Stopping/Controlling Anxiety by Any Method

CBT consisted of trying to change my negative thought patterns and slowly progressing exposure therapy. The exposure therapy consisted of completion of an intensive twice weekly evening group therapy program, that lasted for ~ 3 months. That group therapy allowed me to expose myself (not literally) to talking/performing in front of a small audience (10-25 people).

I also had/have a once/week therapy session with a psychiatrist who gave/gives me some anxiety reducing tips/exercises like progressive muscle relaxation (Jacobson) and meditation and talk therapy. I used to do these:

http://www.hypn … ag/jacobson.htm

The problem is that I’m still scared shitless of going back to work without drugs and just thinking about going back to work fucks me up and makes me anxious. I wish I never had to go back to that shit hole job. It’s very difficult for me to do it unless I’m heavily medicated. And even then, I just get through. Unfortunately, I don’t have that luxury as I have no other skills.

Dear Nervous Nelly,

You sell yourself short over and over. You obviously have an intellectual capacity far above that average talking monkey man. I assume you were never tested psychometrically with those personality tests that Big Brain used to love to bitch about?

Were you using any medications (prescribed or otherwise) during the period of the exposure therapy?

Are you saying that your social anxiety was made worse by the exposure?

What is your job?

Para-Goomba: All I used was 5 mg cipralex (lexapro in US). It felt like taking a jelly bean. No other medications. My performance anxiety improved during the exposure part of the therapy as I seen improvements in public speaking/participation over the weeks but no generalization occurred, outside of this controlled, friendly, environment. But the negative thought experiments/assignments/practises made it worse as I kept thinking about my anxiety, etc. The exposure part was the most useful part. The changing my negative thoughts part was useless, for me.

Twatteaser: Not sure what the personality tests that Big Brain used to love to bitch about are about? I scored high on 3 tests: Aspergers, Social Anxiety and Highly Sensitive Person Test. The only confirmed diagnosis is Performance anxiety and GAD.

Commanderblop: I don’t like to talk about my occupation for personal/privacy reasons, but it’s in a health-related field. But here’s some of the programs/ jobs I have started (some of which I actually finished) or quit due to anxiety: Physics, Geology, Neurosciences, Radiation Sciences, Law/MBA, Medicine, Dentistry, Pharmacist, Personal Trainer, Lifestyle and Weight Management Consultant, etc. I did manage to finish 4 of these programs. I hope I’m not coming across as bragging but I just wanted to show how my anxiety fucked up pretty well all my career goals. And I only succeeded sorta because of my heavy use of benzodiazepines and narcotics. Without drug use, I tended to fail/quit.

I don’t have any phobias. Could I use this EFT stuff to acquire some?

Yeah, that probably wouldn’t have affected anything. I figured you’d have mentioned if you were popping benzos as-needed during the exposure period ;)

Context generalization is critical in behavior therapy, and that’s why a good intervention involves not only serious exposure homework, but actual visits, with the therapist, to sites much more representative of your daily life. Did you build a fear hiearchy with your therapist? I’d think that the controlled-environment group work would have been just one of the first steps in the exposure hierarchy.

The “C” in CBT has not been shown to be particularly helpful for a lot of things. For example, studies suggest that behavioral activation (getting out and doing rewarding things) is the active component of CBT for depression, and exposure is the active component of CBT for anxiety disorders. And unfortunately, as you suggest, cognitive-restructuring exercises can sometimes even be harmful, if they lead someone to ruminate excessively and fight helplessly against their negative thoughts or emotions. Given the experience you describe, it does seem that if any “cognitive” work were to help, it might be the more mindfulness-based approach advocated in ACT, in which the goal is to learn to accept that anxious thoughts and emotions inevitably occur sometimes, but that this is okay and that you are not identical to (or “one with”) those thoughts and emotions. (This is, of course, part of how behavior therapy itself works: you learn to sit comfortably with the anxiety that certain situations such as public speaking evoke, without having that anxiety fuel further anxiety that your anxiety will rise and overwhelm you, further exacerbating anxiety, ad infinitum.)

If you can afford it, I’d consider trying to locate a therapist or clinic that specializes in intensive treatment for severe anxiety through a behavioral approach (perhaps with some ACT orientation). From what you’ve described, the therapy you received may have been the equivalent of 5 mg lexapro, whereas a more comprehensive and skillfully applied therapy could have some of the power of the narcotics and benzos to reduce your anxiety, without all the unbearable side effects and unsustainability.

[Disclaimer: I’m not a doctor and am just giving personal opinions, no medical advice intended.]

