Wednesday, July 30, 2008

Showing up

Woody Allen said that 80% of life is showing up. This is a great reminder for everyone, but especially so for people with anxiety. So often when I'm working through anticipatory anxiety, I remind myself - all you gotta do is just show up.

One of my big pitfalls with doing exposure work in the past was that I measured my success by whether or not I experienced anxiety & panic. Even though I felt good about the fact that I was regularly going out and driving parts of the highway that were hard for me & sticking it out, I wasn't satisfied because I still had spots on the road where I would get huge waves of adrenaline & experience that familiar doubt of "can I really do this?" I kept waiting for those feelings to go away.

Now I realize that good practice and getting past anxiety is to take the power back & upset the normal pattern of anxious thoughts & symptoms which can lead to panic. . . I realize that I can choose to be excited when I feel anxious in a situation & see it as an opportunity for good practice. Whenever I can, I try to say "yes" to my symptoms, even if I don't really mean it at first.

In Dave Carbonell's workbook, he says that you should ask yourself these questions to measure your success in doing exposure work.

Did you show up?

Did you work through the AWARE steps to the best of your ability?

And, after reading Reid Wilson's article (The Anxiety Disorders Game) I would add that you get extra credit for these -
Did you try & provoke your anxiety symptoms? Did you invite & say yes to them? Did you try & make the symptoms stronger & keep them stonger for at least 45 minutes?

Sometimes this is exciting work for me - I get psyched up and am ready to face anything. Other times, this is hard, hard work and I just want anxiety to go back to where it came from. But, I know that showing up time and time again and saying yes to my anxiety is the way to freedom for me. What kinds of tools/techniques are working for others out there - whether you're working through your own anxiety or helping someone through theirs?

Monday, July 28, 2008

I don't want to

Sometimes anxiety means “I don’t want to”. I’ve read about anxiety sometimes being related to hidden emotions and had an interesting experience with it just last month. First of all, I’m one of those women who hates shopping for clothes. I have a hard time finding clothes that I like in my price range and often feel like I’ve wasted my time, coming home empty handed. (If only I was a trust fund kid) But recently two things happened - my Mom & I were looking through old photos and there I am wearing the same cranberry turtleneck and black skirt in a decades worth of holiday photos. Then, we were having dinner with friends and my girlfriend commented on liking the color green in my shirt. “Oh, I’ve had this shirt since we were in grad school together”, I told her. Smiling, she said, “Oh, I know.”

It was time to venture out.

I pulled together a short list of what I was looking for and drove toward the mall. I dropped into a few stores, not seeing anything I wanted. A few more and now I’m checking my watch. Shoot, I only have an hour before I need to be back to nurse the baby. What am I doing here on this beautiful day?

The phone rang and it was my husband checking in – “How’s it going? Have you found anything yet? We’re fine, don’t worry.” I heard the joyful chortles of my kids in the background. As I walked toward the dressing room, armed with about 20 items, I felt a sudden surge of adrenaline and began feeling panicky. My first response was – “What’s this?” I questioned why I would feel panicky while I was out shopping – that’s not a trigger for me.

In the dressing room, I looked at myself in the mirror and utilized the paradox technique thinking, “Do you wanna freak out here? Bring it on.” It took a little while, but I realized that sometimes anxiety means I don’t want to; or I feel guilty. I felt guilty that I was away from my family; I felt silly for spending so much time with nothing to show for it and I wasn’t having much fun. Bingo – my anxiety was telling me to either change my attitude or just go home.

Looking back, I can think of other times I’ve had similar experiences. Maybe not panic, but that cocktail of “I don’t want to” mixed with adrenaline – for example: dragging 3 tired & strung out kids through the grocery store while they all beg for something – Can we get a cookie? Why can’t we get a cookie now? Is it time yet? Or, times when I agreed to volunteer for something just because I couldn’t find a good reason not to or a way to nicely say no.

I did end up finding a few cute things. I stopped to grab a cup of coffee and kicked up my feet to really feel like I got a break from parenting. And, when I got home, my family was excited to see the goods and welcome me back like I’d never been gone.

