For years, I thought I had a pretty good handle on my anxiety disorder. Although I had been diagnosed with Post Traumatic Stress Disorder (PTSD) and panic disorder in my early 20s, a combination of therapy and antidepressants kept the worst of my symptoms at bay. When some underlying panic bubbled up to the surface, I relied on a few tried-and-true coping methods to make myself feel better, and largely, they worked. I took long, hot showers. I snuggled up under my comforter and napped. If I was really struggling, I took half a Xanax and calmed right down.
But in 2017, when I was 30, something happened that blew everything out of the water. After noticing small amounts of blood in my urine, I went to my urologist thinking I had the beginnings of a kidney stone or an easily-treatable UTI. The source of the bleeding turned out to be four tumors on the wall of my bladder—cancer. They were high-grade tumors too, meaning they grow quickly and are more likely to metastasize.
Luckily, the treatment for my bladder cancer was pretty tame—just a quick, four-hour surgery and chemo applied directly to my bladder, and I've happily been in remission ever since. Still, in the days after my diagnosis, anxiety swallowed me whole. I couldn't think about my impending surgery or treatment without feeling like I was going to collapse. Even after the surgery (a success!) and the post-op checkup (all clear!), I couldn't hear the word “cancer” without thinking immediately about dying and leaving my kids, who were then four and five, orphaned. To combat this, my showers got hotter. I slept for hours. I upped my Xanax dosage to three times the usual amount. Nothing helped. The anxiety was constant, choking.
Finally, one night, I broke. While my husband stayed with the kids, my mom drove me to the emergency room. I felt like I was going to claw off my own skin if I had to endure this panic for one more hour. In triage, I sobbed my story out to the nurses: The cancer, I could survive. But the nauseating, smothering, never-ending terror? If I couldn't find a way out of it soon, I would have to kill myself.
With the help of some Ativan, a friendly nurse, and a competent psychiatrist, I managed to pull myself together. I didn't want to die—not really—I just wanted the panic to stop. With their help, I left the hospital that night and found an outpatient program, one that would teach me “mindfulness-based” coping skills to manage my anxiety.
I was willing to try anything at that point, but mindfulness therapy—defined as the self-regulation of attention with an attitude of curiosity, openness, and acceptance—had me deeply skeptical. How was meditation supposed to wick away years of repressed panic when even Xanax and antidepressants couldn't fully contain it? Unbeknownst to me at the time, however, mindfulness has actually been shown to be hugely helpful for patients with a wide range of anxiety disorders. In one NIH-sponsored clinical trial published in 2017, researchers found that patients with generalized anxiety disorder (GAD) who took an eight-week, mindfulness-based stress reduction program had a significant drop in stress-related hormones and inflammatory response at the end of the trial. Even more impressive, a different study from 2018 showed that patients could reduce their anxiety symptoms significantly after just a single hour-long meditation session.
In anxiety group, on our first day, we sat in stiff plastic chairs in a wide circle and shared our hopes for the program. When it was my turn, I shrugged. “I guess...I guess I just don't want to have anxiety anymore?” I said.
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The counselor's reaction surprised me. Chuckling, she shook her head. “So, you want us to perform a miracle, then?” she asked.
I was confused. A miracle? Sure, I guess I expected a miracle—in the same way that when I went to the doctor's office for an ear infection they prescribed me a “miraculous” combination of drugs that got rid of my infection. Isn't that just how treatment worked? But mindfulness, I learned, was a profoundly different approach. The counselor explained patiently that using mindfulness methods like awareness, meditation and breathing, we could change our relationship with anxiety, rather than trying to banish it completely.
That was not the answer I wanted to hear. Immediately, I thought of that scene in the movie The Breakup where Jennifer Aniston and Vince Vaughn are fighting about cleaning up after a party. “I want you to want to do the dishes,” she snaps, and he explodes back at her, “Why would I want to do the dishes?!” That's exactly how I felt. Why would I want to coexist with my anxiety? Why couldn't I just get rid of it forever, like any other kind of medical problem?
Most patients who go in for anxiety treatment have similar complaints, says Andrea Quinn, interim director at the Center for Psychological Studies at Rutgers University. “It can be a hard sell and it's not an easy treatment,” she tells me. “Clients come in and they think the anxiety will just go away. We have to say to them, no, the treatment we want you to do involves decreasing your avoidance of the thing you're terrified of and experiencing that anxiety. People are generally not sold.”
Like most others who go into outpatient treatment, what I had been doing up until that point was trying to escape the anxiety, wrestling it back or ignoring it, rather than actually coping with it as it came. My tried-and-true coping methods, I learned, were actually just avoidance behaviors—something that relieves anxiety in the moment but makes it much worse in the long term. “What ends up happening is that clients feel anxiety is something dangerous or intolerable, and they can't survive it without those coping strategies they've developed,” Quinn says. “However, as they face more challenging situations, the anxiety becomes too interfering for them. Eventually, the avoidance behaviors are no longer effective, and that's the point where people come in for treatment.”
So why, then, is mindfulness therapy so effective? “What we notice is that when clients observe how they feel and where their anxiety is centered in their body, what the experience of anxiety is like, it dissipates on its own,” she says. “The goal isn't to eliminate anxiety—it's to help the client feel anxiety in a way that's not as overwhelming to them.”
So, I started learning how. Each morning in class we tried a new mindfulness exercise so we could practice observing our thoughts and physical feelings non-judgmentally. It was surprisingly hard. After our first exercise, where the class was supposed to imagine our thoughts drifting in and out of our minds like leaves on a stream—I was so overwhelmed by anxious thoughts that I had tears running down my cheeks. Despite the discomfort, we kept practicing, learning to look at our anxiety like curious observers. Where in your body is your anxiety located? The counselors would ask us, does it have a color? A shape? What would you rate it, on a scale from one to ten? Eventually, the thoughts and feelings that once sent me over the edge started to become familiar—even boring.
The more I allowed myself to really feel my anxiety, the less it eventually bothered me. Over the course of treatment, anxiety became just a weird, uncomfortable thing my brain and body would do from time to time, something I could fixate on and try to control, or something I could just ride out with the understanding it would eventually pass. The more I rode it out and focused on being mindful in the present moment, the quicker it passed—and, curiously, the less it came up in the first place.
When I left outpatient therapy for my anxiety six weeks later, I had something I never expected I would have in a million years: coping skills for anxiety. Real ones, this time. An actual miracle.
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