Anxiety, CBT & the quest for "normality"

So following on from my last non-wool related blog post, I finally went to my doctors and decided to ask about talking therapies on option.

It seems I definitely do have social anxiety. A catch-22 if you like, as the main issue I have is worrying about what other people think of me, and making a fool of myself. Therefore when I tried to seek help about my anxiety in the first place I downplayed it (worried my doctor would think I was silly) and made it seem like it wasn't an evil parasitic twin following me around and endlessly ruining my fun and happiness. 

I was put on anti-depressants to deal with my anxiety, and I can't really fault them. I needed a quick fix because at the time I finally sought help about my anxiety and went to my GP I felt like a ticking bomb that could blow at any moment. I was permanently anxious and the tiniest thing could tip me over the edge and render me useless for the next day or two. Obviously I didn't expect to be wrapped up in a blanket by my GP and for him to flip head over heels to make me feel less like I was going to blow up every time I encountered a troublesome situation, but the whole "here have these tablets they will make you feel better, now off you go" thing meant that I hadn't really addressed my problems at all, and simply had a quick fix for something that had been bothering me for most of my life, and would continue to so if I didn't do something.

While I feel that being put on tablets helped me out massively, it also drew me into a false sense of security. Anxiety is multi-layered and revolves around physical symptoms (breathlessness, cold sweats, feeling clammy, lightheadedness, butterflies...), thoughts and behaviours. The tablets pretty much eliminated the physical symptoms which made me think that I was miraculously cured of anxiety. Not having the physical symptoms was great, and allowed me to function somewhat normally in situations where I would normally turn into a quivering sweaty mess and want to adopt the fetal position in situations where it would  have been a bit inappropriate (buses, lectures, cinemas). However because I hadn't dealt with why I was actually anxious in the first place, the thoughts and behaviours were still there.

For example, things I have problems with: 

phone calls; being in quiet spaces; being in places where it's hard to leave without being noticed; getting off buses; having people in the house I don't know; going to new places, doing things on my own; being at the till in shops...

 While I would be able to manage most of these things now I'm on the tablets and am a lot calmer and don't physically feel like I'm going to invert with panic, there is still a mental block - the anxious thoughts are still there, which leads to anxious behaviours. In my case this involves avoiding a lot of situations, then getting really frustrated at myself, and then crying into a pillow once a month thinking the world is going to end.

So, I went to the doctor and expressed that while the tablets are great and please can I have some more, I also really want to come off them. Being on tablets doesn't really bother me because simply what I was experiencing before the tablets was hell on earth, but they have made certain parts of my genitals as responsive as a dead fox and also make me fall asleep after one pint. Not ideal. So I decided that I would try out CBT to try and combat the way I think and react to my anxiety, and then attempt to come off the tablets. In my head it doesn't make sense to come off the tablets without dealing with the mental aspect of my anxiety, as coming off tablets to me suggests some kind of end process and considering I panic and hide under my duvet whenever the phone rings, I don't think I'm quite ready yet...

The CBT!

I was referred to Self Help Services  (not sure if this is exclusive to Manchester or a national thing) and just had to confirm whether I wanted an appointment and which type of treatment I wanted (online, one-on-one sessions, or group sessions). I was given a practitioner and initially had an hour in which I was able to talk about everything I was bothered about. I was surprised at how easy it was, as I guess the woman was used to irrational anxieties and phobias, so hearing about my thought processes and the things I fear the most seemed pretty normal to her, even if they seem a bit odd to me and other people I've spoken to!

Then over the following weeks (going up to last week) we looked at what goals I hope to achieve, and how I'm going to achieve them. She sent me away with loads of things to read to better understand anxiety and also some information on muscle relaxation and breathing exercises - which I had always been too lazy to do but now I've tried them they actually have worked. Hooray! 

I then was told to keep a thought diary, which involves thinking fully about each situation that causes me anxiety, and to identify the thoughts and feelings I have at that moment and to give them a % rating of how anxious I felt (0 being the least and 100 being the highest). I then had to distance myself from the situation, and try and give evidence for and against what I was thinking, which was useful as it taught me to think rationally about a situation instead of in my panicky mindset which is usually along the lines of "AHHHHHHHHHHHHHHHHH!"

An example:

(I hope this is actually readable...) 

Now I've started doing this for various situations, I've started to note a difference in how I approach certain situations as I become more aware of what I'm doing and can maintain a clearer head if I do start to panic. I'm really happy with how the CBT is going and finally feel like I'm actually making progress in getting the confidence to confront the situations I have always avoided. Before I started CBT, the only time I really got to speak about my anxiety was to friends or really briefly to my doctor in order to prove myself unstable enough to get more medication (fun fun). Talking is good and all, but actually doing these exercises to combat the way I think about things, and in turn how I react to them seems to be the key to finally sorting myself out.