Friday, July 25, 2008

Super Powers

Are you an anxiety super hero? Sometimes we need to appreciate some of the super qualities that may increase our anxiety, but also make us compassionate human beings.

*Empathy – Are you someone who can walk into a room filled with people and instantly feel everyone else’s emotions? Without talking, can you intuit who’s struggling inside?
*Intuition: Do you consistently get gut feelings about things that usually end up spot on?
*Cat-like reflexes: Fight or flight? No problem. Burning building? You’d be the first one out with someone on your back.
*Courage: Do you regularly choose to practice with intense feelings of anxiety in an effort to accept, surrender and allow anxiety to loosen it’s grip?
*Humor – Do you have the ability to laugh at yourself and find the humor in absurd fears?

Saturday, July 19, 2008

A love letter from my Dad

*My Dad sent me this with permission to post. I know of some people who, after sharing their experiences with family, came to find out that one of their parents, aunt, uncle, cousin, etc. struggled with anxiety and they never knew. When we put our vulnerabilities out in the open with people we trust, some really lovely connections can occur.*

This is Kristin’s Dad writing. And I relate so intimately to the experiences she describes because I’ve been there and still am sometimes there myself. She comes by it all honestly via biological inheritance; genetics has an odd sense of humor. It reminds me of Mark Twain’s line about getting tarred, feathered and run out of town on a rail. He said something like, “If it weren’t for the honor of the thing, I would have just has soon passed up the experience.” More on that in a bit.

The year was 1957, I was almost 13 years old, it was early on a Sunday morning and I was out on my bike, delivering the Chicago Herald American. It was sunny, the weather was mild and there was nothing in the world to suggest to me that this would be any different from the hundreds of times I’d done my paper route in the past. I had covered the stretch of 112th Place and had just crossed State Street over by Cooney Mortuary – maybe you know the place - when I suddenly felt like I was in a dream – like everything around me was muted and slightly unreal. And then I recall this welling feeling of panic that I was going to die. I can even recall shouting, to see if this was, perhaps, a dream. It wasn’t. But my recollection is that it went away by the time I got home and I said nothing to anyone about it. But a few weeks later, another shoe dropped. I woke up on a Saturday morning with the sensation that I couldn’t feel myself breathing. The panic along with this one drove me downstairs where I blurted the news to my folks. I can’t imagine to this day how jarring and alien this must have been for them but my Dad, who was always good in a crisis, must have instinctively known that getting me calm was a first step to figuring out what was going on, presumably medically. And I remember that a couple of glasses of water and his reassuring arm around my shoulder somehow convinced me that my breathing was OK and that I wasn’t going to die. At least that morning! That summer we went to California and my folks almost turned around and went home when I had a pretty nasty attack of it in Salt Lake City. Fortunately, they didn’t; the trip still carries many wonderful memories.

The thing was, though, this was the 50’s. And no one seemed to know much of anything about Panic Disorders. After maybe a year of episodic attacks, my father, with his engineer’s way of looking at things, was determined to make a logical and planned assault on the problem. When our family doctor said he didn’t know what this was, Dad took me down to the prestigious University of Chicago Medical Campus for a full work-up. This didn’t quite pan out the way the Old Man planned. They did somewhat of a work-up but, while Panic Disorder wasn’t well recognized in those days, anxiety and phobias were. The 1958 medical establishment answer, of course, was psychoanalytic psychotherapy. And so, I started seeing a psychiatrist at the University of Chicago who, in Freud’s best style, sat there, gazed intently at me - and said almost nothing for 50 minutes at a pop. We stared at each other all summer long and, amazingly, I got better. What I know now, with a doctorate in psychology and a job as the clinical director of a large community mental health system, is that the real cure wasn’t Dr. T’s blank slate act. The “cure” lay in getting on a CTA bus by myself, transferring buses a couple of times, and making the weekly trip down to the University, despite my fears that I’d have an attack along the way. That, and the normal remitting and exacerbating course of a disorder that makes guest appearances and then disappears for months or years at a time. But what I did then on the bus – and what Kristin is doing 50 years later over bridges – carries the same principle of taking it on, practicing, flooding, desensitizing and using cognitive reframes. I would have much preferred an “aha” moment in exploratory psychotherapy, where the key from some childhood experience would be handed to me and the door unlocked. Kicking yourself in the ass and making yourself go beat the snot out of the gorilla, daily, is much less elegant and a hell of a lot more work. Unfortunately, it’s effective.

