Anxiety and a Rigid Life

I have a sincere question for you, and if you have anxiety issues, I suspect you know why I ask this.

One of the best ways I think I’ve ever summarized anxiety – at least the really bad, crippling kind – was by describing it as a box. You live inside the box. And slowly, as the anxiety ramps up, it gets worse, and the box starts to compress. Little by little, it squeezes you in, trapping you and stopping you from doing things you previously enjoyed. Going out late at night. Living with spontaneity. And then you just find your life stuck inside this box, regimented by routines and a fear of fear that you don’t fully understand but absolutely cannot conquer.

Here’s my question: Is this you? Because it does feel like me.

As I’ve discussed previously, generally speaking, I feel like I live a life in recovery. That’s a bit of a complicated statement because I unquestionably still suffer from a series of anxiety and depression related issues. But I say it because I feel like I can lead a good life and a relatively happy one.

But, there’s no question about it: I lead a life that has been limited by anxiety.

Examples? I can’t stand surprises. I have to know where I’m going and what I’m doing. Open social situations – parties, etc – can be intimidating. Weird thing for a politician to write out, right?

I crave routine. I like to be doing X at this time and doing Y at this time. I’m obsessed with my calendar and my to-do list because they keep me on schedule and knowing what I am doing, something I crave and need.

Do I think I’m living in a box still? No. I don’t. But I do think there are some ceilings in my life. Some things which are limited by my anxiety.

Huh. This has been instructive to write. Might be something I want to bring up in therapy later because it’s not something I want to live with. I’d love to live with a bit more flexibility and spontaneity. I’d love to be able to go out places without…fear.

It’s a defense mechanism for me. A coping skill, one developed by the unfortunate reward your body gives out for avoiding the anxiety caused by anxiety-inducing situations. Repeat this pattern enough times and you have agoraphobia. No, that certainly isn’t me, but it is something I always feel like I have to watch out for because I am a natural homebody. I think this is a big part of why.

All of that being said, if you know what I’m talking about, if this writing strikes a chord with you, please comment below and let me know what you think. Does this sound familiar? How do you deal?

 

Why Words Matter – Even If It’s Not You

 

As some of you may have seen in the news or on my Facebook page, we had quite the day this past Friday. Governor Wolf was in town, holding the first of what will be many mental health roundtables. He announced the kick-off of Reach Out PA: Your Mental Health Matters on Thursday. It’s an overall, comprehensive effort to reform and improve Pennsylvania’s mental health system. It’s fantastic and desperately needed.

At the Governor’s Press Conference on Thursday, the Governor said:

“For those struggling with their mental health, we have one message: your mental health matters and it’s okay to reach out for help. We are stepping up our efforts to ensure every Pennsylvanian can access mental health care and more agencies can respond to the challenges facing Pennsylvanians struggling with their mental health. The act of reaching out for help – or to help – can make a huge difference for someone struggling.”

I opened the roundtable with this:

Obviously, I’ve discussed my depression and anxiety before. I haven’t quite gotten that intimate with how close I came to a suicide attempt, so that was a bit new.

I actually wasn’t even planning on doing that until a few hours before the event, when it hit me: I was going back to the place where I had seriously considered ending my life, standing with the Governor, my Congresswoman, friends, colleagues, and advocates, with the goal of saving lives.

(Random side note: I actually tagged my ex-girlfriend on Facebook for saving my life. We’re certainly on good terms, but I can’t imagine how weird that must have been – she looks at her phone and goes, “Wait, who tagged me? Why did that happen?)

I have to say – on a personal level – how much it meant to share that story. At the table with me was the Governor, my Congresswoman (Susan Wild, who has become a dear, dear friend) and Dr. Rachel Levine (PA Secretary of Health). Dr. Levine is brilliant and one of my favorite cabinet members with the Governor. She’s also a pioneer, serving as one of the highest-ranking transgender government officials in the United States. I cannot imagine how many kids and adults look at her and draw hope from her success and competence.

