Wednesday, October 26, 2016

Exposure and Response Prevention

     For the past couple of weeks, I have been discussing exposure therapy with my therapist. I decided this week was the week that I wanted to dive into that part of my treatment. Diving in might not be the best way to describe it because I had to do some prep work before I could try it out again, but, to me, it felt like diving into the deep end when I did the exposure exercise.
     I mentioned before that therapy, especially something as potentially traumatic as exposure therapy, is taken at a baby steps pace. Before I could try out exposure exercises again, I had to make sure I remembered my relaxation techniques. I also had to make sure I had a place in my mind, like a safe area, that I could retreat to in distress. I actually had to construct a happy place in my mind. (I hadn't previously done that, so I had to do that the week before and practice going there.)
     I went into my weekly session this week with my preferred relaxation technique and my happy place at the ready. Near the end of my session, I had to rate my anxiety so we could have a baseline. Then I had to set a number that I thought would be okay for my anxiety to jump to. (Think of it like judging pain on one of those ER pain scales.) A two point jump is all my therapist will allow, and I'm totally fine with that.
     Then came the time for the exposure exercise. Since we are treating my religious obsession first, I had to do something that would deliberately trigger my blasphemous intrusive thoughts, and I couldn't do any compulsive prayer or anything to ward off any consequences of my bad thoughts. My time limit for the trigger was 5 minutes maximum, but I only made it a couple of seconds before my anxiety jumped from a 2 to a 4 and the guilt rushed in. I tried to listen to a Gospel song, and I backed out after at most 3 or 4 seconds of the song. Then I cried. Then I had to practice my relaxation technique and go to my happy place.
     I'm surprised. First, I'm surprised at the fact that I couldn't do the exercise for more than a few seconds. I had expected to get closer to the five minute maximum time limit. Second, I'm surprised at the sheer amount of guilt that came rushing in and caused my anxiety to spike even higher. I hadn't felt guilt like that in over a year, since my diagnosis. In less than 5 seconds, I was right back to feeling like I was such a bad person that I didn't belong in my church with all the good people.
     According to my therapist, you have to deal with leftover feelings doing ERP. I had to deal with guilt that was left over from all those years of sitting in church, with intrusive thoughts screaming in my mind, and then hiding the shame and guilt that came after those thoughts. I have a lot of guilt to deal with after nearly six years of hiding my mental health condition and thinking I was possessed.
     I only needed a couple of minutes to calm back down so I could be logical, and that was also surprising. I had stopped shaking and crying by the time I left her office. My feelings of guilt had also dropped significantly by the time I left her office.
     I had been terrified that doing exposure exercises would send me into a downward spiral that would put me back in a bad place in my recovery. That didn't happen. I was exhausted but fine even after I got home. I still carried around some guilt for the rest of the day, and I was a little bit more emotional after I got home. I did notice, though, that my intrusive thoughts weren't really more intense this time, as they had been the first time I tried out an exposure exercise some months ago.
     How do I feel now? I feel relieved. I feel like I jumped over a hurdle, and I managed to land on my feet instead of flat on my face. I faced a fear and then felt like I could even do it again. Although, knowing that the exposures will become more intense the longer I keep doing them as part of the desensitization to my intrusive thoughts makes me feel a little nervous.
     I'll end with this: Thinking about starting ERP is scary, but going through ERP is definitely a better course of action than avoiding ERP and being controlled by my OCD. ERP is not something to be taken lightly, and it does take some prep work before you can start exercises. I don't like doing the exposures, but I do them anyway because I know that is the way to get well again.

