Finally dealing with anxiety
October 14, 2007 8:16 PM   Subscribe

Tips for dealing with irrational anxiety and starting therapy?

I've long been a worrier, occasionally obsessing over things I know I shouldn't rationally be concerned about. The kind of things I'll worry about (for a month or two at a time, then eventually getting over it): my health, my sexuality, whether some guy I see a lot is stalking me. In other words, it's things that, yes, *may* be true, but are so unlikely as to make my fears logically unfounded. It's hard to talk yourself out of being afraid, though. It was the worst when I was about thirteen and going through the suck that is puberty, and has occasionally resurfaced since. It's never been crippling, certainly, and seems to fairly predictibly wax and wane with other types of stress in my life. But recently I've started graduate school, and since I have so much academic stress (and the pressures of living on my own for the first time, in a new town) I'd like to make this extra, "crazy" stress go away.

I've decided to see if I can work this out and reach a better kind of balance, so I made an appointment with the student psychological services people. I'm supposed to have a phone interview with them on Wednesday to discuss my needs and hopefully set up a regular appointment. So: any suggestions? I've read many of the other questions on this topic, so it seems like this is the right place to ask. I'm not really interested in medication at this point, since I suspect this anxiety is based more on bad mental habits than a chemical foundation, but I am interested in CBT. How do I find a good person? Should I seek out a psychologist/psychiatrist/therapist/something else? Have any of you obtained good results from CBT or some other specific form of therapy when dealing with anxiety? Any coping strategies for dealing with the tension until this help kicks in?

Thanks, all.
posted by anonymous to Health & Fitness (13 answers total) 8 users marked this as a favorite
Start with someone on campus who deals with grad students, if possible. This kind of problem is very widespread among grad students. Don't let yourself make any excuses to miss the appointment. Be sure you set up the next appointment at the end of each session, don't just wait to schedule it "when I have time".

The best way to find someone good is to (a) ask around, and (b) be willing to try again (and again) if your first person doesn't inspire confidence.

Before your phone call: Think about what your most problematic symptoms are (what is the anxiety keeping you from doing, what are your most counterproductive behaviors). Think about what kind of state you would like to be in three months from now.
posted by LobsterMitten at 8:46 PM on October 14, 2007

You are already on track to finding a therapist - the purpose of the phone interview is so they can match you to a therapist on staff (title might be psychologist, MFT (Marriage and family therapist - they do individual work too) LCSW (licensed social worker) but they all do therapy. Tell them you are interested in a CBT approach since it feels like this problem is "based on bad mental habits". I'm not sure how much choice you have in who you are assigned to. The more important thing is that you need good chemistry with your therapist. I suggest that you give it 3-4 sessions and see if you feel like things are starting to shift and change. If not, asked to assigned to someone else.

In the meanwhile, set aside some time each day for focused worrying. Notice what is on your mind and track each worry to its end - what are you worried about? why is that a problem? what's the very worse that could happen? what would you do if that did happen? Writing (or typing) this discussion with yourself might be helpful.

If you start worrying at other times, tell yourself you will get back to that thought at the proper worry time. It might help to have a piece of paper where you write down the worries - writing it down helps convince yourself that you really will get back to it so it is OK not worry about it now.
posted by metahawk at 9:02 PM on October 14, 2007

I'm not really interested in medication at this point, since I suspect this anxiety is based more on bad mental habits...

I've answered several previous AskMe's relating my own experience with a particularly crippling bout of anxiety after my husband was hit by a car while on his motorcycle. You can look them up in my profile if you'd like, but I'll sum up the advice that worked best for me.

I, too, was seeking a drug-free solution, and I did not have access to counseling at the time, so I did a lot of research online. The first thing I learned is that anxiety is a slippery slope. When you initially begin to feel these feelings, you know inside they are irrational and unlikely, but you still allow yourself to ask the question "What if." Not to be flip, but what if the sun explodes tomorrow? Each time you ask yourself this question you are allowing yourself to indulge in the game of anxiety, and the more you do it, the easier it is to get caught up in the crazy downward slide, and the more realistic and "possible" those unlikely scenarios appear.

So, the first step is to recognize those thoughts as soon as they begin and shake them, get them out of your head, dismiss them, so that you don't participate in the make-believe game of "What if."

