4: Anxiety@ The Restaurant

First of all, I would like to wish all of my readers a very Happy New Year, and I hope you had an anxiety-free Christmas.  I have found that New Year is quite a difficult time, where you have a combination of people enjoying themselves (aka getting smashed) and making pie in the sky resolutions, which make people who can't even begin to consider such possibilities (i.e. if you have an anxiety, or other mental health, condition) feel low and worthless.  So I now tend to treat it as just another day.  So it is happy Thursday this year and we'll see what 2015 brings.  I considered doing a 'review of 2014,' or a 'preview of 2015' blog, but I decided against it in the end, to reinforce my belief in relieving the pressure at this time of year.

It's rarely like this...

So as such, I am going to continue with my 'Anxiety @' series and gladly, for me, 'at the restaurant' makes more sense than 'at the holiday home,' my last effort.

This may seem like an odd inclusion in this series; previous topics have been about dealing with anxiety in big scenarios that take up a significant proportion of your life.  Holidays can come around fairly frequently and last for a couple of weeks on end and can involve plenty of travelling.  University lasted non-stop for three years and school lasted for fourteen years!  Eating out in a restaurant only lasts a couple of hours and doesn't necessarily happen particularly frequently.

However, eating out has caused me so many problems in the past that I feel it is more than worthy of a separate entry. You will notice if you read the previous three 'Anxiety @' blog posts that eating out appears as a problem that has been apparent during all of school, University and holidays.  You will also notice that I have written blogs about this before back in 2012 and 2013.  So it's a persistent problem that has plagued me for many years.  I'm still waiting to find someone, among the myriad of us anxious nutters, who has struggled in particular with eating out.

In the 2012 blog that I mentioned above, I try and work out why it is that this has been a problem for me.  It took me many years to work out that it was connected to my overall anxiety condition; I went for a long time thinking it was some sort of eating disorder that I had, but for it to only usually affect eating out made this scenario unlikely.  The 2013 blog I mention above provides you with a case study of one of the many (and one of the worst) incidences I could write about in relation to eating out.  I'd recommend reading both of these before continuing reading this blog as they sum up the problem quite nicely.

Without wanting to repeat the content of these blogs, I think eating out is one of the most consistent themes I have mentioned on this website since its inception.  Look how many blogs appear when you type 'eating out' in the search box in the top right corner.  It has caused me years of social misery and at the worst times has also affected my eating in general, affecting my physical health and then consequently my health anxiety condition.  You get the picture.

In the aforementioned 2013 blog, I wrote:


"I've since learnt it's all down to some bizarre anxiety that to this day still baffles me a bit."

In other words, I don't really know why my anxiety condition particularly has a problem with eating out.  My 2012 blog does a reasonable job at working it out, and to sum it up I think it is largely down to pressure.  I'm a perfectionist, a fussy eater and someone who doesn't deal well with certain pressure situations where you are expected to behave in a certain manner.  Therefore, in simple terms, if you combine these factors and put them into a person with chronic anxiety, it's no real wonder that I've struggled with eating out.  

However, writing this particular blog now is quite timely.  Not because the eating out problem is currently making a big impact on my life - quite the opposite, in fact.  I've been on my Christmas break since 17th December and for me this is the most social time of year.  During this period, I have eaten out a total of seven times, and have two more occasions to go before I start back at work on 5th January.  Each time I have been fine and the only case of slight anxiety came when I was away in Yorkshire (see previous blog) where I did wonder a couple of times whether I'd be able to cope.  But not only have I managed to eat everything, I've done it with very few anxious thoughts at all and have even asked for dessert on a few occasions!

As such, I thought I'd focus this blog on trying to work out why this is the case.  What's going on?  How can eating out almost be impossible for years and, for now at least, be okay?  My musings are as follows - and please use some of these as the equivalent 'lessons' that I have included on the previous 'Anxiety @' blogs!

1) My anxiety as a whole has declined over the past couple of years, thanks to numerous reasons.  This, I presume, has led to a general calmness in situations that would have led me to panic in the past, such as eating out.

2) To follow on from point 1, the CBT techniques that I have learnt via my therapist that I saw in 2011-12 have helped when applied in certain situations, eating out being one of them.  These include:

+ Concentrating on breathing, particularly important when eating as the simple act of eating can make it harder to breathe in the first place.

+ Rationalising about the social occasion (difficult and I know it sounds far-fetched, but it does work quite well after plenty of practice).

+ Focus on the conversation that you are having with the person/people you're with, listen intently to what they are saying and join in - as a way of taking your mind off the eating.

+ If this fails, do some people watching for the same purpose!

There may be others, but you get the point.  

3) "You can't beat traditional English cuisine."  This is what I say whenever I'm eating out, as I usually order fish and chips, a burger or sausage and mash.  You can have a laugh about it, whilst your friend orders the quails eggs, the Thai curry or the blue venison.  My point is, order something you know you like, and don't feel pressured to order something 'fancy' just because it's the 'in' thing to do, or because someone else is.  That makes me really uncomfortable because there is then more pressure to enjoy it and thus a higher chance of experiencing food related panic.  Food needs to be kept simple in these situations.  Order what you like, not what other people want you to like.  