Wednesday, October 19, 2016

Roller Coaster

     Since I have been forced to deal with my anxiety for the past year, I have realized something. I have realized that living with anxiety isn't just about managing the anxiety symptoms day-to-day; it's also about managing the roller coaster of emotions and mood swings that come with living with anxiety.  I have even noticed (thanks to my mom for pointing it out and making me keep up with it) that my anxiety-induced emotional roller coaster tends to go in a specific pattern.
     My pattern is always the same as far as I have noticed. I get the really high anxiety for a few days or weeks, depending on a number of factors. Then, after the anxiety starts to drop, I get super emotional. I just want to cry, about anything and everything or for seemingly no reason at all, and that lasts for a day or two. Then, after the crying comes the low period. I just feel "blah" and mildly unhappy and exhausted. I just want to curl up and watch TV all day. The low only lasts for a few days or a week, like the really high anxiety, and then I go back to feeling more like myself. (I can go for weeks or even a month now, or this last time a couple of months, without high anxiety, and then the emotional roller coaster doesn't happen. I can feel like myself all the time.)
     Becoming depressed and suicidal is actually one of my Pure O obsessive worries, so you can imagine how much I freaked out when I realized that these low periods were becoming a regular part of my life with anxiety. Then the freak out just caused me more anxiety that would start the whole, overwhelming roller coaster ride all over again. I worried for a long time that I might have Bipolar Disorder because of the ups and downs I experience on a regular basis now. (My therapists both assured me that I don't have Bipolar Disorder, so I haven't been misdiagnosed a second time.)
     In other words, my anxiety can make me feel like I'm all over the place emotionally, and I didn't understand that or know what to do with it. All I knew was that it freaked me out and made me feel out of control. My therapist calls it something like my pattern of getting well (I think). Now that I know that this is a pattern I will likely always live with as long as I live with anxiety, I just ride the roller coaster and hope it doesn't take a long time before I can get off of it and back to myself.
     I can't really change the pattern or force myself not to have any low periods. So, I just cry when I need to cry. When that goes away I treat myself like I would treat someone else who was feeling low. I Pinterest and I watch my favorite movies. I rest. I also hang on to the fact that I know I will eventually feel better if I give myself the time I need to get there. (I also try not to give in to my obsessive worry that I'm getting depressed and I won't recover, but that is a little bit difficult.) It's apparently a pretty common thing for anxiety to directly cause mood swings or to cause so much distress that it indirectly causes mood swings, much like any other stress can make some people moody.
     I'll end with this: Living with anxiety is more than just managing anxiety symptoms day-to-day. Sometimes it feels like I'm unwillingly strapped into an emotional roller coaster. It's okay to cry and be exhausted. You can't force your emotions to always be under your control. Sometimes you just have to ride it out, and that's okay. Feeling like you're riding an emotional roller coaster when you live with anxiety doesn't mean you require a new clinical diagnosis, but if you feel like something else is to blame you should definitely talk to a therapist/your doctor. You won't always feel all over the place.

Wednesday, October 12, 2016

Hormones and Mental Health

     We all hear about how pregnancy can impact our mental health because of Postpartum Depression. We all hear about how menopause can impact our mental health because a lot of women experience clinical Depression after menopause. We all hear about Premenstrual Dysphoric Disorder (PMDD) and how rough the couple of weeks before periods can be for some women.
     The thing I don't see talked about a lot (outside of a couple women's discussion forums) is how normal monthly hormone fluctuations (your period, your lady's days, Aunt Flo, whatever you want to call it) impact an already existing mental health condition. I know that since I've been struggling with severe anxiety since last summer, my anxiety and my intrusive thoughts spike about a week, sometimes 2 weeks, before my period. I get normal PMS, and then my anxiety skyrockets on top of that. It seems like any little thing can trigger my anxiety around that time, too. I even started to wonder if I might have PMDD. I don't, but I was concerned about it until I figured out how common it was for most mental health conditions to be worse during monthly hormone fluctuations.
     I was curious about this because I never knew that my mental health condition could be so closely tied to my hormones. I talked about it with my therapist, and she said it was a common complaint among females with anxiety. I read in 2 discussion forums for women that most women felt like their OCD, Anxiety, or Depression was more severe a week or two before their periods, even when they didn't have Premenstrual Dysphoric Disorder.
     What can you do to help when your mental health condition is so closely tied to your hormones? Well, a large number of the ladies in the discussion forums with anxiety conditions said they chose to go on birth control just to level out their hormones. If Depression is the problem when your hormones fluctuate, my therapist mentioned that doctors will usually prescribe Prozac to help. You just have to talk to your gynecologist and/or your regular doctor. Since my problem is OCD, I just take L-theanine (200mg) that my therapist suggested when my anxiety gets higher than normal before my period.
     I also do some other things when my anxiety is high because of hormone fluctuations. I try to stay busy doing things I enjoy. I spend extra time practicing ukulele, and I watch people play songs on ukulele on YouTube. I talk to friends more. I try to write, even when I don't feel like writing because I'm exhausted. I read more. I watch funny shows like I Love Lucy on Hulu. (I also ate a whole bag of marshmallows over a period of a week and a half, which may be a bad thing...)
     My point is that during the 2 weeks before my period, I have to double my coping efforts. I have to cope with the PMS as well as the extra high anxiety. I can't give in to the all the cravings for the extra sugar and caffeine and the junk food like I used to because that would just negatively impact my anxiety. I also can't just give into the PMS fatigue because then my anxious brain gets bored and goes haywire, so I clean things in spurts of energy between rest periods.
     I'll end with this: I hadn't realized that my mental health condition could be impacted by the usual, monthly hormone fluctuations. PMS with an added mental health condition can be an overwhelming combination, and it's okay to talk to your doctor/gynecologist about something (like medication or some extra coping techniques) they think might help. It doesn't even mean that you have PMDD, but if you think you might you should talk to your doctor because PMDD has a specific treatment plan outside of your already diagnosed mental health condition.

