Managing the panic

anxiety-girl

(credit: Natalie Dee)

I had a rough weekend with anxiety, and it continues today, so I wanted to share with you a little of how I manage it at this point in my life, particularly anxiety concerning my health (although the weekend wasn’t really health anxiety, it was just an unpleasantly bad non-specifically anxious time).

After a moderate day of anxiety on Saturday which mostly manifested in me being grumpy and short-tempered (irritability is a major symptom of anxiety, and I also had a migraine which didn’t help), Sunday morning I woke up with a knot in my stomach, yet not really consciously anxious at all. It’s a strange situation at the moment. I think the longer I live with mental health problems like this, the more convinced I am that brain chemistry is the majority of the problem with these conditions. Of course there are things you can do to make them worse, and thinking patterns/behaviours which are unhelpful, and therefore things that you can do to improve your situation also, but even on a good day when I manage to do all of the helpful things, and hopefully very few of the negative things I still often feel anxious, sometimes very much so. My therapist made the very good point today that it may have been the anxiety related to health that I experienced earlier in the week and on Saturday that resulted in the nonspecific anxiety on Sunday. I guess I hadn’t thought about a delayed effect on brain chemistry.

I have battled moderate to severe (sometimes totally crippling) anxiety for the last 11 years, and am slowly becoming better at doing so. I’m so grateful and so pleased to have got to a point where even on a day like Sunday I actually managed to enjoy my day despite the battle to manage my mind and body. I don’t always win against this, but sometimes I do, and that’s a wonderful thing.

I find that a lot of my anxiety focuses on my health, and that’s unsurprising considering how unwell I have been over the last 11 years. There are a few specific reasons for me to be anxious in this area:

  • Ehlers-Danlos syndrome means that it is very easy to injure my joints, even in the normal activities of day to day life, let alone doing more fun stuff! The best example being that I once subluxed (a self-replacing disolcation) my hip simply by rolling over from my front to my back while lying in the garden. This resulted in two surgeries and years of chronic pain, yes EDS sucks!
  • I have many joints which have been previously injured, meaning that some of them have altered function
  • I suffered with very severe chronic pain for over a decade and continue to experience chronic pain to a lesser extent
  • I have bipolar disorder, meaning that I cycle between depression, “normality” (whatever that is!), and mania/psychosis to differing extents depending on the season of life

So health anxiety is an ENORMOUS battle for me, particularly in relation to my current attempts to get back to work. It is so hard not to worry that I’ll have put in all this effort and spent all this money trying to go back to nursing but then when it comes to it I might not be well enough to manage it and cope with the pressure which that kind of job brings. I had a significant pain flare for about 4 days last week, which is relatively unusual at the moment, and a migraine over the weekend and now another today, unfortunately this becoming quite a regular occurrence. So it was particularly difficult to manage this week.

There is a brilliant allegory written by Christine Miserandino, a woman who has Lupus, describing how life with chronic illness of any kind is like having a certain number of spoons, and that each task you have to do takes a certain number of those. The full article can be found here, and I’d really recommend reading it – if you are someone who struggles to identify I think it clarifies things well: http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/. The main idea is that for an average person, there is less of a limit on the availability of “spoons”, but when you live with extra challenges there is a very finite limit of how many you have available – for instance you may have to sacrifice functioning normally later in order to enjoy or manage something now that a well person wouldn’t even have to think about. When I was at my physically most unwell, between 2-7 years ago, it was such a horrible game to play – what I could manage compared to what I would have to give up in order to be able to do so. Having young children made this a million times harder, with there being so many things that I literally couldn’t do, and also trying to balance remaining well enough to function whilst still actually doing some enjoyable things. It was HORRIBLE. I have also fought this battle in relation to my mental health, and continue to do so although I am so thankful that physically I don’t have to think about it so much any more most of the time. However, mentally I hit my limits nowadays much much sooner than I used to, and because of that have to be much more careful about self-care than I previously was (and I’m still growing in this area!). When I am in a phase where I am higher than usual mentally, I can end up enormously overdoing it, burning out badly and ending up very depressed. Having only been diagnosed with Bipolar Disorder for just over a year and half (although it’s the only diagnosis I’ve ever had that enables me to make sense of the mental health problems that have been happening since my teens), I’m still learning how to balance these fluctuations. And it’s only because my physical conditions have improved and my children are getting older and more independent, that I have enough “spoons” (I hope!) to begin to return to work, which I’m equally excited and terrified by.