4) Only frequent a restaurant with comfortable people.  I may boast above about eating out seven times already this festive break, but all of these occasions have been with 'comfortable' people; by that, I largely mean people who know I have an anxiety condition and who I can trust to be open and honest with if I did struggle.  This makes the likelihood of struggling less in the first place.  Comfortable people can also include those who may not know about your condition, but are quite laid-back in social situations and don't care or pay attention to things like how much you've eaten.  To this day, I still don't eat out with a few people who, by no fault of their own, put too much pressure on me when in eating out situations.


5) There is still an element of avoidance in terms of places I choose to eat.  Pizza Express, for example, is a no go.  Usually I can control where I eat - all of the places I have eaten out at during this festive break have been pubs that do a variety of traditional food (see point 3).  Whilst pizza is usually a comfortable food for me, because of my past experiences with Pizza Express, I know that arranging a meal here would be harder to go through with, due to the natural associations the mind makes.  I'd have to eat there about ten successful times before it became comfortable, potentially.  My point is, where possible, choose to eat out where you can and where simple things like restaurant smells or sounds don't conjure up bad experiences.

6) Drink plenty of water beforehand and during the meal.  One of things I noticed when I was struggling in an eating out situation was how dry my mouth was, which of course made it even more difficult to eat.  I now always order a tap water for me or a jug for the table in addition to whatever drink I am having.  I also drink a glass of water just before heading out.  And so what if this means you need the loo whilst at the restaurant? This can also help you by taking some time out of the situation.


7) Fart.  Okay, so you might think I have left this one until last because it's a less serious one.  And granted it has quite amusing connotations.  But farting, silently and subtly of course, releases trapped gas and can make you feel more physically comfortable during eating and thus more able to stomach your meal.  However, don't let rip an explosive one that registers on the Richter scale, otherwise this may lead to other social anxiety issues.

I'm actually enjoying eating out the moment.  As nonsensical as it sounds, I've spent so much of my life either avoiding eating out or going through hell when I do so, that to be able to eat out with minimal anxiety is such a wonderful experience.  That is one great thing about anxiety: when it disappears from a certain situation, either permanently or just temporarily, it makes things that others take for granted so pleasurable and enjoyable.

And that is the one positive of anxiety: it can make you so grateful for what you have and what you can do with your life.  Embrace it whilst it lasts.

Best wishes
Al

Sharing Experiences III

Eating a burger doesn't necessarily seem like a challenging prospect, but that's the problem with anxiety - it's often the most trivial situations - ones that most people take for granted - that cause the biggest problems.  In fact most people don't take such things for granted because they won't ever need to... eating a burger would never be an issue. 

May contain horse

As I've mentioned in previous blogs, eating out has always been a problem for me, and in summary the more 'pressure' I feel that there is on me, rational or not, the more difficult things turn out.  Two good examples of when eating out has been a nightmare include:

1) When I went for a series of meals out with one of my friends.  ONE being the operative word... Because there was nowhere to hide, it put more pressure on me and thus affected my eating.

2) A visit with a friend to a B&B in the Lake District.  This 3-night break was all but destroyed by the first breakfast.  The woman serving breakfast was very brash to say the least and after the third breakfast even made an observational comment about me not eating much.  The problem with B&Bs is that it feels like there is pressure to eat things, and the subsequent anxiety that I got from this ruined the rest of the holiday, as eating everywhere then caused problems.

I'll come onto the burger incident in a moment.  But what actually happens when I've eaten out - what sort of feelings do I experience?

Well, for a start, the anxious feelings can start days before the meal itself.  The thoughts about a meal could start months before if, for example, a Christmas meal has been organised in advance.  On the day of the meal, I basically feel very anxious, or 'close to a panic attack.' This, of course, makes you feel physically poor anyway and couple this with health anxiety and you have a concoction of... not wanting to eat much, or indeed, not being able to stomach much.  So when it came to the meal itself, my breathing was shallow (coupled with bad sinuses) and my stomach was churning, the LAST thing you feel like doing is eating.  Consequently, I've struggled through a fifth of the meal when the other person/people has/have finished, over-analysing every mouthful.  I get to a point when I can simply do no more and I give in, trying my best to hide what is left on my plate.

This sort of thing has happened numerous times, but one of the worst times was a night out I organised for my birthday in 2010.  Even though at the time I was struggling with eating out generally, I still decided to hold a big night out in Birmingham that started with... yes you guessed it, a meal at Nandos.  Usually, the bigger the crowd during a meal the better, because I can hide and people aren't focusing on me.  However, this was MY birthday, and what's more, it was a strange combination of friends who came for one reason or another - i.e. there were less 'safe' people there.

So, after weeks of dread and despair - yes, instead of excitement which of course it should be before a birthday do - the meal arrives and sure enough, I am panicking by the time the food arrives.  Everyone will have noticed, but the two things that stuck out in my mind was one person saying to my other friend (supposedly out of earshot) 'is he ok, he hasn't eaten anything,' and the person sitting next to me asking me why.  I think I said "I've been a bit ill recently" which, if classing anxiety as an illness, isn't far from the truth. 