Over the years, I have had long periods of full remission, mixed periods of on and off stuff and periods where it has tormented me a great deal and made me fear that I’d lose my ability to function or make a living. I have not always fought the good fight and have avoided things far too often. Note that Kristin hit the nail on the head when she identified shame as factor that intensifies and broadens the illness. The script goes something like this: “I ran away from it. I am an awful coward. If people only knew how little courage I have, it would disgust them.” Given the stigma, you now begin to lie so that people won’t know your shameful secret. And, of course, you find yourself deeper in self loathing because you are now labeling yourself – unfairly, of course – not only a coward, but a liar, too. Yet so often in the face of the intensity of panic and the anticipation of its return, avoidance and lies have seemed like a price worth paying in the moment. Unfortunately, the interest on that credit card payment comes due and compounds itself.

But you must recognize your triumphs, too. When Kris and her brother were growing up I went through an awful period of agoraphobia associated with the panic and a dread of getting on I-95 for the wall-to-wall traffic into DC, where I worked as a reporter. Weekends I rarely ventured out of the apartment, finding comfort in my books and home hobbies like amateur radio. During the week, there were days that I called in sick and made excuses to my bosses. But most of the time, I gritted my teeth and endured feeling trapped in the middle of that traffic. What choice was there, really? I had to support my family. It wasn’t noble, it was necessity. And, for all of that, it helped me back into periods of remission, even though I didn’t fully understand the therapeutic part of it way back then.

Over the years, I have had to confront a variety of challenging situations like that and find, in my older age, I confront less – with the somewhat flawed rationalization that I’ve paid my dues and am going on strike against the damned malady. I don’t fly anymore and I climb stairs instead of riding elevators. I avoid big bridges. The flying keeps me from visiting places overseas but, while I regret the impact it has on my family, I don’t personally feel like I’m missing a vital experience. I like road trips and I like trains. As for the stairs, I’m in better physical shape, courtesy of my phobias. Thanks, phobias. My best to the gorilla! This is not an endorsement for selective avoidance – just truth in advertising. Besides, I take on the things I need to take on. I’m not crazy about public speaking, but addressed an assembly of 350 clinicians recently and am emceeing an event this coming Friday. I had to throw those items in because, despite what I tell my patients, I have more than a trace of hypocrisy about stigma and caring what others might think of me. I’ll go back to my Old Man, God rest his soul, and his wisdom. “Kid,” he’d say, “Do what I say, not what I do!”

By the way, I want to take a quick side track here on another matter. I loved Kristin’s comment about the friend who semi-jokingly asked her about hallucinations. It shows the great perceived divide out there between the putatively sane people and the putatively crazy people. But the divide is phony. What I mean is that people in America are so terrified by the concept of mental illness – and that they might catch it - that they conjure up a monolithic image that looks something like Norman Bates - and they whistle through the graveyard convincing themselves that, of course, they are different. Well, I’m here to tell you that mental illness takes on many different forms, is never monolithic and that all of us have our pieces of idiosyncratic thought and behavior. Lincoln, Churchill, Mozart all had mental illnesses and enriched our lives immeasurably and irreversibly. The great psychiatrist Harry Stack Sullivan was fond of saying, “We are all of us more human than otherwise.” Meaning there is no clear demarcation. Thank God. Get over it, America. Especially film makers who get rich playing to our fears.

At the outset, I mentioned Mark Twain and said that, given the choice at birth, most of us might well have chosen to avoid a lifetime of periodic panic attacks and phobias - - - were it not for the honor of the thing. Well friends, I am biased, but I will assert that there is great honor in the thing. I am absolutely convinced that the majority of people with anxiety disorders are among the most intelligent, creative people around. Almost by definition, it is the intellect and creativity that magnify the biology – dull people don’t create all those elaborate, “what-if” mental scenarios that feed Kristin’s gorilla. There’s an out-of-print book, called “Be Glad You’re Neurotic.” We don’t use that diagnosis anymore, but you’d love the book.

