jakebe | Entries tagged with anxiety disorder

Chronic depression is one of those things that can be very difficult to deal with, mostly because those of us who suffer from it exist in two states. When things are fine, we might think that we've rounded the bend and things will never be as bad as our last valley again. And then, when we find ourselves descending towards another crash, we have no idea how to stop it or make the cliff feel any less steep. I think most of us have an "out of sight, out of mind" attitude towards things that are big problems; when we're not actively battling our depression, we prefer to forget we have it.

But the fact is that chronic depression is a disease; an invisible one, one whose symptoms might not show up for days or weeks or months, but a disease that most of us will have to cope with for a major part of our lives. When a diabetic has his glucose levels under control, the diabetes isn't cured -- it's just managed so that the symptoms aren't making it difficult to function.

I think it's useful for those of us with mental health issues to think of our illnesses like that. The symptoms might not be bad enough to prevent us from functioning most of the time, but it's still doing its thing under the surface. There are things that we can do to help ourselves manage it; taking care of ourselves can make depressive episodes less frequent and less severe. I can't guarantee that we'll ever be completely free of it, but we can develop a number of coping mechanisms to help.

Learning how to live with depression is a process. Sometimes it might feel like we're making no progress at all; sometimes it can feel like we're sliding backwards into our worst places. But it's important to have patience with the process and with ourselves. There is nothing fundamentally broken about us; there is nothing that we can't handle. There are just a lot of considerations we must make that most others might take for granted. This can be a gift of practice; learning how to appreciate many aspects of our life that we wouldn't even notice otherwise.

Here are some of the things I've learned to do over the course of several years. You might find that different habits work better for you, and that's fine. It's not important to do every single thing that people recommend for you. It's important to find your own way of managing your mood and getting to a place where you feel comfortable and capable within your own skin. Take my advice, or discard it and forge your own path. But please try. It's worth it, I promise.

Sleep. This is single biggest piece of advice I would recommend for people dealing with mental illness: sleep well. I can't overstate the importance of rest in helping yourself to get on a more even keel. If you don't have a sleep routine, or you're having issues with getting regular or quality sleep, I really do think this should be a top priority. Sleep allows us to settle our emotions and builds our ability to cope with fluctuations in mood or changes in our environment that would cause anxiety. It is one of the best things we can do to care for ourselves.

Building a good sleep habit takes time and practice. The chemical imbalance that can lead to depression also impairs sleep function, so we end up sleeping too little or too much. However, keeping a regular sleep practice is a great foundation for routine that we can use to help us weather those times. Listen to your body; notice when you start to feel tired or your brain tells you it's time to get to bed. Notice when you're most likely to wake up without an alarm clock. If at all possible, build your sleep time around your own circadian rhythm. If it's not possible, determine when you need to get up and count back nine hours -- start getting ready for bed at that time.

It's not easy, and it's not quick, but it is effective. Once you're sleeping regularly, your body can begin the work of stabilizing itself.

Eat well. I know in a lot of situations this can be exceedingly difficult. Even for those of us in the United States, we might live in a food desert where fresh produce or lean meat might be hard to come by. Many of us simply don't have the money or time to make our own meals. I get it. But making sure we at least eat food that gives us a good balance of proteins, fats, carbohydrates and fiber will give our body its best shot at managing itself.

If possible, eat three squares a day that includes lean protein, unsaturated fat and complex carbohydrates. Think a turkey sandwich on whole wheat bread, multigrain chips and fruit. Try to limit caffeine intake after 2 PM; we all know that caffeine plays havoc with the ability to sleep and too much of it will definitely exacerbate anxiety issues. Drink more water, and cut back on sodas and sugary drinks.

You hear this kind of advice all the time, and I know how much of a drag it can be to try and follow through. But it's definitely important. The better fuel you give your body, the better it will be able to function. That's the simple fact. And I know that the instant you begin to control your diet it feels like you're swimming upstream, and we just can't put in the effort all the time. But try. And keep trying. Notice how you feel -- how you really feel -- after you eat. Does the food sit heavy in your stomach? Do you feel gassy or bloated? Greasy? Light? Satisfied? Focus on the foods that make you feel good -- not just emotionally, but biologically. The more you listen to your body, the more it will tell you what it needs. To be a god-damn hippie about it.