But then it went from bad to worse.  The more people who noticed the worse I got, and then during about the fifth painfully slow chew on a piece of burger, I began to choke. It was so bad that I had to excuse myself to the toilet and phone my friend from there to come and assist me.  Unfortunately, rather than bring me water he brought me my half-glass of beer, which didn't really help...

Eventually, the choking dissipated, and in the end I actually used this incident as an excuse not to eat any more food!  Although in fairness, it wouldn't be easy for anyone if they too had choked.

But of course, the choking wouldn't have happened at all had I ate like a 'normal' person.  I remember my good friend saying that one of her friends who witnessed the incident asked whether I had some sort of eating disorder.  At first I always thought that's what it was, but of course I've since learnt it's all down to some bizarre anxiety that to this day still baffles me a bit.

I'm pleased to say I'm going through a better phase now, but I still don't look forward to eating out in certain situations.  Over the last year, the hardest meal was my birthday again, due to the fact that in my head, all eyes were on me and I couldn't 'escape.'

This incident in Birmingham frightened me.  Not just because I thought I might choke to death; not just because I thought my friends would think I was ill or strange, but also because I wondered where on earth I could go from here in future.

The message is this - anxiety can affect things that others just do without thinking, like eating.  The best - but most difficult - thing I think is to not let it get to you.  Accept that anxiety can do this and seek the appropriate help.  Make things as comfortable for yourself as possible in any situation; so when eating a meal out, I always order a separate glass of water, wear loose trousers, remember to breathe between bites, order the thing I prefer to eat the most and so on.  Every little helps.

And also get a friend ready who doesn't bring you half a beer to you when you're on the verge of asphyxiation.

Best wishes

Al

Food for Thought... Or Thoughts about Food

I’m a little bit obsessed with food.  By that, I don’t mean I do nothing but eat, but I’m obsessed with when I eat and what I eat.  It doesn’t always stop me from eating stuff that’s bad for me, but still.  This general food obsession is probably little surprise, given my health anxiety and also the OCD tendencies that I mentioned on a previous blog. 

But I think much of my ways with food have come about from my upbringing.  My mother, bless her, has always been somewhat over-protective about how much I’m eating and moreover, when I lived at home, dinner was always at the same time.  I remember once my dad apologising once for dinner being made for 5:51 instead of the conventional 5:45.  I told him not to worry, although made a joke that I had nearly died from malnutrition.

Consequently, dinner time has never really been a relaxing affair, and instead has been rather fraught over the years.  And any diversion from this routine almost puts my body into shock, especially when you do factor in the health anxiety.

So this dictatorship in my upbringing, if you will, may have resulted in my main problem that I have with food, and that is, eating it anywhere other than at home.  Or more specifically, eating it when I feel under pressure to eat it.  Food, for me, has always been something that you have to do, rather than something to enjoy.  If you had the choice as to whether you could eat or not, I believe that the vast majority of people would still choose to eat.  I, on the other hand, would not. 

My main ‘fear’ about eating out is about people around me noticing that I’m not eating whatever it is in front of me.  It’s one of those really annoying vicious circles that anxiety is incredible at developing.  It’s like a circular reference, for those of you familiar with Microsoft Excel:

Various factors make me struggle to eat out

|

I struggle to eat

|

I worry that people are noticing I’m struggling to eat

|

I struggle to eat more due to rise in anxiety

...and so the circle is exacerbated until I basically eat nothing, the food goes cold and the waiter whisks my plate away from in front of my nose.

Various circumstances dictate how bad this is.  The number of people I’m with, who I’m with, where I am, what I’m eating (or not), the number of people generally in the restaurant, external environmental circumstances such as temperature, how tight my trousers are (seriously)... and just generally how I’m feeling from a physical perspective. 

So what exactly happens?  Regardless of the final outcome, I’m nervous about a meal out for several days beforehand, and it can be on my mind for months if it’s planned a long way in advance.  Then, in the worst case scenario, I struggle in the painful bit between arriving at the restaurant and the meal being served with trying to keep it together, trying not to make the person/people I’m with notice that all is not well.  It’s like trying to stave off a panic attack.

Then, when the meal arrives, it takes me ages to eat every mouthful.  My mouth has gone dry, so I try and rectify this by drinking something in between, which, unless it is water, isn’t very effective.  I struggle to breathe too; obviously, breathing deeply can help alleviate anxious periods, but when you’re mouth is occupied by eating and your nose is occupied by sinus problems (another factor to throw into the mix), then this is obviously difficult.

I basically over-notice how much the people I’m with have eaten in comparison to me – surprise surprise, usually much more – and then that makes it more difficult.  It varies, but I usually get through about a third to half of a meal before I have to cease. 

Unfortunately, the easy option was avoidance, which of course meant that my social satisfaction was reduced.  I explained the situation as best as I could to my friends who I did eat out with and they understood to the point where we only went out for a drink instead of for tea, but it’s depressing when there’s a meal, such as a work do, from which I have to excuse myself.

Somehow I have managed to avoid eating out, bar the odd picnic and buffet, for about eight months.  I’m in too deep to rectify this problem with one successful meal at a restaurant though now; it would take months of eating out 3-4 nights a week to overcome this totally absurd and ridiculous fear.

