Okay, so, I am 33 years old. For the last 11 or so years, I have been dealing with anxiety and panic attacks.
I feel like a PTSD textbook case - I went from being a relatively normal 18 year old, and then:
I got pregnant and became a single mom at 19
Watched my much loved mother suffer and die horribly from lung cancer when I was 21 and she was 44
Thankfully, I have a good man, and a steady job, and have been able to build a great adult life.
But, being as young as I was, I had no clue how to deal with my mom dying. I didn’t want to “make anyone sad” so I tried not to talk about it. It was really, really bad, and I had to pretend that nothing was wrong (!), that I could handle it and that I was functioning well, in order to keep going with work and parenting.
Except, now I have issues with anxiety and panic attacks, centering mainly around my health. I also successfully buried my feelings so well that I don’t remember a lot about my mom, and even a lot of things that happened prior to that time. I don’t think the pregnancy thing effected me as much as the mom thing, since I had my mom there to help me through it.
I’m finally at a place where I’m not as afraid to admit I need some professional help. I have no idea how to go about it - I have a primary physician, but haven’t seen him in 6 or so years. I’m assuming I need therapy, and am far more interested in coping mechanisms and finally dealing with my mom’s death, than any kind of pills. But I am interested in your opinions on pills as well.
No, I’m serious, breathe and take this current issue you are reflecting on as a serious wake-up call to have a healthy inside AND outside.
Could I overgeneralize a bit more?
It sounds like you are still living above your neck, meaning you may still be packing things away, but you are only now maturing to a point where you can look at the issues and reflect on them in a healthy way. In my line of work I talk a lot about living below the neck, meaning taking what you think and breathing it down into your heart…essentially feeling it, not thinking it through.
Perhaps someone to talk to i.e. a therapist would be best, just take the time and make this a serious issue in your life so you can choose the best therapist for you and not just a family doctor who may want to control the symptoms with pills. Perhaps for a time a dual attack on the issue would be best, medication and therapy. But take you time and seriously look at what is going on in your life, and then take control of it.
I’m a co-leader of an anxiety support group in real life, and my recommendation for you would be a therapist who specializes in Cognitive Behavioural Therapy (CBT). They may or may not recommend medication as well; in my experience, if you go on medication for anxiety, you will not be able to see the results of CBT as clearly; many people go on meds and basically never come off of them, because anxiety is an unpleasant feeling and they don’t want to face it. If you do go on medication, it should be for a limited time, and in conjunction with a therapist who is helping you develop coping skills.
My personal experience - I had anxiety for 13 years, treated with Selective Serotonin Re-uptake Inhibitors (SSRSIs) and tranquilizers. I am six years medication free now with the use of CBT, bibliotherapy (books on anxiety treatment), a self-help group, and some limited therapy with a counsellor.
Could you be a little bit more specific about the characteristics of your anxiety? What thoughts, specifically are going through your head? What are you doing in response to them?
Ultimately the path to overcoming anxiety is going to involve both changes in how you think and how you act, and it won’t be easy, but I imagine it couldn’t be much worse than what you’ve already been through.
If your insurance provides mental health coverage, just look up one in your insurance company’s provider list. If you would feel more comfortable talking to a female therapist, pick a female or vice versa. Make an appointment and go see them. If after a few appointments, you don’t seem to be clicking with the person, be frank and honest with them and see if they can recommend someone else, maybe in their practice.
Since most therapy is about helping you become more self aware, they mostly listen and ask probing questions. You need to be ready to critically analyze your own feelings, motivations, emotions and the root causes of those things.
You didn’t say how old you are today, but could it be that as you approach your mother’s age when she died you are getting more anxious about your own health. In any case, it’s best to talk this out with a professional and get treatment.
Well, my most recent issue was last week - I woke up Saturday morning with leg cramps in my right calf. We were also getting ready to drive to Tennessee for vacation, so things were fine, but a lot was going on.
My cramps happened on and off all day, and it totally freaked me out. I spent hours in the car thinking about blood clots, then I would tell myself I was being dumb - it was just cramps, then I would think about how to get to a hospital when we were on the road, then I’d reason with myself about how sleeping wrong can give you back pain and leg cramps, then…, etc., etc.
Two days in the car led to a huge anxiety breakdown on Monday - I was sent into a near panic by looking at a brochure for “Magi-quest” which featured a mirror maze and thinking about being stuck in there, trying to get out. Which is fun for a lot of people, right?
