Any tips/methods for breaking out of negative thought spirals?
October 16, 2014 9:07 AM   Subscribe

I have some pretty serious anxiety issues and depression. These have been tremendously exacerbated by some rather overwhelming recent events. I'm seeing professionals for help, but I am getting stuck, for many hours a day, on these thought loops where I imagine in vivid detail the worst case scenario for whatever is bothering me. If I don't have anything to latch onto at the moment, I just feel constant general physical anxiousness. Are there any methods that have worked for you to break out of a similar cycle/pattern? Not looking for medical advice, but for anecdotal advice.

I was recently prescribed an SSRI for the anxiety and depression but it's only been a couple weeks and has not started to help yet. There's some stuff going on in my life right now with my partner that I am focusing on, to the point where I work myself into a panic, obsessively researching medication side effects and horror stories online, and such, and I can't seem to control myself. Even if this wasn't happening my anxiety would latch onto something else though, even something trivial.

I am not in a great place mentally, though I am not suicidal, I do often fantasize about having/wish for a stroke or heart attack, or an aneurysm or something. My therapist even says I am too negative for him to help me unless I can pull myself out of it a bit. I have tried meditating, but have extreme ADHD and it's not that meditation is hard, it's practically impossible for me. My partner and I have also been exercising at the gym a few times a week, but he doesn't feel like going sometimes and I am afraid of people, for the most part, and won't go alone (this doesn't really seem to help my mood anyway).

What I would like are any additional tips or methods or suggestion I can use to keep myself from spending the whole day dwelling on every negative thing that could happen, in horrific movie-like detail. I try to distract myself but with little success. For the most part I am stuck at work all day, alone, and we have no assignments to work on at the moment, so I feel like I'm compulsively drawn to reading and thinking about this stuff.
posted by polywomp to Health & Fitness (21 answers total) 36 users marked this as a favorite
First off, don't let what your therapist said discourage you-- just because you are outside the abilities of that therapist, doesn't mean you are beyond help.

Continue attempting to meditate- nobody is automatically good at it, it is called a meditation practice because *you have to practice*. If you can even take five breaths in a row as part of a meditation practice, you can start meditating.

Exercise is critical, but don't feel like you have to go to a gym. Go on walks- long walks, short walks, it doesn't matter. But move your body around.

Last, I don't know if you're OK with self-help reading, but basically Pema Chodron's entire catalog was and is *extremely helpful* to me. I'd recommend any of them, but "Comfortable with Uncertainty" is one of my favorites.

Also look into a loving-kindness practice. Sharon Salzberg's "The revolutionary art of happiness" is amazing and turned my entire mood around.

I understand that sometimes this kind of reading material can seem a little woo-woo, but I think those two authors are solidly within the realm of real solutions for real people.

The #1 most important thing is you have to believe that you can get through this, absolutely no matter how much it feels like you never will. Let me repeat, because I have been through it and I know how hopeless it can feel: your belief that you will never get out of this is factually incorrect. You can do it.

If you ever feel like you are actually going to harm yourself (or come up with a plan) instead of just fantasizing something would strike you down, tell someone close to you immediately.
posted by BuddhaInABucket at 9:28 AM on October 16, 2014 [5 favorites]

I've found this book to be very helpful: Feeling Good: The New Mood Therapy, by David Burns, MD. The book is mainly aimed at depression, but most of the techniques are also applicable to anxiety, obsessive thoughts, and other sources of mental distress (and he discusses these at some length, as well). I first read Feeling Good over twenty years ago, but it made a big impact on me. You might also look up "cognitive therapy" or "cognitive behavioral therapy" online for additional information.
posted by alex1965 at 9:29 AM on October 16, 2014 [1 favorite]

With the help of a counselor, for me, the first huge step was recognizing that the negative thought spiral was happening. Once I started recognizing it, I got better at saying to myself, "oh! I just had those thoughts. I'm going to set them aside for awhile." I had to force myself to tell myself this for a long time, and sometimes I must have said this 100 times an hour. But eventually that number went down a little, and then a lot. Telling myself this led to me learning to ACTUALLY set aside the thoughts. And setting them aside for awhile helps give me the perspective to be able to recognize what is/isn't actually important.

To explain another way, I had to learn to give myself gentle reminders, without judgment, that I did not need to go down a particular negative thought track. "Without judgment" means that I had to stop chastising myself for having the negative thoughts, too (no, "you idiot! Stop having negative thoughts!"). My counselor gave me little scripts to help me, like, "it's okay, I had that thought, but right now I'm just going to leave that alone for awhile and instead [work on ____, or enjoy this music, or whatever other neutral/positive activity you want]."