(I have never undergone CBT, but from my understanding it is somewhat similar to this — recognizing negative thought patterns, acknowledging them and them setting them free. By that token, this is also very similar to medidation, which has helped me to an extent.)

The second thing I learned is a phrase you have surely heard before: Accept the things I can not change and change the things I can. There is no use worrying over events and problems you are powerless to stop. But there is also no use worrying over things you *do* have control over, because instead of idly worrying you should be taking action to prevent them.

I hope this helps. Email is in profile if you would like to talk.
posted by Brittanie at 9:09 PM on October 14, 2007

medidation = meditation
posted by Brittanie at 9:10 PM on October 14, 2007

I think that women in particular are told that our fears, anxieties and intuitions are totally irrational and that we should block them out and blunt them with pharmaceuticals. That said, it's pretty easy to be controlled by your anxieties, especially when you are in a stressful, new grad school environment.

You are making a good step regarding finding a therapist. Plan to shop around a bit for a therapist who you feel comfortable with, who seems to understand your issues. Most therapists will probably try to get you on an anti-anxiety medication right away. My experiences with university health center therapists has been fairly bleak, honestly. If you don't find anyone good at your school and you have insurance, seek out an off-campus therapist who has experience in dealing with anxiety. Do not be afraid to kind of "interview" a potential therapist.

If you are feeling anxious about your health, it can help to go get a full physical, blood work, everything to see what/if anything is wrong with you. If you suspect that a guy is stalking you, but you can't really confirm it, take precautions to make yourself feel safe. Get yourself some mace & take a self defense class. Exercise. I find that when I start to feel my own anxiety levels rising when I spend a ton of time helps A LOT to go hang out with some other people for a bit to study or socialize.
posted by pluckysparrow at 9:13 PM on October 14, 2007

For a grad student, I agree with you on avoiding medication. Once you get out into the professional world I'd consider it. There's a huge difference between doing something because you fear what will happen if you don't -- which is the way that most people are after they've moved out of their parents house -- and doing something because you think it will further your path towards fulfillment.

Right now, though, your anxiety is what's driving you. You just need to learn to control it and keep it from getting too bad. If it's so bad that you absolutely need medication because otherwise you will end up in a mental ward, then you need some time away from school to get back in balance, too.

For me, it was little things that led me down the slippery path to anxiety attacks... like keeping my room clean because my mom always told me to, or doing the dishes at night because mom always told me to. Or keeping the lawn mowed and my car cleaned because dad told me to. Or doing homework because my parents were paying for my education and they would be disappointed if I failed because I didn't.

A few years after I graduated, I realized that the only reason I ever did something was because my parents told me to... not because I wanted to, or because I thought it was a good thing. It took a breakdown over a relationship to make me see this. At that point, got into counseling, got onto some antidepressants, and battened down the hatches for the ride. I had to learn to do things for myself and not because someone else was expecting me to.

Before that, my anxiety manifested in weird ways. I'd exhaustively research something inane. I'd stay up all night banging on a particular programming problem even though I knew the outcome wasn't what I wanted. I'd get paranoid thoughts about things -- my health (hypochrondia) , my work performance (I thought I was always one step away from getting fired, and that other managers at work besides mine were out to 'get' me), my relationship with my ex-girlfriend, my beast of a dog's aggressive behavior, business relationships were always "out to screw me", I couldn't deal with my debt (and it spiraled out of control, just like my mental state) or my taxes... basically, take every negative thought you can ever have in life and take it to the nth degree, and you'll freeze like I did. And I'd do that spiraling with positive thoughts, too -- I'd get into the start of a relationship, and I'd spin it WAY beyond the point where it should've been, and then it would go down in flames when the chick found out I was a psycho. The ups and downs were very intense.

That last up and down with the relationship was a *very* memorable anxiety attack, and it's what scared me into seeking therapy and being willing to consider drugs.

What you're seeing is all classic generalized anxiety disorder. It's not healthy to stay that way. Getting help via counseling can take you pretty far, as Brittany has said... but it's a tradeoff, because 'dealing with it' helps you reduce your anxiety since you have a plan and you're moving forward on it. So if you start going to counseling, set up a regular appointment and stick to it. Don't skip sessions, don't try to go without because you're feeling better.