Now, a week later, I woke up with sore legs, after a week of on and off back soreness and leg soreness. But it’s not “soreness” - when I was at the store today, I was shopping and looking around and dealing with people, and my legs were not even on my radar. On the way there, and on the way home, I felt it again.
I can tell myself that I’m just freaking out - I can recognize that my legs, if they are a little sore, it’s probably just due to the fact that I haven’t been able to relax them for a week. Or, maybe it’s because I slept wrong, and then traveled to the mountains and hiked on river beds - all while not relaxed. But I still feel anxious in my head. I have sweaty palms and a hard time concentrating, and I rub my neck and worry my hands.
When you say you overcame PTSD, does that mean you don’t feel that way anymore? Ever? Did you consider meds? I have to say that, I’m so beat down right now, that the thought of just taking a magic pill sounds very attractive, even though it goes against everything I stand for, and I have at least two people in my immediate family that have become med zombies.
Sort of. I first started experiencing symptoms at age 18. I didn’t just ‘‘consider’’ meds, I was a walking pharmacy for a while there, I was hospitalized, declared a disabled student, withdrew from college for 2 years, those were dark times. Meds did very little for me and in all honestly probably made things worse. In retrospect it is clear my biggest problem was lack of access to the proper treatment. Too many therapists encouraging me to beat a dead horse rather than find empowerment in the present.
I am 27 now, very high functioning and med-free since 2006. Things aren’t perfect, but I will say that since doing prolonged exposure therapy last fall and starting cognitive therapy this summer I have been improving on a basis I can only call exponential. Today, in fact, I did something (a personal thing) I never thought possible due to PTSD. So yeah, there is real hope for recovery without meds. I’ve been telling people that for years but I mean it more than ever today.
One of the first steps in cognitive behavioral therapy is identifying and refuting irrational beliefs. It sounds like you know you have some, as you are already trying to argue with yourself in the moment when you feel pain in your legs and begin to wonder if you have a clot.
On the subject of blood clots, I guess where I’d start is to go online or somewhere and look up the actual risk for blood clots for someone in your age bracket. You will likely find the probability vanishingly small. Tuck that in your personal arsenal the next time this seems like a reasonable outcome.
One big fear I struggle with is of someone breaking into the house at night and stabbing me to death (this particular fear has no relation to my original trauma, but it doesn’t have to.) One of the first things I did to try to address this is find out the statistical prevalence of murder in my neighborhood. I found that in the past 6 years there have been zero murders. Zero.
Then I asked myself how many times have I been certain someone was breaking into the house? And how many of those times did someone actually break in? What I learned is that my fear is in no way an indicator of real danger, it’s just fear. Likewise, you can ask yourself, ‘‘How many times have I worried something was seriously wrong with my health? And how many times has that turned out to be true?’’
Now here is something very important I learned recently, which has made a world of difference for me. The above refutations of irrational beliefs are really important when you’re writing them down during the day specifically to refute them or whatever, but they aren’t necessarily helpful in the moment of anxiety. Those refutations have to be turned into positive statements.
For example, if I was panicking and said to myself, ‘‘It’s not likely someone is breaking into the house,’’ my brain, in its panic, will likely only process ‘‘someone is breaking into the house’’ and I will probably not feel calmer.
Instead, I have to create a positive reality.
Such as:
The house is empty.
The cat is making noise.
I am safe.
I have found that envisioning the empty house distracts me from the imaginary spectre of serial killer. It’s better to focus on the positive reality in the moment. So you’d want to avoid thinking, ‘‘It’s not a blood clot’’ in the middle of a panic attack. For you a positive statement might be, ‘‘I really slept funny last night,’’ or ‘‘I am healthy and take care of my body.’’
Anyway, that’s just a start. This stuff is going to take time. And because you have trauma, it’s probably going to require processing all that grief you stuffed. By ‘‘processing’’ I don’t mean ‘‘talking about it calmly as you carefully suppress your emotions,’’ I mean getting to that place where you feel like you’re there and the world is falling apart. If thinking about your Mom dying makes you want to cry snot bubbles, then dammit you gotta cry those snot bubbles. You have to feel the pain and agony and grief and learn that it won’t kill you or else you will keep trying to avoid it, and it will keep popping up again and again in the form of PTSD. (This process I refer to is the basis of prolonged exposure therapy.) You won’t be truly better until you can feel that pain in the moment and experience it without feeling the need to push it away.
