How to manage my anxiety until I can get to see a therapist?
March 30, 2015 3:32 AM   Subscribe

Anxiety flare-up. I have a therapy appointment... in 6 weeks time. What can I do to manage my anxiety till then? I have included details of what I am already doing after the jump.

I have anxiety flare ups every few months, though more and more often since hitting 30, sadly. Usually I just kind of ride it out till I feel better. But this time I feel pretty miserable and also miserable about the prospect of future flare ups, so I have been referred for therapy for the first time. The waiting time is 6 weeks, minimum.

My anxiety when it flares up takes different forms - sometimes I get depressed, sometimes I get upsetting intrusive thoughts. Right now, I am having that perennial favourite, health anxiety, where I find new things wrong about my body every few days, and convince myself that I have a horrible illness and am going to die. I've also made the mistake of telling my parents I'm experiencing an anxiety flare up, and now THEY'RE all worried about me and I wish I hadn't told them. It's a nightmare.

The steps I am taking are as follows -

Meditation: I know you're all going to tell me to meditate and I do TRY to meditate. I've been good at it before and found it helpful, but right now, I find I'm just HORRIBLE at it. Either it doesn't "work" and I just end up frustrated, or (and this is ridiculous) I fall asleep!

Exercise: I have recently (in January) started exercising 3 times a week, for about half an hour at a stretch. (I know that's not enough, but it's a big jump for me, and I do aim to work up to doing it more frequently and for longer, but it's not going to happen overnight.) Prior to this I was a little active but not in any structured kind of way. One of the reasons I started working out was to improve my mood, but although I'm perfectly happy while exercising, the effects of it do not last very long and in fact sometimes I have the opposite reaction and feel sad or panicked after working out. I am fat and pretty unfit, but I have noticed a rapid improvement in what I am able to do, and I take a lot of pleasure from that. I just wish the effects would last beyond the half hour session.

Eating: I definitely find that my anxiety gets worse if I eat sugary food, so I am trying to eat less of that. I do not have any food restrictions.

Keeping busy and seeing friends: I feel fine when I am busy or socialising but when I come home I find myself very susceptible to random bouts of panic.

So what am I missing? Do I just have to suck it up or is there anything I can add or improve about my current anxiety-abating measures in order to make them more effective?
posted by Ziggy500 to Health & Fitness (30 answers total) 19 users marked this as a favorite
 
Is there a reason you are not trying medication? For example there are meds people take specifically to help them through panic attacks. Have you talked to your regular doctor about this?
posted by zennie at 4:24 AM on March 30, 2015 [1 favorite]


I've got health anxiety, too. I hate it because half the time I KNOW I'm being irrational, but if I could logic myself out of it that easily I wouldn't have such anxious thoughts all the time! The worst thing about it is how the anxiety seems to create its own health symptoms which, in turn, freak me out. It's such an endless cycle. :(

A few things have been working for me:

1. A while ago (it may have been on AskMe) I read something that went something like "Good health means something new is wrong every day." At least, I think that's what it was. I could be butchering it in every possible way. But that general sentiment helped me gradually come to realize that if I were truly experiencing a horrible health affliction, the symptoms would be constant and persistent. I wouldn't have a week where one day I have a weird pinchy pain, another day I have bowel issues, another day I have a horrible headache -- I would probably have just one of those things, and it would probably be more severe than what I've usually got, and it would NOT go away. This helps me to keep my minor issues from getting too "loud."

2. Similar to the above, I've realized that since I've hit 30, my body's simply been deteriorating more noticeably. It's not that all my bones are about to break and my muscles are going to fail me or my GI tract is about to explode -- it's just that I've reached some sort of tipping point where every little thing is suddenly more noticeable because, well, I'm getting older. This has taken a lot of getting used to, but the longer I go with this thought in my head, the easier it is to bear and the better I get at categorizing things into "aging body" or "this isn't right, I should see a doctor."

