Help me explain my anxiety.
October 27, 2019 12:15 PM   Subscribe

I have always been an anxious person, and it is only quite recently that I've twigged onto the fact that not everyone lives life tensely waiting for the next bad thing to happen. I finally started therapy after resisting it a while. I did not expect to magically feel better immediately, but I do think that perhaps I'm not communicating well enough with my therapist about how debilitating my anxiety can be. How do I do that better? Details below.

One of the things they focus on is how functional I can be - and this part is mostly true. I hold down a very high pressure job with fickle top management, manage a remarkably horrible commute, live alone , do a good deal of caretaking for family members (including a ton of logistical heavy lifting), and I generally sound quite sorted. I think what's happening is that I'm not really showing them how much all of this costs - I've started having crying jags at work (this is a new and utterly horrible phenomenon), I find it increasingly hard to pretend that the commute isn't soul-destroying, or that I'm starved of companionship and meaningful interactions outside of workplace (workplace itself has gone from reasonable to really toxic in the last one year with no hope of improvement in the short term and no concrete exit plan yet, what with all the overwhelming stress and anxiety), and whatever pitifully little downtime I have is eaten up by worry and stress and physical discomfort from the stress. Unfortunately, I think I approach even therapy as something that I should have my game face on for, and I constantly qualify everything that is hard or emotionally exhausting or saddening with that perhaps I'm overthinking it. Or being extra sensitive. Or I joke about it. They don't agree with my characterization of the situations, but they do think I'm very functional (I think the words 'surprisingly so' were mentioned more than once) and have a healthy set of coping mechanisms (primarily because I'm eliding over the less healthy stuff like the crying and obsessively rechecking work and really really bad panic attacks). I find myself wanting them to think I'm competent, which is basically ridiculous because I am excluding myself from the help I need.
How do I make this work better for me? How do I communicate my issues more clearly? I like them and I do not really want the additional anxiety (heh) of shopping for a change yet. Even general advice for dealing with this would be very welcome, thank you. I'm very tired.
posted by Nieshka to Human Relations (18 answers total) 21 users marked this as a favorite
 
Try showing your therapist this question. Or make a list of stuff/behaviours that you feel unable to verbalise and give it to them to read, making it clear that part of the therapeutic relationship for you will require breaking down your "game face" in order to be able to actually discuss this stuff.

Also bear in mind that therapy is really hard and can be scary, and it may take a while for you to build up enough trust with your therapist to fully "let go" and be present with all the full brutality of your anxiety and hard life stuff. If you are able to bring up the fact that you at the moment still need to hide stuff behind competency and functionality in sessions, that will be a really good step towards a therapeutic relationship that will actually be able to do something for you.
posted by Balthamos at 12:22 PM on October 27, 2019 [9 favorites]


Oh hey this is me, high functioning and anxious with a therapist who is like "Wow you do a lot." and I think I do, partly because my anxiety has kept me on a hamster wheel of achievement but I'm not sure I actually LIKE being that busy. SO what was helpful for me was to have goals.

- I'd like to be able to go to the supermarket without being angry at everyone
- I'd like to be able to drive into the city without parking somewhere weird and taking public transportation
- I'd like to be able to hang out with my imperfect friends and have a good time and not be silently judgey all the time

So for you maybe you want to

- Not have crying jags at work (I am so sorry, that sounds hard) or panic attacks
- Make and maintain some low-key friendships
- Not downplay how hard this all is for you

And then you can talk to your therapist about ways to work on those things. Because it may be, I don't know, that your therapist is hearing you but also trying to be supportive of your positive attributes which can be somewhat helpful for some of the "letting go" that moving past anxiety can require. So don't assume you haven't been heard, but also be a little more open "Look I do all this stuff but it makes me despair daily and that's no way to live. I'd like strategies for moving out from under this cloud in my life" and see where you can go.
posted by jessamyn at 12:27 PM on October 27, 2019 [33 favorites]


Hello, you are me. I recognise this really well and have initiated my most recent contact with the healthcare system by saying, explicitly: "I seem in a lot better condition than I am. I will turn myself inside out to make you think I am fine. Please don't believe me.". I've explained that I can hold it all down, but only, as you say, at the cost of all of my wellbeing and mental health. I got a great contact who helped me work out what was the thing I couldn't compromise on, and to focus on keeping that ok, and letting other stuff "go to hell" while I got my feet under me and got my stress levels down to manageable levels. So yeh, I didn't do nearly any recycling for six months, but I feel a shitload better now and that's getting worked back in (for example).
posted by Iteki at 12:29 PM on October 27, 2019 [6 favorites]


Oh, also as a people pleasing anxious doer, my contact person has also gotten the go-ahead to just tell me I am not allowed to do X. So she banned me from working out, even though I was like "but as a responsible anxious person I should be working out regularly because of the benefits to mental health" and she was like "no, you've other priorities right now, we'll talk about getting that in when you've landed a bit".
posted by Iteki at 12:33 PM on October 27, 2019 [3 favorites]


I find myself wanting them to think I'm competent, which is basically ridiculous because I am excluding myself from the help I need.

