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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Stomach Confusion

It has been a very long couple weeks since I last posted here. Regular readers know that I struggle with almost daily stomach pain. The source of this problem has been sought after by more than one doctor to no avail. When they can’t find the source they invariably fall back on the “its stress” diagnosis and tell me to get more exercise. In recent months I have discovered a direct relationship between my digestive misery and the quality and quantity of the food I put in my mouth. This discovery led a therapist I have recently begun talking with to question if I have some sort of actual food sensitivity to something like dairy or gluten. I am suspicious of this position. It just doesn’t reconcile in my head. I will have weeks or months where I continually feel nauseated and experience discomfort then I will have a shorter stretch of a few days or a week where I feel remarkably well. Nothing about what I eat has ever affected this except my recent discovery of what should have been the obvious impact of too much junk food. I have been under some pressure the last few weeks to try an elimination diet and see what happens. This past week I inadvertently did the opposite, and have had a better week for stomach pain than the two preceding. Continue reading

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.

Time For A Fresh Look

This coming Friday I have an appointment with the doc to go over my medication. The Wellbutrin has helped a great deal. For the first couple weeks I felt brain dead. It was hard to concentrate and I sometimes felt a little disoriented, but all that has passed, and while not 100% I feel much better than before. This short lived foray into a drug free life has raised some questions. I think my official diagnosis is Severe Depressive Disorder without Psychotic Tendencies, or something like that. I remember the first time I heard it I thought the word “severe” was stretching things a bit, but he was the doc so I let it slide. Over the past couple months as things started to come apart a depressed mood was not the problem. Everything started with, and was centered on, anxiety. I was having these crazy thoughts about the purpose of life and what happens at the end of life, and even then I wasn’t sad about those things as much as I was scared of them. I could tell that if I allowed things to continue a depressed mood was going to be the result, but the problem was anxiety. I mentioned this in passing at my last appointment and was told that early onset of depression in men takes the form of agitation and anxiety and that he didn’t think a new diagnosis was warranted.

Initially I accepted that, but as the weeks have passed I am not so sure. I don’t remember exactly what my original diagnosis was, but I do know that I wasn’t sure what was happening to me, and I waited a long time to get help. When the picture began to clear I knew that use of medication would end the career I had just spent a great deal of money and effort to attain. As a result I went to talk therapy, but I held off for nearly a year taking any medications. I was initially hit with symptoms in early May, and did not take any medications until mid-March of the following year. By then I was surely depressed by a number of things including living with the elevated level of anxiety and the loss of a career path I truly enjoyed. Given the amount of time that passed from the start of the problem to the effective treatment I am no longer convinced that depression was the problem so much as a symptom. My recent discovery concerning emetophobia also sheds some light how long I was actually living with these high anxiety levels and really didn’t even know it.

I think that on Friday I am going to present this line of thought to the doctor and see if he is open to revaluating what is happening with me. This particular doc never knew me before I was on Klonopin either. He always said it was a mood depressant. I have had problems with depressed mood over the years there is no doubt about that, but could I have been more susceptible because of the Klonopin? Again this makes the depression more a symptom than the core problem. If he is not open to a revaluation I am going to consider switching docs. I really think there may be something to this.