Monthly Archives: November 2010

is social anxiety real?

Please note: I wrote this post for the first ever Blog Carnival of Mental Health. The topic is diagnosis.

***

So, as many of you know, WordPress allows me to see what people search for to find this blog. As of late, I’ve had some alarming searches, namely–“is social anxiety real” and “is cyclothymia real.”

I guess it’s good that people are questioning their inner experiences, but I’d like to know to what end? Labels are dangerous. It’s very dangerous to define yourself by a set of labels (or diagnoses) because you limit yourself. For example, if you say, “I have social anxiety, so I should be acting a certain way,” you can literally limit yourself to those courses of action. I also believe that the pharmaceutical companies profit greatly on these labels. If they can make us believe we have something wrong with us (i.e., a particular diagnosis), when in fact there’s not, then they can profit at our expense.

I think it’s easy to forget that there is a big difference between experiencing some anxiety during social experiences and having Social Anxiety Disorder (more on this here).

However, diagnoses can also be good, namely because they allow you to get the treatment you need. If you don’t understand your inner experiences, it’s hard to get treatment. When I finally sought out professional help, I felt greatly empowered. I took back some control from my anxiety, but I also had to take responsibility for my well-being. In other words, I had to do the work inside of therapy and out, to learn strategies on how to manage my social anxiety.

In a sense, the people who conducted those searchers are right–labels aren’t real. They’re only the tip of the iceberg. When we label things (without looking deeper), we ignore the essence. We ignore what’s really going on. I think it’s good to question your labels and diagnoses, as long as you are still addressing your inner experiences–because those are real, without a doubt.

If you deny the way you feel, you only strengthen the negative emotions, in my opinion. You must learn to accept.

***

As for me, I’ve been suffering with social anxiety since high school. It took me a long time to figure out though what was going on. I just thought I wasn’t trying hard enough and needed a stronger will to get through social situations. I’ve since found out that only makes the anxiety worse. Anyway, I was officially diagnosed with Social Anxiety Disorder in the Fall of 2008, and I was just diagnosed with Cyclothymia this past August. In both instances, I felt relieved, because I could finally explain what was going on inside of me–and start getting the treatment I needed.

EDIT: All the posts on the Blog Carnival can be found here

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happy thanksgiving

I had a good Thanksgiving. My girlfriend and I stayed the night at her brother’s house on Wednesday. On Thursday, I got up early, went for a short run, popped an Ativan (plus my normal medication), and started cooking.

It was a relaxing morning, spent with my girlfriend and her brother and sister-in-law. I felt calm and at ease. I’ve been spending more time with them as of late, and thus am feeling a lot more comfortable around them. I wouldn’t say I’ve connected more with them; it’s more like I’m easing up a bit around them and overall less tense because I’ve been seeing so much of them lately (see my issue on constancy for more info).

I took another Ativan before the rest of the family arrived, and when they arrived (10 in all), I tried to stay as busy as possible–I helped in the kitchen, played with the cat, set the table, etc.–and, honestly, I felt good. In all, it was a success–and I actually enjoyed myself!

The medication really helped. Unlike in the past, I took it preemptively. That is, I took the Ativan as soon as I felt an inkling of anxiety in my body, instead of waiting until I was flooded. This helped to break the anxiety cycle. By taking the medication early, I didn’t allow the anxiety (thoughts and physical symptoms) to build on itself. In other words, I broke the cycle before I reached a point where nothing, not even numbing myself on alcohol, can bring relief.

I noticed a huge difference in my thoughts, as well. They weren’t as negative. More neutral, I guess. This can be attributed directly to CBT. It’s really starting to help, especially when coupled with medication. I’m breaking up the negative thought patterns and experiencing less anticipatory anxiety.

Speaking of which, this past week or two, I’ve been able to manage my anticipatory anxiety better. Writing, exercising, working on school, that sort of thing, has helped me to avoid my negative thoughts. Instead of wallowing in my negative thoughts, I’ve been active.

I mentioned in a previous post that I wanted to approach Thanksgiving as a social experiment–to see if I could avoid becoming flooded. Well, I succeeded, and I am proud of myself. I also felt very connected to people, and I do believe (for now, at least) that the people around me care about me and my well being. At the dinner table, we all went around the table saying what we were grateful for. When it came to be my turn, I said–

“I’m grateful for being surrounded by such wonderful people who care about me.” In my head I told myself that I was grateful for just being able to connect with my thoughts in a group social situation–and not feeling flooded from talking in a circle. (Usually when there’s a group circle where people go around introducing themselves or something, I get flooded. I DO NOT like those situations at all.)

