Archives for Cognitive Behavioral Therapy
"Just...just do it," she said, looking me straight in the eye. She wasn't a Nike spokesperson: She was my therapist, circa 2004, warning me against the dangers of agoraphobia. "Even if you feel panicky," she said, "Just go. Go out with that friend or this one. Go to the store. No matter how your body feels, just keep going. Don't cancel plans. It'll get worse in the long run if you do." Wise words. Did I always heed them? No.
Have you ever noticed your respiration rate increase during periods of heightened anxiety? It's okay if you have -- it's completely normal and part of the body's fight-or-flight reaction. But what if you're anxious about something that you can't fight or flee from? Then, your quicker-than-usual rate of breathing becomes an annoyance at the least -- and a panic trigger at worst. Perhaps you've read about abdominal breathing in Edmund J. Bourne's classic text, The Anxiety and Phobia Workbook. Breathing retraining can help with panic and anxiety symptoms, he notes -- and I agree. It can. But perhaps, like me, you absolutely hated his 5/5/5 "Calming Breath Exercise" because, let's face it, fellow panickers: holding your breath for 5 seconds between inhale & exhale is...uncomfortable, to say the least. Right? My body hates it! For me, it raises my heart rate, and I still can't quite understand why it's so often recommended. So, what else can we do?
There's a lot of guilt involved in having an anxiety disorder. (If you, reader, have an anxiety disorder, you know exactly what I mean, right?) For the rest of you, I'll spell it out clearly: we feel guilty for not being able to keep up with household chores, everyday errands, or taking care of the kids. We feel guilty for giving our spouses or significant others more "blah" time than happy fun time. More shaking, less adventure. More nausea, fewer vacations. More fear, less novelty. And that guilt? It sucks. We feel guilty for so many things: for not being able to grab a couple things at the big bright grocery store. For not being able to work a "normal" job with a "normal" schedule. For RSVPing for a friend's wedding and then chickening out at the last minute because it's a 3 hour drive and you feel too lightheaded to even drive down the street (and I'm still sorry about that, Melissa). We feel guilty for not being able to do all the things we believe we "should" be able to do.
We live our lives through metaphor after metaphor. Now, don't let the word "metaphor" scare you. It might sound familiar -- perhaps from your high school English class -- or maybe you've never heard it at all. I like the definition from Englishforums.com: A metaphor is a situation (generally a literary situation) in which the unfamiliar is expressed in terms of the familiar. A situation in which the unfamiliar is expressed in terms of the familiar -- say, a foggy brain or a heart of gold. Fog and gold are simple and familiar concepts. They're easy to picture. And so, we use them to describe slightly more unfamiliar concepts -- in these examples, the unclear thinking that might come after a hard day's work (brain fog), or a person who is incredibly good-natured and giving (heart of gold). Metaphors can also be expressed (and defined) more simply. They're a comparison without the word "like" or "as". Here are a few examples off the top of my head: War is hell. Banana cream pie is orgasmic. Love is a garden. His brain is a machine. Time is money. We know love isn't really a garden -- it's an abstract concept. But, in order to make it more concrete, we compare it to something that's easily to understand. You can plant the seeds of love. If you water your garden (nurture your love), it will grow. ANXIETY AS A METAPHOR But I'm not here to drone on and on about metaphor. (Hmm -- was there a metaphor in that sentence? Did I just make a metametaphor?) I'm here, as usual, to talk about anxiety. Let's see what kind of metaphor you use to describe anxiety. Fill in the blank: anxiety is ______________.
Think back to first grade, if you can. Alphabet posters on the wall, Dr. Seuss books, and simple math. You were probably pretty comfortable with counting to ten, twenty, thirty, and beyond. In first grade, you probably began doing some easy addition and subtraction problems, too. Maybe you used flashcards. Maybe you remember your teacher using beans or pasta or coins to illustrate the concept of adding something more or taking something away. And then, you feel like a genius when you master 7 + 2. And then, you move right into long division. Right? No. Come on. Of course not. You can't jump right to long division right after learning how to add. It just doesn't make sense. ONE STEP AT A TIME And likewise, it doesn't make sense to dive right into treating your worst fears when you've got some minor and mid-level fears that you need to work on first.