Congresswoman Wild is an advocate for mental health in and of her own right after she lost her life partner, Kerry Acker, to suicide. And Tom Wolf is truly one of the most recent people I’ve ever met in this job.

To be able to share that story – with those fine people, and everyone else in the room – that was meaningful. It gave meaning to what I had endured.

So, away from myself now. What the Governor has said about mental health, what others in his cabinet have said…it matters deeply. It matters because the Governor is lending his personal credibility and institutional strength to a push for better mental health access.

Public policy, public statements, and stigma are all interwoven. By doing events like this, there are people out there who are recognizing what the Governor is doing. At least some people will be touched by his words, by all of our words. And hopefully, they will be more likely to get the help they need and deserve.

Look, this system needs investment. Massive investment. We need more workers, more funding and less stigma. That all ties together. I hope and pray this was the start of a more comprehensive effort.

But I know that hearing someone as important, well known and well-liked as the Governor say that it is okay to ask for help – that matters. And it should matter if you say it, too.

“People who conquered depression and/or anxiety, what’s the #1 factor that helps you?”

As some of my prior entries have indicated, I’m a big fan of Reddit. If you use it the right way it can be hilarious, inspirational and adorable.

One of the more popular subreddits – and certainly one of my favorites – is AskReddit. In AskReddit, users can post a question to the Reddit community. Some of the questions are serious: “Why can’t you sleep tonight?” Some are hilarious: “You’re being interrogated and so far you’ve held strong. What song do they play on repeat that breaks you?”

And then there’s moments like these:

This was truly interesting. The top responses are largely along the lines of answers you might expect: Sleeping well at night, keep busy, stay away from social media (irony, right?), stop overthinking, etc.

I answered this question (surprise!), but I took my answer in a different direction. Here’s what I said:

I’m gonna spin this one on its head a bit. I think it’s important to address this answer to those of us who haven’t conquered depression or anxiety, and who never will.

Depression for some is a temporary condition as a result of a variety of factors, including social or cultural experiences, genetics, your upbringing or traumatic events. For people like this, time, therapy and/or medication – as well as lifestyle changes – can result in permanently defeating depression, and never seeing it again.

For other individuals – and people like me – it’s a permanent, chronic condition. Personally, I’m lucky – my ups are relatively long and my downs are manageable. For now. But, for people who will never truly rid themselves of depression or anxiety – who will experience it all their lives – it’s important to realize that this may be your world. Some people are cursed with physical disabilities which dramatically alter their lives and the way they experience it. For others, like us, it’s a mental disability.

What’s the #1 factor that helped me? I honestly think that one of them is this knowledge. The idea that I will never, truly be rid of depression. Why has this helped? It takes the pressure off. It makes me realize that I can lead a good life, even if this is always who I’ll be. That the “black dog” – as Churchill called it – will be a constant companion and challenge.

Second: To an extent, I have power over it. No, I don’t think I’ll ever be rid of depression. I don’t think I’ll ever be rid of the sinking feeling in my chest, the tension at the base of my neck, the imposture syndrome, the constant fear of losing everything and everyone I love. But I do have control. If I seize it, there are things I can do. That means self-care – therapy, medication, writing, working out being a type-A personality, etc. I accept that it has ruined other parts of my life, but strove to make me better in a variety of others.

Third: Accepting the positives of depression. It has made me constantly force myself to do something to improve myself, my life or those around me. It has made me tougher. It has given me a perspective and sense of empathy which I could never have imagined. And it has dramatically and positively impacted my career (I’m a State Representative in Pennsylvania, where I work largely on mental health issues – I also write and blog on the topic).

Yeah, leave it to a politician to not answer the question and answer it at the same time………..

