Hope Filled Recovery From Depression And Anxiety
Copyright 2010 William C. Smith
Cover Photo Copyright 2010 Julie A. Smith
Smashwords Edition, License Notes
This ebook is licensed for your personal enjoyment only. This ebook may not be resold or given away to other people. If you would like to share this book with another person, please refer them to Smashwords.com so that they may purchase a copy for themselves. If you’re reading this book and did not purchase it or have it purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
Dedication and Thank You
This book is dedicated to Julie, Hannah, and Sarah, who have stood by me since 1994 as I have struggled with the depression and anxiety associated with bipolar disorder. Their strength and patience is to be honored and not taken for granted. Thank you, girls, I love you!
My thanks go to Julie for her constant and unwavering belief in me and her support in writing this book. I especially appreciate her allowing me to use the cover photo, which is one of her many beautiful works of art. I also wish to thank Pastor Greg for asking me to share my testimony, which was the spark that I needed to set my pen in motion. A special thank you goes to my psychiatrist and friend, Dr. Mary Delduca, M.D. Your expertise and compassion have kept me sane and in good humor during my struggle with my illness. I don’t know how you do it! Thank you Matt, Mike, and Sue for your patient guidance and determination to bring me to the Lord. Thank you to the two Mikes. You know who you are! I give thanks for my Lord Jesus Christ for His love and protection.
Legal Disclaimer
The tips, suggestions, and advice contained in this book are those of the author. The author is not a medical professional. Therefore, the information in this book is presented from a lay person’s perspective for the sole purpose of describing his observations and opinions regarding his experiences with depression and anxiety in his own life, and how they may apply in the reader’s situation. Nothing in this book is meant to be medically prescriptive or to be used for diagnosing or treating any medical condition. The reader is strongly encouraged to check with a licensed medical professional prior to deciding on any approach to mitigating the symptoms of depression and anxiety, or any other medical or nutritional decisions.
Important Definitions
Depression: Prolonged and otherwise medically unwarranted period of emotional lethargy; withdrawn, a general feeling of sadness and despair.
Anxiety: Sense of dread and uneasiness; unwarranted thoughts of impending doom; often accompanied by racing thoughts, a sense of panic, and wariness of crowds.
Recovery: Generally a return to a healthier state of mind and perception of self; from sickness to health.
Hope: Trusting belief based upon a reasonable expectation that a desired outcome will occur.
Table of Contents
Goal One: Attain Emotional Stability
Goal Two: Good Physical Health
Goal Three: Harmonious Relationships
Take Stock of Your Accomplishments
Category One: Skill Development
Category Two: Informal Learning
How This Ties In With Recovery
Introduction
It was 1994, at the height of my personal and professional life, that it hit - the deepest, darkest depression that one could know. Seemingly out of nowhere, I was suddenly saddled with anxiety to the point of not being able to eat or enter public places such as grocery stores or malls. The combination of the two issues was terrifying! Visions of suicide flashed around in my head; I couldn't sleep at night; I couldn't stay awake during the day - needless to say, my world was a living hell!
The speed with which this condition came on was amazing. I was on a training deployment with a military unit as an up and coming officer. The first day of the exercise, I was in a command center with several other support personnel when I suddenly felt like I was having a heart attack – breathing became difficult and I had sharp pains in my chest. When I was taken to the clinic, I learned that these were the symptoms of a giant anxiety attack. Wow! I literally thought I was going to die, and to be honest, I only half believed the doctor when he told me that I wasn’t.
Within a week, I progressed from anxiety to full depression, a deep, dark depression complete with suicidal ideation and intrusive images that had me terrified. Eventually I could not drive without having very strong urges to pull the car into the path of oncoming traffic. These images, urges, and the depressed feeling that I was experiencing really began to terrorize me! I was so afraid of the possibility of hurting either myself or my family members that I packed up my hunting knives and my gun collection and asked a friend to keep them.
All this took place during the first weeks of the summer of 1994. By October, I just could not keep it together any longer. I was at work, with my office door closed, the tears pouring down my face; I had no control over them or my emotions. I was not crying about anything in particular, but I could not stop the tears. A close friend and co-worker, in whom I had been confiding all along this rocky path, was also a licensed clinical social worker. His office was down the hall from mine, so I got up the nerve and headed for his office to seek his advice. When he saw me, he told me to get to the emergency room right away, which I did. He called ahead so that they were expecting me. Thank God they were understanding and empathetic.
The emergency room staff immediately took me back to an examination room so that others couldn’t see me because I had just come from work and was wearing my military uniform. At that immediate moment, I could not have cared less, but in retrospect I am grateful for them shielding me from curious onlookers. The doctor that examined me took my situation very seriously. He started calling around to find a bed for me at a mental health ward, but none were available locally. He eventually found a place for me at a medical center about an hour away from my home. I certainly needed to be admitted to the hospital at that time. If not, I truly believe I would have ended up in the morgue within a week or two. I actually didn’t want to commit suicide, but the intrusive thoughts and images were driving me to the point that I could not take it much longer
I have left out long periods of time and many events that happened during that time for the sake of getting to the point of this book. Suffice it to say that during this whole period, roughly half a year at that point, I experienced many very low points and a few bright spots. What I want to focus on in this book is how therapy, medication, and the application of various techniques have helped me to essentially overcome my depression and anxiety symptoms. I aim to share the concepts that I learned from professionals, fellow patients, books, and a tremendous amount of self-discovery. The remainder of this book is an exposition on the concepts and techniques that I came to know, how I applied them to my situation, and a discussion of the limitations that professional therapy alone had for me. Finally, I will discuss what I discovered that allowed me to overcome these limitations.
