Still Working On My Anxiety Management Plan

The chaos of the holiday season has left me little time to think or write over the past month. A few ideas have run through my head, but finding the time to put them to words has been near impossible. As the first week of the new year comes to a close I find myself with a little time and it has occurred to me that I have reached something of a milestone. It was at the end of December 2011 that I took my last Klonopin. I have now been flying without my anxiety safety net for an entire year. Continue reading

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Brainstorming CBT Strategies

WARNING: This post contains conversation about, and descriptions of people vomiting. If you are uncomfortable with this please do not read any further.

During last week’s visit to the CBT guy we talked further about strategies that might be effective in treating my specific circumstances. I gave him the breakdown of clearly identified problems, but told him was really at a loss as how to proceed. He threw out some ideas and after spending a bit of time talking them over he suggested I go home and give it some more thought. Continue reading

Identifying The Problem

In my last post I vented my frustration at the process that lies before me. I was already coming around in my view of the situation, but I still needed an outlet for my disappointment. Now it is time to get to work. My plan is  to make sense of this by writing out the problem on paper, and I will post the results of that writing here. Be patient as these posts may ramble a bit.There is no obvious path ahead of me and the problem is a large and complex web of interrelated fears. There is only one way to deal with large complicated problems, and that is too break them down into smaller manageable pieces. The actual problem needs a clear and specific definition. The first question that needs to be answered is simply what it the problem? The problem is clearly emetophobia, but that is not specific enough for this purpose. Emetophobia references fear of vomit and/or vomiting that my actually mean a variety of different things depending upon the individual. So what specifically am I afraid off? Continue reading

The Extinction Curve And Making A Plan

This past Friday I had the second appointment with the CBT guy who is supposed to help me work through this emetophobia. The appointment included a required background questionnaire that frustrated us both as we plowed through a bunch of extraneous crap that wasted a lot of what could have been otherwise useful time. Eventually the conversation did turn to the topic at hand, and I was able to fill in some cracks in his understanding of my circumstances that became apparent to me after I had time to process our last appointment. I also detailed a somewhat new realization that pretty much every time I have found something that gives me some joy in life it is eventually sabotaged by these fears. Continue reading

Peeling Back The Cover

Last Friday when I went to my appointment I expressed my concerns about the depression versus anxiety diagnosis and laid out the degree to which this fear of vomiting has impacted my life. I was surprisingly nervous going into the appointment and wasn’t realty sure I was going to do it until I started talking. I find it a little strange that after six plus years of seeing this guy I still have trouble expressing myself, but talking about this is still something I have some trouble with particularly with male doctors. For some reason I am more comfortable verbalizing my fears and insecurities to a woman. He listened politely to the entire story; I laid it out from the beginning and asked that he be patient with it as I explained seemingly unrelated parts of the puzzle and brought everything together in the end. I had had the conversation in my head a number of times in the days leading up to the appointment so once I got talking the ideas flowed pretty easily despite my apprehension.

When it was all said and done he agreed that the fear of vomiting thing was a significant issue that needed further exploration. He strongly suggested I seek out psychotherapy and suggested a guy he knew he has a special interest in dealing with phobias. I was not thrilled at first for a couple reasons. First this guy’s office is in a very busy area in the center of one of my work routes. I drive a company vehicle that may as well be a billboard on wheels. I take my privacy concerning this stuff very seriously and I was concerned that I would be too conspicuous. Second as I mentioned in the first paragraph I am not thrilled about talking with men, and this was going to be some difficult work. I just didn’t know. I was further discouraged when the office ladies indicated that there was a waiting list to see the guy and the wait would probably be several weeks. In the end I decided that the wait would give me time to decide if I really wanted to peel back the cover these issues at the moment. One could imagine my surprise when later that afternoon the office called me back to arrange and appointment for the following Wednesday. I am off this week so traveling to the appointment in a company vehicle wasn’t an obstacle so I decided to give it a go.