My answer was long enough and pretty self-explanatory, but it’s worth noting again: Some people don’t “conquer” depression. They just learn to live with it, how to manage its ups and downs. I think that’s me. Once I accepted that – once I stopped kicking myself for feeling the way I did – it let go a lot of stress.

That being said, I don’t want to make it seem like my answer to the question was somehow crapping on the other ones. Less time on the internet, sleeping right, etc. – those are REALLY GOOD WAYS of beating depression. I just think that, for some of us, the idea of “conquering” depression is a bridge too far, sadly.

But that doesn’t mean it gets to run our life!

 

It’s not your fault: The brain circuits behind rumination, depression & anxiety

A fascinating examination of the brains of people who suffer from anxiety and depression has revealed some really interesting insight about how your brain works, and why its so hard to stop thinking once you get in a negative state.

According to a report on the study from Forbes, an examination of 9,000 brain imaging scans has showed that people who suffer from depression or anxiety show low levels of activity in areas of the brain responsible for “cognitive control,” while showing increased activity the parts of the brain which “process emotional thoughts and feelings.”

In other words: People who suffer from depression/anxiety have a harder time controlling their thoughts and keeping their mind from running away from them.

I mean, realistically speaking, this should surprise absolutely no one. If you suffer from depression or anxiety, you know that it is nearly impossible to control your thoughts or your feelings. But, for those of us who suffer, I would hope you can take a degree of comfort in this study, as it physically explains why your brain simply will not shut off on days where you are in pain: It can’t.

It’s okay. It’s not your fault. It never was. But this is just so interesting to me because it shows the biological mechanisms behind depression and anxiety. And it unquestionably lends credence to the notion that we have to treat depression, anxiety and other mental illness as a physical disease, rather than some separate emotional one.

As I’ve written in the past, there is a strong connection between rumination, depression and anxiety, and this study may help explain why: They are all physically connected.

Of course, this begs the question: What can we do about it? When our brains get “locked in” to this state, how can we alter it?

I mean, there’s the usual stuff: Therapy, medication, meditation, exercise, etc. We know that this stuff works to an extent.

I’m not even sure where to go from here, but I do think this study is absolutely fascinating. It provides a biological explanation that we already knew was out there. It explains why its so hard to stop our brains. I am walking, talking rumination, and I would LOOOOOVE to see what my head looks like when I get into a funk.

Let me wrap this entry up by adding to what I said before. If anything, I would hope that this study provides some perspective and can help get rid of some of the guilt and self-loathing that you may experience when you get into a depressed state. Depression and anxiety are not your fault. They never are and they never will be. And this entry helps to prove it. Your brain is, quite literally, working against you and making it hard for you to break out.

Your weirdest anxiety

The Mighty ran this absolutely fascinating list of 27 of the “weirdest” anxiety triggers which impact members of their community. The list was intriguing, if only for the breadth of seemingly minor things which can negatively impact someone. Examples included:

  • Not knowing where a bathroom is
  • Car headlights
  • The Mailbox
  • Power Outlets

These are interesting. Some of these fears are more common, some less so, but they all seem “weird” enough to the owner that they were willing to share them with complete strangers on the internet.

I don’t know this for certain, but I’d be willing to bet that all of these fears are also a source of shame for the owner. Shame that they’d be embarrassed if anyone found out. That’s how I felt, certainly. For the longest time, I had a “weird” and unexplainable phobia about going on mass transportation – bus, plane, train, whatever. If I wasn’t in control of the vehicle, I was terrified, to the point of a full blown anxiety attack. It wasn’t a fear of death or crashing, I don’t think. I think it was a matter of not being in control of the vehicle, of being stuck somewhere with no way off.

I’m lucky and I was able to get this “weird” fear under control, and while new ones have popped up, this one was put to bed. It took a good chunk of work and therapy, but yeah, eventually I got there.