Being competent does not mean that you don’t need help. In fact people who are truly competent are ones who know what the score is and ask for help when they need it. Which you have by going to a therapist.

I could definitely see where doubts about your own competence could feed into some severe anxiety, which I’m guessing is why your therapist is reassuring you about it.
posted by Tell Me No Lies at 12:48 PM on October 27, 2019 [1 favorite]


I present as way more together as I am when I see the meds shrink/health folks here for my ADHD, etc. In the spring, when my ADHD meds stopped working, my shrink agreed that we should focus on getting the ADHD meds problem fixed because I was worried about losing my client. We also agreed that I should come back to start tackling my lifelong anxiety and (sigh) chronic depression.

But I don't think he really gets it. So I am going to write a letter I can give him so it is all down there in black and white. I think the advice above is good in general, and I would be totally happy printing out my own AskMe, if I had one, to show to my shrink. I think that is a fine plan. Therapists aren't super human; they cannot read minds either. I used to see a therapist who triggered this odd desire in my to somehow take care of her, so I was always at my fucking best during our appointments and she would talk to me admiringly about how together I was. Only I absolutely was not.

The shrink I see now from time to time does not trigger the same issue in me but he sees me briefly and I am articulate and have some self-awareness, which somehow seems to make me seem healthier than I am. (Last Spring a psychiatric nurse asked why another nurse had referred me to her, for example, and kind of implied that there was nothing wrong with me, which was super upsetting.) So anyway, I am following this question with interest and encourage you to do all the things, starting with showing your therapist this question, so that she understands fully your distress.

I'm eliding over the less healthy stuff like the crying and obsessively rechecking work and really really bad panic attacks. Yeah, no. Kindly stop doing that. I understand it is hard to be honest but be honest. I have had those panic attacks. They were a nightmare. Print out you question, hand it to your therapist, and say "Please read this, then we can talk." You will be doing yourself a huge favour. Good luck!
posted by Bella Donna at 1:28 PM on October 27, 2019 [5 favorites]


Hi! I am pretty newly back in therapy and my therapist and I dug into almost exactly this topic this week. My also brand new psychiatrist rescheduled our appointment 2 hours before our first meeting by asking me if it would be ok to move the meeting out a week. I firmly responded that this would not be ok and we were able to find a time. In discussing it this conversation my therapist she was like, "you do not present as someone who needs a psychiatry appointment urgently, let's explore that."

And I was like, it takes almost all of my energy to seem ok out in public. I would like to turn the anxiety down a few notches when I'm alone and when I'm with people. I need to stop engaging in some of the avoidance behaviors I've developed. After spending decades literally being punished for any moment of not seeming ok, investing in appearance is a deeply rooted strategy for survival.

I will be printing your question for my therapist because "doesn't seem that unwell" and "accomplishes things" are not a great metric for a lot of stuff. This is part of how terrible things happen and afterwards there's a chorus of "I had no idea" and "I wish they had said something." Society has an image of what it looks like when someone needs help. Yes, I appreciate that my therapist wants to celebrate that I am currently securely housed, food secure, and volunteering. She doesn't get to dismiss the areas where I am really really struggling.

I'd like to say, asking for help is enough of an indicator that help is needed.

I feel this so hard
Unfortunately, I think I approach even therapy as something that I should have my game face on for, and I constantly qualify everything that is hard or emotionally exhausting or saddening with that perhaps I'm overthinking it. Or being extra sensitive. Or I joke about it. They don't agree with my characterization of the situations, but they do think I'm very functional (I think the words 'surprisingly so' were mentioned more than once) and have a healthy set of coping mechanisms (primarily because I'm eliding over the less healthy stuff like the crying and obsessively rechecking work and really really bad panic attacks)
because I live it. I can't bear to be or seem too emotional. I have to keep it together. Part of this is because I fear that if I finally fall apart I'll never put myself back together again. I carry a handkerchief (or three) with me everywhere I go not just because of allergies and nosebleeds, but also because I could run out of energy to not be in tears at like any minute and that is terrifying.