Whatever the cause of my anxiety on a particularly day, I manage it in a similar way. It’s a mash-up of CBT, mindfulness, distraction, thought-challenging and various other things that I’ve learnt along the way. Here are some things I find helpful:

  • Working very hard (and finally being less depressed enough to make some progress) on not being angry or judgemental with myself for being anxious.
    • Being anxious about being anxious is such an easy trap to fall in to, and it makes things so much worse. I think my final acceptance of the brain-chemistry aspect of these things has been really helpful with that, along with having finally found an antidepressant which works (having been tried on maybe 6 different ones before and found them all useless. I’m going to write about that more later). I’m counting depression and anxiety as equally brain chemistry related here which is why I’ve mentioned the medication I’ve never yet been on a medication specifically for anxiety apart from when psychotic, but there are many people who have found real relief from medications for anxiety. It doesn’t work for everyone, and it’s a scary prospect, but if you’ve been struggling for a while and aren’t coping by using other methods alone it’s worth a try. There is stigma around using medication, but I think many more people than we expect are on psych meds, people just don’t like to talk about it.
  • Being around people who empathise well with people with anxiety.
    • There is a lot of judgement out there, and it takes bravery to put yourself in social situations when you’re anxious. But being around others is so incredibly important, even just for the distraction aspect of it, for me I am much more anxious when I am alone. Unfortunately I am often very grumpy when anxious, so it needs to be understanding nice people! I’ve found when opening up about this issue I’ve found that so many others who I wouldn’t have expected to be are fighting this battle as well. This doesn’t have to actually be in person if it’s too scary to start off with. This is where the internet comes into its own – find a nice group to join where you can get some support. I am part of a small online mental health group made up of women who have been in the mother and baby mental health unit in Nottingham where I spent 3 months 2 years ago. It’s a lovely group of very supportive women who have all been through serious mental health problems and are a different stages of recovery, and it’s a great place to vent and get practical advice.
  • Not underestimating anxiety.
    • Anxiety is a serious mental health problem, not just worrying too much over things. Telling yourself (or others)  “it’s just anxiety” or “everyone worries about things sometimes” ignores the impact that this condition can have on people’s lives. I’m by no means saying that everyone who suffers from mild anxiety has a major mental health problem, but that it can be such, and by downgrading it to classify it as something not very serious you do many people a disservice. During my worst anxiety crisis, three months after Maya was born, a very well meaning person told me “it’s just anxiety Jenn, it’s a paper tiger”. I wanted to scream back “yes but the paper tiger is ripping my mind to shreds!!”, but instead I just self-condemned more which made recovery even more challenging.
  • Recognising patterns of thought which are repetitive and unhelpful and challenging them or reframing them with a different emphasis.
    • I have repetitive self-condemnatory phrases which come to mind more when I am struggling with the anxiety. I have to catch them, challenge them and talk myself down when that happens. It’s hard!
  • Constantly challenging myself to live the the particular moment/day/hour/minute that I’m in.
    • I try to do this whilst actively planning for the future rather than worrying about it, as at one extreme this approach can lead to procrastination which makes anxiety much worse! Trying to keep my mind focused solely on what I am doing at that particular moment makes all the difference, particularly in terms of connecting with and enjoying time with my kids. I know this is an incredibly easy thing to write about and an incredibly hard thing to do, but I’ve found it to be like a muscle, it gets easier as you use it more, and again with less depression I actually have more energy to do this and find it pays off hugely.
  • When I’m panicking about fitting things in, stopping and slowing down a bit for a while.
    • I am often overwhelmed by the amount of things I need to get done, and about trying to get any kind of quality time in with my husband, kids and friends whilst doing them. I have to be strict with myself when it gets really bad and slow down, telling myself that if I work slowly and steadily I’m likely to get much more done than if I run around like a headless chicken trying to fit things in.  I sometimes use mindfulness techniques to do this like stopping and focusing on my breathing for a while to re-centre myself.
  • Learning to take care of myself in the stage of life that I’m in.
    • It’s really tough making time for yourself when you have small kids, but it’s so important. This doesn’t have to be major chunks of time away from everything, but just allowing yourself to be kind to yourself really helps. Yesterday that meant actually lying down on the sofa while I made the 10 phonecalls I needed to make, rather than standing in the kitchen like I normally would. Today it meant allowing myself to take an hours nap rather than doing the things I had on my list. Both of these made a huge difference to how exhausted I felt by the time Joseph woke up and the girls got home and today it was particularly important because I have a migraine and am already understandably irritable . I also ended up going for coffee with a friend last night instead of studying, which meant I studied at lunchtime instead of cleaning. I could panic about how I’m going to fit in the stuff that I left, but again I’m choosing to be kind to myself and realise that many things can wait, and I’ll be more likely to have the energy and motivation to do them if I have friends and I’m not miserable.
  • Breaking down tasks into smaller chunks
    • I am often really overwhelmed by large tasks, again particularly as I get very little uninterrupted time to achieve anything with three kids around. I have found that the only way I can manage bigger tasks is to break them down and do a little bit at a time. I find that I work better by doing little bits of several different tasks at one time than I do trying to tackle one large one which means I often procrastinate. This is definitely at least partly a personality/way my brain works thing and may not work for everyone.
  • Recognising that modern life IS anxiety-provoking, especially parenthood.
    • The media bombards us constantly with ideas of what we should/shouldn’t be doing, and it’s overwhelming. Once you have a child it gets a million times worse, and the responsibility you can feel to provide the “perfect” parenting within your very imperfect situation is so tough to manage. Also we were not designed to live in isolated nuclear families with no extended community, and this makes modern parenting so incredibly difficult.
  • Understanding at least a little about biological functioning and how the brain works and hormonal fluctuations affect us
