Monday, June 30, 2008

Why Anxiety Girl?

A few years ago I was hanging out with my sister in law Hilleary at a bridal shower. We’re notorious for scoping out the dessert table and behaving badly at “formal” family functions – making raunchy jokes in the back of the pack; laughing out loud at inappropriate times.

Hilleary also wrestles with anxiety and has a great sense of humor.

So, there we were nibbling anything we could get our hands on and talking about feeling claustrophobic. You know how showers can get – too many people shoe-horned into a small space, oohing and aahing over houseware products, going on for hours on end. As much as we adored the hostess, we were just over it.

Noticing a sliding glass door, we had the following conversation.

“Oh my God, I’m so ready to go home. You think we can just sneak out the back door?”

“Well, if I was a super hero, I would fly right through that glass door and get out of here!”

“Yeah, how about an anxiety super hero!”

“Able to flee social situations in a single bound!”

Over the years, I’ve had lots of fun visuals of Anxiety Girl fleeing social situations in a single bound; running away at lightening speed from speaking engagements; using her super powers to transport herself to California instead of flying in an airplane.

Of course, Anxiety Girl’s real power comes from staying in the feared situation. Her real courage is in feeling the wave of fear build up – feeling the dread that something very wrong is about to happen – and, despite her worries, diving head first into the swell and floating on the other side. Avoidance is her kryptonite and exposure breaks those chains.

Friday, June 27, 2008

I'll cross that bridge when I get to it.

I’m quickly learning that one of the problems with blogging is that you’re accountable. But then, maybe that’s one of the reasons I started writing.

So, this week my husband was out of town for work. Grandma came to visit the first half of the week. The second half, I packed up my mini-van with 3 excited girls and we traveled about 90 miles to Grandma and Gramps’ house, which happens to be on the water.

About 4 or 5 years ago, I would get pretty anxious driving the highway route to her house that included two long, but low bridges. I worked on it first by driving with my husband as a passenger. Then I graduated to following Grandma’s car while I drove my own. And, finally, I took it on by myself (that is, me with the kids).

Just when I felt like it was no problem & couldn’t remember why it seemed so difficult, this particular town decided that they needed bigger bridges to let the passing cargo boats go through. “Dammit”, I said, “Why would they destroy those sweet little bridges? There’s no way I’ll ever drive over those huge monsters.” I was really irritated. Why would the town do that to me? ‘That’s fine, I really love the scenic views of the back roads’, I thought. ‘There’s no shame in driving that way.’




Well, over the past year I’ve driven over the new “monster” bridges with my husband riding as a passenger & cheerleader. It’s been predictable – real scary at first (I hate the ascent); then not so bad; and finally no big deal as long as someone was with me.

So, as Mom & I drove our separate cars this week she checked in.
“Which way do you want to go?”
“Let’s drive through the point.” I said.
“Wanna lead or follow?” she asked.
“I’ll lead.”
“Alright. See you there.”

As we approached the first bridge I felt a flutter of adrenaline, but it was alright & I felt good. But, my mind was already thinking of the return trip. I could always take the back roads and it would be no big deal. Then again, I’d started this blog and had been talking about facing your fears. Didn’t I just say that I didn’t avoid anything in my daily life anymore? Well, this route was not part of my daily life, but avoiding anxiety in general does tend to feed the beast.

Over the visit, the thought of crossing those bridges stayed with me, popping up here and there in the middle of otherwise fun events. This morning I woke up feeling anxious, but also feeling like I really had to do it. It was important not to run away. But, a chorus of voices offered differing points of view.

“You have to do it. Avoiding fear makes it grow exponentially.”
-Well, I don’t HAVE to, but the 2nd part really is true.

“Just take the back roads. It’s not big deal. We’ll be back next week & I can really take the time to practice and do it over and over again. That’s a good idea.”
-Sounds reasonable.

“Looks like rain. No one would expect me to drive over big bridges for the first time in bad weather.”
-True, but Gramps’ says the rain isn’t coming until much later.