3. And on that note, when it comes to categorizing things into "see a doctor" territory, if something weird starts to bother me and it triggers my anxiety, I tell myself that if it's still bothering me in a few days, I'll go see a doctor. At the bare minimum, I give myself 3 days. For weirder things, I give it a week. And since I'm so anxiety-prone, most of these things just end up being phantom afflictions -- by giving myself that waiting period, I usually either forget about what's bugging me, or it clears up, or I "get acquainted" with it and I can see it with a clearer head and I can figure out if there's a legitimate pattern there. This kinda goes with #1 -- if it's persistent and constant for more than a few days/is following a pattern, then it's worth paying attention to.

All of this is part of a larger effort with myself to be more mindful in general. I've been working at it for quite a while now, and my rational mind has actually gotten a lot better at evaluating my body's quirks before my anxiety has a chance to take hold and make me run to the doctor. With anxiety, it's so important to try to take a step back from it so you can see things more clearly -- but it takes so much practice. Hopefully you can hit upon some cocktail of thoughts that help keep you out of the anxious health spiral!
posted by phatkitten at 4:30 AM on March 30, 2015 [5 favorites]


To be honest sounds like you are reacting very well - proactively trying to change your life rather than just flailing around.

Mediation:
Falling asleep during meditation isn't something you should worry about. It shows you are relaxing. If you are finding it difficult then try a shorter time (and build it up) or try a guided meditation tape.

A comment on the idea that it's "not working." From my very novice perspective mediation is really about "failing" and picking yourself up again. Your mind will wonder. You can't force that to stop happening. Instead just notice that it's happening, let go off the thought and go back to what you were focusing.

Other strategies:

You can try some self help materials/CBT in the interim:
http://www.nhs.uk/conditions/stress-anxiety-depression/pages/self-help-therapies.aspx

Breathing:
When you feel anxious try and breath in a slow relaxed way, into your abodomen.

Stress diary:
Keep a record of times when your anxiety peaks. What the situation was, where you were, what your thoughts, feelings and body were like, actions you took and their outcome.

Worry plan:
When you feel anxious about a problem try and break it down on paper and come up with a very concrete plan to solve it.
posted by Erberus at 4:37 AM on March 30, 2015 [4 favorites]


Since you're already meditating, you might find this book very helpful:

The Mindful Way through Anxiety

It has a lot of fantastic meditation exercises that focus on dealing with anxiety, and it completely changed how I think about anxiety and emotions in general. Highly, highly recommended.
posted by deeparch at 4:49 AM on March 30, 2015 [3 favorites]


Set a timer. You've got 10 minutes to stew, to google horrible diseases, to perseverate and worry. Ding! Now you're done. If (when!) you start worrying again, congratulate yourself for noticing! Then say to your anxiety, "no, I'm done that for the day" and redirect yourself. You'll have it on your to-do list for your 10 minutes tomorrow when you can gross yourself out on Google Images to your heart's content. Spend the rest of your evening doing something else.

Doing something else can be the difficult thing. Podcasts can help if you pay full attention to them. Meditation is hard, but active meditation (eg Zentangle drawing, walking meditation, learning something complicated that requires focus) is less difficult and gives you a break from the anxiety obsessed time. Learn a new bodyweight exercise. Go for a walk and notice the things around you. Count the birds or the signs of spring or tattooed people or whatever strikes your fancy. Give that busy brain a job.

Finally, cultivate compassion for your anxiety. Talk to it, not about the specifics but about the overall. "Oh hello, anxiety. No, I'm sorry, we already spent our 10 minutes on that today. We're doing a jigsaw puzzle now! Yes, I know you're trying to look out for my health, thank you. I hear you and I'm going to take care of us."

I learned these things mostly from Acceptance and Commitment Therapy which I stumbled upon from the book Things Might Go Terribly Horribly Wrong. Best of luck to you. You can do this.
posted by heatherann at 4:52 AM on March 30, 2015 [8 favorites]


Fellow health anxiety sufferer here. That's great that you're already doing exercise - I found that really helpful. Have you tried yoga instead of meditation? It can really help focus your mind and helps with breathing too.

I guess you probably know this, but seeking reassurance only increases your symptoms - so looking things up online (which I was addicted to), asking your friends if you'll be ok, going to the doctor etc, will only ever bring temporary relief, but you need to keep doing them and that causes more anxiety.

