Home again

I'm just getting settled back in after being away for two weeks. My Mom and Step-Dad live by the water and we had the chance to house sit for them while they adventured off to Alaska. It was so nice to be away and long enough that I was excited as we drove back into our cozy, little neighborhood this past weekend. One of these days, we'll have enough money to fly our family of five somewhere exotic, but for now, house sitting in a beautiful location was just what we all needed.

As I was getting our kitchen back in order the other night, I found myself needing to take frequent breaks and pop into some favorite blogs. (Speaking of distraction - this is fabulous ice cream and you can sub 1 tsp vanilla extract for the vanilla bean.) I also found this wonderful video by Brene Brown. I was so touched by her talk and am still processing what she had to say. Enjoy and I'd love to hear what you think.

Watch live streaming video from tedxkc at livestream.com

"Intense anxiety is not in itself a problem"

I know, did we read that right on page 60? Isn't that what we struggle and fight not to feel, worrying that we'll be washed away in all that misplaced intensity?

Let's look at that again: "Intense anxiety is not in itself a problem. Many people experience intense anxiety, even panic attacks, in their daily lives and continue to do what's important to them." " Intensely felt emotions need not be a barrier . . . they can be welcomed in as a vital part of you." (p. 60)

We know from research that when people accept or even invite their anxiety, it often dissipates. But this takes that notion one step further. Is it possible to welcome anxiety as a vital part of ourselves? Is there value to our anxiety that we're overlooking? Anxiety, energy and excitement are so closely related. Some even say that anxiety might be linked with their energy source and, used with intention, can be useful.

The other morning I woke up feeling tense and anxious. I started thinking "what if I used my adrenaline to my advantage - you know, jump into my high energy tasks and/or exercise when my engine is already revved up?" I remembered watching PBS's "This Emotional Life" a few months back. During episode two, there was a writer who said that his anxiety started getting better when he realized it was something he could learn to use; his anxiety was like his own personal caffeine pump. Accepting what is and making anxiety work for you - now there's a concept!

Something I'm enjoying about this read is the way the authors are turning old, stubborn beliefs onto their heads. If intense anxiety is not a problem or a barrier to doing what's important to you, imagine the possibilities!

Anxiety Coach has got a brand new bag

If you haven't been on Dave Carbonell's site recently, head on over and check out the new look! His newsletter is fantastic, as well, and I encourage you to sign up and enjoy the information and inspiration. Here's the email I just received from his website:

"You may recall that I suspended publication of my Anxiety Coach® newsletter this summer in order to upgrade the website. I'm now ready to resume publishing the newsletter. If you want to receive it, please visit the site at http://www.anxietycoach.com/newsletter.html and sign up again.

Please do this now, so you don't miss any issues. If you don't want to receive the newsletter any longer, just discard this e-mail and you will no longer be on the list.

I also want to invite you to stop by the new website, at www.anxietycoach.com <http://www.anxietycoach.com> . There is a lot of new material, including more articles about panic and worry.

Feedback about the site, suggestions for articles, and reporting typos are always welcome!

Best,
Dave Carbonell, Ph.D.
www.anxietycoach.com <http://www.anxietycoach.com>
A self help guide for recovery from fears and phobias"

http://www.youtube.com/davecarbonell
My anxiety self-help videos on YouTube

Travelogue Part Three - Island Mama/ Adventures in Paradise

So, now for the good stuff.

After planes, taxi's & ferry boats, we arrived in the sleepy, little island of St. John and made our way to the Maho Bay Campgrounds where we stayed for a whole week. Now, some of my girlfriends laughed when I told them we stayed in a tent cabin, had to walk to the common bathhouse and fill water jugs every day. But, they have no idea what they were missing. There's something to be said for simplicity and being so close to nature.

I gotta tell you, every anxious moment was worthwhile when I walked into our tent cabin & realized that we could sit up in bed & see the Caribbean ocean. Seriously - right from our beds!