I can only relate my personal experiences to you. I am not a trained, professional therapist, social worker, psychologist, or physician. However, my family, friends, coworkers, and I have lived with these experiences and the outcomes for many years now. I feel that my experiences and insights may be helpful for many people who are struggling with the pressures of life while dealing with the agony of mood disorders, such as depression and anxiety, and those around them who are also affected. Let’s get started!
Chapter 1 - The Struggle Begins
My Family and Coworkers Despair
I think most people can understand how hard this was for me to deal with. The story would not be complete, however, if I failed to mention my family, friends, and coworkers. My wife and I had two young children at home, a three year old and a seven month old. Julie was a stay-at-home mom, which was very important to both of us. We felt that our girls would benefit by having mom at home in their formative, pre-school years. When all this upheaval took place, my wife was as confused and terrified as I was, if not more!
You can imagine how a mother of two very young children would feel with her husband, the bread winner, locked up in a mental health ward at a medical center an hour away from home. She suddenly had to be mother, father, and overall protector of the family, not knowing whether I had completely lost my mind or when I might be home again. Neither of us had ever experienced anything remotely like this.
Knowing about her situation caused me to feel extremely guilty on top of being depressed and anxious. Add to that the embarrassment of having friends and coworkers know that I was in the mental health ward. At the time, the military simply did not understand how to react to an officer with a mental health issue. Heaven forbid! Things were kept extremely quiet at work, and nobody came to visit except for my wife and kids. That is simply an observation, not a complaint. I could not have received any visitors in my state of mind anyway.
Meaningful Therapy Begins
The first morning in the hospital, staff wasted no time getting me into therapy. I was rousted out of bed at 6:00 am after a sleepless night, fed breakfast, and then was hustled into group therapy. That was followed by occupational therapy, then by one-on-one counseling, then group therapy again to close out the day. This routine went on for the whole time I was an inpatient.
At first I kept asking myself why I was there. The night that I was admitted and first thing the next morning I was having second thoughts about being there, wondering what I possibly had in common with the other poor unfortunate folks who I was locked in with. Once we all began sharing with the group that first morning, I found out exactly what I had in common: I was very sick and needed help, just like everyone else in the place! I think that is when I actually woke up to the reality that I had an illness, that I was not going crazy, and that I wasn’t the only person feeling the way that I did or facing the issues that I faced. It was in that moment of realization that I was able to begin my recovery.
I was an inpatient for only two weeks or so because the insurance company, though they had agreed to provide up to three weeks of coverage, called the hospital daily and demanded a status report on my case. The doctors and psychologists came to a compromise with the insurance company that allowed me to be discharged from the hospital and enter day treatment. I found this to be a great thing for me. When I was in the hospital, I felt like I could never re-enter normal society again. I was locked in the ward, could not have sharp objects, and the ward had protective steel coverings over the windows, all designed to protect us from harm. The day patient program offered me a chance to ease back into everyday life, very slowly taking on some home and work responsibilities, while providing necessary counseling and support. This was held at a residential facility only a block or two away from the hospital, and it was staffed with many of the same professionals whom I had come to know at the hospital. I was there for five weeks; five days each of the first two weeks, three days each of the next two weeks, then just two days the final week.
During my time, both inpatient and day patient, therapy was focused on changing my flawed thought patterns. I was to learn that in the depressed state one usually engages in negative self-talk, promoting a poor self-image, which of course just acts to perpetuate the person’s depressed mood. I was no exception, finding as time went on that I fit this pattern exactly. When depressed, a person’s mind is not processing information normally anyway. Add to that a negative self-image reinforced by faulty thought processes that help create feelings of isolation, low self-esteem, and that nagging, but false, feeling that everyone around you is perfectly healthy, happy, and prosperous while you are suffering. Those were my thoughts as well. It’s no wonder that depression is so emotionally painful. Sounds odd to me in retrospect that I thought everyone in the world except me was in perfect health and totally happy with their lives; however, it was very real to me at the time just the same. Have you experienced similar thoughts and feelings?
Trying to Control My Therapy
The period of my most intense therapy, that is the time during which I worked most closely with therapists of all kinds, was between October, 1994 and March, 1997, after which the military medically disqualified me from continued service. The reason for me working so hard to overcome the depression and anxiety was that my sense of self-worth was wrapped up almost completely in my career. I completely identified myself, who I was as a person, with what I did for a living. I was trying desperately to salvage my military career, which in the back of my mind I knew was a losing cause. The military could not tolerate an officer with a mental health flaw. That probably was a good thing considering the responsibilities placed upon us.