    • Our bodies were not designed for artificial light and it can really affect our brain chemistry, particularly white/blue light in the evenings, which affects the body’s productions of melatonin and therefore our ability to fall asleep/stay asleep.We were not designed to lead such artifical lives e.g. exercising at the gym versus in nature. Also extended periods of stress can dysregulate production of a hormone called cortisol, which had an enormous affect on brain function and anxiety levels. Parenthood alone is an extended period of stress!
  • Limiting your social media time, and making sure you take everything you can read with a pinch of salt.
    • People mostly display their best side on social media, so you get a very false view of things compared with the actual reality of how people are living day to day. Two examples of this are the album of photos which I put up from our visit to England and how much it looks like we had an amazing time. We did, but the photos don’t show just how stressful and exhausting and emotionally overwhelming it was also.  Another one which hit me hard recently was that I had to look back through facebook for something and ended up spending time looking at my photos from around the time of Amelie and Maya’s births. In the vast majority of them I look really happy and as if we’re thriving. There are ones of times when I know I was seriously suicidal when I look absolutely fine. It really shocked me that actually the only external evidence of the mental and physical battle that I was fighting is the odd photo of me looking really pale/really flushed, and a few where I was wearing wrist braces or occasionally using a wheelchair. It was shocking to see how someone looking in from the outside could have interpreted my life compared to the painful reality. Also, when you’re really depressed the temptation is to dissolve into various things in your phone in order to not have to deal with the unpleasant reality of the moment. This works briefly (apparently it gives us a little boost of serotonin every time), but generally makes things worse overall. I really struggle with this, and often think I’ve cracked it, only to fall back in to the habit when life gets a bit harder again.
  • Spending time with people who have older children, and for me also just watching my children as they get older.
    • I find it so helpful realising that the things that I worried about so much when they were tiny are either not as important as I thought they were, are things that they grow out of with age, or are much less dependent on my abilities and influence as a parent than I thought they were. For me, having 3 kids really helps with this as I have parented them in a relatively consistent way, with three incredibly different outcomes! So much of a kid’s character is innate and it’s so interesting to watch that develop over time. I haven’t historically had that many friends with kids older than mine (unless they’re WAY older), and I so wish I had done, I think it would have been really helpful! Also within this, realising that life IS crazy, and that you don’t have to have long periods of one on one time with each of them to meaningfully connect with your kids. Little moments are really valuable, and can be done creatively, or in fact not very creatively, as I’m not very creative!
  • Eating well.
    • This is hard, and I am very variable on it. Too much caffeine is definitely bad for my anxiety, so I only have one cup of caffeinated coffee a day, and not too much tea either. While I was in England this made things difficult! Blood sugar fluctuations can affect mental health a lot, especially anxiety so trying to avoid big peaks or dips is important, and particularly difficult while you have young children as it is so easy to forget to eat, or grab mainly high carb snacks that are easy to eat on the go. I also find that weight gain has a horrible effect on my mood, both anxiety and depression, but depression makes me comfort eat. It’s an unpleasant cycle. I also have had the problem of medication (antipsychotics) related weight gain which has been really really difficult. Addressing this is important to me, although it is going annoyingly slowly.
  •  Exercising.
    • This is so helpful for me, and it’s so wonderful that I’m actually well enough to do it now. I find if I’m feeling depressed or anxious and I go and put in time at the gym, it balances me out really nicely. Being fitter also actually gives me back “spoons” as my body is stronger and I’m less at risk for injury, stronger, and more able to do physical things with my kids without paying for it later. An extra factor to this is that apparently posture is a significant contributer to mood, and that therefore hunched posture can contribute toward mood disorders. This is really difficult to do when you’re very depressed and when you’re anxious, but may help.
  • Prayer.
    • I am variable on this. I have struggled with my faith a lot since my last psychotic episode but am trying to still continue to incorporate this in to my life. It has been helpful to me in the past and continues to be so for many people.
  • Music.
    • I use this a lot. I find it to be a really helpful distraction. I have finally put some speakers in my kitchen and often listen to music when preparing food and doing admin. It’s made a big difference to two annoying boring tasks where I used to often have my mind wondering uncontrollably and worsening my anxiety. I listen to an enormous variety of things depending on my mood, both Christian music and not. It’s not that I don’t ever want silence, but too much silence allows my mind to race in an unhelpful way. I have had a lot of trouble falling asleep during times of mania and hypomania. Over the last few months, and during this last episode recently I’ve got in to the habit of listening to a couple of songs on my headphones when I lie down in bed. For me it stops the anxious habit of dissecting my day or worrying about the day to come. It’s such a simple thing but has been pretty revolutionary for me, especially because I really struggle to be self-controlled with my sleep hygeine!
  • Therapy.
    • It’s easier to find good counselors here than it is in England because there is much more of a therapy culture and it’s generally covered by insurance. But it is possible in England, and it’s worth asking your GP to refer you if you feel you need it. Some counselors/therapists have a sliding scale for payment which takes into account your income. I think there are also online CBT courses you can do if it’s hard to access counseling because of availability, finance or childcare. Getting an independent person to give input in to your situation can be really helpful.
  • Writing things down.
    • I find that getting things on paper/in type means that they’re no longer spinning around in my brain. It really helps, whether it’s in a journal form or emails to a trusted friend or therapist. I have gone back to doing it recently and am finding it very useful.
  • Not taking a deep breath!
    • That advice which is so often given is quite misleading. Deep breathing actually increases your heart rate and blood pressure. Slow controlled breathing is much better, and I actually find that blowing air out through my lips like a horse really helps me when I’m having a difficult moment. I look and sound like an idiot, but it helps.
  • Mood tracking apps.
    • My therapist and health centre use an app called Ginger.io, but I know that there are lots of similar applications like it. It’s interesting to see the fluctuations in your mood in a concrete manner, rather than relying on memory which when you’re battling with depression and anxiety isn’t the most reliable source! My healthcentre has it set up that if certain entries are made which are concerning then it flags it with your health provider who can then contact you to check on your welfare. Pretty clever.