I’m not even pretending this is easy, in fact going through the exposure process sucked balls. I basically had to relive my traumatic experiences for two hours a day for three months straight until they didn’t scare me any more. But the way I look at it, I’d already been reliving them for 9 years, what’s another three months?
Oh, and like you, IIRC, I also have an amazingly supportive husband. I strongly recommend you use his support whenever you need it, don’t be afraid to reach out to him and always remember that because of his love you’ll never go through any of this alone.
I feel like I’m babbling. Anyway, I really want what’s best for you and absolutely believe if you can handle a baby at 19 and something as difficult as your mother’s death that you can pretty much overcome anything. I mean I’m 27 and I’m planning on conceiving a baby soon, a baby I WANT, and I’m still scared shitless. You’re obviously a very strong person to come through all that. I wish you best of luck.
I’ll echo what others have said. Find a therapist who does cognitive behavioural therapy. I finally did that a few years ago after suffering from chronic anxiety since my childhood. The therapy was helpful by itself, and I now take medication as well. It’s been a tremendous help to me.
Oh, I just realized by above comments on medication might be construed as disapproval of psychotropic medication. I don’t disapprove of medication for treatment of mental disorders, I think they can be a successful part of any treatment plan. Though I will note that they haven’t been shown to be terribly effective for symptoms of PTSD.
I’m about the same age and finally sought some help, beyond self-administered CBT, from my GP about a month ago – I’m on 20mg of Citalopram (Celexa) and have a small supply of Alprazolam (Xanax) on hand.
The SSRIs seem to have helped balance my mood out somewhat (although it’s only been four weeks) which I find helps to forefend anxious moods, based on observation of my own link between mood and anxiety in the past without drugs, and I think that sparing use of the benzos in conjunction with exposure and behavioral therapy is a useful tool. Not all the way there yet, but I feel chemotherapy was my last and best resort.
For what it’s worth, I have mostly overcome near-crippling anxiety (but not PTSD) with intensive short-term dynamic psychotherapy, rather than the CBT that seems to always be recommended in these threads. I’m not saying that one is better or worse, and in fact they are sort of inside-out versions of one another in some ways. Both have evidence of clinical efficacy, although CBT has been more studied. But if the descriptions of CBT don’t sound “right” to you, you could try ISTDP instead. There’s a comparison of the two at the end of that Wikipedia article that you might find interesting.
I was diagnosed with depression and anxiety 3 years ago and was prescribed Citralopram (I think, can’t find my records right now).
I hated the side effects but stayed the initial course because a) my judgment was clearly not good at the time so second guessing the doctor was not a good risk b) the medication made my thoughts of self-harm less intense.
I’m doing much better, but still find it difficult when tired to stop obsessing on my personal and professional shortcomings. Still have difficulty handling job stress. Still have too many nights of poor sleep. But not as much as at the bottom.
My issues are undoubtedly not the same as yours, but FWIW, finding joy and beauty in life and being able to keep the pace of the day-to-day demands in line (very difficult as a parent!) are crucial strands of my life-line. Getting regular exercise has helped me keep an even bearing, but I find it important not to depend on working out to exhaustion-very tempting because it temporarily halts the downward spiral, only to make things worse the next day.
For some odd reason, I find maga comics to be relaxing on nights when the insomnia has its way. They are actually rather silly, but just interesting enough to take my mind off whatever it has locked onto. Actually, I think this is an important point. If you can find something to distract yourself when the anxiety is not too extreme yet, sometimes it will just fade away on its own.
Best wishes to you in your struggles. Sorry about the loss of your mom.
I take that for a combination of depression and anxiety that therapy and CBT really don’t seem to touch. I’m self aware, I’m just self aware and CAN’T STOP even when I recognize how stupid the thought patterns are. The best thing about Citralopram (other than suddenly the destructive thought patterns are GONE) is that a month if $4.08 at Target.
Simple things can work. Breathing deeply in and out is very helpful. At one point I couldn’t do without my little bottle of lavender oil, maybe there’s a placebo effect to it, but it really helped to calm me down.
Consider that your view about not taking pills may itself be a manifestation of anxiety.
I’m not saying that pharmaceuticals are an easy answer, but it’s not unreasonable to think that they can be part of an integrated solution along with some form of talk therapy. Lots of illnesses respond to drugs.