Finally, as weird as this sounds, I’m actual looking forward to future social situations to see how I fare. I want to build on this success. I want to experiment more.

I want to say more, but I’m really tired (I’m sure that’s reflected in this post) and need sleep. So, I’m off to bed. Good night. I hope everyone is doing well. 🙂

perfectionism or punishment?

Why are pdocs always late? I’m always having to wait at least fifteen minutes after our scheduled appointment time. It’s not fair. Because of I was late like that, I would probably get a lecture on the importance of being on time. It throws my day and all my structure off. On days I have to see him, I can never plan for anything after. Anyway this time I decided to say something–

“Right on time, as usual,” I said, quite passively. His non-response indicated that he didn’t appreciate my sarcasm.

I had high hopes for the session. I wanted to drop the other medications I’m on–Lamictal and Klonopin–and start taking Nardil, as a friend of mine with social anxiety has found Nardil quite helpful. The problem was/is that my pdoc hasn’t prescribed Nardil in over twenty years as he had a patient almost die while on it. You see, there are some dangerous food interactions, particularly alcohol, cheese, aging fruits and vegetables, some meats, soy, and so on. It’s quite alarming. You could eat the wrong kind of cheese and end up in a hypertensive state and have a heart attack.

But if the ends justify the means, I think I can live with the reduced diet–and the risks. My pdoc, however, wants to exhaust all other options first. So, he increased my dose of Klonopin and added Xanax into the cocktail (both of which, I might add, I’m having trouble filling due to insurance restrictions–so frustrating). Anyway, I came out of my appointment disappointed.

Oh, and I also got lectured.

My perfectionism came up. I told him I’m frustrated because I don’t have many friends, and outside of my relationship, I pretty much only hang out with my girlfriend’s family. And since she has a large family, I pretty much bounce from one large group social gathering to the next. I don’t believe that type of exposure works. I need gradual exposure. I need to see small successes and build from there. I won’t get any better if I continue going to huge social gatherings. But I don’t feel like I can opt out of them, either. Otherwise, I would just sit around the apartment, isolated.

“It’s okay to avoid things,” he said. “In fact you need to take back control from your anxiety and start saying ‘NO!’ every now and then.”

“But then I’ll be completely isolated,” I said.

“You’re going to school, you’re starting an internship, you have a girlfriend–you don’t sound isolated to me.”

“I’m going to school online,” I countered, “which isn’t helping my anxiety. I’m scared to death of the internship. I’m too dependent on my girlfriend.” We sat in silence for some time. “I can’t help but think this way. I know my perfectionism is fueling my anxiety but I can’t control it.”

“Mike, it’s not perfectionism. It’s punishment. You’re punishing yourself for not being perfect, and by doing so, you’re giving control to your pain. You still have control, though, but you don’t feel like you have it anymore, because these beliefs of yours are so ingrained. I don’t think you’re challenging your beliefs enough.”

I’ve been in therapy for over a year–is that not enough? But he’s right. I do not feel like I have control. I feel like I am my anxiety. I am my beliefs. I am who I say and think I am. How does change occur, though? It’s easy to intellectualize this process, but that can only take me so far. Change is deeper, in areas that I don’t like to touch. In areas I don’t know how to touch. When I do touch them, I shut down, I get flooded, and I push away.

He also brought up the issue of learned helplessness. I’ve failed so many times in the past, I do not believe I can succeed. I’ve taught myself how to fail. I’ve let my anticipatory anxiety get the best of me. I think I’ll fail, therefore I will fail. But maybe–just maybe–being conscious of this will help me change? I hope so.

***

Later on in therapy that night, my therapist asked, “What does it mean to be perfect? What does perfectionism mean to you.”

“It means I avoid being judged negatively,” I said.

There’s more but I don’t feel like typing it out. It was a tough session, to say the least. He pushed right up against my beliefs, and I pushed right back, shutting down in the process. I feel like we’ve been at a standstill for some time now. Why does change have to happen so slowly?

high to low and back again

I started writing this post yesterday afternoon, and it was originally called, stable .. for now, but nothing I wrote felt right, and by the evening I had abandoned it altogether. Some highlights–

I’ve been fairly stable since the wedding. That is, not depressed. I’m caught up with schoolwork again, and I’m starting to enjoy activities again, like reading, writing, running, and cooking. (I even went to a yoga class on Friday!) I’m looking forward to seeing my student on Wednesday and tutoring in general (I volunteer at an adult literacy center), as well as Thanksgiving. (I’m not delighted about being around fourteen people, but I do want to see if my mood holds up and how, or if, that will affect the outcome of the social situation. Plus, I want to test out some of my new cognitive techniques. So, it’s not so much about the social situation itself; it’s more about seeing whether I can get through it without being flooded with anxiety [an experiment, really]. And I’m actually feeling more confident that I will be able to do just that, and if I don’t–NO BIG DEAL!)

