.

After the 3rd "intervention" that was staged for me this year, I've finally decided that I must change something. I'm taking steps to break my problems down into manageable bits, and organise my life. But at the same time, I need reassurance that it will get better (because it's been a year and 3 antidepressants later and nothing seems to have changed), and also I need advice on what else I can do.

Thanks in advance.

 

[guesswho]

Hi,

You're not the only one with this. Although it may feel that way, and the 'snap out of it' line really annoys the hell out of me. It's like saying...gee.. grow some chemicals in your brain.
I changed many antidepressants till I found one that actually worked, I remember I took prozac and it made me worse. That was a long time ago and pills didn't really fix me.

Anyway, depressions sucks, and it won't go away that fast...so that's kind of the bad news, I guess I should have started with the good news.
The good news is that it's manageable. You will need Cognitive behavioral therapy for that... you can't really handle your issues by yourself, as most of those issues , aren't particularly conscious, that's where the therapy comes to help I guess.

You must have a healthy lifestyle to recover faster, so no caffeine/alchool/ late nights.
You must do some kind of sport, although you probably don't want to , you must.

Depression never really goes away... but I managed to stay about 7 months without it, that's my personal record.

You don't need to be positive, that is BS, however thinking negative won't help, the best way ( at least for me) is thinking rational.

Ok, these advices were ok, here comes the crappy one.
You must go out when you're depressed/anxious, and...kind of challenge your anxiety. So even if you get anxious when you're out, you must expose yourself even more to the feeling, instead of avoiding it, by exposing to it, it will reduce. It worked for me. You must do things when you're depressed, like clean your room, bla bla bla get busy, and the feeling will kind of wear off a little ( it won't completely dissapear)

That's about all I can say, I do have one question though, is your depression getting worse in Winter? Summer always makes me feel fine. I don't get depressed in summer and spring (although I used to)

 

[nonsequitur]

Thanks for your response, guesswho. I've tried cognitive behavioral therapy and my psychiatrist is trying that with me again... it's just that beyond trying to change the way that I think (which is difficult in and of itself) I feel like I need something more practical to kick my life into gear. The pills are something that I hoped would fix the problem completely, but they didn't. I really hate switching pills, and sometimes I think that it would be better to stick with something even if it isn't really working, as opposed to the tapering/side-effects cycle all over again.

Thanks for the advice on sport (every doctor and my supervisors recommended that but I didn't listen). I'll give it a go and try to discipline myself into doing something regularly. I'd quit caffeine and alcohol back when I started my antidepressants in January, but went back on caffeine when I found that I just couldn't keep myself awake. I now try to limit how much coffee I drink, but have decided not to quit entirely because I'm more effective while on it. I'm still 100% off alcohol though.

My psychiatrist says that I must slowly try to permanently shift my thinking away from the negativity (which I think is 'rational'), or my depression and anxiety will recur. He's described it as a form of "necessary self-brainwashing", which amuses me, but I'm trying my best because I recognise that it is my 'rational', continually negative worst-case-scenario thinking that got me into this mess.

That's the first that I've heard to challenge my anxiety... I'm really terrible to be around when I'm having severe anxiety... I just start shaking and I can hardly get words out. When people talk to me, I ignore them or snap because I'm concentrating so hard on not running away or appearing normal. That's why I try to avoid everyone when it hits. How do you make it less extreme? I'll give it a go, but usually this places so much stress on me that I'm exhausted.

Yup, I'll try to distract myself from the depression by keeping busy... I've worked out a list of "distractors" to do that I'll run through when it hits.

With regards to your question, nope, my depression and anxiety are pretty constant all year 'round. I'm actually living in the southern hemisphere, so it's summer right now. It's still a problem though.

Thanks again!

 

[Kasper]

2) What can I do to overcome my paralysis by analysis/worry?

Over thinking is a bitch, can you compartmentalise? Focus on the reality of "what's the worst that can happen?" use meditation or other relaxation methods including physical exertion?

What techniques have you tried in the past besides medication?

3) How do you "stop worrying"? (My psychiatrist told me to 'just stop worrying', which wasn't helpful.)

No one stops worrying, that's crazy, the idea is to have concerns but put them in perspective where they are realistic and not debilitating. Using some method of centering/grounding/relaxing so you can slow your mind down before you focus on what you are worrying about is ideal.

4) How do you "brainwash" yourself into becoming positive?

