How do I continue to live a full life and overcome my anxiety of doom?
October 11, 2017 11:11 AM   Subscribe

I've had mild social anxiety, depression, and ADHD, and have managed it relatively quite well (with adderrall and effexor) since adolescence. However, a new trigger has emerged (nuclear war) that has been the most debilitating ever for me (multiple panic attacks, sometimes unable to concentrate at work). What self-help, anxiety books, worksheets are helpful for those whose anxieties are specifically related to mass tragedies (like nuclear war) and the thought that my fears might be warranted?

What I've done:

My previous practitioner moved so I saw a new one a few weeks ago and overall wasn't engaged with me. They told me to avoid the news and gave me a script for Ativan.

I've consumed a lot less news (and added filters on twitter to ignore keywords) and that has really helped.

I've tried telling myself to be helpful to others who have other crises going on in their lives and channeling that into volunteering. This helps to an extent but sometimes the anxiety still paralyzes me (even while volunteering). I also realize that I, even as a relatively wealthy cisgender white male, I have relatively limited power to stop it (which makes me feel even more unhelpful and hastens my anxiety).

I have the Burns book and have practiced CBT but I am fearing that my fears are valid and with an unprecedented president, that my catastrophic fears are legitimate and more possible than ever before in history.
posted by anonymous to Health & Fitness (12 answers total) 15 users marked this as a favorite
I have the Burns book and have practiced CBT but I am fearing that my fears are valid and with an unprecedented president, that my catastrophic fears are legitimate and more possible than ever before in history.

When I start worrying about things completely out of my control like this (global warming, earthquakes, etc), it's usually a sign that I need a medication adjustment, not a sign that I'm a very astute political observer.

That said, getting to know your neighbors by involving yourself in local efforts for disaster planning is a good idea for everyone. It won't cure your disaster panic, probably, but it might help your social anxiety.
posted by Snarl Furillo at 11:21 AM on October 11, 2017 [2 favorites]

Hoo boy, do I feel you. This has long been a trigger of mine. I was relieved to move from NYC right at the height of Shelter In Place fever. I wish I had a Jedi mind trick to convince your brain to STFU, especially when it feels like just thinking it through a little more just might get you there.

But it’s a trap!! It’s the O in OCD, in full effect. Here’s what wound up helping:

1) Drugs, and it looks like you’re doing pretty well on this path.
2) Other distractions. I love terrible true crime shows, and advice columns. I’m down with OPP: other peoples’ problems. You might prefer birding and sports journalism— whatever you find absorbing in a detatched kind of way.

3) Maintaining a vague awareness of who’s helping. Sam Nunn and the Nuclear Threat Initiative, for example. It’s comforting to me to know that Experts Are On It.

Good luck to you!
posted by chesty_a_arthur at 11:23 AM on October 11, 2017

I am a member of Al-Anon, and I use the serenity prayer a lot. Which is weird because I'm an atheist but it's a super helpful reminder that I'm not the only one who can't control things. Most things are outside of my control. A therapist once told me that worry is not a strategy and that my brain gets confused and thinks that by worrying about stuff I am somehow being constructive when I'm actually being the opposite. So consider the serenity prayer, consider meditation, see if exercise or more exercise can help, check out a medication adjustment. I too suffer from anxiety and anxiety attacks and I sometimes need to have my medications adjusted as well. I also have ADHD. Best of luck, fellow sufferer!
posted by Bella Donna at 11:27 AM on October 11, 2017 [9 favorites]

I've had some success with leaning into the anxiety, but take this idea with a grain of salt. Generally if I'm worried my ultimate fear is around loss. So I lean into it, get to know the fear more intimately. What, specifically, is that loss fear about? Death? Dismemberment? Looting? Loss of status? Loss of pleasure?

And then I allow the anxiety to help me develop a contingency plan for all the chunked up what-if scenarios. If the fear is about death, is death so bad? If about looting, I can do some emotional labor with the prepper neighbor to strengthen that relationship.

