A way through anxiety: Accepting ourselves

Imagine you’re holding an ice cube in your hand.

You concentrate on the sensations doing that causes.

Eventually, you begin to have thoughts unrelated to the sensations, thoughts like, “This is really uncomfortable,” or “How much longer do I have to do this?”

When those thoughts come, you notice them, acknowledge that you have them, and then go back to concentrating on the sensations of holding an ice cube.

Acceptance

That is an illustration that my therapist used to explain acceptance in terms of generalized anxiety disorder or any anxiety.

On my last visit, I told him about the increased anxiety I’ve had lately. I’ve felt revved up and unable to settle down and concentrate.

So he talked to me about accepting my anxiety. He said it’s not the same thing as liking the anxiety.

And it’s different from actually making the anxiety worse by worrying about the bodily sensations of anxiety, worrying about worrying, “catastrophizing” the fact that we feel anxious.

We can practice acceptance by focusing on the bodily sensations that come from feeling anxious. When an unrelated thought comes along, we can acknowledge it but then return our attention to the sensations.

With this mindfulness, we can begin to accept that our body is expressing anxiety.

Acceptance is to acknowledge what we’re experiencing and then to go on to something else.

Ironically, that makes the anxiety easier to deal with, my therapist said.

Mindfulness

The ice cube example also helps to illustrate the importance of mindfulness. We can choose to focus on our anxious feelings, but I’ve learned that we can also choose to focus on something like the breath, or our senses.

Every time we realize we’re thinking of something other than the breath or what we’re hearing, for example, we can bring our attention back. Usually I have to do this again and again

That puts me in the moment. It takes me away from my worries. It takes me away from worrying about my worries.

And even a little while away from the worries provides me with relief. And a little more acceptance.

What about you? Does accepting the anxiety make sense to you?

Making art to ease the anxiety and depression

Mandala #1

I am not an artist.

I have never been able to draw.

   I have taken one art class in my lifetime, one called “Drawing on the Right Side of the Brain,” which helped me understand that, unlike an artist who draws what he or she sees, I tend to draw what I know.

For example, I know that a dining chair has four legs of equal length, so that’s what I draw—and it doesn’t look like a chair. One who sees like an artist, though, automatically draws the chair with perspective, drawing how the chair appears.

Other than my work with that one class, I have allowed my lack of basic talent keep me from my love of creating, of color and of design.

Then, as I wrote about in a past post, last fall I pulled out my art supplies and started coloring and drawing mandalas. I consider making them part of my therapy.

That making art, being creative, can be therapeutic is not a new idea. According to the International Art Therapy Organization website, art therapy is considered a mental health profession, though it is also used in non-clinical settings.

I have not participated in art therapy with an art therapist. I have simply found that making art, specifically mandalas, helps to calm my anxiety and feel the satisfaction of completing something.

In her blog “The Healing Arts,” Cathy Malchiodi wrote about art therapy using mandalas.

“According to [Carl Gustav] Jung, mandalas symbolize ‘a safe refuge of inner reconciliation and wholeness.’ They have the potential to call forth something universal within, perhaps even the proverbial archetypal Self. And at the same time, they give us an experience of wholeness amid the chaos of every day life, making the ‘sacred circle’ one of the very coolest art therapy interventions for both soothing the soul and meeting oneself.”

An idea for a mandala usually starts with an idea or experience that I want to express. I may not put pencil to paper for days, but I mull over how I want the design to look and what I want to include.



Mandala #2



Sometimes a picture of a mandala is complete in my imagination before I draw it. Other times, I create as I draw.

In mandala #1 pictured with this post, I chose to express my priorities. At the center of the circle, the blue, smaller circle represents for me the center of all life. Around that I have the bond of the wedding rings to represent my marriage, and other symbols to denote my spiritual life, my cats and my writing and reading.

Around that are other symbols representing my love of animals, nature and music and my search for peace.

In mandala #2, I created a picture of chronic depression: the dips into the darkness of depression, the gray of the chronic disorder and the blues and greens of whole life available.

I enjoy creating such pictures to look at later and even meditate on.

The process of sitting and drawing and coloring is relaxing. I focus on the task at hand and practice mindfulness. And creating a mandala teaches me about myself.

I want to venture into other art forms and types. I just need to get over my fear of not being good enough and my notion that if I’m not good at something, I shouldn’t try.

What activities do you engage in to feel soothed, to feel like you’re getting in touch with your real self? Do you make art? If so, what kind? How does it make you feel?