I'm not sure what kind of therapy you're getting, but the kind that finally worked for me (I'm still anxious but haven't had a health anxiety freak out for more than 4 years now) was Cognitive Analytic Therapy.

I also highly recommend Citalopram to level out your anxiety so you can function until you can get therapy. And second Heatherann's recommendation of Things Might Go Terribly Horribly Wrong.
I hope you feel better soon x
posted by Dorothea_in_Rome at 5:00 AM on March 30, 2015 [1 favorite]


One more thing: You mentioned exercise but not much else about your body. Anxiety is a very physical thing and if you can't get at it via thinking you may be able to get at it through the body.

When I am anxious, my shoulders are up and tight. My jaw clenches. My brow furrows. My breath is shallow. My stomach is held tight. My body is curled up, coiled.

Drop my shoulders. Loosen my jaw. Elongate my neck. Relax my face. Deep breath. Loose stomach. Big stretch. My brain begins to quiet.

Get in the habit of checking in with your body. How are you holding it? Is it tight? Is it uncomfortable? Can you unclench anything? Would a stretch feel good? How is your breathing? Is it shallow? Remember to breathe in day to day life! People with anxiety are often found to breathe less often and not as much, and this changes the resources available to your body and brain.

A couple resources:
3 breathing exercises including the famous 4-7-8 exercise
Relaxation techniques for anxiety including a body scan
posted by heatherann at 5:08 AM on March 30, 2015 [5 favorites]


Journaling! My anxiety has been so much better since I started. I list things I am grateful for, things I am proud of, and keep a Feeling Good style three column record of my anxious thoughts. Reading the book itself helps, but it can be as simple as writing down things like "I am surely going to die in a horrible car crash today" in one column, and opposite writing, "I am no more likely to die today than any other day and the odds are never very high." You're just deliberately trying to counteract your anxious thoughts with normal ones.
posted by chaiminda at 5:29 AM on March 30, 2015 [1 favorite]


You say you're exercising, but are you really getting that heart rate up? Just wondering because while a calm hour-long walk does very little for my anxiety, an hour of cardio pretty much destroys it. At least 4-5 hours a week is kind of the sweet spot for me. I'm a big girl and it took me a while to get to that point but now that I'm there, it has been life altering.

Cut out the sugar. Sugar compounds my anxiety and I notice my jaw clenching gets worse when I have been chowing down on the sweet stuff. Ditto caffeine. I could drink coffee 24 hours a day if it didn't make me feel like I wanted to climb the walls. I have had to seriously cut back or risk being a jittery mess.

I see Citalopram (aka Celexa) recommended above. I was on it for a couple of years and it really helped me stop being gripped by fear so I could get out there and do stuff! I'm no longer on it, but it was an important stepping stone on the road to managing anxiety.

From what you have written here, you're doing great. Keep going. Anxiety is part of your personality. It does not own you or run your life.
posted by futureisunwritten at 5:32 AM on March 30, 2015 [2 favorites]


I see The Anxiety and Phobia Workbook recommended here quite frequently, and my own therapist suggested it when I first started seeing her for anxiety as well. Definitely helped me, especially when I was first starting to figure out how to formally address my anxiety. Good luck!
posted by DingoMutt at 5:37 AM on March 30, 2015 [4 favorites]


My anxiety isn't your anxiety, but the things that help me tremendously when I'm experiencing trouble are vitamin D supplementation (I'd say get the 5000 IU tablets and take one or two of them a day for a week to see if it helps you) and quitting caffeine. But my anxiety appears to be directly caused by D deficiency, and apparently this is a thing? At any rate, D3 is cheap and odds are good you need it anyway, so can't hurt to try. The overdose level of vitamin D is equivalent to taking more than 10K IU every day for months, so you have a lot of safe room to experiment.
posted by Andrhia at 6:10 AM on March 30, 2015


Avoid caffeine and other stimulates. Continue to work out and focus all of your energy on shopping and cooking lovely meals.

