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Too much anxiety, therapy isn't working, help?
May 15, 2012 1:11 PM   Subscribe

My anxiety is running my life. I've been to therapy, it made it worse. What next?

Basic problem: I have really high anxiety mostly related to my work performance, I live in fear of public failure, I have high expectations for myself, and I can't be proud of much about my work since objectively I have achieved less than some of my superstar friends/peers and I feel I'm underperforming even relative to my own capability.

I have a tendency to quit things that make me feel bad rather than stick them out, so I can have down time to feel calm again, even if I know I shouldn't quit for some good reason. I think a work project is going poorly because I'm getting stuck and making mistakes, so I ignore it until my boss demands to see progress, even if I liked the project for its own sake at the start. I am terrified that my career is going to stall or even worse that I will get fired, that I'm not good enough to stay in my field and I'll need to find a whole new less ambitious line of work, but that will be "settling" and will also make me miserable. I am a decent cook but constantly feeling guilty about how much I eat out because I'm stressed and busy and just want someone else to worry about the food preparation. Same with exercise; I bike and jog short distances inconsistently but its not enough and I feel bad occasionally that I'm still unfit, and I know exercise would help. I should probably be more proactive about socializing even though I have a bigger social network now than I ever have. But the main goal is to improve enough so I don't risk my job at this point.

So I need therapy, obviously. I went for several sessions. I said that the main problem was that my work was suffering because I couldn't manage my time, I was constantly stressed, not having many good days where I felt calm and mentally sharp, which I really need to do my kind of work, which is intellectually taxing. She said I was just secretly telling myself I sucked and that deep down I think I'm a terrible person all the time, and that I had to stop that (I don't think that was true, but okay, she's the therapist). Then we talked about my social life, and she thinks I am too cold or introverted. I guess this is true, that I am slow to establish intimacy with people, but I think I'm well liked in general but I never want to push closeness on someone who doesn't indicate they want it, so I have quite a few friends I have fun with, none of whom are best friends or people I regularly tap for support. She focused on this problem, and the work stuff was getting ignored in sessions. This made me feel like even more of a failure than when I started therapy, so I quit (see problem with quitting previously mentioned). Apparently I misled her or something, or I was doing therapy "wrong." I feel like most of my worries are totally rational and normal but I just can't set them aside long enough to be super productive, and that's what I want to be able to do.

Questions-
1) I am putting my career at risk if I don't fix the work performance anxiety eventually. I am smart, I don't suck at my work, on a good day I find it interesting, but I'm not a superstar. My boss just says I need to work harder and be more passionate/committed. That's not helping. We have a plan for some concrete things to fix but if I can't turn around the anxiety, the plan won't work. That means I have a few months to get this under control and find some calm source of inner motivation or I will probably end up fired, broke, and in an even deeper hole. Are there any stopgap measures I can implement RIGHT NOW that will help me avoid this outcome?

2) I probably need to go back to therapy but I don't know how to do therapy right, apparently. I'm not even sure it will help because I'm just realizing how bad the anxiety is and how much it feels like just part of who I've always been, and it's not always at some crazy dysfunctional level, I'm just bad at managing/ignoring it even when it's mild. How do I do better with the next therapist? I won't have much choice for the next therapist, I will get one pretty much at random, and there are only a few available to me that are covered by my insurance.

3) Is there ANYTHING else I can do to get some traction other than trying my best to make therapy work on the second round? First therapist said drugs won't help me, but do I need to demand to try benzos for the short term until this is under control?
posted by anonymous to Human Relations (21 answers total) 32 users marked this as a favorite
 
Have you been to a medical doctor about this? I take Celexa for anxiety and it's really great.

Therapy and drugs are both things that need some trial and error to get right. So your first therepist wasn't a good match, find another who is.

Definitely talk to your doc about drugs, they may not be for you, but then again, they might, so give it a try.

Re: Question 1, you are catastrophizing. You won't get fired. You may not get a raise or promotion, but as long as you're coming in and doing your job, you won't get fired.
posted by Ruthless Bunny at 1:16 PM on May 15, 2012 [3 favorites]


First therapist said drugs won't help me, but do I need to demand to try benzos for the short term until this is under control?

I'd see an actual psychiatrist; a therapist probably can't prescribe anything anyway. Long-term, benzos are not a good solution for some people because of the possibility of dependence, but in my experience they have been very helpful in the short term. Anxiety is a physical thing, and you can learn to reduce it by controlling the physical symptoms, but you may need a shortcut until you can learn to do that. If you do not have a history of abusing alcohol or other drugs, I would consider asking for medication.