As an alternative, I sometimes allow myself a brief period of time (5-15 minutes) to either just sit and stew or to write about my worries. I give myself a time limit to ensure that it's an outlet rather than fanning the flames. I try to write down absolutely anything and everything I'm thinking about the problem, including--especially--the most ridiculous stuff. Getting that on paper feels like a huge relief, like, "okay, it's written down, I can now focus on [whatever real work I need to do] for awhile."

One other strategy for me, in the hardest moments, was to focus on the concrete NOW. I would run through my five senses and describe what is happening now. Example: "I'm hearing cars on the street. I'm smelling my morning coffee. I feel a little chilly." This was just enough to bring me back in the moment to help me break the spiral.

Be gentle with yourself. You will get through this.
posted by pril at 9:34 AM on October 16, 2014 [4 favorites]

I had very similar problems (ruminating, unable to meditate due to ADD, fearful of going places alone, etc.) back before I started taking 1mg/night of clonazepam (Klonopin). It turned out to be a miracle drug for me -- I was back to almost normal in less than a week.

So, you may want to ask your doctor about getting a prescription for that in addition to your SSRI. They can be taken together -- I took mine with Celexa.
posted by Jacqueline at 9:49 AM on October 16, 2014 [1 favorite]

Response by poster: I should mention I do have a prescription for clonazepam but it seems to do nothing except perhaps stave off a full on panic attack (which I am not prone to as much really, I just get very close to one and stay there).
posted by polywomp at 9:55 AM on October 16, 2014

Do you only take it "as needed" or do you take it as a proactive preventative measure every night? It was the latter that worked for me.
posted by Jacqueline at 10:05 AM on October 16, 2014

Response by poster: I will try that. I am just afraid of getting hooked.
posted by polywomp at 10:10 AM on October 16, 2014

There's some stuff going on in my life right now with my partner that I am focusing on, to the point where I work myself into a panic, obsessively researching medication side effects and horror stories online, and such, and I can't seem to control myself. Even if this wasn't happening my anxiety would latch onto something else though, even something trivial.

Put a rubber band around your wrist and snap it when the thoughts come up. Also helpful for me was to have a word or phrase that I would say to myself when I felt things getting out of hand (it can be irrelevant, like "strawberry") that would help me refocus.

Most of all my therapist was a huge help with this sort of thing - we would talk about spiraling and how not to spiral all the time. I know you said your therapist said you were too negative to help you but I would ask more about what this means and what steps he wants you to take in that regard - I don't think it's fair for your therapist to say that without outlining some things for you to do.

Like anything, stopping spiralling thoughts takes a lot of intention and practice. Keep at it, like you'd keep at perfecting a tennis swing.
posted by sweetkid at 10:10 AM on October 16, 2014

The clonazepam + SSRI combination worked for me when I developed a panic disorder. But it took a number of months to set things right, during which time my doctor said my brain was 'rewiring itself.' In the meantime, walks out in nature helped, in fact, just letting the sunlight hit my face seemed to help. I started jogging every morning soon after that, and it's so essential now to my happiness and sanity that I can't imagine ever quitting voluntarily.
Clonazepam is very gentle and you shouldn't fear getting hooked. SSRI discontinuation is rougher, but manageable.
Additionally, breathing exercises helped me a lot back then, and still do now. Slowly exhale for ten breathes, for ten seconds each breath. Then hold a breath for 30 seconds and release. This kickstarts your body's own calming mechanism. HTH
posted by jabah at 10:18 AM on October 16, 2014 [2 favorites]

I recently asked a similar question to help me interrupt ruminating and negative thought spirals. It's specific to my negative thoughts, but the idea is the same -- you tell yourself firmly, "I am not going to get Ebola because someone sneezed near me, and I am done thinking about it." and force yourself to consciously think of something else (like ... recite the plot of Game of Thrones to yourself, or imagine climbing Mount Everest, or plan a menu in detail, whatever, something happy or at least neutral) to get your thoughts on a different track.

It is fairly strenuous mental work and doesn't work too well at first, but as you remind yourself, over and over, that this is an unproductive thing to think about, that starts to become an instinctive response and it gets easier to redirect your thoughts.

I don't know your job, but if I was stuck alone with no assignments at work, I'd be listening to background music on my iPod and reading "gentle" books that I pre-selected and brought from home to keep my mind busy. (Pre-emptively ... harder to get back on track once you're off.) If I were just surfing the internet all day, it'd be all-Ebola, all-the-time, and I'd be a wreck.
posted by Eyebrows McGee at 10:18 AM on October 16, 2014 [1 favorite]

Polywomp: I think you are right to be cautious with using clonazepam (brand name: Klonopin). It's a benzodiazepine drug, and these are known to be addictive and can cause rebound anxiety when you stop taking them. Anything beyond short-term use is probably not a good idea, as you run the risk of serious side-effects.

