Monday, June 29, 2015

Anxiety, Failed Methods, Helpful Methods, and ACT

(this is cross-posted from Renaissance Wife)

Hello there random reader-person,

My name is Melody, though everyone calls me Mel. I'm a wife, a stay-at-home mom (what a misleading term), and a professional assistant. I'm a writer, a geek, a baker, and a lover of pretty shoes and designer lingerie.

I'm also anxious as all hell, practically all the time. And I'm going to do something that pegs my anxiety to an incredible degree, all the way to the red zone.

I'm going to write about anxiety.

My experience with anxiety

I'm not a doctor. I don't have initials behind my name.

... but if you're anything like me, you're sick of dealing with doctors, and counselors, and psychologists and psychiatrists anyway.

What I am is a long-time sufferer of anxiety who spent much of her life undiagnosed and misunderstood. I've tried many methods, watched many methods fail, spent thousands of dollars on therapy, spent hundreds on self-help books, and finally figured out some stuff that actually worked.

The technical list of psychiatric ailments I've been diagnosed with (in order of diagnosis and age):

Depression (15)
Bi-polar Disorder (17)
PMDD (psychiatric symptoms are part of the disorder) (26)
Generalized Anxiety Disorder (26)
Social Anxiety Disorder (26)
Panic Disorder (26)
ADHD (30)

Only one of those diagnoses is inaccurate (Bi-polar Disorder). The rest were incomplete without the full list.

I've seen a lot of psychiatrists and counselors and taken a lot of different combinations of medications.

As for when the anxiety started, it took my now-husband watching me go into a panic attack before anyone figured out that's what my "tantrums" were. Watching my then 3-year-old daughter suffer through a panic attack, my mother remarked "oh, we just thought those were tantrums".

In other words anxiety and panic attacks became my companions at a very early age and, evidently, have a genetic component.

Why am I laying this out on the table like this?

I dealt with enough psychiatrists and counselors and well-meaning people who just DID. NOT. UNDERSTAND. Frankly, if you've never experienced a panic attack then you don't know how it feels, how out of control you feel, how ashamed you feel, how crazy you feel.

That leads to getting several "helpful" suggestions that are anything but.

So when I say I've found some methods just don't work, and some methods actually do, I've personally tested everything listed. When I say I've managed to significantly reduce the suffering that comes with my anxiety and the impact anxiety has on my life, that also means something.

Well maybe your anxiety is mild, and that's why it's so manageable...

My life went from being a "normal" amount of anxiety-inducing events to a raging flood of doom in September 2010, when my ex-husband tricked a judge into letting him take my daughters out of the country.

In January 2011 my husband's brother died suddenly. In February 2011, while we were at the memorial service, the IRS started auditing my husband due to lost records and seized all of the funds in our bank account. Also in February 2011 we found the cancer that caused my husband's health issues. In May 2011 we found out my husband's job of 6 years would be disappearing due to workforce reduction. In October 2011 the job officially ended. Contract work would be sporadic after that, and still is. February 2012 my husband's mother died AND the IRS seized our bank accounts, again. In August 2012 my husband went in for cancer surgery 2 days after we found out I was pregnant. We found out a few weeks later that he'd been close to dying. September 2012 saw radiation treatment and the repossession of one of our vehicles. Between September 2012 and February 2014 my husband's health fluctuated so badly that he came close to dying multiple times. In March 2013 our son was born. In August 2013 we were so financially strapped we had to leave a place we loved and move in with my father. In November 2013 we moved across the country for a job that ended up lasting only a few months. In January 2014 we ended up back at my father's while my husband struggled with health issues that almost killed him. In May 2014 we moved across the country again to live with a friend.

It is now June 2015. Work has still been sporadic. We've lost another vehicle. My husband's health is finally somewhat under control. I'm handling a hyperactive hyperintelligent 2-year-old on a daily basis. We're broke, we're almost out of food, income is another month away, our car is currently undriveable, and yet THIS IS THE BEST WE'VE BEEN DOING IN YEARS.

I know about anxiety and stress y'all. The very fact that I'm not hiding in bed 24/7 is an indication of how far I've come in managing my anxiety.

10 years ago this level of stress and anxiety would have had me popping Xanax like mad in order to not be a completely non-functional shaking mass of human hiding from the world.

I know of what I speak.

Methods I've tried and discontinued for various reasons

Life coaches
Talk therapy
"Parenting myself"
Several antidepressants
"Working through it"
... all forms of navel-gazing

Seriously, if it involves "tell me about your mother" I've done it. Identify the causes. Figure out the past. Find out why I am the way I am. Try to fix my brain. Try to undo the damage. Blame other people. Blame myself.