Can you please turn that down?

This week I’ve been building my posts around the five senses. Today, I consider the sense of hearing.

Loud noises bother me. A lot.

Noisy restaurants, crowded parties—I can stand only so much, and then I have to get out. And the silence that comes once I escape seems heavenly to me.

Loud noises make me anxious, and anxiety makes my OCD more difficult to deal with and can even make me feel depressed.

I’m reading the book The Highly Sensitive Person: How to Thrive When the World Overwhelms You, by Elaine N. Aron, and I suspect that I am a highly sensitive person—prone to not liking loud noises, lots of chaos, bright lights and other stimuli that most people handle just fine.

I found this passage interesting:

“One general rule is that when we have no control over stimulation, it is more upsetting, even more so if we feel we are someone’s victim. While music played by ourselves may be pleasant, heard from the neighbor’s stereo, it can be annoying, and if we have previously asked them to turn it down, it becomes a hostile invasion” (p. 22 of e-edition).

When I’m in the car by myself, I turn up my music, and usually sing along. But I remember the days when I lived in apartments and it drove me crazy to have to listen to neighbors’ music, especially pulsating, booming music that shook the walls.

After a while of listening to loud music in the car, I do like some silence, and I’ll turn it down or turn if off completely. And chronic noise bothers me.

But noisy restaurants and crowded parties probably bother me in part because I can’t control the volume.

Sometimes my husband has the television turned up louder than I’d like it. In the room across from our bedroom, where he sometimes watches TV, the television is old. You have to turn it up to hear the dialogue in a show, but then the commercials blare out.

It used to really bother me, especially if I was trying to go to sleep. But since I’ve been working on being more mindful, I’ve tried to actually tune in to the TV’s sounds and sense them as part of many sounds around me.

That said, I still prefer quiet. The quiet helps to soothe my anxiety.

When I want sounds to be soothing, music will sometimes do the trick, usually instrumental music with no words. But some artists, like Alison Krauss, can soothe me even with words.

Here are some other sounds that soothe me:

*The sound of my husband when he loses himself in laughter.

*His soft breathing as he sleeps.

*The purrs of my cats.

*The soft pad of the cats’ paws on the floor.

*The birdsongs in the early morning.

*The slight whirl of the ceiling fan over the bed.

*The wind high in the oak trees.

*Gentle wind chimes.

What sounds drive you crazy? What sounds soothe you?

She called me high functioning: My first visit to a psychiatrist

Dear readers,

This is a very small excerpt from the book that I’m writing about my experiences with OCD and depression. It’s the story about my first visit to see my first psychiatrist when I was 26 years old.

I’d like you to read this not just to find out about that experience, but to also give me some feedback on how you think this would fit into a memoir. What would you like to learn more about? What needs to be fleshed out or clarified? Are you interested in reading more?

And please share your experiences as you feel comfortable. If you’ve been treated by a therapist or psychiatrist, what was that first visit like? If you were diagnosed with a mental illness, how did the diagnosis make you feel?

I always appreciate your comments and feedback. Thank you!

She called me high functioning.

What the psychiatrist actually said was something like, “I would consider you high functioning since you have managed to stay in school and do your work.”



Me at 26.



High functioning seemed to be more than generous, because I certainly didn’t think of myself that way.

I spent countless hours cleaning my small bathroom. If I cooked or even just cleaned the top of the stove, I spent several hours checking to make sure the stove was turned off. Any cooking, whether it was on the stove or in the microwave, produced repeated and careful washing of the countertops. My hands and wrists were red and chapped from my repeated washings to rid myself of any germs that might hurt others. I couldn’t walk up a sidewalk or path without starring at the ground, looking for sharp sticks or rocks that could possibly harm someone. My mind was full of prayers and chants to a God I couldn’t really talk to.

I didn’t consider myself to be high functioning.

I had never been to a psychiatrist’s office before. I was 26, and after a year of talk therapy, the psychologist had decided that my depression was not going away and I probably needed some medication.

I had also revealed to her my obsessive-compulsive disorder symptoms. That surprised her.

“All the time we’ve been talking, and you never mentioned it,” she said. “I would have never known.”

So perhaps to her, too, I was high functioning.

When I arrived at the psychiatrist’s office, which was located in a town north of the town I was living in while attending graduate school in northwest Ohio, I wasn’t sure what to expect.

Would I lie down on a couch? Would she ask me questions about my childhood that I wouldn’t want to answer? Would she judge everything I said through the lens of Freud?

