Seven Steps to Stability - Step 7: Raising Awareness

MHAW 2014

The final Step to Stability that I think is very important to include is how I have sought solace and compassion in talking to other people about anxiety and other mental health problems.  Previous to the last couple of years, I'd never spoken to anyone about such issues apart from close friends (see MHAW blog 4) and therapists, not least because I'd never have had the ability; just the thought of talking to a stranger, even if it isn't face to face, would have been too much to bear.  I suppose this is for two reasons: 1) the fear of what they would think of me and me caring too much about this, and 2) talking about it would probably trigger off unwanted thoughts that in turn would lead me to have a panic attack.

But since the therapy I've received, I have wanted to do my little bit to spread the word about mental health, both for myself to try and improve my confidence around talking to other people about the issue and secondly to help or provide comfort to a fellow sufferer, who may be in the depths of anxiety.

The ways I have done this have mostly been via the means of various forms of media and communication.  I have rarely spoken to someone face to face about anxiety other than the aforementioned friends and therapists, but in this day and age where everyone can know everyone else's business, it's not difficult to raise awareness via other means.  People who are experiencing severe anxiety may also prefer to talk via the web than face to face at first anyway, simply because it is easier.  The very step of talking to someone verbally can be anxiety inducing in itself.

The main channels that I have used to try to awareness are as follows:

1) Anxiety UK's pen pals booklet.  This is a little booklet included every six months (I believe) In Anxiety UK's magazine, that simply provides brief details about where a person lives, a little bit about them and their anxiety condition.  By signing up, you are basically obliged to respond to anyone who contacts you.  I have been emailed by a couple of people via these means and written to by someone too.  It's really interesting to hear their stories and each one I have admired, because I could tell that they were going through difficult spells at the time they wrote their email/letter.  If I have helped just a tiny little bit or given them any ounce of comfort then I deem this a success.

2) Research and blogging for Mind.  I wrote a blog for Mind quite a while ago now and regrettably time appears to have condemned it into the web's ether, but I had a fair few positive comments on the website and a couple of emails about this. I also posted it to my Facebook account, following which I got some unexpected comments from a couple of people who had no idea I had anxiety and who showed some real support whilst sharing their experiences.  This was really nice and to be honest not the reason I originally blogged for Mind!  I have also done a telephone interview with Mind about the effect that mental health had on me as a young person and the help (or lack of it) that was available to me at the time.

3) This website.  This is obviously my main tool through which I use to raise awareness or ask questions about myself and mental health.  I have been blogging for nearly two years now and even though writing a blog can sometimes (but not often) be a chore rather than something to enjoy, I'm glad that I've managed to keep it relatively regularly updated.  I admit that this week, given the amount of work I've had and tiredness etc, it's been a mini challenge writing a blog each day but I feel it's been worth it.  Doing this for Mental Health Awareness Week won't raise any money or change anyone's life, but I hope at least that it will do what the Week says on the tin - raise awareness of mental health. 

I'm also on Twitter now too, something which I should have done a while ago but have only got round to in the last couple of months, but love it or hate it, this is a very good way of raising awareness and already I have connected with some very insightful and interesting people regarding the mental health agenda.  If you're stumbling across this blog not via Twitter, I'm @AnxietyTracker incidentally.

Obviously, one of the main things I've got from doing this awareness raising is a positive feeling of helping other people.  My therapist talked a lot about compassion and how the feelings associated with this are, in themselves, very good at alleviating anxiety and panic.

Another reason for doing this blog and the rest of my contribution is to help others, not in a therapy way (I'll leave that to the professionals, contrary to MHAW blog 2's topic!) but in a 'you're not alone' type way.  I thought I was well and truly alone with anxiety when I first started doing all this, and it's only in the last year or so have I really learnt how many people have had experience of anxiety and other mental health problems, both people that I know and that I don't.  If I can provide some wisdom and experience to someone's chaos then I count that as an achievement.

And the third thing I've already touched on - people have also helped me, and this is the primary reason why I have included this as a key step in the seven towards my stability.  The comments, tweets and emails that I've seen, either in response to something I've written or just generally, have been fascinating and it's great that so many other people are out there doing their bit to raise awareness as well.  I've learnt so much from so many 'real life' people!  It's almost like there's a community of us who just want to do our little bit and even though few of us know one another, there is an increasing togetherness in the overall drive to make society more aware and accepting of mental health issues.