Anxiety attacks are just moments- bubbles of time that will eventually pop and turn into a new bubble. Find ways to pop the bubble faster. Whatever you are doing when it starts, force yourself to do something else. If you are at home, make yourself go somewhere. It may take all day for you to get yourself out of the house but get out of the house. If you are at work, take a break, go for a walk, buy yourself some ice cream and watch something on YouTube. Set aside money in your budget for bubble popping expenses. Buy yourself something that you wouldn't normally buy. Call a friend. Dare yourself to do something you have been afraid to do. You will get through this. It's just a moment, and you can get past a moment.
posted by myselfasme at 6:57 AM on March 30, 2015 [3 favorites]


Thanks so much, all.

Just wanted to answer a couple questions -

zennie - I do plan to talk to Dr re: medications.

futureisunwritten - I don't know what my heart rate is at the end of a gym session but I know it is definitely beating quite hard. My gym is air conditioned and quite cold, but by the time I'm done I'm at that sweat-dripping-down-my-face stage.

Thanks again. :)
posted by Ziggy500 at 7:14 AM on March 30, 2015 [1 favorite]


Hey! I was in exactly your situation a little while back, and what helped me was:
1) going to see the GP/doctor (I'm sure if you wanted to, you could do this within this week) and getting medication. I was very reluctant but 2 months down the line I am so so so so so relieved.

2) writing out my emotions and READING THEM when I finish. I can't do meditation either, so this was my equivalent for getting some distance/perspective on how my emotions work. Please do this! It sounds random and pointless, but I've struggled with anxiety for YEARS and it has never been as ok as it is now.

3) talking to someone wise and calm. For me this was the pastor at church. Just talk to someone who understands, blerg it out, do it as many times as you need!!

Basically, in my experience, taking care of my mental health means a) exercise b) diet c) socializing d) getting it all out - in all its icky panicky sludgey form - whether by speech or writing or drawing... Just get it all out!! And read it over. e) medication.

Please try this! Especially (2). And good luck :)
posted by dinosaurprincess at 7:27 AM on March 30, 2015 [1 favorite]


P.S. by writing out emotions and reading back what you wrote, I meant at least once a day! Not a one-off exercise. Also try to write in nicer handwriting! My thoughts at least are nicer when I try to write well. I know this sounds like mumbo-jumbo and I would have dismissed it myself too but it really worked. Please try it! And be patient.

P.P.S. I have found sudoku to be quite similar to meditation because it forces you to slow down and breathe. Worth a try too!
posted by dinosaurprincess at 7:30 AM on March 30, 2015


Just wondering because while a calm hour-long walk does very little for my anxiety, an hour of cardio pretty much destroys it.

I don't know what my heart rate is at the end of a gym session but I know it is definitely beating quite hard.


Just chiming in to say my experience with anxiety/exercise has been the exact opposite. Anything that would get my heart beating fast and my body would be like "oh, our heart's beating fast, we must be having a panic attack, CUE PANIC ATTACK MODULE 8.57B! THIS IS NOT A DRILL! GO! GO! GO!"

I found yoga, stretching, breathing exercises, and mild bodyweight work to be much better for me during my anxiety-prone times. Just enough to get the blood circulating and release tension. But as soon as I'd feel my heart rate picking up, I'd stop and work on calming my breathing until my heart settled back down.

If vigorous exercise works for your anxiety, that's great, but don't take it as a given - it might actually be working against you.
posted by melissasaurus at 7:34 AM on March 30, 2015


I had read (though it's been years) that 30-40 minutes of cardio at your target heart rate is the sweet spot for reducing anxiety -- going longer than that doesn't necessarily help much with anxiety. Which means about 10 minutes of warm-up (to get your heart rate up) and then 30 minutes of working at a cardio heart rate. It may be worth seeing if you can add 10 or even five minutes to your workout.

I very much second the recommendation for the Anxiety and Phobia Workbook. It has a lot of information in the beginning about what anxiety is, various treatments for anxiety, etc., as well as exercises you can do on your own. It would likely be a great pre-therapy resource and then as an adjunct to therapy.
posted by jaguar at 7:40 AM on March 30, 2015


On non-preview: melissasaurus's point about exercise triggering panic attacks is also a good one. Experimenting with gentler exercise may be worthwhile, and I've also seen suggestions for reminding yourself during or after exercise that your heartrate should be up right now, your breathing should be rapid, etc., as a way of calming your mind. You may want to play with doing longer cool-down or stretching after your work-out, too; I find that five minutes of walking after my workout followed by about five minutes of stretching leaves me feeling calm and energized, but skipping the cool-down and stretching leaves me feeling tired and a little foggy and just out of sorts.
posted by jaguar at 7:45 AM on March 30, 2015


These are the three best things I do to alleviate the physical symptoms of anxiety for myself.