I am not a doctor. Please do your own research.
posted by alex1965 at 10:20 AM on October 16, 2014

I will try that. I am just afraid of getting hooked.

I don't take it anymore, so I'm at least one example of how you can use it until you get your anxiety under control and then go off it. In my experience, the drug gave my brain a chance to rest a while from the anxiety downward spiral and I was then able to get into the habit of more productive thinking patterns -- a habit that stayed with me after I stopped taking that medication.

When I finally tapered off, I did experience some rebound anxiety for a couple of months but that rebound was minor compared to the level of anxiety that preceded me starting the medication. Now, almost two years post-clonazepam, I am 99% anxiety-attack-free (the 1% being due to unusually stressful situations like getting lost in the middle of nowhere with a migraine while driving long distances).
posted by Jacqueline at 10:37 AM on October 16, 2014 [2 favorites]

Keep taking the SSRI! I have suffered with awful anxiety for a very long while. I recently started a low-dose SSRI and I am a different person - I feel like myself. And after the first three weeks all of the side effects subsided. I now have only one that is very intermittent - clenching my jaw - and no others.

Remember that people that write about medication on the Internet are more likely to experience issues with said medication. If you feel good, there's no reason to talk about it online very much. So take what people say about side effects etc with a nice-sized dose of salt.

A big thing I also do is a little game I play in my head. It's called "What are the Facts?" If I'm obsessing about something (which has not happened since my SSRI medication really took effect) I say to myself "what are the facts?" I will write them down on a piece of paper. Only facts, no emotions or feelings. That almost always lets me relax because the facts don't add up to my level of worry at all.

I also like taking a walk and making myself notice at least three pretty things on the walk.

Best of luck to you.
posted by sockermom at 10:39 AM on October 16, 2014 [5 favorites]

It may seem obvious, but is it possible to get away from your major stressors / physically remove yourself for a while?

I was lucky when I was in a really bad place that I'd agreed to go and dogsit at a friends house for a fortnight, just getting away from the sources of my anxiety and into a different place was really good for me - and having a dog to care for gave me constant company and shape to my days.

After I'd been to see my doctor and was referred on to a psychiatrist who I trusted to prescribe the right stuff for me I found the SSRI's I took really helped take the edge off my free-floating anxiety, and in sussing that out made me less likely to be triggered into a downward spiral, while in boosting my brain chemistry long term helped me feel ready to tackle the stress causing situations.
posted by Middlemarch at 10:53 AM on October 16, 2014

For the most part I am stuck at work all day, alone, and we have no assignments to work on at the moment,

This is exactly the kind of situation where I begin to stew and, depending on other factors, cuss out loud at "god"/the universe/the freaking sky.

Is there any way to keep yourself constructively occupied at work? Can you find some kind of work related busy-work that they would let you do? Would be okay to play games on your computer or cell phone -- games that you would find fairly immersive? If at all possible, try to find something constructive to occupy yourself with.

If you really cannot find work or acceptable distraction that you can do at work, then something that has been helpful to me is intentionally dreaming up alternate endings to my angsty nightmare scenarios. Recently, I was angsting about the idea that money would come to me but in a bad way, like someone would have to die in order for me to inherit. I found that extremely upsetting. I finally remembered that a relative used to play the lottery and always talked about giving some of the money to me and other relatives if they ever won. So that was a huge relief to go "okay, if money is suddenly going to come to me, it will be because (relative) wins the lottery instead of because someone dies."

So if you can dream up alternate endings to your personal nightmares, maybe they can lose some of their ugly grip on you. This is a thing I have worked at for many years and I used to write my own fiction and the like to try to work on that. I have a long history of worrying about things and I think worrying has a constructive purpose of trying to prep myself to deal with problems, so it does not work for me to try to just push it away and forget about it. But turning my mind towards finding positive scenarios -- realistic positive scenarios, even if they are long shots, they are still plausible/possible -- really helps. Actual outcomes are almost never what I imagine them to be, but thinking about things ahead of time does serve a constructive purpose of helping me figure out how to respond to problems. Trying to dream up positive outcomes is both calming and helps improve my ability to bring constructive solutions to the table when something does come up.

I will also suggest you start a food diary. Certain foods just really put me into a tailspin, emotionally. This is so consistent that my oldest son has become super observant of what I eat and he often says things like "Tomorrow, let's try skipping x pizza topping. You were fine until you began eating the pizza and now you are angsting again." Sure enough, skipping that topping means I am not anxious after lunch the next day.