I don't think that's necessary, being negative or "realistic" as some like to call it is different than being depressed. As an E7 even when at the lowest of my lows I was still optimistic, didn't necessarily help. I guess how much you listen to negative thoughts would have an impact but I still see it as quite different. Anyway as an E7 (and therefore not necessarily combatable) I focus on things in this world/universe that I find amazing and recognise there is beauty, kindness and wonders out there that prove not all is bad. It can be as little as a kind deed from another person, a small bug going about it business in nature, an dog barking, anything that makes me happy, focus on it for a moment and recognise how precious it is. Experiance the beauty of a moment.

5) How do you "force" yourself to communicate how you're feeling?

It has to get to the point where the discomfort of not communicating is greater than communicating. Finding the person you trust to communicate with and making sure they are capable of listening is the first step then gradually you ignore your fears of not being in control of your emotions or being vulnerable, look at the big picture and release more. You do it for survival.

6) How do you stop the shame that comes with being unable to control how you feel?

You accept that it's irrational to feel that shame. Depression is a real thing, it's not a weakness or a failing on your behalf, it's real and one of the impacts of depression/anxiety.

7) How do you "know" how you feel anyway?

For me, I clear my head by doing something relaxing then I write.

I also hate that I cannot resolve an issue within myself by myself. That makes me feel useless and further feeds the depression.

That one makes me shake my head, I get it but not being able to resolve the issue within yourself is not a failure, so many people go through this stuff and when it gets debilitating the answer cannot be found within as depression gives the need to resolve things but takes away the ability to think clearly about how to.

 

[tovlo]

These questions include:
1) Do suicidal and self-harming thoughts go away with medication? (They don't for me, and fighting myself and the urges is really tiring.)
2) What can I do to overcome my paralysis by analysis/worry?
3) How do you "stop worrying"? (My psychiatrist told me to 'just stop worrying', which wasn't helpful.)
4) How do you "brainwash" yourself into becoming positive?
5) How do you "force" yourself to communicate how you're feeling?
6) How do you stop the shame that comes with being unable to control how you feel?
7) How do you "know" how you feel anyway?

My psychiatrist says that I must slowly try to permanently shift my thinking away from the negativity (which I think is 'rational'), or my depression and anxiety will recur. He's described it as a form of "necessary self-brainwashing", which amuses me, but I'm trying my best because I recognise that it is my 'rational', continually negative worst-case-scenario thinking that got me into this mess.

That's the first that I've heard to challenge my anxiety... I'm really terrible to be around when I'm having severe anxiety... I just start shaking and I can hardly get words out. When people talk to me, I ignore them or snap because I'm concentrating so hard on not running away or appearing normal. That's why I try to avoid everyone when it hits. How do you make it less extreme? I'll give it a go, but usually this places so much stress on me that I'm exhausted.

If no one has ever mentioned ACT therapy (acceptance and commitment therapy), you may want to look into it. It's a form of CBT, but rather than focusing on changing your thoughts and feelings, it focuses on becoming aware of them on a meta-cognitition level. As you become aware of your thoughts and the resulting feelings/physical sensations, you begin to be able to accept their occurrence without being so completely at one with the experience. You can kind of step off to the side and observe it all--experience it and then let it pass without giving it further life. In many ways we really do create our experience, but I think we often become so habituated in creating a certain kind of experience, that we find it hard to believe any other exists. The only way to change that belief is to create a space that allows other experiences emerge and demonstrate the possibilities. It is only when we engage beyond our habitual responses, that we see these possibilities. It takes courage and expenditure of resources to make the first few steps through the fear and the habitual negative experiences that will arise at first, but eventually as new experiences emerge and insert themselves into our beliefs about reality, the experience emerging from our beliefs begins to change.

It's got to be unpleasant to be so physically aroused in social situations and experience the social discomfort of being observed in that state. It would likely reinforce the desire to avoid the experience, but experience tells me that the only way to minimize the discomfort is to willingly choose to engage it. Doing so eventually teaches you that it's not really a mortal threat. It takes a lot of energy to face it, but as the brain learns that death isn't an imminent danger, it slowly learns to turn off the fear response and allows a different possibilities of reality to form. As those new beliefs solidify and the resulting behavior choices become habituated, it begins to take less energy to engage.

I hope you find the resources to face the fear and in doing so, shine light on the possibilities the fear has so far darkened from your view.

 

[Tallulah]

Hi, nonseq! I agree with everything guesswho said. I had panic attacks several years ago, back before information about panic attacks and anxiety was everywhere. Medicine helps take the edge off, but it doesn't deal with what's causing the anxiety to begin with. I credit this book (and following the advice in it to the letter) with helping me conquer anxiety. http://www.amazon.com/Panic-Attack-...0438/ref=sr_1_1?ie=UTF8&qid=1293310648&sr=8-1 You can buy it super-cheap used. It helps you understand anxiety, what might be causing it, and how to stop the cycle. It also helps you tweak your lifestyle so that your blood sugar isn't contributing to the panic attacks and feelings of anxiety.