After six months in therapy and on a moderate dose of Lexapro, I'm finally doing all right. My room's clean because I want it to be clean and it makes me feel peaceful when I'm in it. My lawn's mowed and the beds are trimmed because I like the way it looks when I come home. My health issues were mostly a result of seasonal allergies, and they're under control and I'm doing immunotherapy. My parents are helping me figure out my debt picture and deal with my back taxes, and I'm working to repair their trust in me. It takes time, but you'll eventually get there too -- just don't try to do that and grad school at the same time.
posted by SpecialK at 9:47 PM on October 14, 2007 [1 favorite]

I have been curing my anxiety with the simple phrase "So what?" Its very effective, did I just make an ass out of my self with that girl, so what. Are people staring at me right now? So what. Try it out.
posted by pwally at 12:00 AM on October 15, 2007 [1 favorite]

"Did I just skip Christmas dinner with my family because I can't stand to be around my dying father? So what."

Hey, that's an amazing technique!
posted by rhizome at 12:54 AM on October 15, 2007

Some things you might want to try in addition to everything else said here:

- get more aerobic exercise
- avoid sugary treats
- cut down on caffeine if you use it
- take a tablespoon of flax oil (for omega-3 fatty acids) in the morning
- work through Bourne's "The Anxiety and Phobia Workbook"

These have been a help to me. ymmv, ianad, etc.
posted by DarkForest at 4:33 AM on October 15, 2007

If you find a therapist who is trained in CBT and you are upfront about wanting this kind of therapy, finding a good fit is less important than with other kinds of therapy. You will be doing exercises that help you cope with reality, not plumbing the inner depths of your psyche. Obviously, you want to be comfortable with the therapist, but you don't need the same level of connection as you would want for psychoanalysis.

CBT is pretty straightforward, it's about understanding the irrationality of your emotional responses and learning to overcome them through repeated exposure.

I had REALLY GOOD results from CBT. I used medication for about a six months because my mental illness was severe enough that I had a hard time using reason to break down its walls. Then, while I worked to master the CBT, weaned myself of the drugs.

I am still more anxious/neurotic than the average soul, but I no longer suffer from a debilitating mental illness. In fact, I haven't had a panic attack in seven years and feel more on top of my life than ever.
posted by croutonsupafreak at 9:26 AM on October 15, 2007

The things you worry about and the way you worry sounds a lot like what I was going through for several years. I strongly recommend CBT. I have been doing it for about a year and a half and it has definitely helped me develop strategies for dealing with stress and working my way through anxieties that crop up. I don't think the anxiety will go away entirely as it's supposed to be there to some degree in order to protect you from danger, but learning to control it is key to being healthy.

I would gladly recommend my therapist (I'm in NYC) if you are in the area. There are several CBT associations that you can google to find someone nearby. I was lucky to find someone I liked right off the bat (I chose someone who takes my insurance and whose office is covenient which is all pretty random but I really lucked out). You might have to go meet them for a session to see how you like them and the style of therapy and you may have to try a few therapists until you find one you like. I feel that because CBT isn't as emotionally wrenching as regular tell-me-about-your-mother therapy, you don't need to feel that strong bond with them; think of your CBTist as more of a life coach when picking someone.
posted by kenzi23 at 2:32 PM on October 15, 2007

I hear the pain you're going through - all I can say is that therapy puts bandaids on the wound but the wound doesn't go away - maybe lies dormant at the most. The triggers are the symptoms which pharmceuticals mask. If anyone knows of a way of reaching the deepest recesses and addressing trauma from a therapeutic level - please post.
posted by watercarrier at 11:49 PM on October 16, 2007

I did the CBT thing at my univerity's student health center as a grad student and it worked for me. I went in there ready to change things -- I did my homework -- I showed up when I didn't feel like it. I was done in a few months.

I should note that I also took medication while I was in therapy. Without meds, my anxiety was so high that it was hard to focus on the CBT. The meds brought me down a couple of notches and made it easier to work the CBT.

I went off the meds not long after I ended the therapy.
posted by whatideserve at 1:49 PM on October 25, 2007

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