In part because I've been framing my re-entry to therapy in part as a desire to work on avoidance behaviors, my therapist was able to identify "seeming ok" as itself an avoidance behavior, for me. So I have no idea what we'll do next week to advance this work, but you are not alone in it. You are not alone in needing help for this.

A good key phrase is "interferes with activities of daily living." If this is disrupting your sleep, work, cooking, eating, cleaning, healthy relationships, it needs attention. You've expressed issues in nearly all of these areas. So mention those to your therapist as well, even if you aren't sure how the disruption is related to what you're feeling.
posted by bilabial at 1:30 PM on October 27, 2019 [19 favorites]


'I can't bear to be or seem too emotional. I have to keep it together. Part of this is because I fear that if I finally fall apart I'll never put myself back together again.'
This times ten. I am tearing up as I write this, but thank you, thank you, thank you. I feel seen.
posted by Nieshka at 1:38 PM on October 27, 2019 [21 favorites]


There's a model of emotions that I don't think is accurate or useful. That is that emotions well up and get suppressed, and then you need to release them.

If you're like me, you don't formulate emotions well in the first place. They lead to all sorts of thinking instead of feeling, and thinking is the worst way of handling them as they arise. I talk and analyze a lot in my head, when I could be feeling, or just being. So the emotions aren't welling up and getting suppressed; they just aren't happening, or becoming stunted.

I wish I knew the way out of this. Therapy helped some, but, like you, I tend to "win" at therapy. I'm very good at telling the therapist what I thought I would say if I were an ace student. An earlier therapist would keep directing me to what I was feeling, to attend to that, to how it felt in my body. I remember several times I became sort of catatonic — there wasn't feeling there, not quite. I remember him asking: "Where did you go?"

That's the spookiness. I don't feel like I'm going to sob if I touch my emotions — I fear I'll be paralyzed, dopey, nonexistent. It's like, under the intense jungle gym of think think think there's nothing there. I don't want to be nothing.

I know I should wrap up with how to resolve this problem. I don't know how.
posted by argybarg at 2:21 PM on October 27, 2019 [15 favorites]


I hate the common advice to print out the question and share it with a therapist. It makes sense if you forget things. But the problem isn’t the forgetting. It’s the minimizing, it’s conveying the facts while being dissociated from the overwhelming experience. Because I don’t yet feel safe in the therapy space to know that I can be overwhelming and yet, not overwhelm the professional in the room.

Intellectually I know I’m safe. And I actually have good rapport with my therapist. But an entire childhood of being the adult of the family, my brain isn’t wired to trust and be the child in the therapeutic relationship. Just last week, I was talking about waking up into a panic attack. And it took him a few minutes to point out that was what happened, because I was talking about waking up a bit tense and disoriented in the same tone as though I was recounting an uneventful trip to the grocery store. my fear and anxiety are walled up in another part of my brain for safekeeping, and I had to be nudged that this was the place for safekeeping.

When your therapist is saying that it’s surprising how much you do, that doesn’t have to be a compliment. It’s also an opening to say “yeah, it’s really hard and my gas tank is empty”. That you can’t yet do that is evidence of how counter-dependent you are. It’s possible this is a poor fit. But it sounds like it’s early days that you might just need to let her know you’re having a difficult time really conveying how hard things are, and you recognize the people pleasing tendency you have in the session. And then slowly notice when you’re actually doing it, and not just in retrospect when you feel she didn’t really get it.

And I realize that’s a lot like printing out the question and reading it to her. But I just want to acknowledge it’s an unsatisfying stop gap until you feel safe enough to be emotionally vulnerable so you can actually feel seen and understood by your therapist.
posted by politikitty at 3:00 PM on October 27, 2019 [3 favorites]


Omg the pressure to seem ok is so culturally pervasive. You’re right, I do see you. And being seen is also so hard. I feel seen right back and I want to hiiiiiiide. The thing I need most is for people who are invested in me to really see how fucking hard I’m gripping everything. Making what I do accomplish look easy. Filling my time so that I don’t have to be alone with my thoughts.
posted by bilabial at 5:10 PM on October 27, 2019 [1 favorite]


Show them your question. I was really lucky and got a psychiatrist at one point who is very experienced and went 'you're not depressed, you've got anxiety' and put me on an anti-anxiety medication. Now I'm supposed to learn to take one day off a week to do nothing but relax and self-care, which is the stupidest thing I have ever heard of, but apparently healthier than working continually until you collapse.