Of course, none of the stuff I do would have been possible without the help of the therapy, which of course I received by going via Anxiety UK, the charity that kicked off all this in the first place.  So in terms of my Seven Steps to Stability, we've kind of gone full circle.  From finding the charity, to helping them myself either directly or indirectly.  In just over three years, that's not bad going.  That said, we all think that the contribution we make is bigger than it probably is and I know that I don't do much else beyond the virtual world, such as skydiving or running a marathon to raise money for mental health charities.  Just the thought of either of them would give me a nosebleed.  But within my bounds of comfort, I hope that this blog and other work that I will endeavour to continue to do will at least make a little difference, both to me and to others. 

Finally, kudos to the Mental Health Foundation for running MHAW in the first place.

Mental Health Awareness Week may be concluding, but our mental health problems will keep going.  In writing these daily blogs, it has brought some anxious feelings to the surface for me, which perhaps has been the main negative in doing this for MHAW.  Perhaps if I was more comfortable from the beginning about talking about anxiety, writing about it quite intensely like this wouldn't have this affect.  Which leads me onto my final message: The fight continues - the fight to get better ourselves and the fight to challenge the stigma that still exists in some parts of society. 

Thank you to everyone who has read my MHAW blogs and please do keep coming back for (semi) regular updates.

Best wishes
Al

Seven Steps to Stability - Step 6: Exercise

MHAW 2014

This is an interesting one, and actually exercise wasn't something I was initially going to include in my Seven Steps to Stability.  Reason being, putting it simply, that I don't play competitive sport at all or go to the gym.  It's just not for me and never has been, despite my school trying to force me to play rugby for five years.

The only thing I've ever really done consistently exercise-wise is walking, but even this became difficult after the 2011 incident.  I remember once walking on my own around in the rural area around where my parents live (and where I lived at the time) and because I was on my own and a fair while from home, given I only had my feet to take me places, I started panicking that I wasn't able to get out of the situation.  I had a mini panic attack on my walk back and as such it was difficult to differentiate between the feelings of this and the physical effects of the gentle incline back to home.

Anyway, overall, walking and trying to increase the amount I do has been a really good way of helping my anxiety.  It allows you to process thoughts, which sometimes is the last thing you need, but other times it allows you to gather them and in fact make them more rational.  In the meantime, you're getting good exercise. 

The other problem I had around this time was, linked to health anxiety, the fear of what more vigorous exercise may do to the heart rate, especially when you factor in the medication.  Although I was reassured that doing exercise wasn't affected by the medication, believing this is easier said than achieved when you have health anxiety.  So, walking was good exercise, but not particularly anxiety inducing.  And, needless to say, it got easier over time, so I was able to go walking and enjoy it.

I'm fortunate that one of my friends I mention in blog 4 also likes walking, so we often go on significant hikes in our nearby rural area.

The other thing I started just after this incident was swimming. I hated swimming at school for two reasons; 1) the pool was full of slime and 2) the competitive element again.  I hated all PE at school, but I'd heard from various sources that swimming was quite a good way of alleviating anxiety.  Again, you could control the amount of severity you put into it and how far you did with no pressure, as well as it being good exercise and different exercise to walking.  So I reluctantly started and haven't looked back.  It was hard, both physically and mentally at first, but I knew I had to increase my exercise levels. 

Since then, I have got more out of swimming than I had anticipated.  I have met some really great people whilst doing this, most of whom I see every time I go.  I go early in the mornings before work, twice a week if I can.  Now I commute a reasonable distance it would have been easy to stop, but these people have kept me going and I now look forward to going as a result.  Such is the nature of swimming at similar times each week, you will see the same people and chances are some of them will be like minded.  But this social element has done as much for my recovery as the exercise I get from swimming itself, and I would wager others would get the same experience, if they let it happen.

Walking and swimming are great.  They give you good exercise, improve your social life and help you to forget about the anxieties in your life.  I would definitely recommend it.  The worst thing you can do when you have anxiety is to sit around and dwell on your thoughts that's experience talking.  It takes you away from the modern era of screens too; social networking, which in some cases can do more harm than good. 

Let's just hope, as I mentioned in another blog recently, in the case of walking, we still have plenty of places to walk in years to come.

Last blog of MHAW to come: the theme is helping others.

Best wishes

Al

Seven Steps to Stability - Step 5: Trains

MHAW 2014

The next blog to arrive on this website will be the 17th May Anxiety Tracker service to... wherever you like.

The reason for this blog, perhaps unsurprisingly, is because the severe incident of March 2011 happened on a train. It was a bizarre situation in many ways; I'd been visiting Cornwall overnight, but on the train down and during my visit there, I was okay.  I didn't have any major anxiety, other than struggling to eat which at the time was my main problem anyway, so that came as no surprise. 

And I think one of the main reasons the panic attack I had on the train back was because it came as a surprise.  It was so out of the blue that I didn't have time to react, and of course back in those days I didn't have the CBT techniques to help me out or the beta blockers to keep a lid on things.  In hindsight, it was actually not too surprising, because I know now that at the time I did have quite a few issues, to say the least.  But anyway, that's beside the point.