But then, that’s anxiety for you.  I’m off to cook tea. 

Best wishes

Al

Pizza Off

I posted a blog fairly recently about my problems with eating out.  Somehow, I have managed to avoid an evening meal out, bar the odd takeaway in a pub (don’t ask) for getting on for a year.  But this is all about to change.



Pizza Express, or 'hell,' Stafford



*Dramatic drum music, with fanfare*

A week on Friday, there is a meal out planned for someone’s work leaving do.  Given the economic climate, there have been many leaving dos lately and all of them have had meals involved.  I, however, have always ‘just gone out for drinks afterwards’ as I have ‘things I need to do’ beforehand. 

Basically, I’ve lied to get out of it.  I’ve had a reality check this time though.  Why should I have to lie to get out of an occasion simply because it might not agree with anxiety? 

But this particular meal out is going to be hard.  It’s at Pizza Express in Stafford, which is actually a nice venue for a meal out.  But this particular restaurant has a pretty big stigma attached to it.  I remember, eight years ago now, there was a meal at P.E that involved quite a few people, at which I had my first major ‘struggling’ episode in terms of eating out (see previous blog), which put me off eating for a long time subsequently.  Of course at the time, I didn’t really know what was going on, which made it all the worse. 

I’ve also had a couple of less major ‘struggles’ at P.E since this incident, which have meant, all in all, I don’t like going there.

So after I agreed to challenge myself by going for a meal out, when it transpired that it was going to be at P.E, I raised an eyebrow awry in ‘sod’s law’ irony. 

The main thing I have to do is remember that, actually, people aren’t going to be focusing on me; they will be focusing on the person who is leaving.  So why should there be any pressure on me?  Easier said than done, of course...

I’m not really sure what I’m feeling about it.  Ask me this time next week.  But what I do know is that it is a challenge that I feel I need to set myself, so I can move on into the future...

...into the future, where, on 21 December, I will be attending a Christmas meal at another venue in Stafford. 

Hurrah!

Merry Christmas and a happy pizzeria.

Best wishes

Al

8: Anxiety@ The Pub

The final of my eight part 'Anxiety @' series (blimey, this has been going on for a while eh?!*) focuses on what it is like to have social anxiety.  I refer to the pub specifically, although this could include any type of social activity involving other people. As I understand it, a social activity is not 'social' if it doesn't involve other people, so by it's very nature, this is the sort of anxiety that occurs in the presence of others.

Photo from Anxiety UK website - Google's were all crap

What a great blog this is so far.

The way I would define social anxiety is having a chronic lack of confidence when in a social situation; a fear of looking foolish; a fear of appearing uninteresting; and of course a fear of all of this resulting in a panic attack.  It's often the case that social anxiety and panic disorder collide.  In fact, panic disorder pretty much collides with everything.

The other factor to throw into the mix which is more specific to me as an individual, is the fear of eating, which, as number 4 in the 'Anxiety @' series demonstrates, has been particularly difficult for me over the years.  Often, struggling to eat can lead to social embarrassment, as various previous blogs have described. 

So for now I'm going to cut out the panic disorder and eating elements, which cloud the social anxiety problem as a whole.  I don't have social anxiety just because of the panic disorder and eating problems.  These are simply other factors that make it worse.  This is proven by the fact that even today, when both my panic disorder and eating out issues are much improved, I still experience social anxiety.  So the two questions are how and why?

This is best demonstrated via the medium of case studies.  Sorry - I appear to have gone back to work.  But in all seriousness, examples of where social anxiety has occurred where eating out hasn't been involved, and recently enough so that panic disorder was less of an issue, is the best way for me to explain what it's like.

Example 1: This was about 18 months ago, not long before I left my previous job.  There was a fairly generic work do taking place.  Work do's are generally a fuel for social anxiety, because 1) I never feel as comfortable with work colleagues anyway for obvious reasons, and 2) because no-one at work has ever known about my anxiety conditions.

Ah - and this is really interesting actually as I'm kind of finding out things about my condition as I write this.  Because of health anxiety, I have a fear of the effects of stimulants on the body.  Alcohol is included in this, and consequently I tended to only drink a little and then go soft, so to speak.  In the past, whenever I drank too much, I woke up at about 4am with my heart racing and feeling terrible, which then led to a panic attack.  So I stopped drinking.  But of course, when you're out with work colleagues, and they ask you 'why aren't you drinking much,' my reply generally won't be 'because I have an anxiety condition and it causes me to have a panic attack if I drink too much.'  Call it stigma, call it a conversation killer, what you will, but I never gave a legitimate reason.  Well OK, so I may have said 'for health reasons,' which technically is true, but you get the point.

Anyway all this drivel shows how significant the influence of alcohol has on a social situation.  Sadly, in modern society, you're often automatically seen as uninteresting if you're not drinking for no reason that is deemed acceptable by those who are drinking.  So I often go into social situations, especially with people who don't know about my condition, knowing that talks of alcohol are going to dominate the night.  And you may have noticed (or maybe not, if you too are pissed), that when people start drinking, one of the main things they talk about is around stories of other times when they have been so off their face that they had intimate relations with their friend's grandmother, or something equally as worrying.

