The title says it all. It’s my anxiety. I own it.
It’s a pretty basic statement on it’s surface. Straightforward.
When I left my weekly CBT session today, I had that feeling. You know that feeling. The one that feels like you just bullshitted your way through a situation. But the thing is, you didn’t actually bullshit anyone. You went through the motions, did the things you asked, and responded truthfully. But something still seems off. It’s the things you didn’t say. Those are the things that are bothering you. The things you didn’t reveal.
I have a great doctor. He is holding up his side of the bargain. I have a plan that’s realistic, executable, and proven. Now it’s just up to me to make it happen.
And I do. I really am doing a great job. But there is more that can be done. I’m putting in 90% effort. But that extra 10% … that extra push … that’s where I’m starting to fall short. And it’s not out of desire or effort. So what is it?
(I think I’m on to something here.)
It’s taking responsibility for my anxiety. I need to own my recovery plan. While I have a great doctor, the plan is given to me to use for me. It’s onlyour plan in the conceptual sense. It’s my plan in the execution sense.
When I report my exposure results each week, I’m treating it like I’m reporting my progress to my doctor. But I should be reporting my progress back to ME. I am the boss of this plan. The buck stops with me. Nobody else can push me to make that last 10% of effort.
It’s not an assignment graded on a curve by my doctor. It’s not ok to do the minimum amount of work to declare done while my doctor gives me a few atta-boy’s — all the while knowing that I didn’t put in that extra effort.
I have to own this, completely. I don’t think I have thus far. That needs to change.
Yes, I’m talking to YOU, Brian!
I can take the physical symptoms of panic. It’s the emotional side that makes the event almost unbearable.
Physically, our bodies go into ‘save yourself’ mode. More commonly termed the fight or flight response. While the physical symptoms are uncomfortable, I feel confident in my ability to cope.
Emotionally, we feel a deep fear. It feels wrong. It feels urgent. Like being locked in a space in which you can’t escape. You just want the experience to end and now.
I was on a slow moving train yesterday. It was an express train in NYC from 34th street to 14th street that was anything but express. As we crawled along I looked out of the windows in an effort to gauge our progress. I have to do this. My disease is all about control and my ability to escape. The slower the train goes, the more out of control I feel. I want to scream at the conductor “GO FASTER!!!”. I want to pry open the doors to jump out and sprint down the tracks to an exit. I began to panic.
Physically, my body tensed. I squeezed my shoulders and my hands. My feet, previously being flat on the ground, were now resting on my toes at a 45 degree angle, with my calves almost fully flexed. But I don’t think about any of these things. This is just my reaction. My mind is fully focused on escape. I just wanted it to end. I wanted it to be over, and now. But I was locked in a cold steel subway train. I couldn’t go anywhere even if I wanted.
And this fact made the feeling worse. The panic didn’t last though. The train began to speed up. I then got out.
I don’t recall the specifics of the physical feeling I had. But I do remember the doors, the emergency intercom to the conductor, the other people in my subway car, the size and thickness of the windows, the brightness of the lights that illuminate the advertisements along the ceiling. That’s the emotional side of panic. That’s the stuff that makes it so hard — at least for me.
So I went back today and did the same route. Hell, I went even longer. I had to. I had to keep working my courage muscle and prove to myself that I’m not actually in danger and am perfectly safe just sitting there. It’s tough. Man, is it tough.
It might be uncomfortable, but I will cope.
I'm fearful of doing something today. I've promised that I would get on the Q train from Manhattan to Queens, specifically Astoria. The promise was made to my doctor, my wife, and most importantly, myself.
My fear is strong and it's pulling me toward avoidance. Or maybe I'm pulling it toward avoidance.
This fear, my phobia, agoraphobia, does not care about logic. It does not care about intellectual reasoning. Facts are malleable things to be manipulated in the service of safety and comfort. My fear convinces me that I'm safe where I am, at home, on my couch. My fear does not play the long game. Rather, it feeds off of short term rewards.
But life doesn't work this way. Life is a long game. Immediate rewards are appeasements without structural value. Foundational work, the work that is hard and arduous. Foundational work in the long game is steel while the work that rewards immediate gains is straw.
Intellectually, I completely agree with this previous paragraph. Hell, I wrote it. But this logic is ignored when it comes to panic. Why? Because by the time you've considered the logical route, you're sympathetic nervous system has already kicked off. You are already experience anticipatory anxiety. This emotional side of fear has begun to setup camp in your consciousness. You're awareness of it is vague unless you're really paying attention. It's a stealth feeling, by design.