We have this drum kit in the basement now, and just for fun, I sat down. And I tried to play. And I became woefully frustrated -- no surprise there, if you read yesterday's post about my coordination-related woes when it comes to drumming. But this time, I kept playing around. I yelled at my right hand for moving when I wanted my left hand to move instead. Slowly, it began to comply. That was two weeks ago. And now, today, I can keep a beat -- a very simple beat, yes, but this is a notable change for me. With concentration and practice, my brain adapted to the idea of my right foot on a kick drum and my left hand tapping a snare. No longer does the kick drum kick when I want to tap the snare; no longer does the snare make that, uh, "snare" sound when I want to kick the kick drum. My limbs, it seems, have resolved their life-long impasse with my brain. UM, HELLO? THIS BLOG IS ABOUT ANXIETY, RIGHT? I know, I know. I'm getting there -- promise! So, why do these drumming revelations matter to me? Well, for starters, I think it's pretty damn fun to now say that I can keep a simple beat on a basic drum kit. I can drag my laptop down to the basement, play any of my favorite songs, and pass the time by drumming along in a really rudimentary-yet-satisfying way. And, of course, I'm pretty pleased with myself for trying something new and sticking with it for long enough to get past the "I HATE THIS!" hump. But most importantly, this reminds me of something very important: the brain's capability to learn and change.
In kindergarten, I played the woodblock. Yeah, the woodblock. And I was such a badass about it, too. By the end of the year, I was ready for some stage time. (The other kids at our kindergarten graduation got kazoos or something. Lousy, whining kazoos.) But I got a motherloving woodblock, people! And I was proud. A small wooden mallet in my right hand and a -- well, a hollow block of wood -- in my left, and there I stood wearing my construction-paper graduation cap, ready to keep time to songs like "Fifty Nifty United States". And kept time I did with my toothy grin and crimped hair. BOOM BOOM BOOM I grew up rather fond of tapping out beats on tabletops with pens, but that's about where my percussion experience ended. Yeah, I took piano lessons here and there, spent a year with a clarinet and a horribly cranky band instructor in 5th grade, and I sang in choir from middle school up through the end of college -- but that's it. Nothing with drums. Drums have always fascinated me. Well, let me reword that -- drum beats have always fascinated me. No, no wait -- that's not it either. Drummers. No. A drummer's ability to drum. Yeah, that's it.
Once, when I was in elementary school, I got a 97% on a test. Pretty good, right? I took it home to show my mom. This was fridge material. "Wow," she said, "not bad..." Pause. "...but you probably could've gotten 100%." Ugh. As an adult, now, looking back, I know she was kidding. She had to be kidding. Right? I wish I could go back in time and watch this interaction with adult eyes, detecting the subtle nuances in her brow movement, to prove to myself that it was a harmless joke from a mother who knew her kiddo was on the straight and narrow. But that pint-sized brain of mine, tucked inside my skinny little body that wore a hefty neon pink and yellow backpack, heard only one thing: you could have done better.
Recently on my blog, a commenter named Ted posed the following question in the comments to this piece about how I'm preparing to withdraw from Celexa: You’ve left one relatively major part of your Celexa experience off your blog… was it an effective treatment for you? Did it reduce your anxiety and panic attacks? I think ignoring, or at least not writing about, whatever positive effects the therapy had for you for the past year does nothing to help those of us who read your blog. Focusing only on the negative/potentially negative withdrawal effects doesn’t speak to your whole experience with the medication and what symptoms the medication may have alleviated so that you could pursue better long term cognitive management of your anxiety disorder. What a good question, Ted. This deserves an entire blog post and not just a comment reply. DID IT WORK? In short, I don't think so. Undoubtedly, it did something -- like Paxil, it blunted my emotions (although in a more subtle way) and stripped me of my drive. But did it help to reduce my panic attacks?
The scene: late summer, on a leave of absence from my cubicle-farm workplace. The culprit? Panic. Really bad panic that was keeping me, for the most part, stuck in my apartment. Most days, I was too scared to even drive down the street to Walgreens. I had been relying on Xanax to treat my panic attacks as they happened. I'd been diligently working through Dr. Edmund Bourne's Anxiety & Phobia Workbook (which I would honestly recommend to anyone who suffers from frequent panic attacks), but not seeing any immediate benefit. I'd been doing therapy and trying to eat normally again. At only 95 lbs, an all-time low for my adult life, I felt unhealthy and deflated. "Why don't you just try Celexa and see what happens?" my family doctor said at my next appointment. "If you don't like it, you don't have to continue taking it." Yeah. I've heard that story before. Cough cough PAXIL cough.