The incident did occur on a train and it was the worst few hours of my life.  I remember dropping my phone onto the floor just before I stepped off the train just before my first of four changes and not noticing, and someone picking it up for me.  I must have been partially crying because they asked me if I was okay.  I think I said thanks and turned away.  I also tried to seek the help of a platform assistant at this first stop, one of whom was useless but one who made the effort to try and talk to me and calm me down. He went away and then I asked for him again, so he could warn the train manager at my next connection to keep an eye on me - this is how serious I deemed it to be.  I remember thinking when I was sitting at the station 'I've never been hospitalised for anxiety before, but this could be the first time.'

Anyway, I asked for him again but he'd finished his shift, so just as I managed to find someone who seemed to understand, he'd gone and I had to stagger, quite literally, to the correct platform.  I couldn't stand up for long so this was difficult in itself.  The rest of the journey didn't get much better.  The two images I have in my mind was 1) sitting next to quite an attractive girl on one of the journeys and wondering what on earth she must have been thinking of the gibbering wreck and 2) at the last station I had to change at, sitting on the platform floor shivering, made worse by the fact that the train was delayed. 

It's difficult to emphasise how bad this few hours was, although I'm sensing you're beginning to get it.

As I mentioned, it took months to make even leaving the house remotely comfortable. But catching a train took far longer than that to become easier again.  The first time I caught a train after that was a few months later and it was very hard.  I hadn't had much therapy at this point so again I didn't have the full suite of techniques at my disposal, let alone had time to digest them. So I spent the whole journey there and back very anxious, only saved by the fact that it was quite a short journey and so was over before it could get very bad.  I did, however, cancel a trip up north at this time because I just couldn't face it.

Through therapy - and this is another technique I could have mentioned in blog 2 - I learnt that, again unsurprisingly, the best way to make catching the train easier... was to catch the train.  I didn't have any train journeys scheduled around this time, so I had to spend money on going somewhere that was a reasonable distance, but not so far that it was too dangerous to consider.  And what did I go for?  To come back again.  I took a one hour train journey - this must have been around four or five months after the March event - to a main station... waited about half an hour, and then took the trip back again.  Knowing I didn't have the pressure of having to do something or meet someone when I got to my destination may have helped too.  I then did it again about a month later and went a slightly longer distance. 

Again, financially this was nonsense given that I was spending train fare on a journey to nowhere effectively, but actually it was an extremely useful exercise.  I was able to test out my other techniques like those mentioned in blog 2 and both journeys, albeit with nerves, were difficult but went fairly well.

The first proper journey after this was slightly harder, again exacerbated perhaps by me actually going for a purpose (work), which of course put pressure on me when I arrived at the destination - I had to do something!  But the two aforementioned journeys gave me some practice that I much needed.  Had I gone straight in at the deep end and taken a journey - after so long - that actually meant something, I could have set myself up for a fall.

The message here is twofold: 1) practice makes perfect, or more accurately, practice makes things that bit easier later.  It would be the same is someone's worst incident of their life occurred in a pub.  Go into a pub briefly at first, then more regularly.  The most difficult thing would be to go into the SAME pub again - and I have to say I have yet, even to this day, gone on the same train journey as the March 2011 one, or even one as long as that to somewhere else.

2) There's something obvious here that says 'just because an irrational panic attack happened in this situation, the only reason it would happen in the same situation again is because your mind makes it happen.'  True, but trying to control this is not easy.  Therapists and probably even friends will say 'don't associate the two events,' but trust me, this is not easy.  And that's why I would advocate practicing a similar situation first, if possible.

Apologies for the delay to this blog. This is due to my inability to access a computer last night, rendering the post impossible. 

I suppose the fact that I delayed this blog is fitting, given the topic.

Later today: Exercise

Best wishes
Al

Seven Steps to Stability - Step 4: Friends

MHAW 2014

Blog number four this week focuses on the power that friends have had on my recovery.  The first thing I should explain is that some of my friends know quite a lot about my anxiety issues and some don't.  Those that do know I've kind of generally told over a long period of time; it's been very rare to tell someone everything in the space of a few hours.

One of the most difficult things to do when you are going through severe anxiety is speak to other people.  In my experience, it doesn't matter whether you know them well or not, whether there is a group of you or someone on their own. Talking to other people when you're feeling like you're going to break is almost impossible.  But what I have learnt is that it is fundamentally important to try and break through these feelings and, as severe is this may sound, forcing yourself to speak to people usually helps in the long run.