 Next step is to actually implement this into gradually exposing myself to the situations I fear, taking little steps from the smallest worries to the biggest. Eek!

My anxiety in a (slightly-big) nutshell

So tomorrow morning I have booked a doctors appointment in which I intend to confront my social anxiety once and for all, and hit my anxiety on the head instead of tip-toeing around it like I always do.

For as long as I can remember I've always felt very uncomfortable and awkward in certain social situations. Not as in shyness, but as in having a sense of dread so large that I felt like I could throw up at any moment, and not about situations which warrant such a reaction. I'd have these reactions to the thought of having people I didn't know in my house, going for meals with family friends I barely knew, answering the phone, answering the door to pick up a takeaway...the list goes on. In my second year of college I developed IBS, partly due to a lactose intolerance that no one suggested might be the most obvious cause of me being ill every day for two years, and with that sprang extreme anxiety and depression. As a result I would have numerous days off college, a lot of which were because I was too emotionally tired to deal with the emotional effort of having to cope with both the pain and the anxiety that I knew would flare up during the college day. I was constantly having to leave the classroom to go to the toilet, I would have almost permanent crippling stomach cramps and my stomach would always make weird noises in class. I was so embarrassed about my IBS that I didn't tell any of my teachers which made the whole thing worse, because along with constantly having to leave the room, the embarrassment of actually leaving the room multiple times every lesson and knowing that I was drawing unwanted attention to myself devastated me. I thought that everyone would think I was weird or would question my behaviour. The embarrassment manifested itself into very extreme anxiety, to the point where I not only avoided college but also social situations, as even the thought of my close friends knowing I had IBS filled me with shame. I got even more despondent about the situation because I would miss college and get moaned at by my teachers, all the while having no control over my body physically, or the way I mentally reacted to it. I loathed myself and my body for removing me of my freedom. I ended up having a massive panic attack in an A level exam because my IBS was acting up and I was told I couldn't leave the exam room, and as a result I now can't sit my exams in exam halls, or even be in quiet, busy spaces unless I know I can leave easily and discretely at any time.

So, that was college. I then moved to Manchester to start university and the combined stress of moving, not getting on with my flatmates at all and having a bad diet full of dairy (still not knowing I was lactose intolerant) made my IBS incredibly bad. I started missing lectures, being constantly anxious and getting worked up about everything. There were a few times when I couldn't even bring myself to leave my room because I felt so anxious about what could happen if I was ill - which there was a high chance of happening - and have to deal with the anxiety that came with it. I ended up avoiding everything. So, I thought. Enough is enough. I dragged myself to the university doctor - I should say at this point that I didn't even realise my anxiety was anxiety, and attributed to just being IBS - and said something along the lines of "I have IBS...it's making me panic a lot...I can't cope with exams etc..." At this point I hadn't mentioned my IBS or the anxiety to a single person, and so I felt like I confessing a huge secret (and source of crippling embarrassment) and I expected to be reassured that it was okay, that I was normal and for my doctor to give me options to deal with it. The whole affair took an incredible amount of effort on my part. It turns out that I had booked an appointment with the grumpiest, rudest doctor I've ever encountered, who didn't even look at me once throughout the whole appointment, and simply repeated to me what I had said, asked if I had any questions and then ended the appointment. Nothing at all happened, and I was absolutely devastated. I felt like an idiot, I felt like I was making up everything I felt, I felt completely alone and I ran home (bursting into tears before I even reached my halls to further increase my embarrassment) and cried for the rest of the day. After that I felt ashamed of my anxiety and gradually felt even more hopeless and more anxious, partly because I didn't have a clue what was happening to me.

Attempt #2 to get help came shortly after with a doctor I had at home. This was slightly more successful, however I mentioned that I thought I had social anxiety (I've had issues long before the IBS developed, but I think the IBS was a trigger for the extreme frequent anxiety I felt) and my doctor offered to put me on anti-depressants. Great, I thought. And I must say, they were absolutely amazing. They made me feel free of panic and I could finally do things I wanted to without panicking and wanting to run away from wherever I was and curl up into a ball before it felt like the universe was going to implode on me. 