Also find another therapist and be assertive with him or her. "I'm not here to talk about my social life, my immediate problem is work performance."
posted by desjardins at 1:20 PM on May 15, 2012 [2 favorites]


Wow, yes, this is all part of the anxiety. I don't know why your first therapist said meds wouldn't help you, but you should give them a try. Not necessarily benzos - go to your GP and ask for an appropriate prescription (if they feel confident prescribing something) or a referral to psychiatrist who will be specifically for prescriptions and trying different things.

You should also find a different therapist. Your problems all sound inter-related around anxiety, and a good therapist will work on them with you (you can't do it "wrong" unless they let you, or you quit). This can (and probably should) take a long time and cover not just your work life. You can also look into CBT for the short-term work-related stuff, too - a lot of people find it helpful.

Lastly, the same things that mefites push for depression help with anxiety: exercise, nature, meditation, yoga. They could help some in the short term and long. But don't rely on one thing - definitely pursue meds and therapy along with these other options.

Trust me, life is So Much more fun when you, and not your anxiety, run it.
posted by ldthomps at 1:22 PM on May 15, 2012


Wait, why don't you get choice over your therapist? Why is it random? (If there really is a reason why it's random, you can let us know by asking the mods to post your response).

For now I'm going to assume it isn't actually random, and that's you being overwhelmed (a valid way to feel given the circumstances!)

I think you have some control here- you have a few names (those covered by your insurance). Either do the legwork of meeting with each one yourself and see if there's a fit, or find out more about them (what style of therapy they practice, how they feel about your wish to focus on just the work issue, their approach to medications) first. I'd expect you can do this by phoning the office ahead of time.
posted by nat at 1:24 PM on May 15, 2012


It sounds like you need a new therapist, stat, because you are not experiencing any success with your current one. I'd also strongly advise you to see a psychiatrist and not just a therapist because they really know whether you would benefit from pharmacological intervention (meds) or not. It's okay to not click with a therapist and it's okay to find another one. As a person with GAD and PTSD, it took me a while to find just the right person to help me. My own therapy now consists of monthly sessions, meds at night to help me sleep and turn my brain off (a good night's sleep has helped enormously), xanax as needed for triggering anxiety events, and phone appointments as needed. Your first priority should be finding a doctor (not necessarily a therapist) who meets your needs as a patient and helps you move towards your goals. Your current therapist isn't, it's time to move on.

When you seek out a new therapist, you need to be upfront about your needs as a patient right away, at your first session. You need to say concrete things like, "I have performance anxiety at work and it makes me unproductive. I need to be able to function at my job." "My anxiety is generalized but in the short-term I need your help to focus on the job-related performance anxiety that I have so that I can get into a good rhythm to address the underlying problems without fear of losing my job."

Short-term drugs might help you. They helped me. YMMV. I also found that in the short-term, getting good sleep was a huge help. Hang in there.
posted by juniperesque at 1:29 PM on May 15, 2012


You are allowed to interview the therapists on your list. You don't have to walk in blind and immediately engage.

Go to a GP and get a physical with bloodwork, thyroid panel and all. You can discuss meds at that time, as a starting point, or get a referral to a psychiatrist. Non-MD therapists cannot prescribe, and some are not interested in discussing medication and others are interested but won't discuss because they can't prescribe and want you to see someone who is educated in that area.
posted by Lyn Never at 1:30 PM on May 15, 2012


I have been in your boat before, trust me. I was on an anxiety med for a while (Lexapro), but the side effects were killer so I had to quit.

Daily exercise is essential, preferably in the morning. I know it's hard, but you have to make it a habit - Try to find a form of exercise that you can look forward to each day. Eating well is important too - Also, take a good multivitamin with B-complex.

Making a list of what you will do the next day and at what time is helpful as well. Try to stick to that schedule, but don't beat yourself up if you miss a day.

I know, I know: It's easy to say these things but hard to put them into practice when anxiety is messing with you. This site helped me a lot with this problem: http://www.succeedsocially.com/

Go through the site, and pick out the articles which are relevant to your problem (or heck, read them all! That's what I did).

The site deals mainly with SAD (social anxiety disorder), which seems to be what you are experiencing.

PS. I recommend discussing CBT (Cognitive Behavioral Therapy) with your therapist. It is quite helpful in defeating anxious thoughts.
posted by Kamelot123 at 1:32 PM on May 15, 2012


I apologize if any of this is projecting, since this is me to a tee.
Here are things that have helped me...