I’ve been doing lots of CBT lately. I still don’t know whether it’s working or not–whether it’s affecting deeper change–but I do know that it’s changing the way I think. I’m more positive and upbeat. I haven’t been engaging in my normal destructive behaviors of finding faults in the past and using those to ruin the present, etc. It’s a strange feeling, really. I’m not comfortable with feeling good–or, more precisely: not feeling bad. I guess I’ve just been feeling neutral lately. I look to the future and I don’t get the hopelessness that I got a week ago; it’s more like a staleness.

Finally, I’m also excited about trying a new drug. I’m not comfortable with taking Klonopin daily, so I’m going to talk to the pdoc on Tuesday about trying an MAOI–Nardil. A friend of mine who also has social anxiety is on it and I have noticed a huge difference in her behavior. Yes, MAOIs have some pretty bad side effects and you have to be on a strict diet to avoid hypertension, but maybe the ends will justify the means (for once)? I just have to talk my pdoc into it, because he had a patient die while on Nardil because s/he ate the wrong kind of cheese (aged) and didn’t seek medical attention.

Anyway, somewhere between writing and watching a football game and reading and taking a bath, my mood changed. By the end of the night, I was pretty low. Actually, I could feel my mood turning pretty much throughout the evening. My energy level dropped, and I couldn’t do the things I wanted to do. I’ve been pretty hyper (or hypomanic) this past week. I’ve bounced from activity to activity to activity. I haven’t given myself much leisure time or given myself time to think about things, which is good and bad. Sure, I didn’t think about the bad things, but I also didn’t get to process and own my negative feelings. I pretty much suppressed everything throughout the week, and maybe some of the those feelings were coming up while I was writing.

It’s a strange feeling knowing that your mood is going to turn. I started to panic a little, actually. I wanted to do everything I could to stop it from happening. I stopped writing altogether, and I tried to just sink into the feelings a little with the hopes of crying. I always feel better after I cry. I think it allows some of the feelings to release. It’s healthy. But it’s very hard for me, especially now that I’m on medication. I need to find more triggers. Last week I found a good song that brought me into tears almost immediately but I played it like ten times over the week, so when I listened to it last night, nothing happened. I need to find more triggers. What works for you?

I’m also very stressed about school and the holidays in general. I have three papers and two presentations to do in less than a month. The papers are no big deal. Sure, they’ll be a lot of work, but I’m more worried about the presentations. For those who don’t know, I’m in an online graduate program studying Library and Information Science. I’m becoming a librarian. Anyway, the presentations are done over a conference call, and even though they aren’t in person, I’m still a little upset about them. CBT is helping, though–I may have had lots of anxiety in the past, but I’m doing better. And it may not go exactly how I want it too, but I will get through it–and it will be okay. Again, I don’t know how much of that’s suppressing my feelings and how much of that is subtly dealing with the feelings but not letting them take control. I don’t know.

The holidays are another big thing. Thanksgiving is coming up. As I said before, I’m going over to my girlfriend’s brothers, where fourteen people from her family will be there. I am still hopeful that I’ll be able to get through it without getting flooded–with the help of Ativan and Propranolol, of course. I’m counting on there being a little anxiety there, just not the debilitating kind like I had at the wedding. I want to be able to converse with people and smile and not have to worry about sweating through three sets of shirts and looking like a complete idiot all the time.

I’ll address Christmas at a later date.

So, with my mood rapidly changing, and without being able to release some of the pent-up emotions through crying, I went to bed feeling like I’d wake up feeling even worse. But here I am. I feel a little down, a little stressed and depressed, but a little happy and hopeful too. Maybe I avoided a depression? I don’t know, only time will tell. But for now I am going to continue with what I’m doing: schoolwork, running, keeping myself busy.

Oh and I probably won’t be updating much until the end of the semester (12/9). I hope you are all doing well, by the way.

