two years

Today's the anniversary of my "breakdown." Actually, I guess it really started the night before with the first of the panic attacks, but this was the date where I was in the hospital all day, so I consider this to be The Infamous Day.

I never thought I would feel like myself again, but I do. I can now say I feel like my anxiety is under control, at least as much as it can be while still having a phobia. It's just exhilarating to know that. Two years ago I was such a mess, and I had never imagined that things could get that bad. And then I couldn't imagine that they would ever get this good again either.

In celebration of this, I'm posting the timeline of my improvement. This is pretty much how the last two years went:

September 10, 2010: I was in the hospital most of the day discussing my non-stop panic attacks with various people. Then they gave me Ativan, and I went home and took that immediately, and then one or two other times in the next few days.

September 11-19: I went to the doctor three times. The first time I was given Lexapro, which made me feel sick, so I only took it once. The second time I got my thyroid tested (problems with it can cause anxiety issues), and nothing was wrong with it. The third time I was given Cymbalta, and I only took that once too. It didn't make me feel sick, but it did have minor side effects that bothered me (like restless legs).

I missed a lot of work. I couldn't eat or drink much. Everything I ate made me feel nauseous; I was taking a lot of Zofran during this time. I couldn't sleep and basically spent every night in the living room, dozing with the TV on.

I started seeing a therapist and doing breathing exercises, and I listened to a guided meditation CD every day and tried to meditate as much as possible. It was not something I had done much in the past, but it helped immensely anyway. Just made me feel temporarily calmer.

September 26: I started working through The Anxiety & Phobia Workbook. I know I've talked about it a lot, but I'll say it again. It's an amazing book. It helped me so much.

October 5: I joined a gym and started exercising more to see if that would help. It does help, but I still have a hard time sticking with the habit, even now.

October 8: By this point I was doing word searches almost constantly, especially when I woke up in the middle of the night (which was almost every night). They really helped me calm down when I was anxious.

October 16: I wouldn't let myself watch anything (on TV or in movies), read anything, think about anything upsetting or anxiety-producing. I felt frustrated by having to hide from negativity, but now I think it was the right thing to do. It helped me get better faster, and obviously I no longer have to do it. But I still don't watch horror movies. I used to watch them all the time and now don't let myself, because they have too much of an effect on me.

October 20: I had gotten a little notebook and was writing out affirmations in it every day. I would pick one from The Anxiety & Phobia Workbook and write it out five to ten times in a row, pausing in between to reflect on what it was saying and really try to believe it. I did this at least once a day, but more if I was really anxious. It was another activity that calmed me down.

December 4: I started noticing that PMS always made my anxiety issues much worse. I began reminding myself of this every month around that time so that I wouldn't take my thoughts and feelings so seriously.

February 3, 2011: I started doing yoga. I don't do it much anymore, but it was helpful and calming at the time. 

April 30: I printed out some of my favorite affirmations and would tape one to the wall above my desk so that I'd be reminded of it frequently throughout the day. Every so often, I'd switch to a new one. 

May 9: I was still seeing that my anxiety got significantly worse and hard to deal with during PMS, so I started taking 100mg of B6 daily (on top of a multivitamin) to help with that. It seemed to work wonders (after a couple months I think). I still take it. 

July 23 - 26: I started having bad panic attacks again. It felt like a repeat of the initial "breakdown" only to a much lesser degree. But again, it was extremely difficult to eat or drink for a few days, and I felt horrible all the time. I'm not sure what caused this relapse, but I got it under control much faster than I had the first time, mostly through forcing myself to eat as much as possible, which kept me somewhat stable. This gave me hope that I was moving in the right direction. 

August 29: I started taking a class at a college nearby. This forced me out of the house on a regular basis, forced me to interact with the world again, which was something I really needed. I had gotten pretty homebound. 

September 10: I tried hypnosis for the first (and only) time. I felt slightly better for a few days after it, but I have no idea if it was the hypnosis that caused this. Or the placebo effect. Or coincidence. 