Thanks Para-Goomba. I really appreciate it. ACT does sound more my style. I can’t seem to trick myself about my negative thoughts. Sometimes, I think it’s because deep inside me I really do believe that my negative thoughts about my performance is true. That’s why I suspected I may have some Aspergers. I give the illusion of being able to do/understand stuff in theory and trick people but I really don’t. But then, my skeptical side says no, it’s just the anxiety talking. Or maybe a combination of both? My psychiatrist though is pretty convinced that I don’t have Asperger’s, even if I did have some Aspergers qualities when I was younger. But the line between Aspergers/autism and Normality is not crystal clear, same with social anxiety disorder and shyness. It is context/culturally dependent which really makes it confusing.

The other thing is, most of my negative thoughts leading to anxiety are about the fear/anxiety/panic attack itself, not how much my performance will fuck up. I’m pretty sure I don’t care if I fuck up/make mistakes as much as I care about getting a panic attack and looking like a total degenerate, trembling, idiot. It has happened before and I must of swallowed ~4 mg clonazepam all in one shot to shut down my system.

Bohm just out of curiosity, what does your daily routine look like? Do you do any regular sport activities? Do you have serious hobbies?

Currently, I’ve been off work for ~ 8 months. I will be getting back my license in a little while.

I don’t have any regular sport activities except I workout regularly, when I can, either with weights in a gym or home body-weight exercises (push-ups, 1-legged calf raises, frog-squats, etc.). I can’t join a gym right now because my cheap gym just closed down until January and I don’t want to spend any money on an expensive gym or go to another cheap gym that’s too far away from my home. We’re trying to be careful with our money as it’s starting to slowly run out.

The only hobbies, I have are the same ones I’ve always had since I was a little kid: hiking, travel (I’ve been to most of Europe, the U.S., Canada, South America, Caribbean), reading and talking about penises, strength training/nutrition, mental disease. Me and my wife go to Europe for ~ 1 month each year. Both me and my wife have a home there also.

I spend most of time with my wife and a few close friends. I’m not much into socializing. We play cards and gamble sometimes. But I try to avoid it, especially the casino. I never used to serf the Internet at all until about 8 months ago. I never had time, as I worked a lot. I hardly ever watch t.v. or listen to music.

When I was younger (20s) I did what everybody else did. Both sports-wise and socializing-wise. But I didn’t much like the socializing part. It was too draining for me and I used to piss off my friends. But since I got married and even before that I became more socially isolated which is what I prefer, I think. When I go to Europe we’re out with friends almost every night, or drinking, eating travelling, etc.

Sounds like you have anxiety over not having an phobias.

Maybe he has the opposite of anxiety sufferers. He needs stimulation and isn’t getting enough. The opposite of anxiety/aspergers/highly sensitivity people. Kinda like ADHD where they need stimulants to function properly? He would probably feel almost dead on benzodiazepines. My head would probably explode if I took a very strong stimulant?

As you probably know, fear/anxiety centered around the experience of anxiety/panic itself is known as “panic disorder,” with or without accompanying agoraphobia, and popping anxiolytics during panic attacks tends to make the disorder even worse. Panic disorder is one of the most successfully treatable of all psychological disorders. Have you ever gone through interoceptive exposure exercises (i.e., the artificial induction of panic-like physiological sensations within a safe environment)? It really sounds as if you might benefit from seeing a behaviorally-oriented psychologist specializing in anxiety; they’re often affiliated with academic medical centers that have units devoted to the intensive treatment of panic disorder, OCD, specific phobias, etc. I’ve known people whose lives were turned around from several weeks of hardcore behavioral treatments for anxiety.

I had my therapy in Canada’s largest mental health and addiction teaching hospital (CAMH). What’s kinda ironic is I did my rotation there also. I did my rotation in the Schizophrenia Program Intensive Care unit. The thing about my panic attacks is they are pretty predictable. They only occur in performing or public-speaking situations. Since I get them only in those situations, it’s still considered a social/performance anxiety, because I’m basically embarrassed of having them in front of people, while performing. I’ve never had them in other social situations, crowds, etc. (no agoraphobia). If there’s no performing, I don’t get them. So while the fear/anxiety centered around the experience of anxiety/panic itself, it only occurs in performing situations. But, I get what you’re saying.

Performance anxiety is really social anxiety disorder except that it is a bit less generalized although again there isn’t a clear-cut dividing line between the two. I appreciate your and twatteaser’s feedback. I will look more into ACT. Both of you guys seem to know quite a bit of this stuff. I’m guessing you have had some personal experiences with it. I think I saw twatteaser in the Schizophrenia unit. He thought he was a horse just because he was hung like one.

Wow!:eek:

It’s working already!