Once I imagine the "absolute worst" and can make a plan for it, letting it go is a bit easier to do. YMMV

If you also have ADHD then transitioning away from a state is more challenging so maybe do this in a situation with a built-in transition. Like during a bath. Eventually you'll need to drain the tub and shift to another activity which you can leverage as a natural stopping point.
posted by crunchy potato at 11:36 AM on October 11, 2017

When you say "practitioner" do you mean a psychiatrist? In your place I would supplement this care with regular visits to a therapist/counselor who is an LCSW or similar. They can help with techniques to manage anxiety more than a psychiatrist.
posted by capricorn at 11:56 AM on October 11, 2017 [1 favorite]

Exercise is probably the best and safest anxiolytic, with a bunch of other benefits.

This year I have close to tripled my weekly run distance.
posted by grobstein at 12:20 PM on October 11, 2017 [1 favorite]

My anxious thoughts I have made peace with, especially during disasters and times of general chaos. I used to go 0-60mph on the anxiety scale when triggering things occurred - that old fully loaded can't move paralyzed by fear stereotype. A lot of my non-therapy dealings with it has been borne out of my work in becoming more minimalist. As I went from an overly packed hoard-y life to one that is more streamlined, I've been making that same peace with my emotions. I start dissecting "Why is this scaring me? What will be so bad about going through this thing when other people have or are going through it right now? Why do I have to control what happens to me instead of adjusting to things in the moment it occurs?"

It's not perfect, but my anxiousness has leveled off to a more reasonable (to me) 0-45mph range and that gives me enough stopping time to assess my thoughts and rationalize them. Making myself think about why I'm fretting over a thing seems to be like counting to 100 to take my mind off the emotion and more onto the logic. I also write notecards. On the blank side, I put Big Scary Event and on the lined side I put down "It's okay to have feelings over this but it is not okay to let those feelings consume you. This is what you can do to alleviate this feeling:" and put a small list of logic-based answers regarding the topic. Keep them near you so when you have that moment creep on you, you can fight back with brain power.

I also want to second the exercise-as-a-healer recommendation thing. I just get up and pace around in sort of a meditative way. Sometimes I wiggle my arms and hands, in a kind of an interpretive dance. Sometimes it's nothing more fancy than rolling my shoulders and reaching to my toes to get the tension out of the anxiety. I shake the fear out of me - not to mask it but to get my focus back.
posted by missh at 12:56 PM on October 11, 2017 [1 favorite]

I've been struggling with a similar anxiety problem lately.* I've been doing EMDR therapy and seeing a psychiatrist for medication, which have helped, but what's really helped have been taking my mental health self care extremely seriously. This includes:

- No caffeine. I hate to say it, but cutting out caffeine completely really made coping with my anxiety a helluva lot easier.
- EXERCISE, EXERCISE, EXERCISE. I've been taking my pre-work morning workouts very seriously.
- Regular (daily) mindfulness meditation. I don't like talky apps like Headspace, so I've been using a meditation timer app on my phone to keep track of practice. This helps me cope with the physical symptoms of anxiety. Working that mindfulness muscle - what am I feeling? What's happening in my body? - really helps me ride out the worst of a claustrophobia moment.
- Sleep! I go to bed at around 9.30 every week night now in order to get up and run/gym in the morning. I'm also scrupulous with my sleep hygiene - no screens save for my Kindle in the bedroom, lower the lights at night, start winding down at around 8.30. It's a drag but it helps.
- Being very very careful with alcohol. Even a tiny amount of alcohol makes my anxiety significantly worse the next day. I haven't cut it out entirely, but I try to restrict it to times when I really enjoy it - like splitting a great bottle of wine with my husband on the weekend, or having drinks with dinner with really good friends. I work in an industry with a major after work drinks culture, so bowing out of that has been helpful.