I felt that if I could only redeem myself in the eyes of my peers and superiors, I would become well again. So, I listened to the therapists, nodded my head a lot, and tried in a mechanical way to put into practice the concepts that I had learned in the sessions. All the while I had to bear in mind that what was written in my medical records and information about the medications that I took would be available to the military. This fact kept me holding back from exploring some of the issues that I was facing during this time. My therapist told me that many people hold back in therapy for various reasons, which only hinders the healing process. I wanted to keep the negative information available to the military to a minimum. As one therapist put it, it was as if we had a third person in the room all the time, that person being Uncle Sam. That person was really me trying to manage what I was learning and mold it to fit the military mindset so that I would be welcomed back into the fold.
That never happened, of course. The person who sponsored me when I was commissioned became very distant. My supervisor began disassociating himself from me and began asking my staff what my state of mind was, how I was emotionally, and if I was I performing my work acceptably. He simply could not bring himself to address his concerns with me directly. I found myself alone and unsure of how to conduct myself at work. I understand now why these people behaved the way they did. They had no experience with mental illness either, so they were as afraid of it as I was. Also, my behavior often wavered between normal and irrational. The logical thing in their minds, I assume, was to distance themselves from the issue by distancing themselves from me. This situation added to my stress and isolation, which eventually wore me down, added to my depression and anxiety, and eventually led me to stop fighting the inevitable discharge that I was to receive. I felt totally crushed and defeated because I had not previously failed at anything that I put my mind and energy into. After all, I was a perfectionist, and perfectionists do not fail. Sound familiar?
Finally Letting Go
Eventually I realized that I simply needed to stop holding back, start fully engaging with my therapists and doctors, apply the coping skills they were teaching me, quit worrying about how anyone else would perceive my illness, realize that I could not possibly do everything to perfection, and move on with my life. As you continue reading, keep in mind that I am a technically oriented person by nature and by training, so I approached this in an ordered and exacting way. I decided to put to use many of the skills that I had learned in college to explore areas of my life that I would likely have to change. I am referring to the behaviors, attitudes, beliefs, stereotypes, and prejudices that I had been clinging to all along that were no longer helpful, or might even be contributing to the depression and anxiety.
You are lucky readers. In the first edition of this book, I went into a long discussion of how I came to think this way, the mechanics of how I came up with the many ideas that I eventually cultivated, and even a protracted discussion of the exciting world of behavior theories and their application in business. I will spare you most of that and just get to the point, which is to share with you those things that I have found that have helped the most in my recovery from depression and anxiety. I know that what works for one may not work for another, but after reading through what follows, you may find things to try as I have explained them, and maybe other things that you can adapt for yourself. If nothing else, this book will cause you to think more keenly and discover that it is possible to experience recovery from the devastating effects of depression and anxiety. Ready to try it out? Read on, my friends!
Ponderisms
Are you feeling guilt or embarrassment about having depression or anxiety?
Is your sense of self and self-worth tied to something outside yourself?
Is your current therapy making a positive difference in your recovery effort?
What are you doing to improve your therapy?
Do you engage in negative self-talk?
Chapter 2 - Self-Actualization
The Basis of My Path to Recovery - Maslow’s Theory
Though I promised not to bore you with arcane facts about how I came up with my ideas, I still should tell you what I thought would be the end result of all my trouble and effort. Believing that I actually could achieve recovery was what motivated me to continue to struggle in the worst of times. What I was striving for was a concept known as Self-Actualization. Self-actualization, as I learned it, is a concept identified by a behavioral scientist named Abraham Maslow. Not surprisingly, his work became known as Maslow’s Hierarchy of Needs Theory. While many people have created their own versions of the theory, Maslow is generally recognized as its author and originator of the concept in general. In the early 1940’s, after observing many successful people to determine what behaviors they had in common, Maslow published his observations. The extremely short description of this theory is that all people have needs, ranging from the very basic physiological and safety needs to higher order sociological needs, such as love and being esteemed. Until the lower order needs are met, a person cannot be completely aware, confident, high-functioning, and happy. Lower-order needs fall into the categories of Physiological, Security, Love, and Belonging, and include such things as the need for air, food, water, and waste elimination; safety and security of self and family; as well as friendship and intimacy. According to the theory, if a person has a lower order need that has not been completely fulfilled, it will hold him or her back from self-actualization, considered the gold standard of satisfaction and productivity. Once these lower order needs are met, however, one is freed to become fully aware of oneself and one’s surroundings, and begins functioning at full potential. I felt that this theory fit in the case of depressed and anxious people, so I decided to apply it to my quest.
What is Self-Actualization?
Maslow described self-actualization by saying that people desire to become what they can be, which essentially is being self-actualized. Another way of saying this is that a self-actualized person has become all that he or she is capable of. Consider this desire to see if you agree with it. Wouldn’t we all like to be at or close to such an ideal if given the choice? I think so. It is what motivates me in life. The assumption that I made when I set about trying to recover from my depression and anxiety was that if I could fulfill all the lower order needs expressed by Maslow and mentioned above, I would substantially overcome my psychological issues and enter into the exclusive domain of self-actualized beings. Being technically oriented, this sounded perfectly logical to me: A+B=C, right? I think Maslow knew what he was talking about and was on the right track, but his observations were based on a study of people who were considered fully actualized and free from defects of mind or body. The result is that his theory is helpful as far as it goes, but it is limited in its scope in the real world, in my opinion. Even so, it does have merit for my approach to recovery because it enabled me to get off to a good start and eventually realize many of my psychological health improvement goals.