If you don't want to show your question, write the list of symptoms you're experiencing down and don't undersell. Rate them out of ten where 10 is you are unable to work or concentrate because it is that bad and note down that 10 is that bad. They need to see how badly this impacts you, how much time and peace of mind this is taking from you to keep it going. Quantifying it might make it easier for you to talk about it with less emotional intensity.

I do want to say part of this may be a sort of weirdly justifiable nervous fear - when you do put down the anxiety and start dealing immediately with your emotions, it is like being a Baby Fawn again. It can be bewildering and weird and intense. Like you're a grown up with toddler/teenager emotions and you have to Feel Everything again instead of just the static of anxiety, and learn to deal with them. It's good! There's feelings like happiness and joy and amusement, as well as sadness and annoyance, but they are intense at first without anxiety drowning them out.
posted by dorothyisunderwood at 6:37 PM on October 27, 2019 [1 favorite]


Hi! I am also a very high functioning anxious person. I I regularly get told how calm and organized I am.

I went through some major health stuff, and ended up telling my doctor everything. I needed to bring my partner with me, so I wouldn’t tell her everything was fine. I ended up taking some meds while I got myself sorted and when they kicked in...

I got a work email that something I’d set up had gone wrong. I picked up my phone and called people until I straightened out the problem. I Didn’t give myself a pep talk, I didn’t write an elaborate list of what to say on the phone, I just did it.

I don’t take the meds now, but just experiencing life without anxiety for a few weeks has given me a lot to strive for. I don’t think that we’re rare, and I wish you luck. But yeah, drugs really let me know what normal could be, and I’m not there yet, but I’m way better than before.
posted by Valancy Rachel at 7:55 PM on October 27, 2019 [3 favorites]


Dunno about the therapist thing. You, your environment and your internal beliefs have all set up a habitual unconscious patterning about how you experience your life. IMHO, the medical industry, when they aren't fixing something broken, are trying to set up a loop of dependency. Don't depend on the therapist to understand your internal workings if you don't.
When people talk about mindfulness, gratefulness, self-talk and coupling that with exercise, diet, meditation and positive relationships, this is not health gibberish and New Age hoo-haw BS. These are ways of actively countering the biological tendency of our default mode network to ruminate on negatives and potential disasters. Our brains have a biological tendency to look for negative outcomes. Think bears and tigers in the jungle and primitive apes fleeing for their lives. That's in our deeper brain structures.
You are on some level presenting your brain with insoluble problems that it interprets as being fear generating. Or maybe your insula and amygdala are doing a little dance called 'everything is kind of weird and fearful.' I think there's a way out of that and it doesn't involve paying a therapist. Only you can figure it out really since it's your awareness, body, and patterns of experiential reaction and behavior. If you think of fear and anxiety as a kind of internalized bad habit of your unconscious, then reversing that means replacing those triggers or behaviors with something more positive and life-affirming. Good luck!
posted by diode at 8:53 PM on October 27, 2019 [1 favorite]


I also have anxiety, and to be honest what worked for me was going to a psychologist who specialised in anxiety. I tried a few therapists before that but their deep breathing exercises were not what I needed.
posted by thereader at 10:04 PM on October 27, 2019


...part of the therapeutic relationship for you will require breaking down your "game face" in order to be able to actually discuss this stuff.

To add onto Balthamos' advice: If it's too difficult at this time to work against your anxiety, it might help to communicate your therapeutic needs in a way that works with your anxiety. At least for now. Since your anxiety kicks in with reactive responses that seek to minimize the issues (e.g. qualifiers, jokes, omissions, etc.), try framing your issues in a way that provides some psychological distance. That way, you can avoid triggering those reactive responses. Approaches that provide psychological distance might look like jessamyn's suggestion to re-frame your issues as goals, or dorothyisunderwood's suggestion to list your symptoms in a clinical, quantitative fashion. You could try breaking down your issues into more manageable, basic components (e.g. motivations stemming from a need for security vs rewards). Or write down your issues from an omniscient narrator's POV, as if it's happening to somebody else, and then share that "story" with your therapist. Then you and your therapist can work out a treatment plan that gradually broadens your anxiety's comfort zone with emotional intensity, instead of trying to force openness and vulnerability all at once.