Heat has a verifiable calming effect (can't find the studies right now, as I am at work). A hot bath or shower can really help when you're in acute need. Even a hot water bottle or heat blanket can do wonders.

As far as food, avoiding sugar and caffeine are pretty much a MUST at this point. No coffee or soda for you! Even if you feel exhausted. Even if you feel like there's not a correlation. None. (If you're very caffeine dependent, do step it down over a few days instead of cutting it out cold turkey.) Adding extra protein and green vegetables will also help. Protein is very grounding, and can help you feel better in your body.

A final suggestion - go to the local Whole Foods (or other fancy market) and go to the essential oils section. There should be a huge bank of oils to smell. Smell them all until you hit on one that makes you feel better. Buy it and keep it close. It could be totally placebo, but I don't care why I feel better after smelling nutmeg, I just do. (I think it's probably because I have a subconscious memory that's pleasant and comforting that it hooks into.) Learned this from my therapist, and it really does work.
posted by stoneweaver at 7:57 AM on March 30, 2015 [3 favorites]


My therapist taught me a technique called 'worry deferral' which has really helped. The trick is to schedule 30 minutes a day, every day, in which to be anxious. When you start feeling anxious at other times, you quickly write down what you're anxious about, and imagine putting it aside, knowing you will come back when it's time. I find this really helps me stop spinning.

Once you are in 'worry time' there are a few more techniques. First, think about which things are 'solvable' and which aren't. Example of solvable worries: I need to do my taxes; I'm not in shape; I'm stressed about a big project at work; I feel exhausted right now. For these worries you spend time figuring out strategies that will help you solve them, and then you actually do it. You can spend some of your thirty minutes on solving them. Un-solvable worries are things like 'what if I get cancer', 'what if I get fired from my job', 'how will I ever find meaning in my life', etc -- they are big, abstract, all-encompassing, and impossible to do anything about. For these, the technique is to see if there is a solvable item inside -- i.e. if you're worried about cancer, think about quitting smoking -- and then when you have the big nebulous blob left, just spend some time with it.

I have found that when I am worried about 'big things', trying to solve them doesn't really help, because it's impossible. But setting aside time for the big things does help. These worries always arise for a reason and it's important to honour that, and to reassure the part who is worried that they will be taken seriously and given a voice. Just being heard seems to be calming, it takes the urgency and panic away. But limiting worry time also helps contain the worries, and helps keep them from expanding, taking over, and getting in the way of day to day life.
posted by PercussivePaul at 8:00 AM on March 30, 2015 [3 favorites]


You are getting lots of great advice here, I'll just chip in a few additional things that helped me recently during a long wait to see a doctor for anxiety/PTSD issues:

* A sort of mishmash home-brew version of cognitive behavioural therapy and dialectial behavioural therapy. I read a book on each, took the bits that most resonated with me, and walked myself through some of the exercises that seemed as if they might be helpful for me.
* Guided meditation, specifically. If you're trying free-form "sit still for twenty minutes in silence" meditation, that might be more than your brain can handle right now. But you might find some relief in a guided meditation where there is a voice guiding your thoughts, or even more so a body scan meditation where you have a near-constant narration telling you exactly where to focus. I find the body scan to be really helpful, personally, when I'm in the throes of a full-on anxiety spiral. A formal, somewhat ritualistic, focus on the different parts of my body really forces my brain away from eating itself. YMMV but it might be worth a try.
* A new activity to concentrate on. Knitting worked well for me, I've also taken up coloring books when knitting is too much. Something that requires physical motions of some sort, that you do rarely so you can't just let muscle memory guide you, also may really help pull your brain out of its spiral and into the here and now.
posted by Stacey at 8:02 AM on March 30, 2015 [1 favorite]


The piece of DBT that has really resonated with me is radical acceptance coupled with mindfulness. Mainly, that is simply and wholly accepting the things that you can't change. That can include "Yes. I feel this way. This is how I am feeling. And it will pass." Observing and describing how you are feeling may help.
posted by feckless fecal fear mongering at 8:17 AM on March 30, 2015 [1 favorite]


So many great suggestion in this thread. I'll just add a few things that I've done that have gotten me through tough times waiting to see a doctor.