I do kind of think that you need to surrender in order to get better. If you're pretending like you're still in control, you're probably not ready to make the changes necessary to conquer the anxiety once and for all. You kind of have to get to that place where you'll try anything to get better. I don't know where your mindset is right now, but I know I had to reach a place of utter humility to get better. You have to give the anxiety all of your attention.

I don't have panic attacks anymore now (though I still battle depression). The book gave me so much understanding that I was able to ward off anxiety once I felt it coming on. The underlying causes take a while (sometimes a lifetime) to completely rid yourself of. But you can get over the anxiety itself.

 

[nonsequitur]

Hi! I'm back after working out a new anti-anxiety anti-depression scheme. I'm not sure if it's working yet, but I'll give a few updates when I can.

Over thinking is a bitch, can you compartmentalise? Focus on the reality of "what's the worst that can happen?" use meditation or other relaxation methods including physical exertion? What techniques have you tried in the past besides medication?

Compartmentalising is actually what got me into this mess; I compartmentalised everything that I didn't want to think about, pushing it to the back of my mind. It's when it somehow "escapes" and hits me all at once that I get my anxiety attacks. That was basically how I dealt with everything in my life for years. "Compartmentalise, don't deal with it, maybe it'll go away". Except that it doesn't. I've just started a new exercise regime! Because I'm not comfortable exercising with other people and am very much a "own time own target" type, I'm just doing biking. I haven't noticed anything much, except that my mind blanks out while I concentrate on the traffic (not getting run over) and my speed. Beyond medication and my psychiatrists' talk sessions I didn't really have anything else.

No one stops worrying, that's crazy, the idea is to have concerns but put them in perspective where they are realistic and not debilitating. Using some method of centering/grounding/relaxing so you can slow your mind down before you focus on what you are worrying about is ideal.

I guess the "slow down your mind" part is what I have problems with. By the time I realise that I'm in trouble, I'm already partially paralysed by fear.

I don't think that's necessary, being negative or "realistic" as some like to call it is different than being depressed. As an E7 even when at the lowest of my lows I was still optimistic, didn't necessarily help. I guess how much you listen to negative thoughts would have an impact but I still see it as quite different. Anyway as an E7 (and therefore not necessarily combatable) I focus on things in this world/universe that I find amazing and recognise there is beauty, kindness and wonders out there that prove not all is bad. It can be as little as a kind deed from another person, a small bug going about it business in nature, an dog barking, anything that makes me happy, focus on it for a moment and recognise how precious it is. Experiance the beauty of a moment.

Heh, as an E5w6 sp/so, my first instinct is to withdraw and analyse. I hardly notice what's going on around me, and am hardly ever "in the moment". That's why I admire E7s. It seems such a natural thing to you, but I have to consciously remind myself to be "in the moment" which is... kinda counter-intuitive and ineffective. That's why my psychiatrist was trying to "brainwash" me into adopting a positive framework, so that what I automatically observe around me would make me feel better. Kind of like making me wear rose-tinted glasses.

It has to get to the point where the discomfort of not communicating is greater than communicating. Finding the person you trust to communicate with and making sure they are capable of listening is the first step then gradually you ignore your fears of not being in control of your emotions or being vulnerable, look at the big picture and release more. You do it for survival.

I'm afraid that there will never be the point where the discomfort of not communicating is greater than that of communicating. Part of the problem is that most of the time, I don't even think that it's necessary for me to communicate anything. At the lab, my supervisor (an ENFJ who's also had problems with anxiety and depression, she's really understanding) keeps reminding me that she knows what I'm going through, and that she's not a troll and not to feel afraid to talk to her. That is something that I understand, but I really don't see the point in doing so because it just makes me feel worse about myself. It's partially that I grew up in a family where the prevailing attitude is to suck it up and move on, partially a pride issue and partially a "I hate getting emotional/losing control over anything" issue.

You accept that it's irrational to feel that shame. Depression is a real thing, it's not a weakness or a failing on your behalf, it's real and one of the impacts of depression/anxiety.

I think that's something that I only realised in the last few days. I've incorporated that into my (very INTJ) anxiety and guilt workplans.

For me, I clear my head by doing something relaxing then I write.