None of it worked, and I was on a timeline.

What actually started working

My mother's anxiety kept me socially isolated and therefore badly socialized.

I wanted better for my kids.

So despite the fact that social interaction caused me varying levels of anxiety ranging between "get me the hell out of here" and "full-blown panic attack" I did what I needed to give my kids the socialization they needed.

I interacted with the other mothers at school on a daily basis. I talked to the teachers. I volunteered at the school. I took the kids to after school activities, playdates, and birthday parties.

I started to notice something.

Every time got a little bit easier. Not no anxiety, just less anxiety. Like a person with a phobia going through aversion therapy, my anxiety became more and more manageable.

Not gone, just manageable. Like my threshold increased.

The panic attacks started to diminish in number and intensity, but still plagued me.

Aversion therapy was not enough

Aversion therapy didn't get me all the way there. We moved during this time, and leaving behind old patterns and habits helped. Continuing the aversion therapy through social interaction helped, as long as I kept pushing my limits. Knowing my limits and not pushing too far past them helped. Self-care and proper nutrition and rest helped. Self compassion helped as well.

The anxiety still plagued me. I still wanted to be rid of the anxiety and panic attacks forever. I wanted to be "normal", to not be "sick", to be "healthy".

So while I reduced my anxiety, life circumstances never let up and I was always one more major problem away from rolling panic attacks. I'd made tremendous progress but life seemed intent on throwing even more anxiety and panic inducing circumstances my way.

While my ability to deal with the anxiety increased, the physical symptoms of the anxiety also increased and made me utterly miserable.

Sometimes you just need to ask the right person

In this case the right person ended up being a friend who is a doctor who told me to look into an alternate therapy concept called ACT, or Acceptance and Commitment Therapy.

ACT ended up being extremely helpful, and while I still end up in occasional panic attacks (low food supplies mixed with lack of cash mixed with changing life circumstances outside of my control is my panic-causing kryptonite) the panic attacks have gone from controlling me to being annoying. If one more major life stress is resolved I expect the panic attacks to leave me be until something else potentially life-ending occurs.

But isn't the goal to get rid of the panic attacks and anxiety?

That's an awesome, noble goal. I've spent years of my life chasing that particular goal.

I've got next to nothing to show for it, other than an empty bank account and a huge stack of self-help books that didn't help at all.

Learning to live with the anxiety and manage how it affects my life, well, that's actually improving my life.

That's the goal of ACT: learning to live, function, and pursue your goals despite the anxiety

Remember when you thought figuring out why you were the way you were would suddenly resolve the issue and make you a healthy person without insane levels of anxiety?

How well did that work?

It doesn't. That kind of navel-gazing makes the assumption that your anxiety somehow responds to logic and conscious attempts to change.

That's a faulty assumption.

Don't get me wrong. Understanding the "why" is useful, in that it helps you practice the self-compassion you'll need to manage your anxiety. It's just not the end.

The fundamental assumption of ACT: your brain is a dirty, dirty liar that isn't interested in your happiness, only in avoiding pain

This makes sense. Happiness isn't a survival strategy, Avoiding pain is an awesome survival strategy, if your life isn't complex.

Panic attacks are often associated with the "fight or flight" instinct and tend to happen in situations in which you don't pick either option. Your brain has associated the anxiety-causing situation with pain or fear and therefore tries to get you to get the hell away because it might kill you.

Useful reaction, if the situation is coming across a mama bear in the wild. Detrimental reaction if it's your first day at a new job and your brain is balking at the concept of the unknown. "What are you doing?!?!?!?!?!" your brain screams "we've never been there before and there might be a predator hiding in there!"

Congratulations! Your insanely low anxiety threshold would have made you more likely to survive and have children who survived... when we were still in caves.

Our brains haven't exactly caught up to our new world order.

Even better, our brains can "learn" to identify more situations as dangerous because they cause us emotional pain. Ever been heckled on stage? Stage fright for you from now on. Been bullied? Let's avoid other people, because they cause us pain. Cheated on? Have a freak out every time your new man is out of sight, courtesy of your brain learning that situation causes pain.

There's nothing conscious about this. Your brain would just rather avoid the pain. It's not smart enough to reason through the fact that no risks means no change, and no possible increase in happiness.

In order to convince you that you're better off avoiding those situations, your brain plays a dirty trick on you: it lets you think it's right and that your emotions are right and based on reality. In other words it lies to you and lets you think that your thoughts and emotions are truthful and real.