That being said, if you, dear reader, have some sort of anxiety issue, chances are good that you know exactly what I am discussing when I say that these fears are a periodic source of shame and self-loathing. You feel like such a damn idiot for having such a ridiculous fear of something which the vast majority of people can endure with absolutely zero problem. Why does this fear trigger you so?

What’s the answer? That one is above my paygrade. Some fears are minor things that you can handle, and sometimes they disappear on their own. Others are more serious, rehabilitating issues which require therapy in order to be able to lead a full and productive life.

I do know this one: Don’t beat yourself up over whatever your fear is. You didn’t ask for it, you don’t deserve it, and anxiety doesn’t make you any weaker. If you don’t hate yourself for your random depression or anxiety issues (and you shouldn’t), you don’t need to hate yourself for a phobia.

These “weird” anxieties can crop up for a variety of reasons, everything from negative experiences to trauma. That being said, you don’t have to hate yourself for them. Whatever you fear is, let it go. Self-hatred and anger only supercharges the problem by giving your fuel to burn on.

If you want to share your random anxiety, please leave it below. As always, we welcome your thoughts and opinions!

A More Preventative Mental Health Model

I caught this article in USA Today and it introduced a fascinating concept – one I hadn’t heard of.

Many of you are likely familiar with the National Suicide Prevention Hotline, which has been used to stave off countless crises and has likely saved thousands of lives. Of course, calling this number is what you do at your worst moment – when you are at the bottom of the barrel and feel as if you might hurt yourself because you have nowhere else to turn.

What if there was a way to reach a person before it hit that crisis point?

Introducing the “warm line” from the Mental Health Association of San Francisco. From the article:

Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis – and a more costly 911 call or ER visit. The lines are typically free, confidential peer-support services staffed by volunteers or paid employees who have experienced mental health conditions themselves.

In other words – someone can call, get support, talk to someone, and get access to more resources, thus potentially preventing a more expensive and serious crisis.

This is a great idea, and according to article, a wildly popular one. But, does it work? Will it cut down on arrests, suicides or other mental illnesses? According to one analysis, yes.

Here’s the real reason this appeals to me: It’s a paradigm shift. It’s so much more than just a band-aid or a cure for someone in a crisis. Don’t misunderstand – that’s incredibly helpful, and necessary. But what if we can stop someone from getting sick in the first place?

If you stop a physical illness before it gets infected, you save money, time, pain and lives. Hopefully, programs like this can help push in more into that sort of space when it comes to how we discuss, treat and cure mental illness. It’s why we should try to teach mental health in schools. It’s why physicians should conduct mental health screenings on routine exams. It’s why mental health first aid should be taught alongside physical health first aid.

We can stop these problems before they start.

Do you have a puppy folder?

I had a couple of rougher moments over the past weekend. No real reason, just work and stress – the standard stuff, really. I will admit that I was surprised by how intense it was, but these things happen.

Anyway, I was talking with my wife and trying to snap myself out of it, and with a laugh, I pulled up this video.

The background: I was speaking at an event announcing the moving of the Da Vinci Science Center into downtown Allentown (a big deal, locally!). I was surrounded by elected officials, major developers, local residents, the works. And the microphone just went, “Nahh, f&ck you, I ain’t working.” So we have massive feedback, followed by the microphone just straight up falling as I tried to speak. I know it sound stressful, but honestly, it was hilarious for me, and if you watched the clip, you can see I handled it just by laughing at myself. It wound up being really funny (side note: When faced with an embarrassing situation, just lean into it).

Anyway, whenever I watch this clip, I always get a chuckle. And that’s sort of the point of this entry.

On Monday, I spoke about the need to develop specific tactics which can help you fight back against your anxiety. Things that would temporarily distract you from where your head was swirling off to in order to break the cycle of anxiety and get you out of an attack.

This entry is more or less the companion entry for depression. My suggestion: Have a puppy folder. Have a folder (digital or physical) which you watch that features adorable videos which always cheer you up or make you laugh. It can be movie bloopers, cute pictures of puppies, whatever.