I still don't know how I feel when I write, unfortunately. I am able to illustrate many different perspectives and speculate on what I may be feeling, but the identification part is the big hurdle. Many times, I do "feel" many aspects at once, and that overwhelms. It's like, I can't even identify what is the "main" feeling. It's just an ambivalent mess.

That one makes me shake my head, I get it but not being able to resolve the issue within yourself is not a failure, so many people go through this stuff and when it gets debilitating the answer cannot be found within as depression gives the need to resolve things but takes away the ability to think clearly about how to.

I guess the thing is that I don't "feel" any different. I mean, I know that I'm depressed and anxious, but I still feel like "me", you know? So it feels (at least to me) like my own reasoning ability isn't impaired at all. Therefore when I fail to put into practice plans A, B and C to change myself, it feels like a willpower problem. And so my self-esteem slides further downhill and the vicious cycle continues.

If no one has ever mentioned ACT therapy (acceptance and commitment therapy), you may want to look into it. It's a form of CBT, but rather than focusing on changing your thoughts and feelings, it focuses on becoming aware of them on a meta-cognitition level. As you become aware of your thoughts and the resulting feelings/physical sensations, you begin to be able to accept their occurrence without being so completely at one with the experience. You can kind of step off to the side and observe it all--experience it and then let it pass without giving it further life. In many ways we really do create our experience, but I think we often become so habituated in creating a certain kind of experience, that we find it hard to believe any other exists. The only way to change that belief is to create a space that allows other experiences emerge and demonstrate the possibilities. It is only when we engage beyond our habitual responses, that we see these possibilities. It takes courage and expenditure of resources to make the first few steps through the fear and the habitual negative experiences that will arise at first, but eventually as new experiences emerge and insert themselves into our beliefs about reality, the experience emerging from our beliefs begins to change.

I've never heard of it, but I'll definitely check it out. Thanks! It would be awesome if I could just mentally "step away" when I felt myself getting from the "nervous" into "full blown panic" mode.

It's got to be unpleasant to be so physically aroused in social situations and experience the social discomfort of being observed in that state. It would likely reinforce the desire to avoid the experience, but experience tells me that the only way to minimize the discomfort is to willingly choose to engage it. Doing so eventually teaches you that it's not really a mortal threat. It takes a lot of energy to face it, but as the brain learns that death isn't an imminent danger, it slowly learns to turn off the fear response and allows a different possibilities of reality to form. As those new beliefs solidify and the resulting behavior choices become habituated, it begins to take less energy to engage.

I'll bear this in mind during social activities, and make more of an effort. It would be easier to just avoid everyone and go home to my "safety zone" but I guess that won't work if I want to get better.

I hope you find the resources to face the fear and in doing so, shine light on the possibilities the fear has so far darkened from your view.

Thank you very much again.

Hi, nonseq! I agree with everything guesswho said. I had panic attacks several years ago, back before information about panic attacks and anxiety was everywhere. Medicine helps take the edge off, but it doesn't deal with what's causing the anxiety to begin with. I credit this book (and following the advice in it to the letter) with helping me conquer anxiety. http://www.amazon.com/Panic-Attack-...0438/ref=sr_1_1?ie=UTF8&qid=1293310648&sr=8-1 You can buy it super-cheap used. It helps you understand anxiety, what might be causing it, and how to stop the cycle. It also helps you tweak your lifestyle so that your blood sugar isn't contributing to the panic attacks and feelings of anxiety.

Thanks Tallulah! I'll order it immediately.

I do kind of think that you need to surrender in order to get better. If you're pretending like you're still in control, you're probably not ready to make the changes necessary to conquer the anxiety once and for all. You kind of have to get to that place where you'll try anything to get better. I don't know where your mindset is right now, but I know I had to reach a place of utter humility to get better. You have to give the anxiety all of your attention.

I think I've reached the point where I acknowledge that I'm hopeless and have surrendered. The fact that I told my supervisors about the specifics of what was going on (breaking down in tears, embarrassingly) and agreed to hold a committee meeting about all of my problems is a huge step. I recognised that things wouldn't get better without everyone being behind me, and without me being open about everything. Er, my family doesn't know but that's because they don't need to know. They would slow down/reverse any recovery with their backwater views on mental illness.

I don't have panic attacks anymore now (though I still battle depression). The book gave me so much understanding that I was able to ward off anxiety once I felt it coming on. The underlying causes take a while (sometimes a lifetime) to completely rid yourself of. But you can get over the anxiety itself.

That gives me hope. I've probably had depression for a long time, but this anxiety is pretty recent (since I started grad school 2 years ago) and seems a lot more disabling.