Tylenol and Benadryl. Both have been reported to ease symptoms of anxiety. Might be a placebo, but maybe worth trying.

Running. This really helps right as feel a panic attack coming on. Just get up and run as fast as you can down the hall, or around the house until you're out of breath.

Nthing avoiding stimulants.

For a longer term solution The Anxiety and Phobia Workbook is awesome used in conjunction with therapy and meds.
posted by MadMadam at 8:34 AM on March 30, 2015


I am having massive anxiety lately and have one silly suggestion if you have seen the show The Unbreakable Kimmie Schmidt.

There's a part where she asks someone if they can keep breathing for ten seconds and then goes on to relate having to turn "the mystery crank (whose purpose is unknown to this day)" and the way she did it was 10 seconds at a time.

When I am getting flooded in my head I think I can turn the mystery crank (whose purpose is still not known) for ten more seconds and the image amuses me (it's a funny show) and distracts me enough that by the end of ten seconds my brain has moved on to something else or remembers other humorous things.

Oddly enough it has been more effective at teaching me to calm down than my therapist explaining mindfulness and doing exercises. I think it is the humor.
posted by kanata at 9:01 AM on March 30, 2015 [1 favorite]


You could go to a walk-in urgent care clinic today - depending on the place, they may prescribe an antidepressant (which can be useful for general anxiety), a benzodiazepine (like Klonopin or Xanax - these work wonders, but because of the potential for abuse and addiction, they're not as oft-prescribed as they used to be), or a sedative. This could make the six weeks that you're waiting to see the therapist much more pleasant, trust me! Anecdotally, health anxiety is one of the ways that my anxious tendencies manifests (it's such an awful feedback loop - you notice something feels off, that makes you anxious, which inflames your body and makes you feel more off, which makes you anxious, etc.) and Prozac has really helped with that as well as with other issues I have.

If you don't have the funds or the ability to get to a clinic, dipenhydramine (plain generic benadryl - make sure to avoid the ones that have nasal decongestants added, as those can cause severe anxiety) is pretty good, especially if you're having trouble sleeping. Magnesium supplements (get a citrate or glycinated form - magnesium oxide is the most popular form and is not absorbed well by the body) can also help, but I have tried basically all the other herbal supplements recommended for anxiety and I'm not sure any of them have any more than a placebo effect.

I also nth the recommendation to write down your feelings. I've found it's useful in the moment for calming me down and it's also really helpful, over time, to be able go back and see, for example, that last month you felt like you were dying for a week and, hey, you didn't die, and actually had a really great weekend the next weekend! Or whatever.
posted by raisindebt at 12:25 PM on March 30, 2015


I'm past a couple of really terrible period of anxiety in my life, and looking back on them (which is of course much easier than being in the middle of them) the thing that helped both cases was a little bit of resignation.

Not a lot! Just that after months of thinking (correctly!) "This job is terrible, and I am bad at it; every day I wake up and immediately start thinking about how bad I am at it, and then I work on it until it's 3 AM and I'm done with what little I can manage and I go to bed," I got a little better at appending this to it: "Eventually I will quit or be fired, and then I will find something to do that I'm not so bad at. The worst part will be my boss telling me this isn't working out, but that will be over fast."

Eventually I quit; I gave sufficient notice and took a small pay cut to work a job I enjoy. The couple of minutes in my boss's office were extremely uncomfortable for me, but it really was over fast. (Now it exists only as an intrusive thought my brain sprinkles on for taste when other things are making me anxious.)

I can't speak for anybody else, and I was really lucky that things resolved themselves so smoothly. But for me the really crippling periods of anxiety cropped up in moments when the world around me was making my limits abundantly clear, and I was refusing to accept them as a part of me. Realizing that they were—that I was, to some degree, my limits, and that it was OK to not be a famous writer or a young, handsome prodigy—actually made me feel much less bound by them.