“Then again, not doing it today will make it harder next week. What’s the difference. If you’re going to do it next week, why not today? Getting to the top of the bridge will take 30 seconds & it’s all downhill from there.”
-But what if I can’t. What if I have to stop on the bridge with my babies. (Insert image of kids crying on top of the bridge while I’m frozen with fear. Fast forward to images of them all in therapy because of me).
-Ok, in the 12 years I’ve been dealing with this crap, that’s never happened. In all my
experience and in all the books I’ve read, the thing you fear never happens. It’s a hoax. Am I going to let myself be tricked today?

“Do what will make you proud later today.”
-Alright, I’m still anxious, but bring it on.

As I packed my bags, I scribbled out a new coping card to carry with me. I looked over some notes from a pain coping class I’d taken as we prepared for baby #3 (the same philosophy that I teach to expectant parents -- I’ll post later about how amazingly similar childbirth support & prep are to working through the sensations of anxiety). "Looking good man, keep going" is from a sweet note my 8 yr. old made for me before her baby sister was born. You have to read Ina May to get the horse lips reference.



We began our drive. I looked at the faces of my sweet girls. They weren’t worried. Why should I be? I told them that we were going to drive through the point and over the new bridges. “Remember how Mommy’s been working on driving over those bridges? Will you help cheer me on like last time?”

Silence at first. Then a request for food. Then music. Finally I heard from the back, “Go Mommy Go!”

“Yeah! Ok, I wonder how many seconds it will take to get to the top of the bridge and then all the way over?” (I was thinking 30 seconds to the top, max). “Will you help me count?” They were sold. Now I had to work with anticipation.

As we drove the 30 miles it took to get there, I had some waves of adrenaline and visions of getting stuck on the bridge. I was still looking for a way out. I countered those unhelpful thoughts with mantra’s – I can do this. Up and over. Don’t fight it - that’s it. Lean into it. Watch the feelings go up and down. You are stronger than these sensations. I remembered uttering some of those same words, with compassion, to a powerful Mama in labor just last week.

3 miles to go. I called my husband for a little support and he didn’t answer (you needed to do it without me, he later said - which was true). I thought of my friend Melissa, who I teach with, as she leads parents through contractions and heard her voice, “Get up in the face of this sensation. Don’t look for a way out. Do it like your life depends on it!” It may sound dramatic, but my life does depend on it.

Now here’s a funny twist about anxiety for me & many others. The moment I saw the incline of the bridge, I felt relief. The anticipation was far worse – it always is.

I turned on Stevie Wonder (who helped get me through postpartum) and we counted to the beat of “Signed, Sealed, Delivered”. It took 22 "Stevie Seconds" to get to the top & I yelled out, “Woohoo!” out of relief, put one hand in the air and did a little dance. We kept counting – 46 seconds was how long it took in total. The second bridge was 21 seconds to the top and 64 total. I thought about how I could have not done this today, but I did. I felt proud.

The rest of the ride was quiet and uneventful. I threw in a book on CD for the girls, they played peek-a-boo and entertained the baby, we talked about what the world would look like if we could create it ourselves. And, in small, but life changing ways, we can.

Sunday, June 22, 2008

Coping Cards

I have little pieces of paper all over the place with affirmations and coping statements. You can find them in the bottom of my purse, the dashboard of my car, on top of my nightstand and many other places. I write them when I’m feeling good in preparation for the times when logic goes flying out the window. Almost all of them have the acronym AWARE, which I read about in Dave Carbonell’s workbook. Here’s one that I just pulled out of my purse:

*Courage is being afraid and doing it anyways.*

Accept: I expect to feel anxious.
It’s ok to be nervous here.
This is what I came for – practice with fear.

Wait & watch: Resist the urge to leave or make it stop.
Stay put & see that you’re ok.
Watch anxiety – it goes up and down.
Am I being tricked again?

Actions: Deep belly breathing; imagry; music.
Try to get comfortable & enjoy the ride; some rides are longer than other;
if you can’t get more comfortable, that’s ok too.