People with panic and anxiety disorders, in my experience, tend to have finely honed senses of humor, plenty of compassion for suffering in others and an uncelebrated and quiet courage in facing daily battles that are often invisible to people around them. Doesn’t that describe people you’d like to be around and have as close friends? Look in that mirror for a while and take it in. For every avoidance, there are far more uncounted successes – uncounted by people with the disorder. As a matter of fact, we grow and develop into people of substance and character from the struggles of our challenges.

In closing, you’ll permit me the parental prerogative, I hope, of bragging on my daughter. An undergraduate degree in writing, a master’s degree in social work, professional work after graduation in a settlement house in the community helping people in great need, birth educator, doula, spouse and one terrific mom to three lovely children. Woman of character and substance. When I saw this blog, it just blew me away. Talk about creativity, courage and giving help and meaning to others! My love for her and pride in the human being she has become is boundless. I write this with a big silly grin of button-bursting emotion on my face. You go, daughter! You’re the best!

Love always, Dad.

Thursday, July 17, 2008

Look behind the curtain

One of the most enraging parts of anxiety is that one day you feel completely fine and the next, you’ve had your first panic attack and normal, everyday things you’ve done your entire life become places where you fear you might freak out, go crazy, or die. Driving in general, highways, public speaking, going to the grocery store, standing in line, elevators, heights, bridges, tunnels, getting your hair cut, signing your name, crowds, meeting a friend for coffee – I don’t claim this long list, but they’re some typical situations that people end up fearing after experiencing the height of panic.

In Dave Carbonell’s workbook he talks about what happens when we experience that first panic attack. He says that because we can’t explain away the intensity, we make something up. So, if your first panic attack is on an elevator, you tell yourself that you must have a problem with elevators. You see, our brains like to make connections and make sense of things. We either assimilate information into our current mental files or accommodate by making a new hanging file all together that says “Don’t go there. . .”

While we might think it has everything to do with the situation, it’s all about the fear of fear. What might fear do to me this time & in this place? Did I narrowly escape the last 100 times I got anxious on the elevator and THIS time I’ll lose it, go crazy, or die?

I know, I know, it sounds ridiculous in the light of reason. But imagine stepping into a grocery store and all of a sudden your heart begins to race, you feel like you can’t catch your breath, adrenaline surges and your legs feel like jelly. Internally you might think, WTF? I’ve got to get out of here. By the time you get home, you’re feeling better, but wondering if it will happen the next time you try to go shopping. Suppose it does. It makes sense that you’d want to stay away from the local A & P. But, then you find the symptoms & thoughts hijacking reason again while you’re driving, and then at a dinner party, and then at the office.

This is where exposure work is so important. In order to retrain your brain to turn off the alarm when sensations and thoughts of anxiety arise, you have to willingly go into any dreaded situation, stay long enough to feel the full extent of your fear, let it pass, and realize that you’re still alright. It actually works best when you have the attitude of expecting & wanting to feel the fear. Because, really, it’s like The Wizard of Oz. The voices that say “maybe I shouldn’t” and “you can’t” are big and booming, but anxiety is just that little punk behind the curtain. And honestly, you're strong enough to stay and take him.

Sunday, July 13, 2008

Two great resources

If you're an anxiety super hero (or just love one - and really, what's not to love) I encourage you to check out these two websites.

This is R. Reid Wilson's site (author of "Don't Panic"). I would recommend first signing up for his "Free Anxieties Update & E-zine". You'll receive great information & the article that accompanies your first message is fantastic -- "The Anxiety Disorders Game". If you're a therapist, this article has fantastic ideas that might inspire your treatment groups. If you're a client (or maybe wear both hats), I love the message about approaching anxiety with a welcoming attitude. It's worth the time, I promise.