I don't know if that sounds helpful to you or not, but on the off-chance it is I figured I'd mention it. Walker Percy, whose lifelong anxiety was a family history of suicide and early death, explained it in that much different scenario like this:
The difference between a non-suicide and an ex-suicide leaving the house for work, at eight o'clock on an ordinary morning:

The non-suicide is a little traveling suck of care, sucking care with him from the past and being sucked toward care in the future. His breath is high in his chest.

The ex-suicide opens his front door, sits down on the steps, and laughs. Since he has the option of being dead, he has nothing to lose by being alive. It is good to be alive. He goes to work because he doesn't have to.
Also, and probably more importantly, a Benadryl. Just when things get particularly bad.
posted by Polycarp at 9:41 PM on March 30, 2015 [2 favorites]


I have my notes from my new therapist hanging on the white board in my office. Here is what they say:

* Breathing - in 4, hold 4, out 4. This seriously SERIOUSLY works wonders for me. This pattern of breathing has gotten me out of many a panic attack. It's ok if it's a fast 4 count at first. Just keep following the pattern. Breathe in to a count of four, hold it for four, and let it out at the same count.

* Constpiation - tense all muscles. Hold til it burns. Relax. This isn't great to do when you're, oh, say, driving. But it can really help you train yourself to be able to relax the muscles that tense up when anxiety comes to visit. You can tense all your muscles one group at a time, from your toes up or head down, whichever you prefer. Of you can tense everything all at once. It's the holding and relaxing that's going to help.

* Challenge the thought. What I've learned to say when I'm having anxious thoughts repeating themselves over and over and over and over in my head is "Is there evidence to support this thought?" For example, right now (as in right this second as I'm typing), I'm having a flare up of a very painful medical condition. The immediate thought that comes along with it is "Oh hell it hurts and it's going to hurt FOREVER!!! But I instantly challenge that: What evidence do I have that it's going to hurt forever? I have no evidence of that. Every time I've had a flare up, it's eventually gone away. Therefore, I can't support the thought "it's going to hurt forever."

* Replace the thought. Train yourself to replace a bad thought with a more positive one instead. With my example above, I'd replace "Oh hell it hurts and it's going to hurt forever" with something along the lines of "It hurts like hell right now, but it's going to stop, and I can handle it until it does. I've always handled it before, and I can do it again. This isn't going to break me."

I've had a TON of medical anxiety lately. I have a list of medical conditions as long as your arm, and am taking a list of medications as long as your leg to deal with them. I get where you're coming from. I promise, it gets easier.
posted by The Almighty Mommy Goddess at 10:23 PM on March 30, 2015 [1 favorite]


I agree with all of the above but can specifically speak to these two things in more detail:

1. "DIY CBT" -- essentially "challenging the thought" as someone said above. We spend a lot of time telling ourselves terrible things but not a ton of time reassuring ourselves and challenging those thoughts. It feels more awkward to talk yourself out of a bad pattern than to talk yourself into it. The negative thoughts are almost "cool" and more easy to take seriously, and anxious people tend to give them more time at the podium, so to speak. They're like stand-up comedians mocking everything and being all edgy and shit, but in reality they're fucking things up and you have to find a way to laugh them off the stage without judging yourself in the process for giving them the floor. It's OK to be anxious about medical issues, and to acknowledge that the anxiety itself is a medical issue in and of itself, and that sometimes the anxiety is productive but more often than not it gets in the way. Productive anxiety makes you go out and do things that alleviate the anxiety. Unproductive anxiety is its own "reward" and just keeps you spinning.

I read some of "Feeling Good" and really internalized and meditated on the negative thought patterns outlined in that book -- the "all or nothing thinking," "mind-reading," "labeling" etc. It might also give you a head start with your therapist and give you some valuable insight even if you don't do "homework" exercises and keep a journal and so forth. It helped for me to realize I wasn't having some especially profound existential dread that nobody could possibly understand.