Work:
"Time-boxed" work. Spending ten minutes (or whatever) working hard, and then taking as long as I need off. Playing music that makes me feel motivated.

Exercise:
Defining a sustainable (i.e., just barely above complete slacking) work out plan, and telling myself I'm not allowed to do more than that. If I don't do this, I get in a weird feedback loop where I keep setting the bar higher until the routine is not maintainable.

Therapy:
It is ok to have trouble with an individual therapist. If you think this can eventually be helpful, then by all means try again and identify your priorities in the first session with someone new. I have found that the most helpful exercise for my anxiety demons is writing down exactly what is giving me the pit-of-the-stomach despair feeling, and then figuring out what my options are for that exact moment, and then doing one of those things right then. About 90% of the time the best option is for me to go the fuck to sleep because it is 2AM.

General:
Give yourself permission to only focus on being successful or improving one thing at a time. If work is sucking your life away, then you of course get to order take out. You don't have to fix everything all at once; you only have to do one practical thing at a time to be making progress. Sometimes this one thing is just taking a break, and sometimes it is doing your work, etc.

Asinine mantra: how do you eat an elephant

Hope you feel better
posted by skrozidile at 1:33 PM on May 15, 2012 [4 favorites]


If you do go the medical route there is a lot of room between taking nothing and taking Benzos.I would suggest going to a GP and discussing your options with them.

The most important thing with therapy is fit with the therapist and that is time and luck. You should keep pursuing it - you're not doing it wrong. It probably won't be an instant fix though which is why it makes sense to look into medical options to help you cope with your job in the short term.
posted by Laura_J at 1:34 PM on May 15, 2012


Hmm.

It sounds like your therapist was exploring the possibility that your work anxiety stems from the way you see yourself, which is also reflected in your social life. That doesn't mean this is the right therapist for you -- it should be somebody you're comfortable with -- but I also don't necessarily think the therapist was doing anything wrong. Therapists aren't ... like auto mechanics. You can't always say "here's what's broken; stick to that, please" and have them only touch the things you see a problem with, you know? I mean, you always have the right to direct that you won't discuss anything other than work, but I think that could hold you back. The fact that your anxiety manifests at work doesn't necessarily mean it's entirely about work. You also talk about cooking, exercise, non-work stuff. That's all coming from somewhere, and some therapists (like the one you had) tend to try to figure out where it's coming from.

I guess I'm saying only this: Absolutely, find a therapist you like and feel comfortable with. But therapy isn't necessarily supposed to be confined to the questions you originally asked in the way that you originally asked them, and the fact that it exhausts you or frustrates you or it doesn't work out with this therapist doesn't mean you're doing anything wrong or that it isn't working. I think if you're looking for coping strategies, you need to make sure you look for a therapist who focuses on coping strategies -- you seem to have had one who was focused on trying to identify and address root causes, which is fine, but different.

Wanting a different therapist doesn't make you, or therapy, or the therapist, a failure. It's about fit, I think. I think for anxious people, therapy can be really hard, because exploring root causes is upsetting, which in the short term just causes more anxiety. Keep at it; you're doing good things.
posted by Linda_Holmes at 1:38 PM on May 15, 2012 [2 favorites]


Whoa! Your anxiety reads loud and clear and it's taking you all over the map!

"I feel like most of my worries are totally rational and normal but I just can't set them aside long enough to be super productive, and that's what I want to be able to do."

Anxiety problems make it really hard to be a good judge of what is rational and normal worry. Sort of a cliche but: if it feels like anxiety, it's probably anxiety. Don't let the issues at hand disappear into a snowball of human failure. Your question hits about every topic that a person could possibly fail at: work, cooking, socializing, relationships, even fitness...dear god! Please see that all over these myriad "failures" are really about one thing: your anxiety.

I'd also recommend you read a bit about perfectionism. Others above have covered the therapy and medication angles. Before you can get to the therapist, there are also lots of great books on dealing with anxiety that have been recommended time and again on here. Good luck.
posted by Katine at 1:46 PM on May 15, 2012 [2 favorites]


Um, when was the last time you had a full blood work-up?

I ask because a whole host of physical ailments (thyroid issues, vitamin deficiencies including anemia) WILL cause emotional and physical anxiety. No amount of therapy, benzos or celexa or the like will help if the underlying cause is, say, simple iron deficiency.

Ditto if you take hormonal birth control, and that is the root of what is effecting you adversely.