Wednesday, October 5, 2016

Natural Remedies to Help Anxiety

     My therapist and I recently discussed medication, and we landed on my unwillingness to try them because of the side effects that come with certain medications (feeling suicidal, the possibility of worsened intrusive thoughts, more anxiety). I told her that if medications didn't have side effects like that I would be willing to try them. (As in, either the medication works or you don't get anything from it at all is similar to what I told my therapist.) This led her to bring up the topic of natural remedies that have proven effective in managing anxiety symptoms. She mentioned 1 supplement and 2 herbal remedies that could help me with no nasty side effects.

1. L-Theanine (particularly the kind made with Suntheanine): This is an herbal remedy. L-Theanine is found in green and black teas. I consider this one to be the safest because it doesn't have any negative side effects. I ordered myself a bottle of capsules from Amazon. 100mg isn't strong enough to lower my anxiety, so the next time I try it I'll try 200mg. It does make me groggy, but I can still function when I take it. (I also read a study that 200mg of L-Theanine worked better than Xanax. I'll provide a link to that information at the bottom.)

2. Valerian Root: This is also one of the herbal remedies that my therapist mentioned during our session. Valerian is a sedative, and it is often used to treat insomnia, but it can also reduce anxiety. (You shouldn't take it if you take other things that make you drowsy.) I haven't tried this one, and I don't intend to try it since it is a sedative. I need to function normally throughout the day to write.

3. GABA: GABA occurs naturally in our brains. L-Theanine (see above) boosts GABA in your brain, which makes you calmer. The results on taking a GABA supplement for anxiety are sort of sketchy. It's even suggested that it might be better to try L-Theanine or Magnesium, and some B vitamins to help with GABA without having to take a straight GABA supplement. (Link below, at the end of this post.)

     I know there are more natural remedies for anxiety floating around out there, and I would be interested to hear more about some of those if any of my readers have any experience with things I didn't list here. I listed these 3 because they were the ones that I discussed with my therapist and that we researched a little during my session.
     If you feel like you need some help managing anxiety symptoms, but you don't want to take any psychoactive drugs, these natural herbal remedies and supplements might be another great option. You should consult with your doctor and/or therapist and do plenty of research before you try any herbal remedy or supplement.
     I'll end with this: If you don't like the idea of taking medications just yet or you want to save that as a last resort, trying out some herbal remedies and supplements (with the approval of your therapist or doctor) might be an option to try. These remedies and supplements don't have the nasty side effects that make medications so hard to tolerate, but they may not help everyone. Everyone's brain and anxiety is different, and may respond differently to any of these alternative treatments.

Links:
1. L-Theanine: http://www.lifeextension.com/magazine/2007/8/report_stress_anxiety/page-02
2. GABA: http://overcomingyouranxiety.net/naturalanxietyremedies/gaba-for-anxiety/