This is basic list. I have both a "lumper" and "splitter" personality, meaning that I very often find myself oversimplifying things in either direction. So I would start judging this list and going "these are all the same thing!" and then realize "no they're not, but they're all part of the same problem!" and somehow just really honing in on the patterns that I know I fall into made me more cognizant of their artificiality. The more I tried to lump them together or split them apart the more I was able to identify the specific ways that I predictably fall into certain patterns.

2. Benzodiazepines -- I've taken Xanax before for severe anxiety but Clonazepam (Klonopin) is much more subtle, and has a very long half-life. My father-in-law was on Xanax for years and had to keep stepping up his dosage, getting super-dependent. Once he ran out and was paralyzed with anxiety in his bed. I gave him a Klonopin and he appreciated the difference in effects so much that he had his doctor switch him immediately.

All benzos have a significant potential for dependence so I quickly disabused myself of the notion that I should be taking any of them on a daily basis. My anxiety is not your anxiety and your results may vary, but I save Klonopin for those days where I can tell my anxiety is going to spiral out of control and "roll over" into the next day. I use it to "snip apart" the connection between one bad day and the next potentially good day. I use it very sparingly, like once or twice a week, tops. I think even with that frequency it can become somewhat of a "crutch" where you might think suddenly "I have anxiety for no reason and haven't had a Klonopin for a week" but crutches are made to keep you walking. It's a bad metaphor. More accurately I'm sure I have some baseline level of dependence because it has a 36-hour half-life, but that makes it a less aggressive, less intense, and longer-lasting resource in my toolkit.
posted by aydeejones at 10:18 AM on April 4, 2015


"Crutch is a bad metaphor" if the intent is to portray the "crutch" as a bad thing, is what I meant to say. My most intense existential-grade anxiety seems to be right before falling asleep, and if I've had a good night's sleep, trying to get out of bed the following day. That's where Klonopin shines. Another resource I occasionally use is Temazepam, which is similar to Valium (it's a metabolite of it), is another Benzo, has a very short half-life, but is not intense and "break-though-y" like Xanax is. It's used as a sleep aid, but it doesn't knock you out, or give you a big rush of euphoria, or anything too exciting. Seems to be much better than Ambien. I use it even more sparingly, maybe once every two weeks.
posted by aydeejones at 10:22 AM on April 4, 2015


Theanine might be the most effective supplement (GABA precursor), BTW.

Finally, I have never heard of Tylenol (acetaminophen) working against anxiety and was intrigued and thankful to read that here. I am an anti-Tylenol zealout who is allergic to Aspirin and NSAIDS, which sucks.

I did some brief Googling and was surprised that it specifically is supposed to work well on "existential anxiety," like I specifically mentioned in my previous two comments. My mom is a pharmacist who let me grow up popping samples of children's Tylenol on a regular basis for boo-boos before it became more common knowledge that it was terrible.

I might consider taking 325mg of Tylenol instead of a Klonopin or Restoril (Temazepam) once a month or so if I'm having existential-dread at 1AM but need to be up at 6AM without being even more groggy than I will be due to the sleep deprivation. I try to think about medications in terms of "how many times am I willing to take this in a month? Every day? Every week?" With concepts like side-effects, half-lives, liver-loads, and dependency or tolerance, it's can be helpful to devote some of your obsessive medical tendencies on learning about the pros and cons of treatments that have the potential to help you manage your obsessive medical tendencies in a positive way, if you also spend a significant amount of time learning to really assess the probabilities and risks and any risk factors you might have that would realistically make it a significant risk vs. an over-imagined threat.

But I would never consider taking Tylenol for more than one use (like headaches + anxiety + fevers + colds + in the form of "Tylenol PM" as a sleep aid which mostly works due to the 25mg of benadryl / diphenhydramine) , because it's such a potent liver toxin [precursor] with such a sordid history (IMO), and I suspect part of its effectiveness in treating acute anxiety will turn out to be suppressing the P450 cytochrome enzyme pathway and other things that can make a catalyzing substance "potentiate" your own endogenous "drugs" like endorphins and GABA (pricey GABA supplements can't enter the brain due to the blood-brain-barrier) while also subjecting your liver to more damage in the long term.
posted by aydeejones at 10:42 AM on April 4, 2015


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