What I failed to notice at the time that I was reasoning this out, however, was the completely humanistic approach described by Maslow and others relative to reaching self-actualization. There was no mention of the spiritual realm; no tying together the body, mind and spirit; no consideration for religious beliefs. In the back of my mind I knew something was missing, but I could not put my finger on it at the time. I had a nagging feeling that there should be a dimension of discovery that would address the humanistic absorption with the idea of ‘self’ being the center of the universe. Even so, it made sense to me to strive to be the absolute best that I could be, hoping to rid myself of the ever-present depression and anxiety that was interfering with my work, my family, my social life, and my personal happiness and stability. I could not quite figure what might be missing. I thought hard about it, did not come up with anything concrete, so I passed it over, deciding that I would complete my quest to reach self-actualization, and with that, wellness. I would later discover that there is another dimension, a very important one, which I discuss in chapter six. Stay tuned!
Brainstorming!
Brainstorming - sounds like what is going on in a depressed or anxious person’s head all the time, right? That’s not what I’m referring to here. I am referring to capturing ideas by wracking your brain and squeezing ideas from it, and perhaps from others’ brains too. I said earlier that I had to explore areas of my life that I would likely have to change. How did I come to know what those things might be? I simply brainstormed for the better part of two days focusing on what I knew to be out of whack in my life, what I had learned in therapy about addressing those things, and finally what I would need to do to move from out of whack to at least on the right track. In other words, I considered where I was currently, where I wanted to be, and how I could bridge the gap. I just sat and thought, letting the ideas spill out, and wrote them down. I later put them into a coherent order, picked out the things I was most likely to succeed at, and began to take some baby steps at getting better.
If you are so inclined, you might brainstorm for yourself. The cool thing is that you don’t have to! I have done the leg work already and present here what has resulted in positive change in my life. Take a look at what I present in the following chapters. I think you will find some helpful tips and techniques. If not, feel free to brainstorm for yourself and give it another whirl.
Putting the Information to Use
I should say that the brainstorming exercise is not an end unto itself. It is simply a tool for getting started on the path to recovery. My experience is that once it is completed, you then need to follow through on addressing as many of the valid points that have been identified as possible. It is not possible to work on all the items at the same time, so picking the low-hanging fruit, the simpler and easier things, is a good tactic for some quick results. I suggest that a person work on the first few skills or techniques that will end with quick success. Some examples might be incorporating walking into the daily routine for a week, or setting a daily schedule of tasks for the week ahead. By doing this, a person reinforces the value of what they are trying to accomplish. When we are depressed and anxious, when everything seems to be going wrong and one day seems to blend in with the next, any positive influence is effective in helping you to see that there just might be hope of finding a way out of the darkness and desolation after all.
If you go this route, keep at it, one or two things at a time, and little successes with occur. Using the examples above, you might discover that you walked twenty minutes every day for the past two weeks without fail, or that your daily schedule resulted in no missed appointments for three weeks. These are small successes, but they are successes none the less. Successes will begin to add up to something tangible for you, and soon you will be less and less focused on the anxiety and depression because your mind will be occupied with this work and the little bit of joy that the successes bring. For example, when I was extremely depressed and anxious, I found it very difficult to be alone. After working on my first few easy items and experiencing success, I began to work on slightly harder things. This focus caused me to little by little get out of bed earlier each day and start to feel safe when alone.
There will be lulls, minor setbacks, and frustrations, but push through them. For example, I tried to make sure I ran at least two miles every day. Some days I simply did not have the energy, so I would stay home. This frustrated me and increased once again my feelings of depression, anxiety, and low self-worth, but I worked hard at setting those small defeats aside, taking them for what they really were, which were just minor bumps in the road, and focused instead on the increasing number of days in a row that I was able to run. This is key to your recovery – don’t give up due to frustration!
Recovery is not an overnight process. It is about changing thought patterns and old habits. Breaking free from years of negative self-talk and self-destructive habits is very hard work. It requires energy that is hard to come by when you are depressed or anxious, but you can believe me when I say that it is well worth it! The rewards are a clearer mind, greater freedom from fear, more successful interpersonal relationships, and a better feeling of self-satisfaction overall.
In my particular case, I worked at this very hard from 1997, when I was discharged from the military, until about 2002, when I began exploring the spiritual realm as well. By then I was feeling much better, but even so, I continue to work at maintaining my recovery by applying the techniques that I mention in this book. Occasionally I run into new experiences that can be very trying, so I have to revisit my list and redouble my efforts. I also maintain contact with my doctor about every three months, more often if needed, and take my medications as prescribed. The result is that I feel better now than I did in high school. You may too, but you have to resolve to work at it and stick with it! Let’s start off this discussion with what I feel are important words of advice:
Take Charge of Your Care!
When a person is depressed and anxious, he or she needs to change thought and behavior patterns to help change the situation and lift his or her mood. You should work with your caregiver to discover what is out of whack and learn how to start to turn things around. Working with a professional therapist or other licensed caregiver is very important. I can’t overstate that fact. However, the person with a mood disorder needs to take ownership of his or her condition and its treatment. The therapist or doctor cannot help you if you are not willing to help yourself. As I have said before, it is hard work, particularly when you are already tired and confused and your head is racing with thoughts, but you need to do it if you want to break out of the cycle of depression and anxiety.