November 22: I took a trip to see my family for Thanksgiving. This was very stressful and didn't go as well as I had hoped. Again, I had problems eating, drinking, and sleeping. I felt sick almost constantly. But I did manage to get through it without any medication (psychiatric or anti-emetic). I used affirmations that I had written out on index cards and the EmWave2 I had just gotten.

February 19, 2012: I did an online emetophobia study which started around this time. It involved a lot of CBT and exposure work that was helpful.

May 1: I stopped going to therapy, because I felt pretty confident that I knew what to do when I was anxious. Most of the time I could calm myself down by countering my negative thoughts and focusing on more positive ones.

That's about it. I've been doing really well this year. Basically, the Thanksgiving trip was the last "crisis" period I had, and I am sure that if I took that trip again this November, it would go a lot better.

Speaking of trips, I am taking a small one later this month. I won't even be leaving the state, but I will be staying in a hotel in another city. I'm excited. For the first time in a long time, I feel excited about a trip. I'm not dreading it! I think it's going to go really well and be loads of fun.

self-healing rituals

Most people have heard of the placebo effect. A person is given a fake cure for some ailment, but it actually does make them feel better, because they believe it will work. Usually the person receiving the placebo doesn't know it's a placebo. They think they are getting real medicine (or surgery).

But some studies have shown that placebos can work even on people who know they are taking a placebo. This article from NPR gives more information. The theory as to why this works is that taking the medicine or having the surgery creates a "self-healing ritual" - which is just another way of saying that you're taking action to fix the problem. Your mind is aware of that, and then both your mind and body "expect" that this action will have good results. So it does.

A.J. Jacobs talks about this effect in his book Drop Dead Healthy:

"You could view placebos as depressing, I suppose. So much of medicine is a sham. Your brain is a three-card monte dealer running cons on the rest of your body. But I don't see it that way. I find placebos uplifting and exhilarating. It means that taking action - no matter what that action is - might help you feel better. The key is just to get your aching butt off the couch."

I'm not saying placebos are all you ever need to be healthy. When it comes to more serious illnesses, actual medicine would be necessary (although optimism - believing you will get better - is always a good thing). But for something like emetophobia, or any other kind of health anxiety, or even problems like IBS or chronic pain syndrome (that have been shown to improve using psychological treatment), I think self-healing rituals are extremely important.

I remember that when I started having those horrible panic attacks two years ago, I felt anxious almost constantly. It was like my brain was full of it, like I was always on the verge of hysteria - except when:

• I went to the hospital. On the drive there, in the waiting room, explaining how I felt to various doctors. I felt calmer this entire time - still not normal, but much better. I trusted that they would make me feel better. (It's been said that even seeing the usual attire of a doctor creates a placebo effect.)
• I went to the doctor to discuss trying psychiatric medication.
• I went to the pharmacy to pick up the medication. This one I remember the most. Even now, whenever I drive by that particular pharmacy, I feel my spirits lift a little, remembering how it was a beacon of hope for me at that moment. Even though I hated the medication and didn't continue taking it, I was so relieved at that time to have it as an option. I can see why many people believe medication is a quick fix. I told myself over and over that this wasn't true, but your desperation overshadows what you know.

Once all this was behind me, I realized there would be no quick fix, and I would need to keep working very hard on my own. I kept creating my own self-healing rituals: meditating every day for a certain amount of time, writing out affirmations over and over in a little notebook, and (my favorite, in terms of making me feel more hopeful) flipping through The Anxiety & Phobia Workbook and reminding myself that there were more things to try if what I was doing didn't work - that there was even the possibility that combining certain approaches would work best, which meant there were almost unlimited options.