By the way, I do mean, literally, have an actual folder. As you probably know, when you go down the rabbit hole of depression, it can be extremely difficult to pull yourself back out, or to do anything which has even the slightest bit of self-care involved. That’s why I say you should have an actual folder, a one-stop shopping sort of place: When it comes to self-care in your darkest moments, you need to make it as easy as possible for yourself.

To be clear, this isn’t a long-term strategy. It’s a tactic, and there’s a difference. If you find yourself having these dark moments more frequently, if they turn to thoughts of self-harm, or if you start to lose productivity and the ability to function, you need to do more than just watch funny videos: You probably need to see a therapist.

That being said, everyone has down moments. The tactic of a puppy folder can help you break the cycle. It can feel good and give you a moment of joy, and that moment can turn into the foundation for getting yourself out of a rougher moment.

Any videos, pictures or websites which you use on a regular basis to get yourself out of that darkness? Let us know in the comments below!

 

4 Tactics to Stop A Panic Attack In Its Tracks

Ah, panic attacks.

Last week, I wrote about the difference between panic attacks and anxiety attacks. They are both nightmares, of course, but I’d argue that panic attacks are the more intense, nightmarish ones. I consider myself deeply lucky that I haven’t had either in years, but I still remember the pain: The feeling that my bowels were going to turn to liquid, the heart racing, the desperate desire to escape and sensation that you are going to crawl out of your own skin at any moment.

Defeating panic attacks takes quite a bit – often some combination of therapy, medication or tranquilizers. It takes planning, effort, and strategy. However, there are also tactics which I think you can use in order to defeat or slow a panic attack. Yes, I mean tactics: Specific things which you can do in order to feel more powerful and regain control over your own body and mind.

Here are 4 of them:

Pick a Number. Add By 7. Repeat.

My anxiety was out of control in college, particularly senior year. That time period ultimately resulted in a medication adjustment, increased therapy and the development of a series of tactics with my therapist to stop an panic attack. And this one worked, a lot.

When you have a panic attack, your mind just whirls out of control. The key – as exemplified by this effort and others – is to stop it from doing so. To that end, you have to distract yourself.

So, ask yourself? What’s 1,054 + 7? And then another 7? And then another? Get bored? Subtract by 8 now. Just keep going. Take all of that mental energy you are feeling and put it elsewhere. Do whatever you can to break the chain of anxiety which has wrapped its way around your neck.

Notice Stuff

I actually got this one from a LifeHacker article, and it apparently came from BoJack Horesman. Specifically, two characters are talking, and one starts having a panic attack. The other asks him to notice the things which are giving her anxiety, and then start noticing and describing the more mundane things. Chairs. Tables. Lamps.

I think this one works similar to my example above, but with a different basic idea: You try to distract yourself by immersing yourself in another activity. This, of course, can be impossible to do when your mind feels broken, but it is absolutely worth the effort. With this tactic, you try to lose yourself in something else. You find a detailed object and go DEEP. What color is it? What do you think it feels like? When was it made and who do you think made it?

Allow your mind to run away from itself.

Guided Visualization

Guided Visualization is just what it sounds like – you use it to escape your own mind. Either through an audio or visual file, you follow the narrator on a journey. It often involves breathing deeply and relaxing.

Thanks to YouTube, there are no shortage of examples. Even better is that many of them are highly specific to panic attacks.

I’ll say this: These were hard for me when I had bad ones. When they were on their way out or just starting, my wife could often give me a visualization scenario that worked, but as the panic heated up, it became even harder to focus on visualization. Everyone is different, of course, and I hope this works better for you than it did for me.

Understand What’s Happening

Yes, I understand that this one sounds utterly ridiculous, but if you are capable of thinking logically (big if – big big if), this may be helpful. On a biological level, a panic attack is a misfiring of your body’s flight or fight response. Your brain perceives a threat when none exists. As such, you have to try to trick your brain into coming back to reality.