I admit that I was glad her office was not in the same town that I lived in. I desperately wanted to keep this visit secret.

The waiting room looked like all the other doctors’ waiting rooms I had been it. Muted greens and blues. Semi-comfortable vinyl-covered furniture. Magazines.

I was embarrassed as I stood at the counter in the waiting room and paid for my visit. What was the receptionist thinking? That I was crazy? That something must be scarily wrong with me because I had an appointment with her boss, who was a head doctor?

When the psychiatrist called me back to her office, she had me sit down in a chair, directly across from where she sat behind her desk. There was a window behind her desk, shining light on me.

She then started with the business of the visit. She asked me a lot of questions, questions I’ve since been asked many times by any new counselor or psychiatrist.

Why are you here today? What problems are you having? Are you sleeping too little or too much? What are you eating habits? Do you get pleasure from daily activities? Do you feel hopeless? Have you ever considered suicide?

For the OCD, the questions were along the lines of, what do you obsess about? What kinds of things are you doing compulsively? How do they interfere with your life?

It was more like a job interview than a doctor’s visit.

Eventually, she diagnosed me with depression and OCD. I wasn’t surprised by what she said. I certainly felt hopeless, suicidal and dead inside. And I had read enough to know that my bizarre habits indicated I had OCD.

But hearing her say the words, officially diagnosing me, was an experience that I would now call life changing. Before, I could simply hypothesize that I had these disorders, especially the OCD. I could always imagine that I really didn’t have OCD. I was just a sinful, bad and weird person who wasted time, water and money, all in the name of my strange habits.

With the diagnosis, I had a stamp of officialdom on my habits. They were weird, yes, and wasteful, yes. But they were also symptoms of a disease, albeit a disease I felt humiliated for having.

The psychiatrist talked about a new drug that had just been approved by the FDA called Anafranil. It was the first medication that targeted OCD specifically. She had seen it used in drug trials, had seen its effectiveness.

But it had just been FDA-approved in December, and this was January. It wasn’t yet available to the general population, she said.

So she prescribed Prozac. It would help the depression, and it might help with the OCD. Time would tell.

I walked out of her office with some hope of help. But I also walked out with self-consciousness and a sense of shame.

7 things I've learned about treatment for OCD and depression

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*A combination of tools works better than any one thing.

My treatment has included medication, talk therapy, cognitive behavioral therapy and CBASP, and well as self-treatments such as exercise, yoga, meditation and relaxation techniques.

None of these by itself has been enough. And that’s OK. I know there’s no magic pill. And I like the idea of a synthesis of treatments working for the good of my health.

*You’ll notice improvements before anyone else will.

  My first signs of improvement were so subtle that I thought perhaps I was imagining them. I felt a little less down, had a little more energy, was able to stop washing my hands a little more quickly, didn’t check the stove as long.

But I noticed them. Maybe no one else could see a change, but I did. And my therapists and doctors needed me to tell them of any improvements.

*At first, you won’t necessarily see the connection between the treatment and improvement.

My therapist told me that people tend to not want to believe that medication, for example, is the reason for the improved symptoms. It’s hard for us to make such a connection. A pill can help me not have obsessive thoughts? A pill can help me feel less hopeless?

I’ve found that to be true of medication and with the CBASP. I’m feeling better, but it seems like it is a little too good to be true.

And it’s hard for me to see the forest for the trees, so to speak. Therapy is intense and detailed. It’s hard sometimes to lift my head and see the results.

*It’s not easy.

The CBASP is hard. ERPs are hard. Dealing with medication side effects is hard. It takes dedication and discipline to keep doing the things that will make me feel better.

And there’s the fear of failure. Sometimes during a therapy session, I worry that I’m not doing it right, that it’s not going to work.

That’s when hope is so important.

*It’s usually not a quick process.

  I’ve been in treatment of some kind, even if it has just been medication, for 22 years. That’s hard to admit because there’s a part of me that believes I should have gotten it right by now. But that brings me to the next point.

*It will never actually end.

  Treatment for OCD and depression will go on indefinitely because there is probably no cure, only remission, by which I mean a lessening of symptoms. Even when I’m no longer in active therapy, the exposures will continue, the self-talk and learning will continue.

*Any treatment works better if you take care of yourself in basic ways.

It’s important for me to get enough rest and to eat properly. If I get very tired, I first get very anxious, then I crash and get more depressed.