During our vacation, we learned how to snorkel & saw the most vibrantly colored fish. It was like putting your face into a salt water aquarium. The first day we tried snorkeling, I felt a little tense, a bit nervous and then I remembered -- it's normal to feel nervous when you're trying something new. Oh yeah. OK, let's jump in then. On our snorkeling adventures we had the exciting pleasure of swimming with a few big & stripey barracuda, a big orange starfish, a friendly sea turtle, and a few nurse sharks. We met the most amazing people along the way and spent time in engaging conversation during breakfast and dinner each day, overlooking the Caribbean & British virgin islands from the dining pavilion. Our first full day there, we spontaneously decided to take a sunset sail with a couple we met at breakfast. There was also lots of time for hiking, napping, and for you parents out there - we were able to complete FULL sentences. We saw iguana's & lizards in all shapes & sizes, ate delicious food prepared graciously for us all week long, sipped a variety of rum drinks here & there, and felt the weight of responsibility slide away for a while. Every night, we fell asleep to the sound of the ocean lapping gently at the shore; to doves who sang. all. night. long.; to singing frogs; and, most nights, a nighttime rain storm.

I did have moments of real anxiety during the vacation; nights were I felt on the verge of panic going to sleep, feeling very far away from my 3 precious children; creating images of a plane taking off & feeling dread that the only way home was through the air; and times where I just had an underlying feeling of tension. But you know what? I was able to handle those moments when they came up & I still had a fantastic time. Reid Wilson quotes Helen Keller at the end of his "Facing Panic" book & it stayed with me the entire trip & even back home. She said, "Life is a daring adventure or nothing at all."

The real truth for me is that anxiety is uncomfortable, it feels like something terrible is going to happen, but it's not dangerous. On the trip I remembered a poignant moment when I was pregnant with my 3rd baby. I had a particularly intense panic attack the night before (intense for me, but my husband said that from the outside I just looked a little tense). After tossing & turning & having trouble falling asleep, I finally drifted off. The next day was one of those amazingly gorgeous January days where it almost felt like spring. I was working in the yard outside & looking up at the clouds, feeling the breeze across my hair & face, and it hit me - for as bad as I felt the night before, nothing bad had happened. It didn't last forever; I didn't go crazy; my panic was barely visible to the person I'm closest to; I was still able to fold laundry & talk during this attack which I perceived as intense; and, here I was standing in my back yard gazing at the clouds and almost forgetting that it had occurred. Huh.

I can't believe how many weeks it's been now since we came back home. If I didn't have the pictures, it might feel like a lovely dream. If you're considering an adventure, something that you know is safe, but scares you a little, why not try? People with anxiety disorders have a hidden well of courage they rarely acknowledge.

When you think about it, what amazing things have happened for you when you've been able to live a life of daring adventure?

Travelogue Part One - Getting on the plane

Friday night before the big vacation takeoff:

I am feeling excited, shopping for last minute beach towels & sunscreen, packing into the wee hours of the morning. I write little notes for my girls and fight the urge to say things like, "If we don't make it home, I want you to know. . ." and fill up their journals with memories and dreams for their futures.

I crawl into bed & the anxiety steps things up a bit. Adrenaline becomes my bedmate & I know I'm not going to get much sleep. I remind myself that this is to be expected. I expect to sleep terribly and feel anxious, even panicky. I haven't flown in almost 3 years & I'm leaving my children behind for a week - something I've never done before. Next to my bed is a pad of paper for notes & I write down, "I want this anxiety" - just in case I forget when the alarm goes off. I snuggle up to my man & try to ride the waves while he snoozes with ease. Thank God only one of us runs anxious!

Saturday morning - 4:30am:

I wake up with a real sense of dread. I feel nauseous & panicky. I look down at my "I want this anxiety" note with a smiley face & say "screw that - what a stupid thing to write"! In the shower, I'm weepy and yell out to my husband, "I changed my mind. I don't want to go. I just want to stay home. I feel terrible."

It's so hard in that moment to believe all those coping statements and truths - that flying is much safer than driving; panic always goes away with time; panic & anxiety are uncomfortable, but not dangerous; it's very likely that I'll be able to relax into the flight once we get going & if not, I will survive.

The first step is making it out the door. Then, driving to the airport where I take .25 mg of xanax & review my options - "If we get to our first connection & I feel terrible, we can always come home, right?" Walking into the airport feels familiar - it's been a while, but I've done this before. After going through the security lines & randomly having my shoes checked (are my Keens too stinky? I ask) I rush over to the gate attendant, tell her about my flying fear & ask for seats closer to the front. At first she says that the plane is full, but at the last minute I am called up to the desk & the lovely Miss Tina from Delta changes our seating to bulk head. I think I love her.

As they call our flight to begin boarding, Steve & I wait & I take another .25mg. The funny thing about many anxiety superheroes & meds is that we're actually a little afraid of taking them. From the extremes of -- "What if it's too much & I stop breathing?" to "What if I take it & it doesn't work?"

