I don't know why we do things that don't help us get better. For me that means 13 years of psychodynamic therapy with little to no effect on my anxiety disorder. Part of the reason I stayed so long in the psychodynamic therapy game was that I was afraid of breaking up with therapists. I just didn't like having "the conversation." One time I moved 3000 miles away to break up with a therapist. Occasionally, I would leave one therapist for another therapist, the way some people get out of troubled relationships by "trapezing" onto a new partner. But on the whole, my propensity for people-pleasing and fear of conflict (traits characteristic for many of us with anxiety disorders) kept me in ineffectual therapist relationships for far too long.
I also think my inability to tell the whole truth contributed to my lack of progress. I often distracted from the problem at hand—the place where I needed help the most prominently—because it was too terrifying to go there. It was easier to talk around the problem, to woo a therapist with my sense of humor and self-knowledge. I felt less vulnerable pursuing an intellectual understanding of my family history than saying, "Right now, I feel like I'm dying." If I said it out loud it made it more real. I didn't want to hurt my therapist's feelings or make them think there was something extra fucked up with me. Wasn't therapy supposed to be my "safe space"? Why was I having a panic attack there?
So we continued to talk about my childhood, my history, my mother. Self-knowledge isn't totally fruitless. It's probably good to know the initial sources of your anxiety, but it doesn't really help you in the clutch. Then, during the great meds transition of Spring 2015, a hell that I chronicled here, I became desperate enough to seek a different kind of help. Actually, my psychiatrist was basically like, "Yo, you need to stop with the psychodynamic therapy and get into cognitive behavioral ASAP." When the pupil is dying 20 times a day, the teacher appears.
I've been doing a mindfulness-based form of CBT called Acceptance and Commitment therapy now for about five months and it's the best thing I've ever done for my anxiety. Where the psychodynamic therapy I did for years attempted to get at why I felt or behaved a certain way, CBT and its offshoots seek to eliminate suffering in the now as quickly as possible by training the mind to recognize its own dysfunctional thought patterns.
Part of what has made this therapy so effective for me is that it dwells in the present and in action. It's practical and tangible. When left to my own devices I don't live in reality. I'm drawn to fantasy and catastrophic thinking. So I need my therapy to be super grounded in the present: no rebirthing, no Jungian dream analysis. Also, it's more difficult to bullshit when you're focused on the present. When I came to this therapist I was in such a place of desperation that I couldn't afford to not be vulnerable. Whenever I found myself putting on an act for my therapist, I was just like, Why am I even here then?So I didn't bullshit either of us.
I want to share two of the most helpful tools I've learned over the past few months for readers of this column who are uninsured and can't afford to pay for therapy out of pocket, or for those who just feel kind of like whatevs toward therapy.
The first thing that has really helped me is to examine the difference between the sensation, or feeling, I am experiencing and the meaning I give the feeling. This means that sometimes, when I am on the precipice of a panic attack, I will literally get out a piece of paper and divide it in two. On the left side I will write down the sensations: rapid heartbeat, shortness of breath, tightness in chest, choking feeling, blurred vision, butterflies in stomach, dizziness. On the other side of the page I will write down the meaning I give these sensations—the thoughts that I ascribe to them.
As an example, here are some thoughts that I regularly experience at the onset and during a panic attack: Oh no. Something's wrong. I'm dying. How will I ever hold it together professionally? What's wrong with me? How will I speak? How am I going to stay here? I'm going to have to leave. How will I stand up? People are going to know or judge me. Why am I having a panic attack with someone I love? My time with this friend or loved one will be ruined. I'm going to be like this forever. I'm different than everyone. This is going to last forever. Why do I feel so weird? This is the breakdown. All is not OK. I'm going to be consumed.
When I separate my feelings and thoughts out like this, in different columns, I'm able to sort of slow down the "doom cycle." Sometimes, on a good day, I can even find a reasonable attribution for the sensations. To me, it always seems reasonable that I could be dying. But sometimes I find a more obvious reason. Maybe anyone would be nervous in the situation I'm in. Or maybe it's the first time I've let myself slow down all day to feel anything. Maybe it's feelings from three hours ago.
Obviously, there are some situations (a work meeting, a class at school) where it doesn't seem weird to take out a piece of paper and write. You just look like you are taking notes. But for situations where it would be kind of "weird" to begin "journaling" in the middle of the event (dinner with a friend, during sex), I have another good tool.
I've started to assess my emotions and give them a number on a scale of 1-10. As a lifelong avoider of feelings, I can't always describe exactly what I am experiencing—but I can always tell if it's a 3 (mild discomfort) or if it's a 10 (definitely dying).
Recently I put the number system into play while having lunch with a professional acquaintance who was visiting my city. For normal people, this doesn't sound like a huge deal, but I'm not normal people. We were just finishing our food and I was about to drive her to her hotel, when suddenly, I was hit with a weird-ass feeling, like a wave of existential sadness. What freaked me out the most was there was really no reason I should be experiencing this feeling. What was this sadness? Was I going to cry in front of this person? How would I hold it together enough to drive her to her hotel?
The thing is, the sadness itself wasn't totally unmanageable. If I were to give it a number, I'd say it was about a 4. You can drive on a 4. You can continue living. But my fear around the sadness, the thoughts that catapulted it into high anxiety, ratcheted me up to about an 8 or 9. 8 and 9 are far less doable than a 4. So what I discovered was that it was actually my reaction to the feeling, and not the feeling itself, that made me feel like I was dying. This thought somehow brought me back down to about a 5. I suffered some, but not as badly as I have in the past.
I don't know if I'll ever be "cured" of my anxiety disorder and the depression that underlies it. I was born a sensitive and imaginative person. To cure my anxiety entirely, I would probably need to be cured of myself. But these tools, and others I'm learning, make me feel less doomed when I am in a bad cycle.
I also just like the idea of experimenting with tools. The notion that a panic attack or experience of anxiety can be a time to practice, and is not something that must be solved now, is a big relief. Often I make the situation worse with my urgency—the thought that I must get better today, or else. But experimenting with various tools takes the pressure off my meds to be at the elusive "perfect level" and lessens my need to always feel like everything is OK.
Perhaps because I've struggled so much in this area, I sort of just assumed that successful people, or "normal people," don't feel fear. Like, if I feel fear then I have no chance at being OK, as though fear is a flaw or something that can be smelled on me. The truth is, I still don't particularly want to be courageous. Like, if it were up to me I would not have these issues that force me to be courageous. But when I can approach the doom itself with a looser grip, I feel like less of a freak among people and more like a sort-of OK person.
If you are concerned about your mental health or that of someone you know, visit the Mental Health America website.
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