That’s all I can think of for now. It may be a bit garbled. I hope it’s helpful for people and doesn’t come across as me trying to tell people that I’ve got it sorted. I really don’t, and on Sunday when I came to the end of the day and had managed to have an enjoyable day despite bad anxiety I still commented to Peter just how exhausting it is to manage it effectively. To those of you who battle with anxiety and get up in the morning and face it another day however “successfully” or not, you’re warriors. It’s a hidden battle, but there’s lots of us fighting it. You are not alone,

Jenn

Oh, and just to make you giggle: http://www.buzzfeed.com/erinchack/comics-that-capture-the-frustration-of-anxiety-disorders?utm_term=.mwmXMn3o9&sub=2650461_1752757

 

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~ by jennkeast on September 15, 2015.

2 Responses to “Managing the panic”

  1. Hi Jen, it’s really interesting to read your blog because David has high levels of anxiety and suffers from depression. He takes medication for both but not anti psychotics. Richard and I have to provide an environment for him that keeps anxiety to a low level so be can enjoy his life, I guess in many ways we therefore live within the limits his anxiety will allow. Some of what you write here is also exactly what we do. David doesn’t write things down but Richard and I keep daily records of daves emotions, responses, activities. This may seem excessive but it really helps us to see the balance in what we experience. When it’s bad if feels as if it’s like that forever, and every day, but when you look at our diary you can see all the good times and anxious free days we have had. We also make sure he has healthy food, the process of eating for Dave can cause anxiety and so we are careful to sit quietly and he watches red dwarf while he eats, it’s like you listening to music I think in that it takes the focus away from the process of eating and helps with the tension. We provide an environment for Dave that is described by his psychiatrist as one of low expressed emotion. It really helps Dave and both of us to live in a sort of collectinve harmony. But I am so in agreement with your comments about the Facebook postings and pictures. They only tell half of the story for us as well, Dave smiling and joining in, not the grumpy difficult Dave who won’t cooperate and resorts to self harming instead. But then that’s also good I think, we celebrate the times when just being together can melt your heart and we put the difficult days into a balanced view of the entirety of being together and what we achieve. Outside of the three of us it’s difficult for others to see just how challenging, hard and painful some of those times are but I have found for me anyway that acceptance and focussing on each part of the day and celebrating tiny successes keeps me balanced and strong enough to carry this on. I am also beyond lucky that Richard does this with me, for someone else to share this responsibility constantly takes my breath away, I know I couldn’t do this alone. Hope you are feeling stronger in all ways soon. Alison

    • Another lovely reply as always Alison, it’s nice to know that the blog is being read and that people identify with some of the things I write. It’s interesting to hear that you use some of the same techniques with Dave, and I’d forgotten that he loves Red Dwarf! Glad he finds that helpful.
      I continue to be rather in awe of you and Richard and the way that you love Dave through all of the challenges, but like you I am so incredibly grateful that you’re not having to deal with the situation on your own,
      And yes, mainly I think I am feeling stronger, thanks,
      Jenn

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