(I look back on my 20's when I took bc AND was frequently denied the opportunity to donate blood at blood drives because I was slightly anemic... I sorta wonder how life would felt day-to-day if I had just taken a few extra supplements and dropped hormonal bc or switched brands, or whatever... But I'm here now to tell you that you should look at these common-yet-often-ignored contributing factors to anxiety, in the hopes checking that into these issues might shorten your path to serenity!)
posted by jbenben at 2:11 PM on May 15, 2012


Just putting it out there that while you aren't doing therapy wrong, there is absolutely the problem of having a therapist who's wrong for you. I've suffered from depression quite literally my entire adult life (I was diagnosed with MDD at 18) and even before that, blended family problems meant family therapy. I have absolutely had therapists who made it worse. Perhaps my experiences aren't typical as I've found more therapists who were counter-productive and made me feel worse than those who made me feel better.

The one therapist I had who did indeed make me feel better was amazing. I would have happily paid her in gold. Most therapists I've been to had the first appointment as a sort of "trial session" and if you didn't really feel like it was going to work out for you, there was no pressure to book a second appointment. Start with the list your insurance gives you and go into the first appointment with the goal of meeting someone you can work with. After that, make sure your priorities are being addressed. Of course part of a therapist's job is to poke at the root of the problem and take you out of your comfort zone, but this should be done in a way that feels productive, not in a way that makes you feel worse.

Also nthing the suggestion to see your primary care doctor and talk about your options from a medical standpoint. There is indeed a huge range of things you can do to lessen anxiety other than just taking benzos. In any case, having a temporary prescription might help calm you down a notch while you find a therapist you can work with.
posted by sonika at 2:17 PM on May 15, 2012


I have a tendency to quit things that make me feel bad rather than stick them out, so I can have down time to feel calm again, even if I know I shouldn't quit for some good reason.

You're allowed to quit something because it's making you physically ill. You're allowed to take time out to recover and work out a new plan. Or to develop a plan now to change from what you're doing to something else. None of this means you're a failure.

I keep having conversations with people who are having breakdowns all the time because they won't quit their job that's making them sick and find a new one. Umm, hey, you have one life here. And you won't quit because it will make you look like a quitter? So you're prepared to keep making yourself sick because other people might look down on you - umm...

I'm not saying you should quit, I'm just saying that evaluating why you're holding onto things is an important part of getting better - are you doing whatever you're doing for you? If you don't really want it, is there something else you really want to be doing?

I think a work project is going poorly because I'm getting stuck and making mistakes, so I ignore it until my boss demands to see progress, even if I liked the project for its own sake at the start.

If you do see a therapist - mention to them that you're a perfectionist who procrastinates and avoids things. This is extremely common.

I am terrified that my career is going to stall or even worse that I will get fired, that I'm not good enough to stay in my field and I'll need to find a whole new less ambitious line of work, but that will be "settling" and will also make me miserable.

If any of that happens, none of it will be the end of the world.

I am a decent cook but constantly feeling guilty about how much I eat out because I'm stressed and busy and just want someone else to worry about the food preparation. Same with exercise; I bike and jog short distances inconsistently but its not enough and I feel bad occasionally that I'm still unfit, and I know exercise would help.

You have to eat out because you don't have time and you're stressed. You don't have time to exercise more (and stress generally makes people not want to work out). So, you're dealing with a situational problem, not a deep, personal failing.

So I need therapy, obviously.

Not necessarily - it doesn't work for everyone.

This made me feel like even more of a failure than when I started therapy, so I quit (see problem with quitting previously mentioned).

You're allowed to quit therapy if it isn't working for you. I quit a therapist who did CBT because I found it too rigid - my problem didn't really fit with the exercises she wanted me to do.

Apparently I misled her or something, or I was doing therapy "wrong."

Nope, you can't do therapy wrong. You didn't mislead her. You weren't doing therapy wrong. It was a poor match between therapist and client. It just didn't work for you.

I feel like most of my worries are totally rational and normal but I just can't set them aside long enough to be super productive, and that's what I want to be able to do.

Yep they are. It's just that the anxiety has made them super big and all of your energy is spent fighting things that your anxiety has created for you (that bastard!).

Things you can do without a therapist - externalise your problem (anxiety) by depersonalising it. It's this thing that has set up shop inside you, it's not paying rent, you have to evict it. It's not really a part of you, you didn't create it or make it, it's just this thing you have to kick out. All of this is just about self talk. Swear at it, mentally beat the crap out of it (this is what your anxiety is doing to you, you know).