And here we are now. A year after starting on Citalopram, the symptoms of my general anxiety are pretty much gone. I have wobbles now and again - everyone does - but generally I feel pretty good. However I can't help but feel that while they've helped me massively, the tablets have only masked the problems. You see, I might feel okay most of the time, but there are still situations which terrify me to the core and which I still completely avoid, and it's getting in the way of my life. Phone calls are one of my worst phobias, as I can't answer the phone except on very rare occasions, and I can only make calls when I know the call is structured and there is little room for the conversation to wander and for me to make a fool of myself, i.e. making a doctors appointment. In my head I know that I won't embarrass myself, but by habit I react to the phone ringing with panic, and it seems like it'll take a fair bit to sort it out.

I want to get a job, and yet I can't answer the phone to a) inquire about jobs, b) answer the phone once I've submitted an application and they ring me back and c) the sheer thought of having to answer the phone at work terrifies me so much that I have avoided even applying. The other week I was feeling particularly anxious, went into Manchester city centre, and then had to get the bus straight out again because the thought of the two minutes of standing at a till opposite another human being nearly gave me a panic attack. Hilariously tragic.

So, I can only really hope that tomorrows doctors appointment allows for some progress at least. I'm a bit less bothered about talking about my anxiety because I've realised now that it's not a fault with me personally, it's a fault with my somewhat dysfunctional headspace. I basically need to explain that although anti-depressants have helped the symptoms, they haven't dealt with the root cause of the problem. I need to ask if they could possibly refer me to some sort of talking therapy to actually allow me to try and combat the cause of the anxiety, not just the symptoms of anxiety.

Ah well. Wish me luck.

Hung up - Phone Phobia

(Photo by dissent_is_cool)

I'm trying to blog about my mental health a bit more, as despite knowing how common some mental health issues are, I still cringe talking about my own issues. I suffer quite badly from anxiety (not so much anymore from the physical feeling of anxiety thanks to tablets, but the thoughts are still very much there) and I am aware that some of the things I have anxieties about are absolutely ridiculous. I could even laugh at them if they weren't so crippling.


One of the many things I hate: phone calls. I hate phone calls a ridiculous amount. I hate answering calls, I absolutely despise ringing people. The only person I can ring without panicking is my mum. It makes me feel pathetic. Scared of phone calls? How ridiculous.


My landlord frequently rings and I ignore it. I just tried to apply for a volunteering placement, but then I panicked and realised they had my number and would probably ring me to talk about my enquiry for the position, so I didn't apply. When I say I hate phone calls, it's because every time my phone rings I get a sinking feeling in my stomach, I feel like I'm going to throw up and sometimes I even get dizzy because I get anxious so suddenly. It's completely ridiculous and yet I feel completely out of control of it. In the past my mum has tried to force me to make phone calls because she sees it as me just being awkward, when in reality I honestly feel like I'd sometimes rather chop off my own leg than call someone.


I get pissed off with myself all the time because of it. There are certain situations which I associate with extreme anxiety, and they remind me that despite generally feeling free from anxiety since I started on anti-depressants, deep down I'm still very much a puppet to my anxiety. The hardest thing for me is the anxiety being internal - it's not something external that I can eventually work my way up to battling...it's basically me working myself up to confronting myself, and my anxiety itself has a habit of making me try to forget about things bothering me. So I get confronted with the fear, try my best to forget about it, and push it to the back of my mind. Then each time the anxiety gets brought up again it gets more severe and makes me feel even worse about myself.


So ultimately, at the age of 20, I still avoid phone calls as much as possible, which is really beginning to interfere with things. I struggle to ring my friends so I find it hard to stay in touch unless I see people face-to-face or contact them over Facebook or by text. I struggle to make doctors appointments and I just went a week without anti-depressants because I had run out and was so nervous about ringing up my doctor and changing my appointment to an emergency appointment that I simply didn't do it, and instead made myself ill for a week.


On the rare occasions when I absolutely have to make a phone call it'll probably take me about half an hour to prepare myself before I can even pick up the phone. I'll have to have the things I want to say written out word for word and I'll probably have to say the words over and over again until I'm absolutely positive of what I'm going to say. Sometimes I read over the words so many times that they lose their meaning and I end up mincing my words anyway. However obviously phone calls are not scripted, and so the more off track a phone call goes, the less prepared I am, and the more uneasy I start to feel. Without exaggeration, when I'm on the phone to someone I feel about as tense as if I was stood on the edge of a 50 foot building and could fall off any minute. It's an absolutely horrible feeling, and made even worse by the fact that I know it's completely irrational and ridiculous, and that because of this I'm constantly told to stop being lazy and just make the call. No one really understands that when I say I'm scared of phone calls, I mean I am actually terrified of them, and at the moment, as has been the case for many years, I feel completely unable to do anything about it.