I had two serious bouts of panic. One when I was young, it was around 1981 that was before anyone knew what they were. It was odd as I had a job in recepiton in an ER overnight and I’d get a panic attack, and the doctors would be like “WOW this is so cool, how can anyone go from calm to hyserical that quick.”
Fortunately I found a therapist that could help.
I can absolutely guarantee your attacks weren’t as bad as mine. Even my therapist later said, I’ve never seen anyone as bad as you were.
BUT I was so bad in Janaury, but by June I stopped seeing her. I got over them. Yes six months is all it took. We used behaviour modification and no drugs.
About 11 years later they came back in a very stressful time in my life. This time my therapist (a different one) asked me to try imipramine. It is an older class of anti-depressent. I was better in two days. OK that is highly unusual, usually it takes weeks.
First of all realize panic attacks are not deadly and not dangerous. You don’t die, you don’t go crazy, you don’t lose touch with reality. In fact the phrase you should use when you have one is “This is distressing but not dangerous.”
So how to get over this.
First of all go to your primary care physican and tell him/her. Get a total physical covering everything possible. This is the key. Too often people who have panic problems will say “Maybe my doctor overlooked something.” You need to be able to say “This is distressing but not dangerous, I’ve been checked for everything and this is not a physical problem.”
Second get a book called “Stop Running Scared.” Best money you’ll ever spend.
He describes what the attacks are and how to treat them
I would use antidepressents to treat them. YES you can beat them without drugs. I did it.
So why am I saying use them. Well think of it this way. If you have a headache you can go in a nice dark quiet room and put an ice bag on your head and in two or three hours your headache will be gone. OR you can take two aspirin and in 30 minutes you’re headache will be gone.
You see either method works, but the drugs are a shortcut.
Regardless even if you take the pills you still have to face up to it. I used Paxil to get over my fear of flying. I am so sorry I didn’t do this earlier. I can’t tell you how much in life I missed out of due to that dumb fear. Paxil didn’t cure my fear of flying, I DID. But Paxil allowed me to face it by reducing my anxiety to the point where I could cope. Now I can fly without any Paxil or any drug. I still don’t like to fly, but I can do it and it doesn’t bother me much.
People with panic attacks often hear the words anti-depressents and think that’s an upper. No it’s not. They think if you’re depressed you’re down and you need an upper to even things out. But that is not correct. Antidepressents are not uppers nor are they addictive.
The problem is not all of them work for everyone. Paxil worked great for me. No side effects nothing. Imipramine is every bit as good as Paxi for me. But it has a few side effects like constipation and dry mouth. Prozac did NOTHING for me.
So that is the frustrating part with trying the drugs, not all of them work for everyone.
To find a therapist I would look online for your county in whatever state you live. Call their health department. They usually have some sort of sliding fee scale for help.
Basically a plan of treatment goes like this
Primary care physican rules out any medical problem
Therapist does an intake and determains you have anxiety
You’re referred to a psychiatrist who will have about a 30 minute session with you and he prescribes the drugs. Remember a psychiatrist is a MD (or in the USA and Canada they may also be a DO).
Then you go back to your therapist who will teach you behaviour techniques to help you cope.
Then you start desensitising yourself. Little by little you place yourself in anxiety producing settings and learn to cope with them.
Then after your comfortable you taper off the meds.
If you do what you should you should be coping in a matter of months not years. The problem is some people won’t follow their therapist. It’s like if a doctor prescribes a drug and you won’t take it, how can you get better? If you don’t do your coping exercises you won’t get better. It was like me and the plane. I hated flying but eventually you have to get on that plane to get over your fear. And I find too many people with panic problems refuse to ever do that step. You’re gonna have to be a bit uncomfortable to achieve your peace.
But get that book “Stop Running Scared” read it and you’ll see how you can overcome this.
Do you have any citations on the clinical efficacy of intensive short-term dynamic psychotherapy? I’m interested in the latest research on evidence-based treatments and haven’t heard of this one before.
Excellent post, Marxxx. I did exposure therapy not only for PTSD but also, years previously, for a fear of heights, in order to overcome my fear of flying. I spent an hour a day leaning over the railing of a 5th floor parking structure (I started on the first floor.) The purpose of exposure is to get used to fear and identify what it does to your body, become familiar with it so that you recognize it when it comes up and understand that it’s not necessarily indicative of danger. I have since taken 20 plane flights. I still have initial anxiety that peaks around 30-50/100 on the SUDS, but it always goes away by the time we reach altitude.