Keep your appointments with your therapist. Resist the urge to skip sessions because you are too tired or too depressed. Those are the times when you most need to be in therapy. Your therapy sessions will be more worthwhile and you will find yourself feeling more confident, more in charge of your personal situation. Be completely open and honest with your therapist. Why pay good money for their help only to hold back or mislead them?
Do the work and feel better; don’t do the work and you will be a victim of your own circumstances. The choice is yours! Think like a fighter, not like a victim! You can do it!!
Ponderisms
What is your motivation to go on each day?
Do you know what thoughts and behaviors that you might need to change?
Do you focus on your successes or your frustrations?
Would your therapist say that you are completely open and honest with them?
Who is in charge of your care and recovery?
Chapter 3 - A Healthy Start
If you are still reading the book, great! It is a sign that you have chosen to take charge of your illness and work toward feeling better and being more productive. I applaud you for that!
Just what must a person do to stabilize his or her mood and improve their self-esteem? In my opinion, which is based upon personal experience and the observation of others in similar situations, the following four goal areas need to be addressed for one to achieve a positive self-image, enjoy self-confidence, and experience social acceptance, all of which I feel are necessary for self-actualization: Emotional Stability; Good Physical Health; Harmonious Relationships; and Social Maturity.
Goal One: Attain Emotional Stability
To me, this is the very first thing that people with mood disorders, such as depression and anxiety, must strive for. How can one achieve gains in other areas if, at the core, they are see-sawing back and forth, riding the highs and lows, and experiencing the debilitating fear, racing thoughts, and exhaustion that often accompanies mood disorders? I can relate from my own experience that you probably should not try to skip this step. I needed to become relatively stable so that I could focus on my issues before working on anything else.
As I mentioned, I had to let go and stop trying to orchestrate everything. I began to realize stabilization when I finally internalized and accepted that I was ill and needed help. Help cannot be imposed upon you; you have to want to get better. I am not trying to say that there is a formula for success; but, like building a house, you will need a firm foundation from which to start. But how does one go about improving emotional stability? What follows are the things that worked for me and that just might help you on your path to wellness.
Address Abnormal Anxiety
First and foremost, I had to address the abnormal anxiety that I was experiencing. I use the term abnormal anxiety because everyone experiences periods of anxiety. They are usually brief and situation-specific, such as the time leading up to a public speaking event. Abnormal anxiety is persistent and interferes with daily living.
Panic attacks were the norm for me. I walked around day and night with an undefined feeling of dread, not having any reason to be afraid or worried, but feeling it very strongly just the same. The anxiety and panic were preventing me from enjoying life altogether. I had a hard time going to work, shopping, visiting with friends, and even enjoying outdoor activities. At its worst, I was terrified of being alone. I cannot tell you why, exactly, because I really don’t know. I felt the need to have my wife in the room with me all the time. If she went to another area of the house, I would go into a terrific panic, begging her to come back right now! It was like being in a jail without bars - for both of us.
With therapy I discovered that what was perpetuating the general feeling of dread, though, was a constant checking in to see how I was doing. I was obsessing about it. Every few seconds I would let my mind wander from whatever I was doing and check to see if I felt anxious, which made me more aware of the anxiety, thus making me continually anxious. My therapist told me that this is very common, that it is called free-floating anxiety, which is a fear of being fearful. It took me some time to wrap my brain totally around what that meant. After a while it sunk in – I was afraid that I would be anxious, so I would check on myself to see if I was indeed anxious. Out of fear of being anxious, I anxiously checked to see if I was anxious, which made me more anxious. Got it? The result was a vicious cycle of worry breeding fear, breeding panic, and on it went.
One trick a therapist suggested to break free from this cycle was to stop what I might be doing and count the little holes in the ceiling tiles at my work when I began to feel anxious. Sounds ridiculous, but that is the sort of thing that may take your mind off the issue. Just focus on something that requires concentration, something like reading, building model airplanes, carving wood, or painting figurines. You name it! If you keep your mind sufficiently occupied with something constructive, actively using your brain instead of engaging in passive activity, you can overcome that cycle of checking in. It is similar to how I used to behave when I smoked cigarettes. As long as I was engrossed in some activity that required concentration, I had no craving for a smoke. As soon as I was done, bam! The urge would hit me. I found that my anxiety symptoms were much the same.
One technique for reducing overall levels of anxiety that worked for me was to figure out the locations where I felt the most anxious and consider ways to minimize the anxious feeling when I had to be there. Examples are grocery stores or other crowded places, like malls. The second I walked through the door of a store or mall, my head felt full, almost swimming with noise and pressure. I felt claustrophobic. I would develop tunnel vision, like looking through a fish-eye camera lens, with everything on the periphery of my vision out of focus. My abdominal muscles would flex so hard that it hurt, partially cutting off my ability to breathe, which only added to the sense of anxiety and panic. It seemed like the aisles would narrow and close in on me, and I wanted to know where the exits were and how to get to them in case I had to run away, which I often did. Another example would be movie theaters. I always had to sit at the end of an aisle in case I needed to bolt for the door because of panic.