You should absolutely consult with your mental health team and pursue medication and therapy, but these lifestyle steps, while boring, have really helped me with the intensity of my anxiety.

* I've always been mildly claustrophobic, but since moving to London and using the tube lately I've become VERY VERY VERY LIFE-DISRUPTINGLY CLAUSTROPHOBIC and have an extremely hard time getting on trains.
posted by nerdfish at 12:57 PM on October 11, 2017 [2 favorites]

I have the same general mental health problems that you do, as well as this specific one. While ACT (Acceptance & Commitment Therapy) techniques help me a lot with most anxiety issues, their utility can be limited when a. my feelings are actually pretty rational, and/or b. I am having extremely urgent-reptile-brain reactions that are barely intellectual in nature. And for me, nuclear anxiety often meets both those criteria.

That said, I'd like to share an ACT technique that helps me ride a feeling rather than succumb to it, especially when I'm building up to - but have not yet been consumed by - an anxiety/panic attack. To start, imagine that you are beneath a open and infinitely blue sky. All is at peace. You are at peace. Then allow yourself to notice a cloud passing very slowly overhead. It might be a little cluster of clouds, or a single larger cloud. It might be white or dark or backlit by the sun. Give that cloud a name you associate with your feeling (e.g., "terror," "loneliness," "frustration"), and then watch that feeling as it slowly progresses above your head. Try to avoid being judgmental about the feeling (e.g., "Fuck you, you shitty feeling," or "Why do I even have this stupid feeling," et cetera). After all, it's a cloud right now. The cloud doesn't have an agenda and it doesn't necessarily have anything to do with you. It's still in your field of consciousness, but for now you are just an observer.

If I don't have another immediate responsibility at hand, I will also sometimes pick an important but not 100% urgent task to carry out, one that addresses other elements of my anxiety (such as taking steps to improve my earthquake [or insert hurricane, fire, tornado] preparedness).

There's also a Mad Men quote, of all things, that calms me. It's from S2E13, which deals with the Cuban Missile crisis:

Peggy: Nuclear war...we could be gone tomorrow.
Father Gill: Isn't that always the case?

If I'm still on track for a panic attack after those steps, then it's time for a Xanax.

Have you ever tried kava, by the way? It tastes like bitter dirt, and it won't make you forget your existential terror, but it will make you drool while you laugh about your existential terror. I like to call it my little spoonful of Samuel Beckett concentrate (TM).
posted by desert outpost at 3:09 PM on October 11, 2017 [1 favorite]

However, a new trigger has emerged (nuclear war) that has been the most debilitating ever for me

Maybe you can try to stop viewing this as a "new" trigger that is bigger and more powerful than all other triggers. Yes, it is hard to reason with the idea of nuclear war, and yes maybe you're right that it's the most likely time in history for that to happen.

But the fact is, every human being who has ever lived has faced life-threatening situations that have just as much power to terrify as nuclear war. Famine, flood, getting eaten by tigers, getting beaten by a gang of murderous cave men, drowning, suffocation, impalement..... all these threats to our lives have always existed, and I doubt that nuclear war has the power to create a "bigger" fear than all the other fearful situations that humans have faced. So one way to look at your fear is that even if world political situations are precarious right now, it doesn't mean you're in more or less danger than humans have been since forever, and it also doesn't mean that your anxiety response is more "right" or trustworthy or reliable since no anxiety response that is as debilitating as yours is ever gonna help you survive anything.

that might not have been helpful advice Maybe another option is: Try to change the way you think about your "new" anxiety. Just because it feels bigger, stronger, more powerful than before, doesn't mean it is. Maybe part of your anxiety is caused by your anxiety that your new anxiety is bigger now than your normal anxiety? Could you label that "new" anxiety as just something else like "that big old anxiety again" so that it doesn't carry such weight? Because that's all it is. It's the same anxiety that you always have, just bigger. It's no less curable, no less manageable, no less finite. It's just bigger. And that is not your fault.