Finally we take make our way through the line and warm tears roll down my face as we board the plane. As we buckle up and they seal the doors, I close my eyes and remember where we're going.


More to come:
*Travelogue Part Two: In flight adventures
*Travelogue Part Three: Island Mama

Dave Carbonell talks about "The Panic Trick"

Have you checked out Dave Carbonell's workbook yet? It's fantastic - go grab one! You can also see him here as he talks about panic as an insidious trick. True, the video quality is not fancy, but the message is really good. This video is part one of two. What do you think?

What are you willing to risk?

So, I've been talking about this weekend treatment group I attended in November with Reid Wilson – a world renowned psychologist who specializes in treating anxiety disorders. Something he asked right from the beginning was, what have you avoided or given up as a result of your anxiety? And, now, what are you willing to risk to gain those things back?

So much of the work is a change of attitude and asking the question every time anxiety arises – what am I willing to risk? If I’m feeling anxious one day & someone asks to meet for coffee – am I willing to risk that I might feel anxious & that they might notice? Because, choosing NOT to go because of something that MIGHT happen will only strengthen the anxiety. Choosing to have someone else join us or having an out is still avoidance and strengthens the anxiety as well.

The second piece of that attitude shift is learning to love my anxiety – to get excited that I’ll have another opportunity to practice with feelings of anxiety and doubt/uncertainty. That’s a hard attitude shift, but the only way to win. As Dr.Wilson said, we’ve been worshipping at the altar of anxiety for far too long – We bow down and plead – “Please anxiety, I’ll do anything – just please don’t make me feel edgy & out of control – I can’t bear it”. The shift also encompasses changing your relationship with anxiety. When you begin feeling nervous – perhaps the adrenaline is flowing through your chest, your heart is pounding and you’re telling yourself that bad things are about to happen - you can talk to your anxiety & ask it to make the symptoms stronger. If you’re going to feel symptoms anyways, why not surprise the bully and invite anxiety to take it’s coat off and stay a while.

Something I loved about the weekend was Reid’s “Anxiety Disorders Game” that we played during lunch and night time breaks. We all got score cards and were able to earn points by doing some of the following:

*Deciding what anxiety provoking event we would enter and following through.
*Truly wanting anxiety to show up and asking for more when it did (with an understanding of why we were practicing this way).
*Extra points could be scored for every minute you asked for more anxiety and you got your wish.

A fly on the wall might have overheard people planning their practices like this:

“Well, I think I’m gonna go to lunch, keep changing my order & maybe spill my drink on purpose. I hate drawing attention to myself, so that should make me really uncomfortable. Afterwards, I’ll probably ride in the big elevator and try to make myself hyperventilate.”

“Yeah, I’m gonna go driving around the city, try to get lost & then find my way back. That should get me good & panicky. You do have your cell phone on, right?”

“I’m going to ride in the back of someone’s car with the windows up, heat on & the music blaring. I think that will trigger my claustrophobia and earn me some bonus points.”

On Sunday, during our lunch practice, I drove myself on the downtown expressway for a meal at Elmo’s Diner (delicious!). Reid reminded me that once I got to my destination, and knew where I was, I would probably feel comfortable. Since the weekend was about working with anxiety, discomfort and doubt, he encouraged me to try & think of ways I could make myself more uncomfortable. I was also looking for ways to score more points in the game.

So, as I sat down at the counter, ordered and found myself happy and making small talk with local folks, I remembered what Reid had said. Then something came to mind. Part of my anxiety is feeling embarrassed about it. Oh shit, I thought, as I pulled out my “Self Help for People with Panic Attacks” book and read it at the counter while eating my lunch. As I read, I made sure that the cover was very visible to all those sitting at the counter and to those waiting in line. I thought about how I had encouraged a person with social anxiety to skip through the mall as a practice and how this was just as hard for me.

I put the book down at one point, asked the couple sitting next to me at the counter for advice on the menu. Scoring a few more points, I thanked them and decided to order something else, letting go of the thought that they might be thinking, “Why did she bother asking?”

Coming back from lunch, I put my points on the board, grabbed a prize out of the basket (scotch tape!) and settled in to talk about my experience and learn from the experiences of others. The signs posted around the room reminded me that these were my road maps for the anxiety journey ahead.

I want this anxiety.
I want this doubt and uncertainty.
I can handle this.


What's holding you back? What are you willing to risk in your day to day life? And, what are your road maps?

My Treatment Resume

Subtitles: No wonder more people don’t seek out help when they need it; and, What’s up with all the counselors pushing medication?