It was really terrible, to say the least. There were very few places outside my home that I could comfortably go because the anxiety was so intense. Trying to go to work often resulted in the same symptoms, especially the tightness in my abdomen, sweating, and rapid breathing, usually ending in a full-blown panic attack. Many times I would start to go through the gate onto my worksite and have to turn the car around and go home. I suppose I exhibited symptoms of agoraphobia because I got to the point where I almost literally could not go into public places without experiencing gigantic panic attacks.
At some point, I realized that I could not go through life like this. I gritted my teeth and forced myself to face my fears head-on, one at a time. When going shopping, I started to get good at knowing exactly what I needed, going in and grabbing just those things, and then cashing out and leaving as quickly as possible. But at least I finished the transaction without rushing out the door empty handed! Sometimes I would leave the buildings drenched in a cold sweat and my head completely swimming, but I just had to push through it. Eventually I started to be able to enjoy shopping. That means I eventually found myself browsing the aisles of the grocery store or the stores within a mall instead of just zooming in and out with a few things on my list. I also became good at tuning out the crush of people around me. When I went to work and felt the familiar panic starting to set in, I would stop just outside the gate, rest and relax a few minutes, take a few deep breaths through my nose, then push ahead. I would immerse myself in my work as quickly as possible to create a distraction from the fear. My head might be swimming and I might be sweating hard, but I pushed on. Each time I was able to complete my shopping or stay at work, I experienced a success. Things progressively got better as a result. Eventually, the feelings of panic subsided almost completely, and the general anxiety became less and less pronounced.
What I found was that I simply had to face the crushing fear head-on, a little more each time, for my fear to begin to subside. I resolved to keep at it until I had overcome the panic and fear that each situation was causing. The anxiety remained for a long time, but the debilitating panic was reduced to less and less frequent attacks, the number and severity of which became bearable and somewhat predictable. This in turn gave me some control over the panic. I stuck with it in each situation and eventually overcame!
It’s Not Personal
Another anxiety reducing tactic is to learn not to take personally everything that the people around you say or do. Believe it or not, most conversations are not about you! I used to hear criticism in everything that my wife or boss or other people in my life would say. I thought I was cleverly reading between the lines, but I actually was just being hyper-vigilant about every little detail, just looking for something wrong. Routine things would cause resentment and anger to well up inside of me. A friend of mine who wanted to help me in this area would challenge me whenever it happened at work. If my boss said something, my friend would ask me what I had just heard, in my own words, and what it meant to me. He would correct me when I had taken things wrong, which happened a lot initially. With his help I began to ask these questions of and by myself, and I was able to eventually challenge these thoughts on my own. I learned to give people the benefit of the doubt most of the time. Unless I know for certain that something said is aimed at me personally – that is, aimed at my character – I simply try to assume that it is not personal. I still wrestle with this; however, I have gotten to the point that I have learned to let even many pointed attacks roll off my back most of the time. It is just not worth it emotionally to let what others say and think rule your thoughts. Anger and resentment eat up way too much time and energy. I have to say, this one thing has helped me dramatically over the years. I still fight this demon, but my wife helps me by bringing it to my attention when I relapse.
Educate Yourself About Anxiety!
One of the best ways to do battle with enemies is to learn as much as possible about them before you have to face them. Why should fighting anxiety be any different? Educate yourself on the topic. Read books, articles in print or on the internet, attend seminars, go to therapy sessions, or talk with your medical provider, whatever works for you. I used a combination of things.
When someone mentions anxiety, what does that mean to you? Cold sweats, panic, fear, heart palpitations–all of the above? The more you learn about anxiety and its symptoms, the better you will become at recognizing the symptoms for what they are, thereby reducing your anxiety over time. When extremely anxious, I often thought that I was having a heart attack, but I learned that the symptoms of a heart attack, though similar, are usually greater by a large degree. When someone says a symptom of a heart attack is chest pain, they mean elephant sitting your chest kind of pain and pressure, not the minor pain associated with a panic attack.
Prior to my hospitalization for depression and anxiety, when a doctor told me I was suffering from anxiety, I had no clue what that term meant. I heard it more than a few times because I would end up in emergency rooms thinking that I was suffering heart attacks. Sound familiar? I didn’t want people thinking that I was stupid, so I never asked exactly what anxiety was. Once I educated myself on the topic, I finally understood the concept, quantified it, and worked to ease its effect on my life.
There are many web sites to visit, group therapy settings, therapists, books, videos, etc., that one may use to learn what anxiety really is. You should be able to find something to help you – like this book! Learn the symptoms of anxiety in your individual case. Once you know how you react to anxiety, those symptoms that you individually manifest, and realize them for what they are, you will be able to reduce your obsession with them. Eventually you will have fewer and fewer panic attacks and the anxiety will subside. Identify the symptoms, accept them for what they are, learn to pay them no attention, and like a bully who nobody pays attention to or reacts to, the anxiety will eventually fade away.
What About Medications for Anxiety?
I have some personal insight on this topic. When I first started having panic attacks, my doctor prescribed beta blockers to keep my heart rate from suddenly racing away. These were okay, but as a result of using them I was so tired during the day that I could hardly stay awake. I also liked to run several miles a day. Using beta blockers hindered my running because my heart could not attain the rate I needed for distance running.