So what this example - and many others - shows is that alcohol has a huge influence on social anxiety.  I either drink and suffer the consequences, or don't drink and get badgered all evening as to why I'm not drinking.  Call me a tiresome bore, but I generally go for the latter.  

Example 2: A house party, probably about five years ago now, at my friend's house.  This particular friend generally sits in other 'friendship circles' to me, which means apart from her and my mate who effectively came with me, the other people at the party weren't people I knew well.  Put me in a situation with new or unfamiliar people and I'm petrified.  I feel bullied by others in conversational terms - I feel I need to have seen that film or heard that band or visited that country that they are talking about.  The reality is, I rarely watch films, my music taste is so specific I have no idea what is happening in the mainstream, and my only venture outside the UK and Ireland was on a university fieldtrip.  Sadly, the materialistic fabric that makes up modern life dominates social conversations, especially with people you don't know well, and as such I'm automatically perceived as 'unusual' as someone who doesn't really treasure the same things most others do (ironically - some of these 'unusual' character traits that I have are often as a result of anxiety!)

Now this would be fine if I had confidence.  You could argue that being 'different' could provide a real social opportunity, a tonic amongst the generic nature of most social conversations.  But sadly, what social anxiety makes you do is cower under the discomfort of being 'different' rather than allowing you to express yourself.  You become wildly uninteresting rather than the most interesting.  And even if people don't see you as uninteresting, you feel uninteresting - because you have no confidence.  The reality is this:

I don't feel I have anything interesting to say.  Or rather;

I don't feel I have anything to say that other people would find interesting.

Example 3: I mentioned in my last blog about living in a shared house that social anxiety has been an issue here too.  I've been fortunate, in that this has forced them to find out more about me and in so doing make me feel more comfortable with them over time.  But it's not been without it's difficulties.  There have been other people there during my time at the shared house who have always made me uncomfortable, the sort who assume that you're uninteresting if you don't share their views or find the things they are interested in interesting yourself.  I began to appreciate that's not so much my fault, but it doesn't help my own confidence either.

But even the people I have got on with well, I still find it difficult to answer a question such as 'what have you got planned for the weekend?'  If my answer is 'watching football, chilling, walking' for example, then those feelings of uninterest come back.  I feel like the social eyes of the world are watching me, expecting me to say I'm going hang gliding or parachuting, or at least going out with 'the lads' on the piss until the early hours.  Which takes us back to example 1.

Incidentally, none of my friends, nor myself, could be classed as 'the lads' in any way, shape or form.  And that is one element of my social personality that I'm quite proud of.

Now to factor back in the aforementioned eating problem: could it be that this has caused the social anxiety to be worse, or could it be that it's the social anxiety that's caused the eating problem?  As with trying to identify the cause and effect of many anxiety problems, especially those that interrelate, it's very much a chicken and egg situation. Does health anxiety cause panic disorder?  Or the other way round?  In truth, I don't think even the most highly qualified psychologists know the answer to that.  That said, I think I'd still have social anxiety if I didn't have an eating problem, as the confidence thing can occur whether eating is involved or not.

The final question is, what has caused this social anxiety.  Is it other forms of anxiety and the effect it has had on my personality?  Is it my upbringing?  The eating problem as mentioned above?  Is it purely genetic?  Where does the lack of confidence come from?  Years of being unhappy and, for a while, bullied at school?  Years of being single?  

I would suggest all of the above have had an impact.  I don't think, after so long, it really matters now.  It's more about appreciating the people I do feel comfortable with, of which there a few - but this core group of friends has really kept me together over the years.  It's more about welcoming those few new people into my life who do accept me and value me for who I am, not who society wants me to be.  And it's about managing those occasions when I am thrusted into uncomfortable circumstances and managing them in the best way I know how - if anyone can tell me what this is, by the way, please let me know.

----------------------------------------

* As I said at the start of this post, this is the final blog in the 'Anxiety @' series.  I also said it's been going on for a while, which it has.  Eight blog posts all around different themes in terms of how anxiety has affected and still affects me, and several sub-themes within each one.  What does this show?  Just how much anxiety and mental health conditions as a whole can affect someone's life.

I would never say that I've had a severe mental health condition.  I say that because I'm here today in a position to write this blog, and I've never been hospitalised as a result of my condition.  And yet despite this, anxiety has still affected my life, its outcomes and my future in a multitude of ways.  So how about those people who can class their condition as severe?

Which is why all the talk about cuts to mental health budgets, the stigma that still exists and the lack of awareness that is still abound in certain pockets of today's society frightens me.  This needs to change.  The time to act is now.

That's all I hope to achieve by writing these blogs.  A microscopic needle in a land full of haystacks.  But I hope, occasionally, that the right person with the right microscope picks the right haystack, and finds something amongst my ramblings that they find helpful.

Best wishes
Al

The Talking Therapy Run Down

Hi all

Apologies it has been a while.  As my last blog detailed, I have recently moved into my new house and this, along with the usual, has occupied a lot of my time recently.  Apparently it's important to insure your life and buy plates.