Repeat: Start from the top as often as needed.

End: All anxiety attacks end. It’s not my job to make it end.

Saturday, June 21, 2008

When King Kong Sits on your House,Invite Him In

So, I have this comic strip image in my head where a woman is inside of her house. The sun is shining through the open windows and as she gazes out, she sees anxiety (personified as a little chimpanzee) lurking outside by the back fence, climbing in the trees. She’s gripped by fear and begins locking the windows, sweat beads form on her brow. Over and over again, she peers out the window from behind the now closed curtains, while the chimp (anxiety) opens the front door and taps her on the shoulder.

The woman, already hypervigilant and on guard for any sight of the beast, tackles the chimp to the ground, puts it in a head lock and kicks it back outside. She throws all the locks, as she trembles and shakes, and puts a chair beneath the doorknob to keep it from coming back in.

The more frightened she gets, the bigger the chimp becomes until it’s as big as King Kong and sitting on her house, it’s eye filling up the entire window as it peers inside.

Finally, after trying everything she can think of to force him to leave (think of something else, call a safe person to help ground her, turn the music up loud, thumb through her anxiety workbook, get down on her knees and pray), she gives up and opens up the door. “Come on in”, she gestures with exhaustion. As soon as the door is open, King Kong shrinks back down to the size of a baby chimp, and jumps into her lap. The woman strokes his soft fur, but offers nothing for him to sink his teeth into. Realizing that tonight he won’t be getting fed, he slips out the back door, swings over the fence and moves onto the next guarded house.

Anyone who is an illustrator and wants to draw this, I’d love to see it!

Friday, June 20, 2008

Where are we getting with chronic anxiety?

I must have a dozen books or so on the subject of anxiety. All of them tout that panic and anxiety can be cured or treated without drugs and that cognitive behavioral therapy is the gold standard.

Since I’ve become more open about my anxiety, I’ve found out that many people in my life have the same or similar issues – teachers, social workers, lawyers, doctors – people from all walks of life. Many are taking SSRI’s, recommended by their therapists, and feeling like anxiety still takes the better of them more often than not. Many are also seeing therapists who they really like, but aren’t seeing the real, lasting results they want. I can relate. I’ve taken meds before. I’ve been through therapy. And, even though I work really hard at facing my fears and strive for acceptance & surrender, I’m still not where I want to be. Fear still slips in and can throw me for a loop and I can work myself up irrationally in anxious anticipation and end up feeling pretty miserable. Like Jack Nicholson said, in the classic movie, “Is this as good as it gets?”

So, why do so many people struggle with this on again, off again anxiety or constant, underlying anxiety that grips their lives and can’t easily be shaken? The self help books say 'quick & extremely treatable', life experience & observation says 'years in therapy, medication and just getting by'. If it’s really that treatable, what’s going on?

David Burns’ book “When Panic Attacks” is subtitled “The new drug-free anxiety therapy that can change your life.” I’d like a few sessions with him to find out what I’m missing here as a student of anxiety.

Because, I truly believe what the books say -- that even severe anxiety can be effectively treated to the point that, when it rears its ugly head over the years, a person has the skills to handle it – that with acceptance, exposure and a confidence in your skills, feeling anxious becomes no big deal.

Perhaps, we as clients need to be more willing to do the hard, often scary work of facing fears. And, perhaps more therapists need to become experts in anxiety, get out in the field with their clients, and be creative in their approaches, sticking it out until they figure out which treatment mode is working. It's not one size fits all. Most of the people I know who have quit going to therapy weren’t “resistant”, it just wasn’t helping them to feel better.

With some 40 million Americans struggling with anxiety disorders, surely we can work together to do better.

Monday, June 16, 2008

YOU have anxiety?

"YOU have anxiety?", people often say to me. "But you're so calm and peaceful all the time!"