Thoughts and emotions do not necessarily reflect reality

How much conscious control do you have over your thoughts and emotions?

Try not to think of the pink elephant.

That's how much control you have over your thoughts, next to none.

Ever watch a movie and burst into tears?

That's how much control you have over your emotions, so little that someone who doesn't even know you can manipulate your emotions.

ACT is about recognizing that your thoughts and emotions aren't you and don't necessarily reflect reality.

This is a radical departure from therapies that you may have tried before because...

ACT isn't an attempt to "fix" your brain, it's an attempt to learn to live with your brain

What happens if you accept that your thoughts and emotions aren't necessarily real or truthful and your brain manufactures anxiety based on unconscious assumptions that you don't control?

You stop trying to control it. You accept the way your brain works. You accept that the thoughts and emotions exist but don't necessarily mean anything.

That's the A in ACT. Acceptance. Your brain, your thoughts, your emotions are not "you" and not fully under your control.

Try not to think of the pink elephant. Try to keep the image out of your mind.

Now think of the pink elephant and let your attention go somewhere else.

What took less energy and ended the thoughts fastest? Struggling with them and trying to control them, or noticing and letting them go?

Emotions are much the same. Ever try *not* to be angry at someone? How well did that work? What about just admitting you're angry, accepting it, and moving on to something else?

How much did your anxiety level just drop?

One of the theories behind ACT is that the act of trying to control the anxiety, the thoughts, and the emotions is actually more painful and damaging than just letting the anxiety, thoughts, and emotions happen.

You notice the anxiety, you notice the symptoms, you notice the thoughts, you notice the emotions, you accept that they exist, you let them go (there's several techniques for this that can be found in any book outlining ACT), and you go act in accordance with your values and goals without regard to the anxiety.

ACT isn't about how you think or feel, it's about what you do

What would you do if you didn't have anxiety? Finally finish that book? Get a degree? Ask that person out on a date?

ACT is about learning to do what you want and need to do despite the anxiety, thoughts, or emotions that plague you.

That's what the C stands for: commitment. Commitment to your values and goals.

Is a clean house important to you? Do you go into a panic attack any time you start to clean because of past trauma (I do)?

The goal of ACT is learning to clean the house despite the panic it will induce. Or talking to a stranger, Or being on the stage.

The goal is to act in accordance with your values and goals. The side effect is a reduction in anxiety,

Think about it. Doing things despite your anxiety is just another form of aversion therapy. Every time you do what causes you anxiety and you don't suffer harm, you brain (as stupid as it is) believes in the supposed danger of the situation a little bit less.

Do it enough, and the brain barely puts up a protest anymore.

Keep avoiding it however, and the brain continues to think the situation is horribly dangerous and must be avoided at all costs. The more you think about it, the more anxiety you feel, the more your brain interprets the anxiety as pain and danger, the more powerful the anxiety becomes.

Learn how to push forward despite the anxiety, and the anxiety starts dropping.

Counterintuitive, huh?

ACT is about learning methods for letting go of the thoughts and emotions so you can do what you want to do. There's mindfulness techniques, relaxation techniques, techniques for resolving panic attacks, the whole deal. More techniques than I can list here.

Eventually you get practiced enough that you don't need the crutch in the form of the techniques. You just accept what's going through your head and go on your merry way doing whatever it is you need or want to do.

So why did I spend so much time going over ACT?

Frankly, it's a new way of thinking about therapy, and... well...

Okay fine, Psychologists seem to only speak two languages: jargon, and "woo".

I understand jargon to a certain extent. I hate hate hate "woo".

Jargon makes them sound smart and gives specific words for specific purposes. Woo sells self-help books.

I should know. I have an entire stack of them.

For example:

Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.
I can't tell if that's a mission statement or a description of a new religion, or both.

I love the book I picked up on the subject, The Happiness Trap, but it even has a sprinkling of the woo, enough that sometimes it sounds like the psychological equivalent of healing crystals.

It's not, it's actually very useful, the techniques outlined are very useful, the ways of looking at things are very useful.

If you're expecting anyone writing a self-help book based on clinical therapy techniques to somehow translate into layman properly, you're expecting too much.

That's why I was asked to write something up from the patient's perspective, and why I encourage you to look into ACT and aversion therapy as techniques for dealing with anxiety. They actually do work, and while my anxiety is not gone with a combination of the techniques I'm improving my life despite the panic.

Rather than wait to be perfectly healthy, I'm doing what I need and want to do the way I am, at this moment.

I'd rather be happier now than keep trying for a perfect that will never happen.