There was never a sofa.

Anyway, I thought I'd forego writing about my experience in dealing with anxiety and the aforementioned house move, and how anxiety has fared with recent pressured social events that I have been involved in.  I will say, overall, these have been a success albeit laden with a few sticky patches.  This is progress, though, as said sticky patches would once have been unidentifiable amongst the myriad of total stickiness that I would have had to endure.  

Instead, I thought I would blog about my experiences with talking therapy that has helped me try and keep my anxiety in check, and, ultimately, that has helped me to be able to function more adequately in life than before.  There has been a lot of talk, both virtually and verbally, recently about the effectiveness of therapy so I thought I would contribute, for what it's worth.  I appreciate that there is information on all of this already laced within this website, but hopefully putting all into one blog will be useful.

Therapy No.1: NHS, referred to by GP
Year: 1997
Age: 10
Status: Year 6, final year or primary school

Obviously, so far back, I had no idea what was wrong with me or what the therapy was all about.  My parents went to the doctor's who must have referred me to the NHS therapist.  This came about after I had my first ever panic attack whilst on holiday in Devon.  I also remember fearing death at this time and repeatedly asking God (as someone who isn't religious) that I didn't want to die.  Whether there was anything else to trigger my parent's taking me to this appointment I don't know.  But basically this therapy came about as a result of the first time in my life when it was clear that anxiety was going to dominate my youth (albeit I didn't know that then).

There were only two therapy sessions.  One at the start so that the therapist could make both me and my mum cry in order to try and ascertain what the problem was, and a second one several weeks later to review progress.  I must have had to carry out exercises in between; all I remember about this was drawing circles, the size of which indicated how anxious (whether that was the term he used I don't know) I was feeling.  Given how long ago this was, I can't remember how much success this therapy had; although given I've spent the following 18 years dealing with anxiety, one could make a reasonable assumption.  

Key lesson learnt: I was always destined for an anxiety-filled life to have had therapy at such an early age...

Accessibility: I can't remember how long it took before making the appointment and getting seen.  I don't think it was long, as perhaps children are prioritised?

No. sessions: 2

Cost: Free

Success: 4/10 - may have helped alleviate the immediate issues but no effect long-term.


Therapy No.2: University counselling service, self-referred
Year: 2006
Age: 19
Status: Second year of University

I should mention that refraining from accessing therapy during my entire high school career sounds positive, but I know for a fact that I should have obtained help on more than one occasion during this time.  Call it inexperience, feeling weak, uncertainty or whatever, but for some reason even at my lowest times during high school - and there were many - I never took this option. 

And as it happened, this self-referral in 2006 only occurred out of desperation. At the time, not only was I experiencing well-established panic attacks, but my mind had decided to loop things that I couldn't get out of my head.  I thought, to use a term not conducive to helping remove mental health stigma, that I was going mad.  

Anyway, I won't dwell much on this.  I had only one session, which frankly is all I expected, and my condition was put down to stress.  I knew it wasn't - but you have to remember I was desperate.  At the time I'd have seen a trained chimp.  What I didn't know back in 2006, of course, was that I needed CBT and not a counsellor giving me relaxation techniques.  

Key lesson learnt: Therapists at Universities certainly have their place (especially to deal with issues such as exam stress) but aren't necessarily trained in therapy for advanced conditions.

Accessibility: Outstanding - I went to book an appointment and was seen within 20 minutes!

No. sessions: 1

Cost: Free

Success: 2/10 - chocolate and fireguard springs to mind, but to be fair on them they could only do their best and probably weren't used to someone like me knocking on their door.  


Therapy No.3: NHS, referred to by GP
Year: 2007
Age: 20
Status: Third year of University

At the same time as accessing the above therapy, I booked in to see the GP to obtain another course of therapy on the NHS.  Now, we are in really troubled times at the moment with regards our NHS system, so to have a go at it seems wrong, somehow.  But I can't lie - the service and the therapy I experienced here was nothing short of useless.  For a start, it took 13 months - I'll repeat that - 13 months from being referred from my GP to getting an appointment.  By which time, the reason I had booked into therapy in the first place was less of a concern.  Third year of University was one of the better times for me, so seeing a therapist during this time wasn't as relevant.  OK, so I still had anxiety, but I was in dreamland compared to 6-12 months prior.  

You could argue, therefore, that judging the quality of the therapy in light of this is unfair, but it is the healthcare system's fault that I had to wait that long in the first place. So, here goes.  The therapist was the same person I saw with my parents back in 1997.  I realised after not too long that I didn't really like him as a person; he came across as very unsympathetic and unhelpful, which is not what you need in a therapy session.

Secondly, what I needed was CBT, not counselling.  Now, I couldn't influence this at the time because I still didn't know that's what I needed, but the fact I got counselling shows two things: (1) that the GP didn't properly understand what mental health conditions require what therapy to treat them and (2) that, in my town, there was only one therapist - a counsellor - available to see on the NHS.  Hence the absurd delay.  

I was also limited to a certain number of sessions, again unsurprisingly.  So what I was a victim of here is an over-stretched service and a therapist who, quite frankly, I didn't get on with.  Consequently, the lasting impact was less than negligible.  