It's true. I'm not high strung or type A. I feel calm a lot of the time. I have many friends who confide in me because I’m a calming presence for them and a good listener. But, I've wrestled with anxiety and panic attacks for the past 12 years. My first panic attack was out west while I was on spring break with my Mom. I was driving on the highway and a thought entered my head, "I wonder what it was like for Dad when he couldn't drive because of panic" and BOOM -- it was like my body, genetically predisposed for this stuff, had been waiting for this invitation and jumped me right in to a full blown panic attack. I felt huge waves of adrenaline surging across my chest and back, I felt hot all over, my hands were shaking and I felt scared that I might lose control -- whatever that meant. "I've got to pull over", I said as I very carefully changed lanes, exited the highway and asked my Mom to take over at the wheel. (Which is typical of panic that I only felt out of control, tricked by my brain, while driving perfectly well. )

If you’ve never had a panic attack before, it feels as scary as if you were being chased by a hungry tiger or if someone jumped out from behind the corner and put a gun to your head (luckily, that's never happened, but you get the visceral response). Even when everything you read says that it’s just physical sensations, nothing is dangerous, what you fear never ever comes true - the intensity of panic hijacks logic and says, “Get me the fuck out of here!”

I've learned over the years, from people like Dave Carbonell, that if I could have simply experienced the symptoms without creating a story about them (what if this happens all the time? I can’t function when I’m panicking. This is dangerous. I'll be the woman who stopped driving at 26yrs old! - something's very wrong with me - I'd better not tell anyone or they'll think I'm crazy), it would have been no big deal and the sensations would have melted away.

But, I believed the story in my head and added more chapters. It didn’t take long before I started to fear that I’d panic while driving on the highway and began avoiding. I stopped driving on the highway and even avoided some “regular roads” with which I was unfamiliar. I felt more secure if I was driving with my husband (my “safe person”).

I bought a great workbook by Edmund Bourne, Ph.D. and started doing my homework. I wanted to be over this problem yesterday, asking the question “why is this happening to me?” Unfortunately, as I read, I realized that people could panic anywhere and started worrying about what others might think if I lost it in front of them. What if I panic while I'm getting my hair cut? That would be weird and so embarrassing! What if I get panicky at work? Everyone thinks I'm calm and competent - what if that's not true & I’m just a fraud? What if I freak out on an airplane and can't get off? It might just get so bad that I never really recover and they lock me up. I was being hijacked by these irrational worries that would never happen. But, my brain started wearing a deep groove and the thoughts began to skip and repeat.

Over the years, I started having babies and realized that I had to do something about my fears and began tackling them. I had three natural births with a midwife and two of those babes born at home. From childbirth, I remembered that I was really strong and powerful and could do anything. I began planning and doing the hard work of daily exposure practice on my own, made a lot of progress and then enlisted the help of a therapist.

Since then, I’ve “taken back” the highways for the most part. You won’t see me crossing over big bridges, but those bugged me before the anxiety crept in.

I still get “wiggy” talking in front of people some weeks (which is what I do for a living). I’m not so fond of airplanes, tunnels and bridges. And, sometimes the social piece creeps in and I worry about feeling anxious around other people and what they’d think if they knew I was anxious for no good reason other than “what if they knew? What would they think? What if I lose it here?” Because, really, that sounds pretty silly when I'm rational about it. Who cares what other people think? Why get all worked up? I guess part of me still worries that if anxiety really attacks, I may take a nose dive and never recover. I read once that men commonly fear that they’ll die from a panic attack and women commonly fear losing their minds.

That said, I don’t avoid anything in my daily life anymore. I try to see things that worry me as “good practice”. When I start feeling funny again, I schedule some highway practice drives & even include the kids. Crossing bridges, my 6 & 8 yr. olds yell with joy, “Go Cowgirl Mommy!” I know from experience that I have to keep doing the work of exposure on a regular basis or I’ll slide back and feel really bad pretty quickly.

Well, that’s enough for one post. My goal in writing this blog is to normalize anxiety & offer hope for anyone who is struggling with it & feeling alone. I’d also like to provide some good resource information and links. I hope this has been helpful!

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