*Almost done with graduate school, having fun doing exploratory work in counseling (recommended for social workers) & I have my first panic attack driving on the highway in Colorado. Grad school counselor sends me to campus doctor to get a prescription for xanax. Doctor says to take it before driving (label says “don’t operate heavy machinery after using”) & to give up caffeine. Counseling stops with the end of school with the message, “you’ll be fine”.

*6 months later I receive a six week sample pack of Prozac. I take it for six weeks and then stop because of the side effects.

*About a year later, I try again & seek out an anxiety center in my area. The shrink is very nice, we have a great rapport, but he doesn’t really do counseling. He does a thorough social history, establishes that I have excellent memory skills in repeating number sequences and sends me on my way with one month worth of Paxil samples. He, too, offers me xanax & this time I say no thanks. As I’m leaving, he tells me that once I beat my anxiety, I should come back and talk to him about a counseling job. I take Paxil for one month and then stop because of the side effects &, really, this isn’t helping.

*A co-worker recommends her counselor. He says that I just need to relax & have a little fun, lighten up a bit. I say, “I have a great, happy life except for anxiety, which is a pain in the ass”. We try EMDR. I try to help the process along and bring my own treatment plans and info that I’ve gleaned from reading. After a few more sessions & more “relax more & just do yoga” messages, I know that this is not what’s going to help & give up on counseling for a while.

*After having my first two babies, I’m ready to try again. Anxiety doesn’t own me, but I’m not driving on the highway much. I still remember what it felt like before anxiety infringed on my territory and I want it gone. I find more resources & begin reading everything I can find on the subject of “how can I get over this”. I begin exposure work on my own & make progress “taking back the roads”. I set up an appointment with a recommended counselor & it’s not a great fit. I go three times & keep looking.

*Second try: nice lady, a little rough around the edges, but she goes out in the field with clients & I like her spunk. I tell her that I don’t want to do meds, but she says that if I go on celexa for 2 years & do behavioral work at the same time that my anxiety will be gone. I try it, but don’t like it. I switch to Zoloft & stay on it for about 6 mos. We drive a number of bridges and highway stretches together. She’s got the behavioral piece down. I say that I’d like to work on the cognitive piece, that in some places on the highway, I’m still feeling really anxious & there must be something I can be doing differently. She says, I’m not sure why the exposure isn’t working for you, keep trying & the anxiety will go away. We part ways & I keep working on my own.

*Third try: I contact a psychologist friend of mine & say, Look this time I really need to find someone who’s an EXPERT on this anxiety stuff, won’t push meds & is up on the current research. I find Dr. C. who is fantastic & I really like, but still encourages I try meds. She’s worked in anxiety for years & has trained most of the area clinicians in CBT. I go on Lexapro & do a lot of great work with her. She says that I’m a dream client, that no one works as hard as I do and that it’s part biology & that I really need to work on acceptance. “I know you don’t want anxiety, but you got it. You have to accept what is.” True, acceptance is important, but I’m still feeling like with all the work I’m doing, I’m still missing an important piece. After monthly visits for a year, I feel done for the time being.

*I go off Lexapro during my 3rd pregnancy, experience big waves of panic in my third trimester and it comes back with a vengeance at about 12 -14 weeks postpartum. I go back for 2 or 3 “booster sessions” with Dr. C. and go back on Lexapro (after getting the green light from my midwife & an international breastfeeding expert). Things get better slowly. I come out of hiding and begin telling everyone. This helps tremendously & others begin sharing their stories. I’m dying for community. I start up a workbook study group (with some very cool, fellow anxiety super heroes) that meets inconsistently for a couple of months & fizzles out.

*Currently – I’m “off the junk” & not seeing a counselor. I don’t have anxiety mastered as much as I would like, but I'm realizing that what I was missing was not just the acceptance, but inviting & provoking the symptoms and, yes, acceptance. Good practice means doing something that guarantees that I'll feel anxious. I wish I could transport Dave Carbonell, Reid Wilson or David Burns to my hometown so that I could work with an anxiety guru and kick this thing once and for all (well, at least feel stronger in my skills and ready for the expected ups & downs).

Looking back over all the steps it’s taken to get good treatment, I see why so many people can live with this disorder much of their lives and never learn to beat it. Access to good information, counseling & community (plus a big dose of tenacity) makes a huge difference. When I get to be an anxiety master, I am going to open my own clinic & help offer others a more efficient path. More about that later!

Naked

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.

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.