Finally, I’m curious how you deal with things when you know your mood is getting ready to turn. Do you just accept it, knowing you can’t change it, and try to do your best to weather the storm? Or are you more proactive about it–are there ways for you to avoid the depression altogether, or at least lesson the severity of it?

Thanks for reading, and I look forward to hearing from you. 🙂

a familiar voice

My therapy session on Tuesday went a little better than usual. Usually when things get hard–that is, when we start going deeper–I shut down. On Tuesday I stayed with my t as much as I could. I feel good about myself (for once) for actually having stuck it out even though it was incredibly difficult. I’m giving myself credit where credit is due; it’s a strange feeling, to say the least.

Well, now that I am analyzing, and writing about, it, there were times I felt very frustrated and maybe did quit a bit.

We’ve been talking a lot about the cycles I go through. Anticipatory anxiety, social event, depression–and how each one is setup by my own negative beliefs about myself. My t is interested in my beliefs, because that’s where change will occur. I’m not sure I believe that. It’s hard for my beliefs to change if they’re constantly being reinforced by my actions. But in a therapeutic session we can only work on what’s inside me, not the outside world and what goes on around me. So, we talk constantly about my beliefs, which is frustrating.

There is a genuine part of me that does want change, that does want my deep, rigid beliefs to be exposed for what they are–lies. I want to be able to engage socially without that voice in the back of my head saying, You are no good. People notice you are anxious, and, consequently, they don’t like you. You will never be anything other than what you are right now. Logically, I know I have an innate worth, and I know sometimes I do appear anxious (but it’s not as bad as I make it out to be), and even if people do notice I am a bit anxious, they probably aren’t judging me or coming to conclusions that I am a bad person. But logic doesn’t always help. It’s what’s deeper that matters. And sometimes I do want those beliefs to change–or at least be challenged.

Which is what happens in therapy. Which is why I shut down sometimes. Why would I want those beliefs to change? They are me. Without them, I won’t know who I am. So, most of the time, I don’t want those beliefs to change. I just want to be able to live my life, while still thinking I am a piece of shit, which has been difficult thus far, obviously.

What’s more, sometimes it feels great to fail because it reinforces those negative, irrational beliefs about myself.

“It feels so good sometimes,” I told my t, “coming in here and telling you what a shitty weekend I had, because now I have something to point to. Now I have something to show you, and say, ‘See. I am messed up. There is something wrong with me.’ It’s fuel for the fire.”

“That voice is what I’m interested in,” he said. “That’s the voice that doesn’t want change, the voice that says you’re not good enough and never will be, the voice that says you should die. It’s a familiar voice. It’s something we need to shine light on. But when we look at it something happens in this room, something changes. You get flooded and leave.”

Anyway, during the session, I tried to open up about the voice, explaining when it comes out in social situations and how it’s, seemingly, out of my control during periods of anticipatory anxiety. I stayed with it as long as I could, but, inevitably, I shut down, relinquishing control. But I did stay with it longer than I have in the past, which is a step in the right direction. I just feel frustrated that I wasn’t able to open up more. I couldn’t find the words.

perspective

Although my head is still in a fog, I think I’ve gained some perspective not only about the wedding, but the last year of my life, as well. Despite what most people are saying around me, I feel I’ve taken quite a few steps back over the past year. I wouldn’t say I’m moving backward, but I wouldn’t say I’m moving forward either. It’s more like I’ve been stagnating; some things have definitely gotten worse, while other things are better.

The basis of this post, by the way, comes from two major events that have happened this past week or so. One being the wedding, and the other my one-year anniversary with working with my therapist.

I can’t ignore the fact that I am not the person I was one year ago. I’ve changed in many ways, good and bad. I’m really an entirely different person. I went to a wedding a year ago, and it really wasn’t that bad. I felt some anxiety, but I got through it. The wedding on Saturday, however, was a much different experience. I was completely flooded during it and could barely communicate, let alone smile.

So, what’s different about me? Let’s take a look–

Anticipatory anxiety. My anticipatory anxiety is much worse now than one year ago. The dreading and worrying is much more intense, and it starts to happen earlier and earlier. It’s even been so bad that I’ve had to avoid certain social situations altogether. I never avoided situations a year ago; I’d be scared to go, but I’d still go.

Depression. Like my anticipatory anxiety, my periods of depression are much more intense and they last longer. I’m usually knocked on my ass two days a week, unable to do anything, and I have a breakdown about once a month.

Mood swings. The lows are much lower today, and the highs higher. I’m constantly swinging from low to high, as well; in a typical day, I usually have at least one or two swings.