Exercise. I know, I can hear the groaning from here, but trust me -- being active when you can really helps. Just going outside or getting the blood flowing helps just about every part of your body, including your brain. When you find the activity that works best for you, your brain learns how to release endorphins that tell you that you're doing a good job. And again, pushing yourself to pay attention to your body will help you recognize how it speaks to you -- how it tells you that it's in pain, or needs food or water, or what kind of shape or mood it's in. Learning your body is the first step to being comfortable with it, realizing and accepting its limitation, and appreciating the things you like about it.

Most people think of exercise as a slog; huffing on the street during a grueling run, or sweating through some terrible routine that you can't begin to keep up with. But it really doesn't have to be; it can be any activity that gets you moving and makes you happy. For me, it actually IS running. I get a wonderful high and a sense of accomplishment after putting in my miles. But for you, it might be anything from playing tennis, basketball or football to playing Dance Dance Revolution or Rock Band on your XBox. If it gets your heart rate up and your body moving, it's fair game. Do it as regularly as you can without hurting yourself.

Therapy. This is another suggestion that takes on almost limitless forms. For you, it might be therapeutic to write your feelings down in a journal or talk to the spiritual leader of your congregation. It might be reading, walking in nature, talking to a therapist or taking medication. Whatever works for you, seek it out and do it; develop a self-care routine, arm yourself with coping mechanisms, engage with the world and community around you however you see fit.

Again, I understand how difficult this might be for some of us. We might live in places where mental health professionals are hard to find or prohibitively expensive; we might not have access to an understanding or capable support network; we might not know where to begin to develop a framework of self-care. But if you're reading this, you probably have access to the Internet and that gives you a leg up. Research things that might help you and try them out; describe the results when you use them, and determine if it would be useful to keep doing them. Seek out communities online if you can -- there are a number of websites and forums for those of us dealing with depression and anxiety. Don't be afraid to ask for help if you need it. Try.

Sleeping regularly, eating as well as you can, doing active things you find enjoyable and engaging in a therapeutic practice are all basic things we could all do to help stabilize our mood as much as possible. Again, these are a lot easier said than done for many of us, but please -- do what you can when you can. Seek out help and support where you can find it. And keep trying. What helped me most with my depression is seeing it for what it is. It allowed me to engage with it, really understand it. And by doing that, I understood myself a lot better. Self-awareness is perhaps the most powerful tool we have against our mental illness. It helps us learn how to cope with it and to live happy, full lives even while we struggle.

If you have depression, anxiety or another mental illness difficult to endure and tough to make people understand, I see you. I'm with you. I want to help. And I'm not the only one.

But the best way to get help is to help yourself. We can support you, but we can't "fix" you. There's nothing to be fixed. You're a human being, wonderful and complete just as you are. You deserve to live, to be happy, to be loved. For people like you and me, it takes more work and care. But it makes the results of that work so much sweeter.

One of the reasons I believe Rabbit is such a helpful totem for me is that fear is such a strong emotion within me. I'm afraid all the time, of various things real and imagined, and that fear drives a great deal of my behavior. One of the lessons Rabbit teaches is how to move through that fear to engage with a broader, brighter world where danger lurks unseen just in the peripheries of your vision. You have to eat, you have to sleep, and you have to enjoy yourself sometime. There are moments of grace, quiet and contentment to be had in a scary and sometimes hostile world.

Over the summer I was diagnosed with Generalized Anxiety Disorder in conjunction with ADHD. That diagnosis was a bit of a surprise to me, especially since over the past several months I had been feeling more frustrated than frightened; I was unable to make headway on most of the projects I'd been working on and I was moving into a new position at work that I know I would have trouble with if I couldn't get my concentration issues under control.