So these are the changes that I've made in my life since I made that post:
1) Healthy eating
I've started cooking a lot of fresh food and vegetables, and eating a lot of fruit. Salads, whole fruit, that kind of thing. I've also cut down on my sugar intake and started drinking a lot of water regularly.

2) Exercise
I bought a new bike and fitted it out with stuff e.g. a computer tracker, so that I can monitor how much I'm doing. I'm starting slow, about half an hour of cycling everyday, which I will increase with time. I'm enjoying riding so far, and am hoping that I will keep enjoying it so that it will not feel like work.

3) Following a schedule
I've planned my days so that I will not panic and will know exactly what I need to do. I have also set aside time for rest/hobbies, so that I don't feel guilty about not working 24 hours a day. That used to be a big problem.

4) Following my anxiety workplan:
- Acknowledge the fear
- Acknowledge where you are in terms of what you need to do
- Take one small step NOW to rectify the problem
- Make a plan
- Enlist help
- Talk to someone
- Realise that this fear will pass
- Focus and carry out the plan

So far it's been working. I've also got a quote put up right in front of me to remind me of a few facts that are important:
"One of the most destructive aspects of depression is the way it paralyses your willpower. The self-blame and feelings of shame are not justified because of this. While you're not responsible for your depression and anxiety, you ARE responsible for your recover and MUST take active steps to deal with the problem because it won't go away on its own."

5) Following my guilt workplan:
- Stop beating yourself up about it.
- Do something. Anything.
- Make a list.
- Clear a space in your apartment or at work.
- Ask for help.
- Do something completely different for the moment/change your focus.
- Exercise
- Help someone else
- Have some fun.
- Most of all, learn to enjoy the fun bits in what you do.

So every time I start feeling stressed or worried, I go through my anxiety workplan's steps. Every time I feel down, I go through my guilt workplan's steps. It sounds very INTJ and a little bit crazy/compulsive, but I think it helps. It doesn't do much in terms of my social skills and ability to talk to people, but I think I'd be able to work on that if I had more self-confidence. I'll update in this thread as I go along and acquire more tools to make me normal . Thanks again everyone.

 

[Fidelia]

I think when you have anything bad going on, it doesn't work simply to focus on removing it. Instead it needs to be crowded out by more positive things until the negative behaviours have no place anymore. That's why what you are doing is excellent. The structure you are giving yourself will re-assure you and the good habits end up taking the place of some of the bad. It's a shift of focus.

You talked about the social anxiety issue. I can only imagine how draining it must be to feel that intensely uncomfortable all the time. One of the issues that everyone needs to deal with when interacting is learning to focus on the other person, instead of their own feelings and reactions. By looking outward, they are less self-conscious and it gives them something new to put their attention into instead. Having some generic questions ready to ask people about themselves can take the terror out of them approaching you for small talk. Instead of seeing it as an imposition or cause of terror, try shifting your focus to finding out what it is that they are interested in, who/what matters to them, or some information/expertise they have that you could benefit from. As you become more focussed on them, they will respond warmly which in turn will make you feel more connected and reduce your anxiety. Most people love being given the opportunity to talk about themselves, they are an expert on the topic, and they never run out of material! Perhaps you are already doing/have tried those things, but I found for me it made a considerable difference.

 

[Synarch]

Maybe you could trade depression for suffering. I don't think we have the language for these challenges anymore as we now live in a material world. The reason I say this is not to deny the truth of your experience. I just have come to my own conclusion that suffering is an elemental fact of existence. Depression seems to be the result of holding this fact at bay, for me. Shutting down feeling, which causes feelings of depression and deadness. Just thinking aloud. I sympathize with you. Sounds like rough going and I trust you will be feeling as you wish soon.

 

[Stanton Moore]

You need to go into the sub-basement.

 

[Synarch]

What's that mean?

 

[NewEra]

You probably have to re-condition your entire method of thinking. First off, step out of your mind and become aware of what thoughts are causing your negative feelings of anxiety and depression. Try to be as specific as possible, and really focus on the thoughts - focus on them objectively, not subjectively (so don't take any feeling out of the thoughts). Practice this daily, and train your brain to not have these negative feelings.

Also, do meditation - it is really helpful.

 

[Stanton Moore]

There are things you haven't addressed. Things from long ago.
Life is like an arrow. Any change at the the bow will effect the trajectory dramatically.
So how was the trajectory effected? To be clear: what events/conditions/circumstances have lead to this emotional state?
The mind thinks, but the body feels. So figure out what you feel first. That tells you how the arrow flew to this point.
Then thinking will have a purpose.