Everything you eat or drink impacts your biochemistry and that impacts your brain chemistry. If this is at all treatable with drugs, it is worth a shot to consider that the foods you eat and the things you drink may be impacting this. I have found it much more effective to just not eat x than to eat x and then take drugs to counteract what it does to me. That has led to a much higher quality of life for me.

Best of luck.
posted by Michele in California at 11:10 AM on October 16, 2014 [1 favorite]

I understand that meditation is hard, but here's the thing they don't tell you - the point is not to clear your mind. You will get frustrated and discouraged very quickly if you're expecting that. The idea is to pay attention. So you sit and do something like counting your breath. Your mind will wander. It's normal. Just notice that it happened, and gently get back to counting.
posted by O9scar at 11:17 AM on October 16, 2014 [1 favorite]

Seriously, check out that Feeling Good book. That's EXACTLY what it's about.
posted by callmejay at 12:15 PM on October 16, 2014

My therapist recommended a practice similar to the ones above & it has worked great to stop the spiral. Concentrate on one of your senses - not your thoughts - but something you can see, feel, hear, smell, or taste: I feel the car's vibrations through my hands on the steering wheel, I can taste the garlic I had on my lunch pizza, I can smell the Hershey's factory, for example. For me it helps change lanes in my brain from the overthinky brain to the feeling, sense-y brain (I am not a neuroscientist so that is a bad explanation but it works for me when nothing else did). Good luck!
posted by pointystick at 1:23 PM on October 16, 2014 [2 favorites]

Yeah, for me the point of meditation as a beginner isn't to begin the path to transcendence. It's to help with that whole recognition of the monkey mind, of the recurring thoughts and and worries and anxieties but not get caught up in them. You just pay attention to what's going on, call it by name (thoughts, worries, whatever) with no investment in it. For me, that really helps when the lies that depression tells you kick into high gear. The ability to just recognise, okay, this is depression lying to me again is indescribably reality-restoring. Naming things gives you a bit of power over them - in a weird way, it changes nothing and changes everything.

You could also try setting aside some time to worry - schedule it like an appointment. If you catch yourself worrying outside of that time, just remind yourself that you are going to worry from 4.30-5 (or whatever), not now. Keep a list of things you want to worry about in your worry appointment. Get the satisfaction of crossing them off the list once you've worried about them during your worry session.

As for your therapist, if he really said that you're too negative for him to help, you have to find a new therapist. But be aware of the distortions of depression brain, which tell you that you are a lost cause and no one can help you. Did he say that you will have to be the one to make some changes, that you are the only one who can break yourself out? Because this is true. SSRIs and other drugs are tools. Meditation is a tool. Exercise and diet and all these other things are tools. You have lots of tools you can use, but you need to figure out which ones are going to work for you. We can help you with more suggestions, but you do have to rescue yourself.

I say this in all sympathy, as I am becoming aware that I need some more/different/better tools myself. It's hard, no arguments. You can do it.
posted by Athanassiel at 5:25 PM on October 16, 2014 [2 favorites]

A visualisation my therapist suggested for anxious thought spirals is to think of my brain as a train station, and the thoughts that come into it are trains. I can choose to get on a train and follow the thoughts along a path, which in the case of anxious thoughts, is a spiral into worst case scenarios and imagining detailed bad things. And one anxiety provoking topic leads to the next, kind of like I"m getting to another anxiety station and changing trains.

But I can also see a train come into the station and choose not to board it. It will go off and do its thing, and eventually it will probably come around again, and I can always get on it then if I decide it's something I do need to worry about. Or I can not. Whatever.

Now that I've been thinking about my anxieties like this for a while, when I see a negative thought spiral starting, I just have to say to myself "I'm not getting on that train", and it goes away. But it takes practice.
posted by lollusc at 7:20 PM on October 16, 2014 [3 favorites]

I am slightly embarrassed to admit this, and this is the first time I've actually said it "out loud" but... I have severe anxiety issues, and when I would start spiraling down the anxiety loop, I would become obsessed with disaster survival. The more time I spent on prepper websites, the worse I knew my mental state was. Recently, I bought myself a big old Swiss Army Knife, and it's like a magical talisman for me. Having this thing in my purse has managed to keep things in check. I'm making other lifestyle changes, too, but having a physical object to focus on has been wonderful. If you're focusing on health issues, like heart attacks, maybe buying some aspirin would have the same effect for you? I know, intellectually, that it's a crutch, but it's let the anxiety ease off to the point where I can actually work on things.
posted by Ruki at 4:02 PM on October 17, 2014 [1 favorite]

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