Part of the treatment for the diagnosis is a group therapy class given by Kaiser Permanente every Thursday where we learn what Anxiety Disorder is, how it manifests in people, and what's going inside your brain to cause this behavior. It's been illuminating -- both in my own tendencies and how paralyzing anxiety can be for people. I've met so many people in class who have trouble with dealing with work, or keeping good relationships, or even leaving their houses due to their anxiety. Just coming to the group is a major victory for them, but they can't see it because they just want to be fixed, want to be normal.

From what I understand, Anxiety Disorder is kind of like an emotional allergic reaction. With allergies, your body has mechanisms to protect you from foreign bodies that go haywire on things that it should be desensitized to -- like pollen, or dust, or certain foods. And the best way to deal with that is to either avoid the trigger or take an antihistamine to block the effects.

With Anxiety Disorder, your mind is set up to deal with threats in a certain way. It releases hormones that prepare you to flee the threat or fight it, and those hormones do all kinds of stuff from elevating your heart rate to making you breathe faster to take in more oxygen, to hyper-focusing your brain to deal with what's in front of you. Only instead of the bear that's charging towards you or the really important test you have to study for, it's imagined scenarios about a presentation at work, or the story you're writing, or saying the wrong thing to the wrong person. Most of the time we cannot avoid the triggers that cause this reaction, and most drugs that would lower our reaction have side effects that make us unable to do anything else -- so we have to find a new way to deal with it.

For me, my anxiety is wrapped up in any activity where I have to show a decent level of competence, requires sustained concentration and involve other people being affected by what I do. Writing stories is all I've wanted to do for my entire life, but I just can't bring myself to finish a story and put it out there. I'm so afraid of the process of writing -- knowing that I won't be able to provide the focus that the story deserves really stresses me out. Knowing that I'm not where I want to be with my writing prowess yet is so discouraging, because I'm 35 already and so many people write great novels in their 20s. Knowing that I would have to present my work to a world that is scary and sometimes hostile fills me with dread -- what if it's simply not good enough? What if people rip it to pieces? What if it's deeply offensive in a way that I hadn't anticipated? Or worst of all, what if something that means so much time and effort to me is just met with a gigantic figurative shrug and no one cares? It's better not to do anything than to risk all of the fears I have about myself proven right.

I work in Silicon Valley on a very technical and complicated suite of software. I was brought on in an administrative capacity, but for my career to advance there I'll need to move into a position with significantly more technical work. That terrifies me. I'm not tech-illiterate, but the amount of know-how that the job requires, the attention to detail and the ability to navigate thorny issues with angry customers is just paralyzing for me. My brain doesn't work that way; as much as I would like it to, I just can't remember a host of considerations to be effective with troubleshooting, and confrontation drains my social batteries almost immediately. The job would require me to learn a lot through doing in real-time, making mistakes and recovering from them, all while under pressure to perform at a level expected of world-class support. I'd be moving from dealing with mostly people (which, while draining, I'm more comfortable with) to dealing mostly with tech (where the consequences for a mistake can be catastrophic).

In these, two of the most important aspects of my life, my Anxiety Disorder has pushed me into a spiral I didn't even see but kept me from moving forward. The situation causes an anxious thought, which triggers an outsized emotional reaction, which triggers a *physical* reaction that triggers another anxious thought, which sustains and solidifies that emotional reaction, which ratchets up the physical reaction, which…you get the idea.

Without realizing it, my reaction to these stressors has been to flee; I'll get to work, take stock of what I should be doing that day and get freaked out enough by my workload that I retreat to something easier -- a mindless task that's more comfortable, Twitter or something else. The moment a story gets difficult or starts to diverge from where I had expected it to go, I'll bail on it. Or I'll muddle through it in fits and starts, unable to keep the story disciplined so it fulfills my worst fears and justifies me never trying it in the first place.