Anticipatory anxiety is you're body's way of preparing for anxiety sometime in the future. It's job is to interfere with your thought process prior to the event so that the potential of feeling a certain level of anxiety is inserted as a consideration in your decision to do something. I like to think of it as your mind's way of deconstructing your anxiety into it's own set of facts. It's sort of like reading a recipe for a new dish. You first look at the end result, maybe a picture in a book, and decide that this is what you want to cook. But you still have to take the extra step of vetting the ingredients to make sure there isn't something included that offends your sense of taste.
So, what is anticipatory anxiety telling me right now?
1. You are perfectly comfortable where you are at.
This is true. I'm nicely ensconced on a couch in fluffy grey sweat pants and a big green sweatshirt, looking at the cool gray morning outside. But still, my mind is restless knowing that I still have this chore (getting on subway to Queens) to do very soon.
2. The effort to risk high anxiety or panic is negotiable.
This is also true. I have the option to head into the unknown and potentially face extreme discomfort via anxiety and maybe even panic or I can go with status quo. With the status quo, I have evidence of being anxiety free with many routes to safety easily accessible to me. But this is the exact thing I'm trying to fix. By giving into this idea I'm feeding these avoidance feelings and making them stronger. As a result, the next time will be even more difficult.
3. "Next time" is an option.
True again. I can always punt the day. I can always talk myself into an excuse for not facing the anxiety today. Maybe I have a slight headache anyway and I should probably lie down. Or since today is a Saturday, I should use the day off to rest and get some house chores done. Then I can try to do this again on a weekday, when it's more of a convenience. This is the vicious cycle of avoidance. Punting this decision doesn't make it easier or more likely the next time. In fact, what I've done is validated the avoidance tactic and made it less likely I'll succeed the next time.
4. Panic will be so uncomfortable that you'll do something crazy to get out of the situation, so why risk it?
Intellectually, I know that this is not true. But I do have some evidence that I've stubbornly taken myself out of situations at the last minute in service of avoidance. Things like getting off an airplane after the doors closed or sticking out my arm to stop an elevator door from closing at the last second. So it is true, panic will be extremely uncomfortable. This means, by the way, that it's working as designed. But I don't have evidence that I'll do something *crazy* to get out of the situation. Here's the rub, I don't have evidence that I won't either. Intellectually, it's highly unlikely. Emotionally, it's a possibility.
5. If the conditions aren't perfect, then this is a risky thing to do.
This one is intellectually false, but very compelling. This is called a safety behavior. A safety behavior is anything you do in service of trying to control a situation to make it less likely that you experience anxiety or panic. It validates two false narratives. One, that feeling anxiety or panic should be avoided and two, that the situation is inherently dangerous and should be avoided. Safety behaviors are compelling because they give me the illusion of control. They present an interesting irony, when I use safety behaviors and get through an exposure, I have more of a relief or "glad that's over" feeling. When I get through an exposure without safety behaviors, I feel pride. Interesting.
So yes, I'm feeling a lot of anticipatory anxiety today. I'd rather stay here, in my comfortable clothes, in my comfortable apartment, drinking tea and reading a book. Making sure the world around me is warm and fuzzy and anxiety free.
But I'll eventually have to face anxiety and panic again. It's not going away. How I handle it in the future is largely determined by my courage today. I have to do it in spite of anxiety and panic. In spite of.
There is a rule #1 for panic attacks. If you only know one thing about panic attacks, this is it.
Rule #1: Panic attacks are not dangerous. They can not hurt you. A panic attack is the fight or flight response.
When panic attacks come in close succession, it becomes a pretty scary thing. Anyone that’s experience multiple panic attacks over the course of a short period of time (within an hour or two) can attest to how terrible this feels.
There’s an important thing to call out at this point. The difference between anxiety and panic.
The difference is the intensity of feeling. A panic attack is a short, intense rush. The heart quickly pumps blood to the major muscle groups and away from your extremities. Your chest burns from the CO2 buildup resulting from heavy breathing.
But here’s the thing. Our bodies, naturally, can only be in panic mode for a couple minutes at most. The panic trigger was designed to alert you, warn you, ergo help save you from immediate danger. But it wasn’t designed to last. After about 20 or 30 seconds of panic, the liver quickly processes the adrenaline and the brain begins to release calming chemicals from your feel good receptors.