If I eat too much or too much junk food like sweets and simple carbohydrates, I feel sluggish and my stomach bothers me, which in turn makes less energetic.

And having time for myself to read, think, and just relax is key to me being better able to handle what life brings.

What have you learned about treatment for OCD and/or depression or other mental illness? What suggestions do you have for others going through treatment?

Treatment journey: Not straight, and certainly not quick

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There are two main ways to get from my town to the county seat, where I do a lot of my reporting for the newspaper.

One way is mostly on a four-lane major highway. The speed limit is 60 mph. Even when I have to turn onto a two-lane road, it’s wide and well marked and I can make good time.

The other way is mostly on back roads, narrow and curvy secondary roads. It’s a more direct way to get to the county seat, but narrow and sometimes unmarked roads slow down safe drivers. You will eventually get to the county seat, but it will take longer than if you take the major highway.

Some journeys are straight and true, some not. Figuratively, the same could be said for the journey to effective treatment for mental illnesses.

My fantasy journey

I would have begun exhibiting obsessive-compulsive disorder and depression symptoms, which would have drawn concerned interest from my parents, which would have led them to take me to a doctor, who would have referred me to a psychiatrist, who would have diagnosed me and begun treatment.

Admittedly, since I started showing strong symptoms of OCD in the early 1970s, treatments would not have been what they are today. But as the years passed and knowledge of and research into OCD increased, I would have gotten better and better treatment for both the OCD and the depression.

And so, in my perfect dream, I would have spent my 20s, 30s and now my 40s living a life with OCD and depression, but a life not as greatly affected by them.

Yes, it’s just a dream. My treatment journey wasn’t that straight and true one, and I would bet that most people’s journeys aren’t either.

My real journey

I remember being taken to the doctor when I was about 9 or 10. My mother told me it was because I was crying at night and I wasn’t eating a lot. I don’t remember this. But according to my mother, the doctor said that even though it had been my brother who was in the hospital a lot, I had been through a lot, too, with being away from home and having to stay with relatives.

That was the end of that foray into medical diagnosis. The next time I saw a health professional for anything other than a physical ailment was when I was 25 and started seeing a counseling psychologist for my depression.

That was talk therapy. I talked about my life, and she listened. But she also taught me that my patterns of thinking were not healthy and were not a reflection of reality. For example, just because my mother told me I was lazy didn’t mean that I was.

When I was 26, I saw my first psychiatrist and was officially diagnosed with OCD and depression. I started medication, which greatly improved my symptoms.

In the years after that, I was in a little more talk therapy, but I focused mainly on medication therapy. I thought I was as well as I could hope for.

But in January, 22 years to the month that I was diagnosed with the mental illnesses, I decided to try cognitive behavioral therapy for OCD. Later this spring, I started Cognitive Behavioral Analysis System Psychotherapy (CBAS) for chronic depression, which was getting in the way of my OCD therapy.

I am finally on the road to real recovery.

How can we make it better?

What are some ways that we can better ensure that the road to good treatment is more straight than curvy?

Recently, Elizabeth, of Into My Own, reminded me of the importance of being our own health advocate in a great post.

When I worked as a health educator, I became interested in health advocacy because I saw so much need for it.

Advocacy is “(t)he act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support,” according to The American Heritage Dictionary.

Being an advocate for yourself means asking the questions, educating yourself, and getting the care, including proper diagnosis, for yourself as you navigate the health care system.

Being an advocate for others means doing the same thing, but for others.

Being an advocate or even having an advocate may help you get a diagnosis sooner rather than later and may help you get on the road to recovery more quickly.

The following are ways that I have discovered to be helpful in being your own advocate or an advocate for someone else (Note: I use the term “doctor,” but you can insert therapist or any health care professional):

*Research respected sources for accurate and up-to-date information.

*Before you go to the doctor, make a list of questions to ask.

*If you don’t understand something the doctor says, ask for clarification.

*Take notes and/or ask for available handouts about a diagnosis, test, or treatment.

*Consider taking someone you trust with you to the doctor so you’ll have a second pair of ears to listen and take notes. (I realize this may not be desirable or appropriate if you’re going to a psychiatrist or therapist.)

*Find out the best way to get in touch with the doctor between appointments.

*Don’t be afraid to change doctors if for any reason you are not comfortable or cannot build a trusting relationship with him or her.

Was your road to diagnosis and treatment long and winding, or was it more straightforward?

Do you consider yourself to be a health advocate? How do you advocate for yourself? How have you advocated for others?