Reid Wilson also has a thorough "free self help" section (scroll down menu's). I especially like the sections on use of paradox & attitude. His center is in North Carolina & you can sign up for one of his weekend treatment groups - one for Panic disorder and one for OCD.

This site belongs to Dave Carbonell & is my other favorite anxiety site. I first found out about Dr. Carbonell when I read an article he wrote called "Float or Swim". I instantly liked his style & felt like he knew something about anxiety that I needed to know. I poured through his website, which has fantastic, very readable articles and even bought his workbook called, "Panic Attacks Workbook - a guided program for beating the panic trick". This workbook, along with a KD Edstrom CD helped me fly to from coast to coast by myself (without drugs because I was pregnant. I did warn my seatmates that I might cry the entire flight & made friends with a spanish speaking nun, but I actually felt great once we got up in the air!) But I digress.

Check out the section called "Panic Disorder & Agoraphobia". Also, he has an archive of articles which is hard to find on the site, but here's the link. Great writing, nice laid back style. I once saw him work with an anxious flyer on a TV talk show. He was sitting next to the anxious woman and as the plane took off she began getting visibly nervous & started to cry. He was like a midwife - he validated & supported her and said something like, "Hmmm. I guess that had to happen." No big deal. He clearly wasn't taken aback by her panic or worried about her running amok on the plane. I frequently think about what he said & the calming, normalizing message of his body language. If you live in Chicago, he has an anxiety treatment center - Or, you can contact him for phone consultations individually or as part of a workbook study group.

What other sites have you found to be helpful?

Saturday, July 12, 2008

Existential angst:

I’ve always had a fear of death. I can remember trying to fall asleep at night as a little girl and thinking about how I was going to die some day. The fear would rise to such intensity that I would race down the stairs at full speed and jump into my mother’s arms. “Oh sweetie. Most people don’t die until they’re very, very old and that’s a long time from now. It’s ok.” We would talk about God and heaven for a while. She would hold me and I’d watch a little TV or read a book with her until I was settled down. Then, I’d get tucked into my bed again for a good night’s sleep.

I think anxiety, for some, has to do with these questions of “Why are we here? What’s the meaning of life? Where’s God? Why do people have to die? What happens next?”

Sometimes I’ll be gazing up at the sky or simply going about my day and thoughts will come in like a Fox TV newstream, “You might want to sit down for this one folks. . .This just in. . .We live on a planet. . .you know, one that’s spinning & traveling through space. . . and did you know that outer space is just beyond our atmosphere. . .and, here’s the kicker people, we’re all gonna die someday!” When we’re fully aware of this amazing existence of ours, it can take you back a bit.

Sometimes, I have to remember that these repetitive thoughts are simply symptoms of anxiety (where content has little meaning). When that happens, I start going down the “AWARE” list.

But, other times it’s a reminder to dig deeper. A reminder to have gratitude for life and the love around me. A reminder that the spiritual task of anxiety calls for us to have faith in something we cannot see and to surrender in the face of it’s awesome mystery.

Tuesday, July 8, 2008

Some wisdom in anxiety

I wrote this late on Tuesday night and had saved it as a draft. Before you read any further, know that our daughter is home now and recovering. We're keeping life as simple and low key as you can with 3 energetic kids, accepting the love & support of our tribe and readjusting to home life after hospitalization.

My little girl is in the hospital tonight. She’s 6 years old and her little body is working hard to get rid of a high fever, junky cough, intense stomach pains and all around malaise. Her doctor says she’s fighting both a bacterial and viral infection and is getting IV antibiotics to get rid of the former. The combination of medicine, body wisdom and time seem to be working and we hope to bring her home in two days.

I had many moments today where I felt a surge of adrenaline, wondering what was going on and when my baby would be back to her normal self.

Something I was reminded of is that, even in high stress situations, I can handle anxiety and that sometimes it serves an important purpose.

As the doctor told us that she felt that her symptoms needed to be monitored & treated at the hospital, my anxiety pushed me (and my amazing husband) to ask good questions to make an informed decision.