Binging. I didn’t consciously binge a year ago. That is, I wasn’t purposely binging to elevate my mood. Today, I know how to control my moods through binging; and, consequently, I’m binging a lot more.

Isolation. 14 months ago I quit my job; moved in with my girlfriend, away from my roommates and friends; and started an online graduate program. I quickly became isolated and stopped hanging out with friends. My best friend moved to NY last January. I pretty much have to rely on my girlfriend for support and someone to hang out with.

Joy. I do not get pleasure out of the activities that used to relax me. I don’t enjoy reading, writing, meditating, yoga as I did a year ago. I don’t really enjoy much anymore, actually.

Medication. I’m on some serious medication now. Lamictal, Klonopin, Ativan, Propranolol. What’s next? Just seeing all the pill containers reinforces my beliefs that I am fucked up and broken.

Therapy. Yes, I am in therapy now–isn’t that a good thing? I don’t know. I’ve had to admit that I have issues and that I need to work through them. Instead of internalizing everything, I’m having to face my beliefs, feelings, and fears. I’m not convinced this is a good thing. I’m moving too fast; it’s all too much to handle.

Beliefs. I’m also finding out that my beliefs are extremely rigid. I sincerely believe that I am a bad person; no one likes me; I’m inferior to those around me; I can’t cut it in this world; I’m a fool, a failure, a loser; and I will never get better. These beliefs are obviously reinforced by my actions and social experiences. Each time I engage, my beliefs are reinforced. It doesn’t help either that I bounce from one huge, overwhelming group social situation to the next; there’s nothing in between because I’m so isolated.

Awareness. It all comes down to awareness. I am much more aware of things going on inside my body. I can recognize when a depression is coming (but it’s frustrating because I can’t stop it). I know about my beliefs and feelings (but, again, I feel powerless to change them). The major difference is that I understand why I feel the way I do, but I haven’t been able to change it, and so, I feel even more powerless, hopeless, and listless. I’m scared.

What’s more, last night my g/f said she’d like us to go to couples counseling. It feels like the beginning of the end. I can’t deal with anymore therapy at the moment. I can’t deal with unlocking more deep-seeded beliefs and feelings because I can’t deal with the ones I’ve already unlocked.

I don’t know what to do anymore. Maybe things aren’t as bad as I think they are, but I cannot dismiss the fact that I am more unhappy than ever.

Each day grows harder. The longer my beliefs stay the way they are, the harder it will be for them to change. Plus, my inadequacies are further reinforced each day as I go about my life watching all the other “normal” people function like I should be functioning. Every time I see someone smile, I tell myself I’ll never be happy, which only fuels my beliefs.

I’m stuck. I’m trapped. I’m really, really scared.

    wedding blues

    My brain is so scattered right now, I don’t know where to start. The wedding did not go well, in fact I really feel like I need to apologize. I need to send a thank you card that just says, “I’m sorry.” They’ll know exactly why.

    Actually, I wish I could send cards to everyone who interacted with me, simultaneously thanking them and apologizing. I feel sorry for the people who had to shake my sweaty palms and attempt to sustain a conversation with me. I do not know why anybody would want me at their wedding. It’s absurd.

    No matter how hard I tried, I could not fake happiness. I was completely saturated with anxiety. From head to toe, my body was tense and heavy and uncomfortable. I didn’t stop sweating. Under my arms, the stains went through three shirts, even a heavy black sweater. I felt nauseous the whole time. I barely ate. I did manage to get three beers down, but that did nothing because when I’m that anxious, I can’t feel anything except the anxiety. I couldn’t smile. Most of the time, I didn’t even try. What’s the point?

    The other night, when I talked to my mom about my issues, she said, “You’re like a broken record, and it’s getting a little old.” She’s right. How much longer can I let this go on before people begin to quit on me? It’s one thing to have issues and internalize them, but it’s something entirely different altogether to show them off to the world. I’m trying so hard, but maybe that’s not good enough? I know my g/f worried about me the whole time instead of having fun. She’s always taking care of me.

    When she left on Friday night–the night before the wedding–for a pre-wedding dinner, I got really drunk. The anticipatory anxiety became too great; I had to do something. I had a terrible hangover throughout the wedding, which probably helped to ease the anxiety a little. I’m actually still feeling a bit hungover. Anyway, my g/f had a mini breakdown in the morning, as we were getting ready–

    “I want you to want to look good,” she said, crying. “I want you to want to go. I want you to be happy. I need your support.”

    How much more can she take? How much more can I take?