Key lesson learnt: The NHS needs / needed (as maybe it has improved in recent years?) a radical overhaul in mental health therapy provision.

Accessibility: Shocking. 13 months from referral to appointment.

No. sessions: 7

Cost: Free

Success: 1/10 - no lasting impact.


Therapy No.4: Private CBT, self-referred
Year: 2010
Age: 22-23
Status: Couple of years into my first main job.

I would argue that this was my biggest wake-up call, therapy wise.  By this time, I had researched into CBT and discovered that it was this that I needed.  I was specifically seeking therapy at this juncture to deal with my problems with eating out, although of course what I didn't know then is that this was just a manifestation of a chronic underlying anxiety condition.  Just because panic attacks were less, I thought my only problem was with eating out.  What I didn't twig was that eating out was the only thing I did at this time that really generated panic disorder.  Something, I would reasonably argue, ought to have been picked up by the so-called CBT therapist that I saw.

I say 'so-called' CBT therapist, because I didn't actually obtain CBT.  Although I had ascertained CBT was what I thought I needed, I still didn't know exactly what it was about, so at the time I just got in with it, albeit with a bit of confusion.  I know it wasn't CBT now, because this therapy was all about the therapist trying to find out why I had this eating issue and spent the majority of each session talking about my family history and how this could have caused it.  No. No. No.  This is not CBT.  This was counselling in some form or another.  There was also one session dedicated to relaxation techniques.  I'd heard enough dolphin noises by this stage.

The final thing to emphasise is that, although this was private therapy, it was still limited to only a few sessions.  In this sense, it was no different to the NHS and frankly, the quality of the therapy was no better either.  

Key lesson learnt: Private therapy isn't always the answer!

Accessibility: Good; I was seen within a couple of weeks from making first contact.

No. sessions: 8 - limited to this number.  

Cost: £60 first session £30 thereafter; a total of £270

Success: 1/10 - no lasting impact; I still had problems with eating out, the one thing I was hoping to resolve.


Therapy No.5: Private CBT, self-referred via Anxiety UK
Year: 2011-12
Age: 23-25
Status: Well into my first job, moved out of home for first time towards the end of treatment

And so finally, a tale of good news.  This call for help was as a result of that particular event that took place on a train back from Cornwall, when I had a panic attack for 14 hours non-stop.  Subsequently I could barely leave the house and my anxiety levels had hit a new level that I didn't think were possible.  I knew action had to be taken otherwise I was in serious trouble.

Having had no previous success locally, privately or via the NHS, I was in a bit of a quandary about who I should turn to.  Thanks to Google, I stumbled across Anxiety UK, a charity dedicated to providing help for people with anxiety.  I called their helpline to arrange an appointment with a therapist via webcam, because there wasn't a therapist available in my town.  It was impossible for me to travel any distance at this time, so webcam therapy was my only option - but that fact that it was offered in the first place was a revelation.  

Within two weeks I had my first appointment with a therapist who happened to be based 262 miles away.  She was an NHS therapist part-time and a therapist working privately on behalf of Anxiety UK the rest of the time.  She only had a few non-NHS patients at one time, of which I was one.  And lo and behold, ladies and gents, I was getting CBT.  I was obtaining the help I needed, not just to help deal with the current situation but the whole underlying anxiety condition that I'd had for 13 years.  The focus was on how to deal with the situation as it was in the present, not about why I got to that point in the first place.  This did get discussed later on, but only when I was a little more stable and we were able to get more into the meat of the condition as a whole.  

There was also less pressure to improve, because sessions were unlimited; i.e., you got what you could afford to pay for.  And finally, I must say that the therapist was outstanding.  She listened, advised, and shared her own experiences - as she too had experienced mental health conditions over the years.  We got on almost as friends by the end, and I could not speak highly enough of her manner and intelligence on almost all issues that I had to raise.

Key lesson learnt: Try going via the charity route.  Enough said.

Accessibility: Good; I was seen within a couple of weeks from making first contact.

No. sessions: 50; unlimited depending on requirements.    

Cost: £20 per session; £1,000 overall.  The best £1,000 I have ever spent.  

Success: 9/10 - I will always have anxiety, but this extensive therapy has helped me manage the condition so much better than I ever thought I could.  It's more rational, I can keep it under control more and I have tools in place to help me in the more challenging times.  I set up this blog just after the therapy had concluded which says something in itself.


There you have it folks.  My aim here is to share my experiences, raise awareness of these and to suggest things to look out for if you are looking to access talking therapy.  

My final message is this.  It appears from mine - and others - experiences in obtaining the therapy you need to deal with a long-term anxiety problem, that paying for someone's services is the only answer.  What do people who can't afford such therapy do?  The fact that good quality therapy may only be accessible to those who can afford it is absolutely abhorrent and a shocking indictment of mental healthcare provision in this country.  This is a sweeping generalisation of course, but I'm purely going on my experience.  There will be excellent NHS therapists out there - and as I've documented above, poor private ones - but nevertheless, my point still stands.