Difficult as it can be, try to take a step back, something akin to mindfulness. Say to yourself: “This is just a misfiring of the neurons of my brain. Nothing is wrong. There is no threat. I am safe.”

If you can understand what is going on – that there is no threat – you may be able to get yourself out of the attack.

As always, I welcome your advise. And also, please understand, much of what I wrote will not work for everyone. Or maybe anyone, I don’t know. But these things did help me – and I hope they can help you, you too.

 

What is the difference between an anxiety attack and a panic attack?

Having had both, I feel like I’m overqualified to write this article, but as I was discussing this issue with someone the other day, I realized something: As careful as I like to be in my language – particularly when discussing mental health and mental illness – I had goofed. There is a difference between the two, and an important one at that.

What is it? From what I can tell and what I’ve researched, it seems to me that panic attacks are the dramatically more painful experiences, the ones which make it feel like your chest is going to explode out of your body.

There are a ton of similarities, of course. Both come with painful physical symptoms, including chest pain, difficulty breathing, dizziness, upset stomach and other fun things. Both come with an overwhelming sense of fear.

However, anxiety attacks are more characterized by worry and distress. Panic attacks are the ones where you feel as if you have to escape from wherever you are, right now. They often come out of nowhere, whereas anxiety attacks are usually caused by some stress or worry.

It this a distinction without a difference? I’d say no. Panic attacks – if experienced repeatedly – can be beyond debilitating. They can safely be described as “intense and disruptive.” Anxiety attacks can as well, but I’d argue that they are less frightening, and perhaps less painful.

Why does this matter? Because words matter. There’s a reason that there have been so many efforts to watch how we discuss suicide. Phrasing things one way or the other can have implications. It can also affect treatment – anxiety and panic are two different things. Indeed, the notion of an anxiety attack isn’t even a diagnosable illness, but a panic disorder absolutely is.

I’d also add that we need to make sure we don’t confuse these two things because how we discuss them can alter how others respond to them. Panic implies immediate danger and something to be deeply worried about right now. Anxiety, at least to me, implies an ongoing and persistent fear and worry.

Does this make sense to you? Please let me know your thoughts, and if you think this is the right idea or not.

Why We Need More Articles That Get Specific to YOU on Mental Illness

I’ve been relieved to see that more and more people are discussing mental illness lately. When done right, this is a good thing – people become more aware of the breadth and depth of the mental health crisis we have, and hopefully more likely to seek help themselves or encourage their loved ones to do the same.

As long as the topic is approached with sensitivity and empathy, there is no such thing as a “bad” mental health article. Some articles, however, can have more of an impact than others.

Which ones are those? The ones which focus on you or your loved ones.

Consider, for a moment, these articles which focus on specific professionals:

Or these articles, which concentrate on age groups:

Or these racially or location-focused articles:

If you reviewed all of these headlines and identified with any of them, you felt a moment of empathy. You probably felt a touch of happiness at being mentioned in a story like this. If you fell into any of the groups noted above, I bet you were a little more likely to click on the article and read more, and from there, maybe you found a useful piece of information. Maybe you found something that made you think of someone you loved. Maybe you filed a scrap of information away for later.

Either way, stigma and mental health campaigns work best when they are targeted at the person with someone that they recognize. Often times, in the work of mental health planning, you will hear conversations about the need for culturally competent campaigns – meaning campaigns where it’s people of varying ethnic and racial backgrounds.

I’ll take that one step further by point to the above. There’s no question that cultural competence in every area – including mental health conversations – is very important. However, it’s not the only one. We also need to have these conversations where the reader can look at someone and recognize them because of their job, their age group, their location, and that’s why these stories are so important.

Generalities aren’t enough. The more specific we can get – the more targeted we can be in our efforts to discus mental illness and stigma and suicide – the better our campaigns can be.