When the beta blockers did not work well, my doctor prescribed a strong and effective tranquilizer. When I took the first dose, the anxiety almost immediately melted away. Wow that felt good! Unfortunately, tranquilizers, I am told, work on the same area of the brain that alcohol does. Therefore, like taking alcohol, I needed to take more and more of the drug to reach the same level of tranquility. I started on a low dose, but the doctor kept increasing the dosage to ward off the anxiety until I eventually topped out and couldn’t take more.
I know people who have successfully taken tranquilizers for years at the same dosage and frequency of use, but that was not the case for me. I went for a time at a steady dosage, taking the medication three to four times a day, but there would be times of increased anxiety when I had to take more of the medication between regular dosages. This became the norm for me after a while. I took tranquilizers to mask the symptoms of anxiety rather than do the work necessary to address the causes of the anxiety.
Though the medication was very effective at practically removing all the symptoms of anxiety, it eventually showed the ugly side of being a system depressant; the more I took, the more depressed I became. As I understand it, tranquilizers, like alcohol, are depressants! On top of that, they may be habit forming. However, I would say that if you and your care provider discuss the risks and benefits, and come to a mutual agreement on the idea, then use medications as another tool in the arsenal. If you do take them, do not suddenly stop taking your medications without getting medical advice! I have been told that suddenly stopping many medications may result in side effects that are not good. Please talk this over thoroughly with your care provider and make an informed decision. Ask questions!
Freedom from Guilt
Have you ever felt guilty about having a mood disorder? Do you feel that you are letting those around you down because of your illness? I certainly did. If you were to have diabetes or high blood pressure, would you feel the same? Probably not. For whatever reasons, there is something different about mental health conditions, a stigma that persists to this day. Those around you may shy away or be distant because they may not understand what you are going through. That is normal behavior for most people. You shouldn’t let their behavior make you feel guilty. If you were confined to a wheel chair and people exhibited similar distant and stand-offish behavior, you probably would not feel guilty. So why should you feel guilty about it when the issue is one of mental illness?
Talk to the people closest to you, if they will listen, in an attempt to help them understand what you are feeling and thinking. Help them to understand that you are not crazy and mood disorders are treatable and not contagious. Help them know that your condition is not the result of something either they or you have done. It is a medical condition! If they are willing, enlist their help in getting your life back on track.
Remember the friend of mine that challenged me when I took everything personally? That is the kind of assistance that I am talking about. Getting friends and family members involved will help ease your guilt, help alleviate their fear, and help both you and they find more positive ways of dealing with the situation.
One final word on this topic – your family may be reluctant to discuss your situation with others, so be cautious about bringing up the subject except in private settings. Though they may become less reluctant to talk about it with you, they still may be embarrassed if others become aware of your situation. That is normal. You would probably feel the same way if the roles were reversed.
Avoid Negative Self-Talk
This might seem obvious to many, but I would wager that the majority of people with depression and anxiety will find, when it is pointed out to them, that they engage in very negative self-talk. Rodney Dangerfield made a good living being self-deprecating, but that was just an act! When we do it, and we do it mostly subconsciously, it can have significant impact on our self-esteem. I was a student of electrical engineering for a time, so I tended to look at the world in terms of equations and black and white facts. Because of my analytical nature, some people referred to me as Cliff Clavin, the nerdy mailman on the old hit television show Cheers. Eventually I began to subconsciously internalize that and referred to myself that way. I subconsciously began to believe that I was a nerd or dweeb, and that I was somehow less socially acceptable than those around me. My therapist pointed it out to me when I was first hospitalized because I kept calling myself Cliffy. Sounds silly, but it was very real and bore real consequences.
Challenge yourself to pay close attention to the things that you say or think about yourself. When you catch yourself placing yourself in a negative light, change your thoughts or words. Be persistent and do not let those around you refer to you in negative ways either. What seems funny now may have consequences later. I am not suggesting that you should stop having fun with friends and coworkers. What I am saying is be vigilant. Do not let good fun turn into deprecating, ego-crushing, negative self-talk. You are a good person and deserve to be thought of that way, and to think of yourself that way!
Do you see the glass as half-empty or half-full? Filtering your thoughts and feelings through the negative filter – the half-empty glass – can deepen your depression, can cause you to become cynical, can alienate you from people around you, and can exacerbate anxiety. Talk and think positively about yourself!
Family Involvement
The final area of discussion on the topic of emotional stability has to do with family and friends. Become involved with your family and friends in healthy ways. I have several friends who are big on having family night once a week, a time for getting together for a nice meal, games, talk, and pleasant interaction. I fully agree with this principle. Be honest with family and friends, practicing appropriate transparency. By this I mean let them know what is going on in your life, the things that are on your mind, things that may not be going well. Share what you feel that you can with them. There are topics better left to conversations either one-on-one with individuals or only with your therapist, which is what I mean by appropriate transparency. If you are sharing something and you sense the other person or the group becoming quiet and uncomfortable, that is a good indicator that you are sharing something inappropriate. You will get good at feeling your way around the more you practice this.