As I write this I am several hours removed from that first appointment and have had some time to reflect on the conversation. My first thought is why the hell these doctors don’t talk to each other. I spilled my guts about this just a few days ago. It was hard, and I didn’t relish doing it again, but I figured these guys are in the same practice so the talking doc should have at least seen the notes from the visit that led up to this. Nope. We started from scratch. The guys first question was “what are you looking to accomplish by being here?”. This is certainly a fair questions and even a good starting point unless the patient, me, thought you were already going to have the answer to that. Shit. He followed up with “Why don’t you tell me about what has been happening”. I am out of practice with this stuff. I didn’t have the first clue where to start. It’s not like I am talking about some bump or bruise that just happened the other day. This guy is looking for a what? A summary of thirty years of anxiety? Does he really want me to sum up something that has affected every part of my life for this amount of time in a sound bite? It has become such a large complex issue that I am not sure it is even possible. This isn’t MSNBC or Fox News it’s the actual truth that matters here not just the words.

After something of a shaky start I was able to get out the general idea of how these fears have impacted my life and how the overriding sense of general anxiety sits on top of it all like a dark cloud. He asked interesting questions, though I could tell by some of them that his understanding of my turmoil is far from complete. It is going to take more than one 55 minute appointment to get all that across I suppose. I did like that he seemed goal oriented. My first several experiences with talk therapy were all open ended affairs. One of these therapists was fantastic and I really felt like I gained something with each visit, but even she didn’t really have a goal for our work that she articulated to me. These therapists created a safe place for me to work through some difficult times, but I came to rely on them as sounding boards which made it difficult to move on. This guy and a woman I spoke with a couple years back have both taken more of a no nonsense approach to what we are trying to accomplish. There are already actual outcomes’ being discussed which is refreshing.

There wasn’t much time today for anything more than outlining the problem and discussing a couple rough ideas for approaching them which all boil down to systematic desensitization.  I am cautiously optimistic at this point. He was easy to talk to and once we got going I felt as comfortable as I have in any other therapy office. There is a lot going on here, and I am not sure we can just tease one piece out and make it go away. This one fear has been part of my life for so long that it has imbedded itself throughout my psyche. It’s like a tumor with tentacles weaving its way into places I am probably not even aware of. Is it possible to untangle this? I guess were going to find out.

Introducing Freakout Freddie

About three weeks ago in a post titled Weighing Changes I spoke about my concern related to high levels of anxiety in my new chem free existence. This is a growing problem that I fear will eventually sabotage my chance for success living a medication free life. The frequency and intensity of these anxiety attacks is building. At least four of the last five days have been impacted negatively by what amounts to my overactive imagination.

In the short time I have been living without the chemical safety net to which I had become accustomed I have been reintroduced to some of life’s simpler pleasures. I have written here a couple times about my Latte misadventures, and commented on my increased libido, but I have yet to mention my gentle reintroduction to adult beverages. I have never been a big drinker. I used a lightly abused alcohol for a brief time in college, but my by senior year I pretty much volunteered to drive whenever we decided to go out. In the ten plus years that I took Klonopin I may have consumed ten alcoholic beverages, but I doubt it. The drugs magnified the effect of the alcohol and I have written at length about my intense fear of vomiting so it was simpler to stay away.

A week ago after a long hot day of yard work we all went to the grocery store to do the shopping. The beer cooler is at the end of the last aisle and my wife commented on the ice cold bottles of Woodchuck hard cider. It was a drink I remember from college and it the spirit of my new found freedom I put a six pack in the cart. That night my wife and I each enjoyed just one cold Woodchuck, and they were just as good as I remembered, dangerously good actually. Over the course of the following week I had a couple more, and then last Friday night came around. I had had very little to eat all day and dinner turned into burgers on the grill much later than we would usually be eating. With a plate full of raw meat in hand I grabbed a Woodchuck and retreated to the porch. In less than the time it took for the burgers to do their thing I consumed the entire of bottle of hard cider. Now I am a big guy and one bottle of any beer type beverage is not going to knock me over, but the dehydration and lack of food combined with the relative virginity of my liver left me feeling a little buzzed. For me a huge anxiety trigger is the sense that I am not in control and there was nothing I could do to stop the dizzy sensation in my head. I could feel the tightening in my chest and then I had a flutter in my stomach. This sensation had nothing to do with my alcohol consumption; rather it was just a passing pain that is a regular occurrence for me throughout the day. The truth of the discomfort didn’t really matter as my anxious brain was already teetering on the brink. When the anxiety is triggered I need to move, think the flight part of fight or flight, so I excused myself from the table where I could gather myself out of my toddler’s sight.