But you still perceive danger. Whether it’s legit or not. You’re scared. And, by the way, you’re still anxious, which is a state our bodies *can* be in for an extended period of time. And because you’re still emotionally afraid, you build up that emotion and anxiety and have another panic attack.
But here’s the thing, each subsequent panic attack in a chain of attacks are always less intense than the previous. This is true because in the previous panic attack, we learned something. We collected data in real time that proved that we can have these intense feelings and all was going to be OK. They were going to eventually go away. So while you’re still perceiving danger and in the throughs of your next panic attack, your brain is kicking in with less punch.
And then each one after gets easier and easier until you habituate to the feeling and situation. You become calm.
So panic attacks have their own algorithm that goes something like this.
Variables to consider:
* Perception of Immediate Danger (true or false)
* Panic Attack Intensity (number 1 - 10 with 10 being highest)
* Panic Attack Number (which panic attack in the series of attacks)
As long as Perception of Immediate Danger is true
Panic Attack Number 1 has a Panic Attack Intensity of 10
Panic Attack Number 2 has a Panic Attack Intensity of 9 or 8
Panic Attack Number 3 has a Panic Attack Intensity of 6 or 5
In the example above, two things are true:
It might be uncomfortable, but you will cope.
I didn’t want to go to Warrior fitness camp on the third floor that day.
It was a warm day in New York. The streets full of people. Bumper to bumper cross-town traffic. It was my first time at this new building. This old building.
Twelve minutes until noon. Class starts at noon.
The first thing I noticed is the security guy at the small front desk. He was bored. He seemed not to be paying attention to anything. The shiny gold and mirrored walls didn’t offer much comfort either. It felt cold. Not cold in the weather sense, but uncaring.
I stood, pretending to be talking to someone on the phone. “Yea, I’m just at the elevator but I can talk for a couple minutes before I get in.” I was stalling because I didn’t like these elevators. Something just didn’t seem right about this building. Being stuck in an old elevator on this warm, packed day in New York City was all I could imagine.
So I decided to bail. I’d already paid for the class but this was my first time. I was willing to forgot the $35 in exchange for freedom from the impending stuck elevator and an assured series of severe panic attacks.
Six minutes until noon.
I watched two more groups of people walk into the elevators while I continued to pretend to be talking on my phone. Again, my excuse for not going in the elevator yet. It’s probably important to note that the embarrassment I feel from this fear is crippling. I just want to be seen as ‘normal’.
Three minutes until noon.
A friendly looking guy pressed the up button. This was my last shot to get in the elevator and go to the third floor. I said “gotta go, talk to you later” to my imaginary co-conspirator on the phone and took the requisite four steps into the elevator car. The man pressed three, my floor, and the doors shut.
It was one of the more difficult workouts I’ve had in a long time.
But I feel invincible.
I did something in spite of the overwhelming threat of breathtakingly difficult panic attacks.
Lesson: Living my life in spite of my panic disorder requires courage in the face of fear. Every time. No exceptions. It just has to be this way.
Remember to re-read this post Brian. You’ll probably need this reminder again.
When given a choice, we tend to choose the fastest and easiest path. It's not our fault. Our brain is wired this way. It likes speed and efficiency and rewards us with warm fuzzy feeling when we choose the easy path.
What did you have for dinner last night? Was it what you really wanted or did you choose it because it was quick and easy? You probably felt good when you were off the hook from having to cook the more difficult meal. The one that requires more effort, patience, and time. The one that is easier to screw up. You might have even told yourself "I'll make it tomorrow night instead". You punt.
Men are disturbed not by things, but by the view which they take of them.
The difference between how I felt before attempting to pull the door handle and after was night and day. It was a pretty smooth train ride up until that point. I was elated just being on the New York City subway system, let alone taking the two trains it took to go from the Barclays Center to 125th St. It was a huge step in my exposure therapy. Then I found out that my escape route was locked.
It's not really an escape route. I just tell myself that in an attempt to avoid a panic attack. It's how I cope. I convince myself that I'm not really trapped in a steel and glass tube moving at 35 mph through a dark underground tunnel in one of the world's largest cities. If the train comes to a complete stop somewhere along it's route due to train traffic, I tell myself that I can open the sliding doors, walk into the open walkway between the subway cars, and jump onto the tracks below. These doors are typically left open so that passengers can move between subway cars in emergency situations.