When it comes down to it, I think the thing that frightens me the most about phone calls is an immediate worry about sounding weird/coming across rude or awkward/mincing my words.  I've always been ridiculously shy, self-critical and very conscious of what other people think of me and I think that plays a huge part in it. Despite overcoming my shyness considerably in other situations, the fear of phone calls has always remained. The thought of coming across as rude whenever I'm anxious makes me worry, as I would end up feeling disproportionately guilty and due to anxiety, would think about it over and over again and end up feeling more and more guilty. The fact that I have nothing other than the sound of my voice to communicate panics me, as I can't use my body language or smile to communicate, and thus I feel like anything I say could be misinterpreted and reflect badly on me, or even offend whoever I'm on the phone with. It frustrates me that it bothers me so much, but I find it impossible to not worry.


The point is that when I'm anxious I feel vulnerable, and despite being 20 and supposedly independent, trying to overcome this has seemed like such a massive task to do on my own that I've simply avoided doing it at all costs. I feel like I would need someone to hold my hand the whole way, and yet to me it seems like such a ridiculous thing to be scared of that simply asking someone to help me to get through it would seem unnecessary. I think ultimately I won't try and confront this ridiculous fear until someone forces me too, or at least checks up on me and makes sure I'm actually doing it. I suppose I could start by ringing up friends and family and then work my way up to people I don't know, but the thought worries me so much that instead of wanting to face up to it, I just end up cowering away each time.


As for now, I'm stuck. At the moment I want to volunteer and yet the prospect of one phone call scares me so much that it's putting me off. It frustrates me to high heaven so I can only hope to somehow get over this damn thing. Until then I'm going to sit here on my arse and regret not doing anything about it. Hmph.

Eye of a Tornado

There are some days where being awake hurts. The sheer thought of existence causes you so much distress that you wish to sleep more than anything in the world, because sleep is the closest you can get to not existing. The closest to escaping from having to be, to think, to act, to eat, drink…go out. To go to university, to get dressed. To move. The banality of existence is so plain to you that you wish to take no part in it. Communicating with yourself is too much, let alone with others.

Emotions run away from you, your brain substitutes. This is what makes people happy, your brain tells you. This is funny, now you need to laugh. Did you laugh? You weren’t paying attention. The whole thing is just a personal struggle of will, to function. A greyish drone shrouds your thoughts, someone holds your head under water. You don’t struggle.

You could be halfway through making your breakfast and you stop – your batteries have expired. They don’t properly recharge like everyone else’s. You never quite recharge. You wake up and repeat the cycle of telling yourself how to exist. Must walk upstairs, must open shower door, must wash hair, must get out, must dry hair. If you stop for a moment you resign to emptiness, staring blankly at the wall.

You are living in your own head apart from it’s not really you – you is buried somewhere deep inside, locked in a vault miles away from the part of your mind that deals with the practicalities. Eat. Piss. Shower. Sleep. No emotions, the only way of expression a sigh or the odd utterance. The couch becomes host for the shell of your half-dead body as it surrenders to its half-dead existence. Head is silent yet whirring. You drag yourself to bed in the hope that you’ll manage to fall asleep and not exist for a few more hours.

I feel depressed occasionally, but today I woke up and felt the most depressed I’ve felt in two years. The last time I felt like this is somewhat un-documented; I lost months. I can’t remember anything for what I did from November-March, can’t remember if I did anything, said anything. Can’t remember the places I went to, the only thing I remember is the stomach churning feeling I felt one morning as I woke up and had to continue living. In a dream you go into autopilot and float. And here I was, having to live again. The only thing dragging me through the day was the countdown until when it would be time to go to bed and not exist for a bit longer. Being asleep was the only time I didn’t fucking ache.

Existence dominated by lack of existence. It comes and goes. I’ll probably be okay in a couple of days. I need a cuddle.

World Mental Health Day 2011

Illustration by Claire Pitt

So today is World Mental Health Day! Why is this important?

As many as one in four people will suffer from some kind of mental health issue at some point in their lives, yet it’s still an issue that is presented as a taboo and swept under the carpet.