One last suggestion. Do you ever get the chance to just scream? I once went to an amusement park and found a lot of catharsis in just being able to scream my head off on the rollercoasters.

fear of nuclear war= fear of death
fear on rollercoasters = fear of death.

If you can directlly experience one and feel what it feels like, maybe the other won't be as bad afterwards.

I hope you find some peace soon and don't be afraid to reach out to friends and family and ask for hugs and cuddles.
posted by winterportage at 3:17 PM on October 11, 2017 [3 favorites]

My advice is very similar to winterportage's, but maybe it will help to hear it in a slightly different way.

My therapist wisely says that anxiety is always looking for something to attach itself to; I will spend weeks convincing myself not to be anxious about [work deadline/mysterious rash on my arm/interpersonal conflict with friend/cash flow issue], and the second I solve the problem and feel relief, my anxiety jumps ship and is like, "Okay, but now I'm worried about THIS!" And I take the new topic VERY SERIOUSLY, but really, it's just the same anxiety wearing a new costume. And yet, I obsess about the new issue instead of being like, "I see you, Same Old Anxiety. Stop trying to convince me to be anxious and shut up already." Anxiety is really good at pulling the wool over our eyes.

This is not to belittle your fear about nuclear war and our current political situation, which is indeed precarious-bordering-on-terrifying. But as winterportage pointed out, there is ALWAYS something for humans to be afraid of. When you think about all of the terrible things that humans have faced over the millennia, and about how relatively fragile the human body is, it's kind of a miracle that there are so many of us walking around, and that we somehow manage to find something resembling happiness in the face of so many threats.

So, if I were in your shoes (and trust me, as a lifelong anxiety/panic sufferer, I have been), I would focus less on what the anxiety is telling you to worry about, and more on the anxiety itself. Your anxiety WANTS you to obsess about nuclear war and geopolitical conflict, but instead, you can use the same techniques you've always used to combat anxiety: meds, trying to avoid stress, exercise, meditation, good sleep, whatever. You might need to do more of these things right now, because it sounds like you're having an anxiety flare-up, but really, it's just another version of the same thing you've always dealt with. If you tell yourself, "This anxiety is totally different and unmanageable because it's about something as scary as nuclear war," you're going to escalate the anxiety even more.

I also like Bella Donna's advice about the serenity prayer. I've been working on accepting that most things are totally out of my control, and while it's scary at first, I've ultimately found it pretty freeing. This also works for panic attacks, by the way; mine started getting a lot better when I stopped trying to resist/control them. I just let it crash over me like a wave and it goes away so much more quickly than when I fight against it.

Lastly, and this is minor, but I noticed that you recently got a prescription for Ativan. Ativan SAVED MY LIFE last fall -- I was also having debilitating anxiety and panic attacks, and some of it was due to the election and how crazy everything felt. I wasn't sleeping or functioning well, so I took 0.5 mg of Ativan every night for about 3 months until things leveled out. (I also started an SSRI at the same time.) That said, hopefully this new doctor gave you good information about taking a benzo and, if you're taking it regularly, not to quit cold turkey. I actually had a very good experience tapering off of it, but I do know people with lackadaisical prescribers who didn't help them understand all the benefits and risks of this type of med, and they had a rough time. Feel free to get in touch if you want to talk more about this!
posted by leftover_scrabble_rack at 5:23 PM on October 11, 2017 [3 favorites]

I am strongly seconding the call to see an LCSW or another talk therapy professional in addition to the proactive steps you're already taking. Meds are incredibly helpful, of course, but as a complement to them, it can also be a difference maker to dig into the anxiety and tease it out, maybe gaining some insight into where it comes from.

Even if you're a self-aware and thoughtful person, there's only so much you can do on your own. With the help of a counselor/therapist you can gain some really keen insights into your thought patterns and make some lasting progress with this kind of anxiety.
posted by superfluousm at 5:10 AM on October 12, 2017

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