Over the weekend I had a couple mild occurrences of anxiety, but the Tuesday return to work brought the worst day yet since the Klonopin withdrawals.  I am generally effected by the amount of light outside and as I was driving today through a rainy gray overcast I began to encounter small embedded thunderstorms. As I passed through each it became twilight dark and of course the rain was heavier with the associated lightning and thunder. This is an anxiety trigger I don’t fully understand and is relatively new in recent years, but I have apparently become uncomfortable with thunderstorms. What is ironic and troublesome about this is that with my interests in aviation and the ocean I am something of a weather junkie. I l-o-v-e weather, and have always marveled at the process by which weather is created. It is physics you can see, and geeky as it may be I think it is one of the coolest things going. I could sit down and pound out several pages on what makes a thunder storm happen, and I know that the comparatively week storms we experience here in the Northeast are generally nothing to be worried about. I knew the storms I was experiencing today were of no real concern. So given the strength of my background why the hell do they make me nervous? The truth is there is no real good answer to that question. Like most of my anxious moments it is nothing more than the rapid movement of illogical thought processes. These anxieties take loose correlations to real dangers and blow them up to irrational fears. After the fact I am often uneasy talking about them out loud because I know they don’t make any damn sense. The only thing “real” about them is the fear they create. The sensations they create are as real as if somebody had a gun to my head. Fear feels the same whether based on a quantifiable threat or the gobbledygook that more commonly runs around my brain.

The real trouble with today’s challenges was the length of time over which they occurred. For two or three hours this morning I lived with unacceptably high levels of anxiety that occasional spiked into the sensations I have no desire to EVER feel again. These were the sensations that I spent ten years on Klonopin to avoid and that I endured for several weeks over the winter for the promise of Coast Guard documents and a better life. Today I discovered that I have a very low tolerance for feeling this way. I simply will not live my life this way. It terrifies me to even put those words, “will not live my life this way”, on paper, but I am not yet ready to give up on living without medications.

In the comments section of the Weighing Changes posting referenced in the first paragraph my most loyal commenter, Lady J, told a story about her experience with her children in Cognitive Behavioral Therapy or CBT. She described a technique for externalizing the anxiety where the kids treat their anxiety as an entity separate from themselves. They give it a name and a personality completely separate from their own selves. My own admittedly limited research on the topic revealed a lot of medical mumbo jumbo but I found a couple articles that explained the premise some. The idea is not to say I am scared or I am fearful because you are not, you are you. You feel scared, fearful, anxious etc. The distinction is subtle but important. (If somebody who actually knows about this stuff happens to read this I apologize for hatchet job I just committed explaining and undoubtedly complex idea, but this working knowledge is what I am moving forward with.)

So Lady J and her kids have named their anxieties and she said in her comments that it is remarkably helpful to her. I was intrigued by the idea and have played with it in my head some, but today I went all the way. The prolonged almost sin wave nature of my anxiety today as I passed from storm to storm allowed me some time to reflect on what was happening. I began talking to myself, if your thinking this sounds a little schitzo so did I at first, but I began asking myself if what I felt was real. I knew it was not and by forcing those ideas to the front of my brain I was able to overcome most of my day. The truth is that I also took steps to shorten my work day and remove myself from the stress, but while I was in the thick of it I was able to force myself to function by telling myself the truth about my circumstances. Not my anxieties truth, but my truth: “these are very small thunderstorms embedded in a larger weather system. The atmosphere does not contain the energy required to build them into even moderately strong storms”, or something like that. The anxiety level stayed pretty high no matter what I told myself, but the horrible spikes stopped.

My Truth

Freakout Freddie’s Truth

  

This afternoon I have had some time home alone and been able to reflect further on the day. I am left unsettled by the experience, but there is hope that these new tactic will be helpful. I hope it will become easier and more helpful with time. I have decided to go all in and introduce to the world my not so friendly acquaintance Freakout Freddie. Freakout Freddie’s favorite phrase is “what if” and he runs around thinking the sky is falling. He likes to take single snowflakes and push them around until he creates a ball of ice so large it can run you right over. Freddie is not an altogether bad guy. He will undoubtedly let me know when I have crossed into a danger zone, but it is up to me to decide if what Freddie is saying makes sense or if he had just gone off the deep end again. Wish me luck.