We are quick to judge people who aren’t “normal” by society’s standards, and can be just as quick to disassociate ourselves with those who have mental health issues by calling them “weird” and “crazy”. But at the end of the day, we’re all people. If someone fell over in the street, you’d probably (if you were nice) help them up, yet mental health is an issue that many run away from. It can truly happen to any of us, and it does. Instead of running away from it we need to start talking about it. Granted, you probably aren’t going to discuss suicide over a cup of tea, but then again, why shouldn’t you? Getting things out in the open is one of the biggest things that’s helped me, purely because it’s helped to drain the negative thoughts out of my head, which used to orbit and eventually become obsessive that they blocked all other thoughts out. It’s also helped me to realise that there are lot of people in a similar situation to me, especially people I already know. It’s an issue very close to home and a lot of people, like me, are almost too good at keeping things quiet. But there’s really no need to.

I reckon I’ve always suffered from slight anxiety but when I started university, the stress of moving away from home and living with people I had absolutely nothing in common with and didn’t like made me feel completely alienated, and gradually the pressure from work amplified it. I had another health problem which I constantly worried about, gradually to the point where I felt permanently anxious and had to spend hours getting ready just to pep myself up to leave my flat; often I’d been running through all the bad situations that could possibly happen so obsessively that I wouldn’t even be able to leave for panicking. Out of all the things I’ve experienced, anxiety is on another scale. The word “anxiety” doesn’t sound too bad in itself, it sounds insignificant, just a bit of worrying: one might worry about trivial matters that hold no real significance, but anxiety is more than that. It comes with the obvious; anxiety attacks which I’ve had my fair share of, which gradually manifest into a fear of fear itself which is possibly the most fatal vicious cycle as it means a fear of well…everything…but also there’s an inability to see past the present moment, and the worst, the “fear of impending doom”. Then there’s the general feeling that you’re never going to feel any different and will have to constantly spend your life making-do rather than actually living, which ultimately led me into dark periods of depression.

So long story short, eventually the anxiety got so bad that it overrode everything and I felt like I couldn’t cope anymore. I somehow got talking to someone on Twitter who eventually told me to go to a doctor, but actually checked up and invested some time into making sure that I did, and asked me how it went (you know who you are, and I can’t thank you enough). Going to see my GP was something I wanted to do for so long, but I was too ashamed and embarrassed about how I would address the issue, and thought they might just think I was stupid or I didn’t have a “real” problem. If I hadn’t have been actively encouraged to go I can’t even imagine how much of an anxious wreck I’d be now, and if you honestly have anything that’s getting you down then go and see a doctor too. I can’t endorse it enough. Get a friend to go with you, or even like I did just get someone – anyone – to check up on you once in a while. It’s a scary process to go through alone but once you get past that initial hurdle you will notice a massive difference. I eventually got prescribed anti-depressants to help with the panic attacks – being me I was completely sceptical, didn’t think they’d do much – but within a few weeks and after a couple of initial side-effects, I was as right as rain. Despite a few wobbles now and again, the panic has completely gone. I'm actually amazed at how easy it was, considering the level of anxiety I was experiencing before. I thought I’d never be rid of it, and so to suddenly feel completely “normal” and without panic was amazing. No weird feeling in my chest, no claustrophobic feeling like I needed to get out of certain situations and as a result, no worrying. Or, if I did worry about panicking, it never culminated in actual anxiety. I no longer avoid or panic about certain situations and can actually do things I want to do, not just the things my head will allow me to do. I can go to places, and feel calm, and enjoy myself because my head isn’t preoccupied with anxiety.

Mental health isn’t a smooth ride and there’s always things in life that will resurface and bite you on the arse from time to time, but I can’t imagine how I coped the way I did, and I honestly feel so much better at the moment. I can go to my lectures and not feel like I’m going to run out midway through because of an anxiety attack. I can go to social events and actually have fun. It’s amazing the things you’ll put up with when there’s no visible alternative, and there’s absolutely no need to, but I think the main problem is 1. an embarrassment of confessing to have such a “taboo” problem and 2. people simply not knowing what’s on offer to them, and how it can actually make a massive impact.

Personally, I think one of the biggest issues with mental health is that ultimately, it is all in your head, so it’s really easy to feel alienated and alone when you’re going through a rough patch. But if you go through the process with someone else then it makes it so much easier. If you know someone with a mental health problem, or even if you see someone who might be a bit down, just ask them how they are. Seriously, talk to them. Make them feel appreciated, and let them know that someone cares about them. You don’t have to be a qualified counsellor, and you don’t have to be an expert in mental health. All you need is patience, a little understanding, and less prejudice. Stop labelling people as “crazy” and stop mocking people who have mental health problems, because it could happen to any one of us. It makes the world of good, and I imagine it doesn’t require a massive amount of effort on your part, but can be life-changing to someone else. Everyone deserves to be happy.

So go on, give each other a big hug, have a cup of tea, and let's talk about our problems.

How are you today?