This is all to say, be kind to your needs. Think of this way: your needs don't have to be good or bad, they're just your needs. For better or worse, they have developed that way for a reason and serve as a history of your life experiences. As diode described, anxiety is a manifestation of a "habitual unconscious patterning" that emerged from multiple factors (your environment, internal beliefs, interpersonal dynamics, etc.). In that sense, anxiety may have developed because it did make sense as a strategy or response at one point in your life under specific conditions. So anxiety may simply be your brain's way of implementing a coping mechanism in situations where it no longer applies. So instead of perceiving your anxiety as a personal failing or weakness, think of it as a obsolete, specialist response that needs resetting and retraining to new, different contexts.

FYI, I'm dealing with anxiety as well, so feel free to PM me if it helps to discuss it further.
posted by postmortemsalmon at 11:05 PM on October 27, 2019 [1 favorite]


A lot of what you relate resonates with my own situation, 20 years ago.

I had a stressful job, that was manageable, until re-orgs and layoffs made the job even worse. My good boss moved overseas, and I was left with a decent boss, and then Bad Boss was hired, and it all started turning sideways at work.
 
I was also a divorced mother of two, and around this time, my teenaged daughter began having bad mood swings, skipping school, and hanging out with bad kids. I had a son 10 years younger, who needed attention. My ex, their father, was not very involved, and glossed over and ignored my pleas for help with parenting.

At the same time, I was dating a guy who seemed nice at first, then became clingy and demanding, and wanted all of my time on weekends. I tried to tell him that I needed a break, and he didn't take it very well, further adding to my stress.

The key element, for me, was that I didn't have any "safe" place to go to. If your job sucks, and you can go home and unwind and feel safe at home, that's one thing. If your jobs sucks, and you go home and have further responsibilities (such as your care taking for other family members), and you don't have a good social support network, such as family members and friends who feed you the good stuff, or even down time that is nourishing, your brain is gonna say, "whoa! This is enough!"

Eventually, I was forced to leave my job, when it became clear Bad Boss wanted to clean house and bring in his own people, and I couldn't really think straight enough to seek out a new job, especially with the demands at home. I didn't have a lot of close friends, and my family members lived far away.

I began to have panic attacks, and yes, crying jags at work or on the way to work. When I finally got out of work, my daughter was calling me on my way home, making demands. When I tried to relax, my son didn't want to go to sleep, despite 2 bedtime stories, and his special music. I might have had a little bit of time to myself, but then my daughter would start up again. So it was a constant state of waiting for the next bad thing to happen.

A key thing that was missing for me was validation and emotional support. I was at such a high pay level for my job, there was no way I could have found another one with a similar rate of pay. I loved most of my co-workers, and I was used to the responsibilities. But the constant re-orgs and layoffs, and new bosses, their mercurial nature, and the uncertainty of it all was very distressing.

I like the idea of having goals:

- How do I manage my bad feelings about my commute?
- How can I come to terms with the toxic changes at my workplace?
- What resources are out there for care givers?

It sounds like you might benefit from a support group of similar peers, one night a week, maybe? It's hard to be all alone and managing these things, and the recent changes at work may have just been your tipping point, because now your work is feeling unsafe, so the rest of it seems overwhelming: it all gets magnified. A therapist is just another authority figure, but a support group of your peers might allow you to see that you are not alone, and you can open up and discuss these issues, without having to put on your game face.

When I was going through marriage counseling, the therapist said something once that resonated with me:

"Wouldn't it be nice if you could go to a house, where a motherly woman would open the door and welcome you, with the smell of fresh bread baking in the background, and you could go inside and relax, and just get away from it all?"

Notwithstanding the gendered aspect of that statement, I think what it meant to me was a safe place to go to, to forget my troubles, and have someone take care of me for once.

It can take a few sessions to be able to trust a therapist, to open up to them, especially if you are used to carrying the load yourself, and doing it all. It's possible this therapist might not be a good fit for you, and you might need someone who specializes more in stress and anxiety, and coping skills. Or you could ask them specifically: "What tools and methods can you give me for coping with panic and anxiety, so I can find some mental relief right now? Is there a support group that I might benefit from?"

Sometimes you have to be really blunt with people. "I may seem like I'm managing well, but inside I feel like I'm going to have a nervous breakdown every day, and it's getting worse. Please help me develop some coping methods, so I can calm down enough to decide what to do about my situation."

Best of luck to you, hugs from an internet stranger, if you want one.
posted by Marie Mon Dieu at 2:13 AM on October 28, 2019 [11 favorites]


I'm not better, but I am grateful for the suggestions, and hope they would enable me to seek better, more focused help for myself.
posted by Nieshka at 10:02 AM on December 3, 2019 [2 favorites]


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