So I am in total agreement with A.J. Jacobs when he says that taking any action can help - and that this concept is extremely uplifting. Anxiety can feel like it is paralyzing you, but taking steps, even small steps, to conquer it can be a powerful "weapon" in itself.

celebrating progress

I am usually hard on myself. I think all the time about things I do that I shouldn't be doing, things I avoid that I shouldn't be avoiding, etc. I try to pin down every single way that I am failing to function as a "normal" person due to anxiety so that I can fix it all. I'm not doing that today.

One year ago today, I was in the hospital for almost the entire day because of panic attacks. I knew that was what was happening; I've had anxiety my whole life, so I was familiar with the symptoms. But this was different than anything I had experienced, panic attacks that were hitting me from out of nowhere - while I was sitting safely at home - and lasting for hours. I really thought I had reached the point where I was going to lose my sanity. I couldn't stop thinking about those brief biographies that are written about authors like Poe or Plath or Hemingway, the kind that paint them as people who were doomed all along to a life of insanity, and it was just a matter of waiting for that final blow, the last nervous breakdown or institutionalization.

The panic attacks didn't start from an emetophobic place, but of course they ended up there. Before I even went to the hospital, I had gotten to the point where I wasn't eating much, because I was so overwhelmed. Then that turned into (what felt like) an inability to eat anything, which lasted for about two weeks. I did eat during this time, but only because of my wife. She would bring me something and insist that I eat it. I never once felt aware of being hungry, and everything I put in my mouth, including water, made me feel so "nauseous" that I was terrified of swallowing. I remember her bringing me a small bowl of dry Cheerios one morning, and after one or two bites I started sobbing, because it felt impossible to eat the entire bowl. I was scared I would never want to eat again and couldn't imagine a lifetime of forcing myself to do it every day.

I know the anxiety set this off, and taking Ativan one day, attempting Lexapro another day, and then trying Cymbalta on another, all on a practically empty stomach, can't have helped the situation. Especially when it was my first time ever taking psychiatric medication (I didn't end up sticking with any of them). But I think what caused it to last for so long was my own inaction. I was clinging to my long-held belief that 'not eating is the best defense against feeling bad,' even though I felt absolutely horrible, and it was clear that not eating was perpetuating that.

But since I'm celebrating progress here, I'm not going to talk about how I should have handled that better and could have gotten myself accustomed to food again much faster. I'm going to talk about how I did handle it better the second time around, because about two months ago, this happened to me again. I had a few panic attacks, and once again, I felt like I couldn't eat.

I'm really glad this second bad period happened. At first, it shook me up and made me feel that in spite of all my hard work, I hadn't gotten anywhere in the past ten months. But it became obvious, from the way things played out, that I had changed. There was no hospital trip. Instead of missing about five days of work, I only missed two. I still had some Ativan, but I didn't end up taking any. I increased my focus on affirmations and practiced breathing / visualization exercises. Most importantly, I made it one of my top goals to eat as much as possible. I still wasn't consuming anywhere near the amount I should have been, but I was at least having enough every day so that I didn't get into that emetophobic cycle where it just gets worse and worse: hunger = nausea = don't eat = more intense hunger = more intense nausea = still don't eat, etc.

I was back to eating normally within a week, and it never got so bad that I was crying over a meal. I was able to drink water the whole time. Plus whenever I did eat, I actually thought about what would be the best choice, given that I was somewhat malnourished and might not be able to eat a sufficient amount. I tried to choose what had protein and actual substance, versus a year ago when I only went for "safe" carbs like crackers, toast, cereal.

So looking back over this entire year now, I feel like I've come so far. It's strange even to remember being in the hospital and how I was desperate for them to send me home with some drug, because I figured it was all over for me, and that was the only way I might possibly be able to live a normal life again. It's incredible to know that when these bad anxiety periods happen, I don't have to just fall into that state of helplessness and passivity. I have some control and can do things to reduce both the level of anxiety and the length of time I feel that way. I've been trying to convince myself of this for the past year, and I am finally at the point where I believe it most of the time. Now I just have to figure out how I can prevent these bad periods from happening in the first place.