When I walked into the room and she was in a lot of abdominal pain, panting and looked terrible, I felt a big wave of adrenaline. This was no run of the mill panicky feeling, it was a signal that all was not right. My anxiety prompted me to get the nurse and ask what’s going on with my baby, when will we see the doctor & what can we do for her right now.

As we traveled downstairs to get x-rays, me in the wheelchair and her in my lap, my mind wandered to many dark places. My body listened closely and responded. I remembered that thoughts are not facts, just a collection of ideas, worries and imagination and decided to sing in my daughters’ ear instead, soothing both of us. I whispered affirmations – Everything’s going to be alright, baby; You’re body is so strong; I love you; You're safe - I'm right here.

Today was a reminder that there can be wisdom in anxiety. The flush of adrenaline, welcomed, shouting, “Be alert, Ask questions, Protect” empowers us & gives us direction and energy to do what needs to be done. It's part of a fine tuned alarm system that, at it's best, is essential and serves us well.

Sunday, July 6, 2008

This little light of mine

I watched the movie "Akeelah and the Bee" tonight with my family & they used this poem from Marianne Williamson. I had heard it before, but liked it so much that I wanted to share it. Keep shining your light - the world depends on it.

Our Greatest Fear

It is our light not our darkness that most frightens us

Our deepest fear is not that we are inadequate.

Our deepest fear is that we are powerful beyond measure.

It is our light not our darkness that most frightens us.

We ask ourselves, who am I to be brilliant, gorgeous,
talented and fabulous?

Actually, who are you not to be?

You are a child of God.

Your playing small does not serve the world.

There's nothing enlightened about shrinking so that other

people won't feel insecure around you.

We were born to make manifest the glory of
God that is within us.

It's not just in some of us; it's in everyone.

And as we let our own light shine,
we unconsciously give other people
permission to do the same.

As we are liberated from our own fear,
Our presence automatically liberates others.

—Marianne Williamson

Cat-like reflexes

I’ve got to be honest. One of the upsides of my anxiety is that I have cat-like reflex skills when it comes to my children. I can remember when my first child was learning to eat solids. I’d cut up her apple and cheese into tiny, mouse sized bites. Even when I was taking pre-cautions and being ultra careful, that “breathe, chew, swallow” function would derail from time to time. I’d go to give her another apple bit and she would start coughing and getting all red in the face. Before she knew what was happening, I had grabbed her from the highchair and turned her upside down, patting her on the back to dislodge the “foreign object” while my heart raced.

When I told my former therapist this story, she said that I should be proud. She added that in the olden days, clans needed quick reflexes to flee danger at a moment’s notice. When we talked about how anxiety runs in my family, she laughed and said, “See, it served its purpose then. Your clan survived!”

Thursday, July 3, 2008


I spent a lot of years feeling ashamed of my anxiety. Feeling like it meant something was wrong with me deep down. Wondering if people would still like me if they knew. Even though I told my family and some close friends, I held these competing feelings of wanting to talk about what I was experiencing and also not making it a big deal.

The problem with not telling people, of course, is that it makes the anxiety monster that much bigger and higher maintenance. If it’s something you have to hide, then it must be pretty bad. And, eventually, you start feeling very alone.

It’s not the right time to talk about it, I would think. Or, I don’t want to get into it -- because how do you explain that fears, which sound utterly ridiculous, feel very real in a moment of panic. And, how do you also explain that anxiety is only a small part of you, even if it tries to act big and has a flair for the dramatic?

One time I disclosed to a friend and she joked, “Well, at least you don’t hear voices in your head. . . do you?”

After having anxiety under control for a long stretch of time, I experienced a really hard postpartum after my 3rd child. Part of what brought me out and helped me heal was sharing with others what I was going through. I can’t tell you how many people stepped up and either said, “Me too” or “I get it and I’m here.” One friend said, “I hope you take this the right way, but it just makes me feel so much better knowing that you’re dealing with the same stuff that I am. It makes me feel more normal and less alone.”

Maybe there’s a gift in this anxiety after all? If we can stand psychologically naked among each other, we realize that none of us are immune to life’s challenges – And, just knowing that we’re all in this crazy life together brings us strength and makes the road all the more manageable.