I will conclude by mentioning that this website was three years old on 15 June. Still going strong. Well, still going anyway.  I hope I can keep it up, if nothing else so I can add my two-penny's worth into the 'trying to help raise awareness of anxiety' sphere.  

Best wishes
Al

Talking about Talking Therapies

On the odd occasion that someone asks me about my experiences with talking therapies, I can never just give a short, straight answer (you'll be delighted to know).  My chronic anxiety has led me down various talking therapy avenues in my life, usually at the lowest points when I just couldn't handle the condition on my own anymore.  They have all given me different experiences. 

I've had five separate talking therapy sessions in the past, all for various different elements of anxiety, that temporally go something like this:

·              NHS counselling: 1997

·              University counselling: 2006

·              NHS counselling: 2007

·              Private CBT: 2009

·              Private CBT: 2011-12

I was only 11-ish years old when I accessed the first batch of counselling in 1997, so I'll bypass that for fear of not recalling memories about it coherently.  However, out of the other four, I can confidently state that only the latter of the talking therapies listed above was 'successful' for me. 

We, too, sat in a massive hand

The University counselling, which consisted of just one session with the university's therapist, only came about because it took over ten months to see the NHS counsellor listed subsequently and I was simply getting impatient.  I contacted the NHS for an appointment in about September 2006 and didn't get to see the counsellor, after numerous cancelled appointments, until about July 2007, by which time I'd actually come through the worst of the current situation myself, simply by the gift of time.

So not only was the counselling ineffective for this reason, but also because the counsellor in question was not very sympathetic, to say the least.  I appreciate it's not sympathy you need in dealing with such circumstances, but it got to the point where he didn't appear to appreciate my situation or what I was going through.  I felt bitterly let down by this and consequently I haven't been back to NHS therapy since.

By 2009, I thought that the majority of my anxiety had dissipated (although now I know it hadn’t, but that's a separate story).  However, I still wanted to conquer my fear of eating out which had persisted for many years.  It was crippling my social life and I needed to sort it out quickly, so I sought out my own help via the Internet and found a local private CBT therapist. 

Sadly, successes here are also hard to tease out.  I saw her within two weeks of contacting, which of course was a huge improvement, but the therapist was more concerned with finding out why I had the eating problem rather than trying to deal with it.  I've since learnt that I wasn't really getting CBT, and I knew when we spent one session purely focusing on dolphin noises that I wasn't getting anywhere useful with this.  Despite it being a private therapist, I was also limited to a maximum of about eight sessions, which again I now know was nowhere near an adequate amount for me. 

My anxiety as a whole took an awful turn in March 2011 (see previous blogs) and so followed what was probably the lowest period I’ve ever had in my life – I needed help.  I knew going down the NHS therapist line wasn't going to help me and I was also more wary about the 'randomly selecting a private therapist' route.  I was in despair and spent ages searching for some sort of solace on the Internet, which as with most things these days became the fountain of all knowledge.

That's when I stumbled across Anxiety UK, a charity that offers private therapy sessions.  The therapists themselves may work for the NHS by day, but some take up private clients out of hours, as was the case with me.  At the time, I was struggling to even make it out of the house and there was no local therapist.  So I utilised their option of therapy via webcam.  Within two weeks of contacting Anxiety UK, I had my first appointment arranged... and that's considering some unfortunate admin issues without which would have meant it would have been even quicker! 

So I undertook webcam therapy with a CBT therapist from Scotland, whilst I live hundreds of miles away in the Midlands, and although there were one or two restrictions compared to more conventional talking therapies, it was great.  One thing my therapist did say is that "I can't put you into a totally anxious state, lest I can't adequately get you out again" whereby inducing an anxious state is, of course, aimed to help with progress.  There were also one or two technical problems too, as you'd expect.  But overall, it was a success.

Although of course, the biggest success wasn't whether it was via webcam or not; the biggest success was the therapist herself.  We struck up a great relationship which aided my recovery as much as my actual therapy did.  I had around 50 sessions in total, which goes to prove how much therapy I actually needed, but as you will gather from this, I was able to have as many sessions as I wanted.  We phased out the frequency of the sessions after about the 40th which meant it was a gradual close off rather than a sudden one, helping to minimise the likelihood of a relapse.  And most importantly, what I was getting was actual CBT, the actual treatment that I asked for, which made me realise that what I received before wasn't.

The therapy I received in 2011-12 has really helped to turn my life around.  When it first started, I couldn't see a way out of my lowest point, but with the hard work on top of the number of sessions I had, I'm now much more confident about facing my anxiety and, indeed, writing about it.  The only medication I’ve ever been on is beta-blockers; I’ve never been prescribed any anti-depressants, so as to suggest that one can gain real success from talking therapy without the need for heavy medication.

I grant you that I had to pay for this therapy, which of course I appreciate isn't always an option for everyone.  But if you are able to put some money aside to afford therapy, then I'd strongly urge you towards professional, knowledgeable and empathetic charities like Anxiety UK and Mind first, as they will guide you on the best course of action to take.  My experiences suggest that spending a little bit of time - perhaps more than you'd like if you're in an extremely low point - is well worth the effort in the longer run, in terms of getting the best help for you.

Best wishes

Al