Along these lines, trust your family as much as possible. When sharing, give as well as take. Listen to what others are saying and respond to their needs as well. My church advocates small home groups of no more than ten to twelve people who fellowship weekly and perform community service together. For many, this is their only local family. The groups are kept small on purpose so that people may be able to share and be supportive of each other. When sharing with family and friends, be patient and understanding. They may feel uncomfortable at first because of your mood disorder. That is okay. Go slowly, be patient, support them as they strive to be a better support for you.
Goal Two: Good Physical Health
Exercise! I am a proponent of this goal because of personal experience. I have heard it said over and over that moderate exercise, such as walking thirty to sixty minutes each weekday, will help reduce feelings of depression and anxiety. When I experienced my lowest points of depression, I found it hard to get up off the couch, much less exercise. When I was particularly anxious, I could not stay focused long enough to do a complex workout. However, I forced myself to get out and walk every evening after dinner for about thirty minutes. During my walks, I contemplated the day and sometimes prayed to God to help lift my burden. Walking helped me feel better about myself too. Getting up and doing anything when you are very depressed or anxious is a challenge, so succeeding at walking thirty minutes each day lifted my spirits, even if just a little bit. As I understand it, exercise causes your system to release endorphins, chemicals thought to help improve mood and relieve stress. Less stress, in turn, helps alleviate the symptoms of depression and anxiety.
The job that I have now allows a one hour lunch break each day. I take advantage of this by walking forty minutes almost every day after eating my lunch. In my case, that equates to a little over two miles of walking nearly every day. Some days I really don’t feel like going out and getting into the routine, but I force myself. I always feel better afterward, reinforcing the idea of getting out and doing it again the next day. On weekends, I walk a couple of miles through the wooded area behind my house with my dog. She loves the exercise and the chance to check out all the new smells on the trails. I can report that she is neither depressed nor anxious!
Eat a Healthy Diet
In addition to exercise, one should eat a healthy diet of fruits, vegetables, meats, cereals, and nuts, and avoid the junk food items, according to the USDA’s food pyramid guidelines at the time of this writing. I am guilty of eating too many sweets these days, but I have relieved myself of guilt, remember? Sugary foods, which include just about any snack food or beverage, cause the body to experience quick energy highs and lows. The layman’s explanation of this phenomenon, as I understand it, is that when the sugar enters the blood stream, the body gets a quick rush by the sugar rushing out of the blood stream and into the cells to be used for energy. When the blood sugar levels drop, the body experiences a low due to the deficit. My process description may be a little weak, but the point is this: eating junk food causes one to experience these energy swings over and over throughout the day. These reactions wreak havoc on a person who is suffering with a mood disorder.
You and your therapist are trying to lift you out of your situation, and junk food is making it worse! Eating a poor diet is counter-productive to your goal. Caffeine is another potential problem source, but we don’t want to pile on too many things at once. Let’s keep it simple. You should discuss nutrition with your care provider as part of your therapy.
One thing that I have heard is that medical schools generally do not teach nutrition to aspiring doctors. I have visited many medical doctors in an attempt to come up with a suitable diet. They all told me the same thing; medical school just did not teach nutrition, at least when they went to school. A couple of them who deal with diabetes patients have done independent study and expressed their opinions to me, but I would suggest that this question is best answered by your care provider.
With the internet so pervasive in today’s society, anyone can slap up a web site claiming to have the magic bullet in the area of diet. It is difficult to determine which ones are legitimate. I recommend checking out sites like www.webmd.com, www.americanheart.org, or www.diabetes.org. If you are insured, your medical insurance company may offer a similar web site. From those sites you will find links to other good sites and resources as well. Try to get the best information available on proper diet, exercise, and rest. Try to get the majority of your rest at night rather than by napping. Napping during the day may rob you of the deep, restful sleep needed at night for rejuvenating the body and mind. You need to take good care of yourself now more than ever.
Have Regular Medical Checkups
If you are taking medications, your care provider will likely want to follow you closely, especially at first, to see how your system is reacting to the medications. Keep your appointments! Have regular checkups and take your medications as prescribed. Do not stop taking your medications without medical advice! Even if you start to feel better, stay on the medications unless your care provider tells you otherwise. I cannot stress this enough. I know people who have stopped their medications when they began feeling well. They stopped because they believed that they were cured. The results have been near disastrous – suicide attempts, arrests, loss of jobs and fortunes, that sort of thing. Why? Because they failed to realize that they were still sick, that they were feeling well due in large part to the medications that they stopped using! When their sense of wellness subsided, they failed to recognize it in time and their situation would spiral out of control. Work together with your care provider to determine which medications work and at what levels, and take them as prescribed. Finding the right combination of medications can take time. Work with your prescriber and stick with it!
This is not to say that you should continue to take a medication that is either not working for you, or one that has unbearable negative side effects, but what I suggest that you do is keep a daily log of your feelings, side effects, mood, etc., as they relate to your medications. When you meet with your care provider, help him or her help you by discussing your log with them. Together decide if a change of medication is warranted. Don’t make the mistake of thinking the doctor can do it all. He or she needs your feedback to know how the prescribed course of treatment is working out. Remember, your care provider cannot help you without you pitching in to help yourself. It is part of the bargain.
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