I've learned a lot through the Anxiety class about being mindful with my worries, knowing what kinds of thoughts send me into a spiral, and all the ways people with Anxiety Disorder tend to magnify or distort issues in order to justify the emotional/physical response. Catastrophizing the outcome, "fortune telling" about what terrible thing will most certain happen, "mind-reading" the reactions of those around us or what people are truly thinking all happen in varying ways, to various degrees.

Last week I learned how the fight/flight response tends to work in those of us who have trouble with anxiety, and what we can do about it. The fight response tends to be obsessive worry with a particular problem -- working through every possible angle and outcome until everything is accounted for, which is a problem. Sometimes, even after you've put an issue to bed with a solution that covers all your bases, your brain can be really good at chewing on the bones of it over and over again. The flight response most often manifests in procrastination, sometimes aggressively so. If I'm worried about a project, it often feels like there's a block in my brain that physically prevents me from working on it.

I've been taught that with Anxiety Disorder, the best thing to do is often the exact opposite of your initial impulse. If you're a compulsive worrier, it's best to try and take your mind off the problem (I don't know how that works, but I'll assume we'll learn about that next week); if you're a procrastinator, it's best to lean in with the issue and face the thing that's worrying you.

For example, with my job I'm worried that I will not be able to perform up to the standards of my managers and will face months of disappointed superiors, warnings and eventual termination. As an exercise, we were encouraged to visualize the worst-case scenario of that fear three times; each time, we would deconstruct our imaginations with an eye towards learning how we catastrophize.

I was surprised by just how awful my story was: because one of my superiors is also a friend, I imagined that the situation deteriorated our friendship to the point of dissolution. Because I was desperate and afraid, I'd lash out at work, and THAT put a strain on the relationship between my husband and I, and my superior and his partner. That put this strain on our entire social circle, and because I was so emotionally devastated I just could not deal with it. My world got smaller and smaller until I couldn't even get out of bed, and by association my husband's world got smaller -- between taking care of me and our strained relationship, he was becoming increasingly alienated. I couldn't get it together enough to do anything; I was too fragile to shoulder any of his problems, but he had to deal with all of mine. Our marriage suffered...and I had to bail on the rest of it. It became too painful.

When I was back in the room, I noticed how tight my chest was, how fast my heart was beating, how dry my mouth felt. Then I answered the questions: Is this likely to happen? Will thinking about it make it happen? If it *did* happen, what could I do to cope? What aspects of the situation had I misinterpreted that makes it less likely to happen? After that, I felt better, and the next visualization felt embarrassing for how melodramatic it was. I came out of it, refined the answers to my questions, and visualized a third time -- by then, it was boring and silly. I knew how impossible the worst-case scenario would be, and had a better appreciation of the strength of my relationships and the love of my husband.

The tools I'm developing to deal with my anxieties -- after learning how to clearly identify and understand them -- are allowing me to lean in towards the things that scare me the most. I was able to move through my discomfort talking about mental illness earlier, and I have a lot more patience with myself when it comes to my writing. The progress is steadier, faster than it's been for a long time. I can actually imagine a life in which I am capable of learning new things, becoming more competent with the things I want to do, actually reaching the goals I set for myself. It's so great to learn about myself and take those lessons into direct action.

I'm still afraid, of course, but now I have a much better time with that fear. It doesn't paralyze me the way it used to. And I have professional help to thank for that.

I understand that not everyone with Anxiety Disorder has this experience; there are so many people in my group who are affected a lot more strongly than I am, and will probably need furthere help over a longer period of time to deal with it. My heart goes out to them. I know how much my relatively mild version of it has hampered my life; it must be terrible to deal with much stronger fear day in, day out. Once you see how fear manifests through a broad swath of people, you notice it driving so many other behaviors -- especially the ones I've found antagonistic or particularly angering. That allows me to see myself in these people a lot better, which allows me to check my anger and better understand what they might be going through. Understanding myself helps me to connect better with others.

I'm curious if anyone else out there has issues with anxiety. What about it do you find particularly challenging? Are there ways you've learned to cope with it? Are there experiences you would like to share? I'm all ears!