Benzos I wouldn't really recommend because they will make you feel good but they're a short term thing and they don't really reconfigure anything and they're highly addictive.

If exercise is a problem for you at the moment (it sounds like it is) don't beat yourself up about not doing it. Don't feed the beast here.

Yoga helps, meditations helps, walking in nature helps (anything to do with nature helps - water in particular). Changing your self talk is key. If the therapist is unhelpful - you don't feel like this is the best possible way to spend your time, then you shouldn't go.

Look at your life and see what you're happy with and what you're not happy with (outside of the anxiety) - what do you need to actively change?
posted by mleigh at 2:36 PM on May 15, 2012 [2 favorites]


Hey anon, I've been in your position for a couple of years now (the work anxiety part) and I had to double check that I didn't write this question. I haven't found a solution for this yet but here are a couple of stop gap arrangements:

1) Ask your PCP to write you a prescription for xanax. Take one if you have a panic attack (I usually take half a dose and it works well and doesn't put me to sleep). Very useful to have in person.

2) Pick the exercise that's most accessible to you and just set a goal to do it every day for 30 days. Don't worry about what comes after that.

Feel free to memail me if you want to talk more about this.
posted by special-k at 3:22 PM on May 15, 2012


oh and

3) Meditate daily. If possible the last thing before you go to bed and the first thing after you wake up. I've tried many guided meditations but have found Andrew Johnson's recordings very helpful.
posted by special-k at 3:23 PM on May 15, 2012 [3 favorites]


Finding a new therapist and maybe some meds will help you, but I am also going to suggest another point of view about your anxiety. It seems to me that you are afraid of underperforming, underachieving in every respect, from work (the biggie) to not even exercising enough. I think the root of the problem is you are afraid of a uniquely American fear—being a Loser and failing. Of course, you are not, but there is an underlying premise here of you not measuring up to your superstar peers and keeping up with the culture of believing that Achievements = Success = Self Worth = Happiness.

I disagree with the therapist that said that deep down you were telling yourself you sucked. In fact, I believe you believe the opposite about yourself, that you know you are smart, capable, and all around a pretty cool person. The disconnect and reason you may be feeling so much anxiety here is that you feel the need to prove it, as if Just Being You Is Good Enough (to society) is separate from the You That Needs To Prove Yourself Worthy To Others (even though you know you don’t suck). Are you a perfectionist by any chance? You sound like you are. Remind yourself that one view of success is about persistence, not about perfection, in which failing at things is not only okay, but encouraged. Really. Mind the J.K. Rowling quote, “It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all - in which case, you fail by default.” Pick a high percentage, say 80-90% (or higher if you must), and remind yourself that if you get that much completed in a specific project/task, then it’s already a success (this doesn’t work well for non-perfectionists). Because that way you feel more relaxed and you’re not going to sabotage yourself into an all-or-nothing mode of thinking, because, the All Mode is not realistic, and it’s better to do something while at work 90% than ignore it out of fear and not doing it all. Look up all those quotes about Failure and Persistence as being both integral to Success. Then with your next therapist examine why you constantly compare yourself to your superstar friends instead of following your own path and doing what is right for you.
posted by Gmbee at 4:05 PM on May 15, 2012 [1 favorite]


You need a new therapist. There are sucky therapists, just like there are sucky doctors, lawyers, mechanics, whatever. I have mega-anxiety and have had some great therapists (and a few not so great ones). Please keep trying.
posted by radioamy at 6:54 PM on May 15, 2012


As well as thinking about what anxiety-reducing drugs you might like to try, have you given any thought to what anxiety-producing drugs you might like to try cutting back on?

Caffeine is a big one. I know several people who function perfectly well until about a week after they've started drinking coffee again, at which point the catastrophizing and awfulizing come back in full force.

Making exercise happen more regularly will definitely help as well. What's your time budget for commuting? Is there a way you could build some cycling and/or walking into that? Consistently inserting a little light aerobic exercise between waking and working works really well for lots of people.
posted by flabdablet at 9:18 PM on May 15, 2012


Definitely get some sort of anti-anxiety drug from a doc or psych, and then start therapy again, but in the meantime please get this book and work through it. It was recommended to me by a psychiatrist and helped me a great deal. I think it would help you, too.
posted by hazyjane at 10:30 PM on May 15, 2012 [2 favorites]


I have had serious problems with generalized anxiety disorder over the years, and at one point or another I could have personally written large segments of your post exactly. I highly, highly recommend trying a regular yoga practice. It can change your life.
posted by corn_bread at 9:36 AM on May 16, 2012


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