But I appreciate who you talk to is important.  The whole point of this blog, of the various mental health charities, of people on Twitter trying to raise awareness of mental health, of this week's MHAW initiative, is to try and break the stigma around mental health, because sadly there are still people out there who do not know how to handle it when people tell them they have a mental health problem.  So telling the wrong person could do more harm than good.

So talking to people you can trust is very important.  You can talk to them about anything aside from your mental health problems at first, which in itself will help you to take your mind off them.  I remember talking to a good friend of mine for ages about music; nothing abnormal about this you might think, but because we share a similar interest in music style, we talked for ages about old song and new, bad songs and great songs and then ended up playing some of them very loudly.  It was just an hour or so of laughter and taking your mind off the darker stuff.

But in terms of talking to someone about your problems, this of course is not easy.  It is likely to be harder to talk to someone you know well rather than a complete stranger in these circumstances - perhaps part of the reason why we choose to talk to counsellors.  You don't know how anyone will react, and if a close friend reacts in a negative way, the impact is worse than if it's a stranger.  But in my experience, the closest friends will just want to support you and help you through it in their own way.  A profile of some of my closest friends follows, all of whom know a lot about my anxiety issues:

No.1: One of my very best friends doesn't ever tend to ask me how I am from an anxiety perspective.  They leave me to talk about it if I know I need to, and in a way this takes the pressure off.  But if I do talk to them about it, they listen intently and then ask questions to find out more if needed.  They are understanding, but we can quickly move on to talking about something else, totally unrelated.  Their tactic, overall, is to not talk about it and to take my mind off it with other conversations.  They enjoy it when I laugh - as daft as that sounds - because they know that my mind is clear for the time being of anxiety.

No.2: By contrast, one of my other closest friends does often ask me how my anxiety is.  Now before, I said that by not doing this, my previous friend doesn't put pressure on me.  But by this person asking me, they make it clear that they care and this person also understands some of my issues having experienced it themselves.  When we meet they always ask me how I am and how I'm doing and I'm happy to tell them.  They always reason with me and let me know how they are doing too.  I sometimes ask first.  It's a different tactic but one that works well in a different way. 

No.3: This third example comes from a friend who I now hardly ever see.  We had a heart to heart many years ago about mental health issues as at the time I was going through a really difficult patch.  And although we hardly see each other today, we occasionally have a deep and meaningful via the means of social media.  It tends to happen out the blue and always seems to come at a mutually convenient time.  But it's great and it means that if and when we do meet properly, we can talk about things quite openly.

The point of all this is to explain how important friends are in helping you through your condition.  Whether it is to share experiences, vent, cry or laugh, USE them.  Don't be scared of USING them.  Perhaps this is a bit idealistic, but the way I view it is that if a friend doesn't want to understand or cannot empathise with your problems, they are best not talking to about these issues and you can move on to another friend.  You'll get success with at least one. 

The first step is the hardest. Opening up to someone can be painfully difficult.  But in doing so and getting a good reaction is one of the best feelings you can get and for me is one of the most effective ways of getting yourself through a low patch.  I can only imagine that this is amplified even more if the first time you open up the person reacts badly... because if it goes well the second, third or fourth time, you will suddenly find real elation and it'll seem like a real success.

As the initiative goes, it's #TimetoTalk.

Tomorrow: Exposure on trains... no, not in that sense.
 
Best wishes
Al

Seven Steps to Stability - Step 3: The Meds

MHAW 2014

The third blog outlining my Seven Steps to Stability focuses on medication.  Now, any regular readers of my blog may be surprised with this given my general viewpoint of medication for mental health issues.  As yesterday's blog suggested, I always favour therapy ahead of medication, unless it's a particularly severe circumstance.

There have been times in my life when I've been close to needing medication just to numb the pain there and then; but I've managed to keep rational enough to realise that, if nothing else, the effects on your physical health that medication may have may do nothing but exacerbate health anxiety.  Plus I don't like the general concept of relying on medication, if I'm honest, as below will convey.

But, I have been taking one form of medication for a long time now.  I used to be on them for a good couple of years between what must be about 2006-9 or something like that.  I then came off them, but not surprisingly, after the March 2011 panic attack from hell and the subsequent decline in my mental state, I went back on them again.  Beta blockers, as I understand it, are generally used for people who have had or are prone to heart attacks to control blood thickness and heart rate.  Writing this is difficult by the way; analysing the heart rate and talking about blood often makes me feel faint, so I'll move on and accept that if you want to know more, look it up...

But they are, according to my doctor, often taken by people with anxiety.  They are often taken, for example, just before someone who hates standing in front of an audience is about the deliver a presentation.  I was basically told to have one when I felt I needed one in addition to taking a regular one per day.  I never did this and instead stuck to a regular routine, for fear that there would be other unwanted side-effects that I may notice if I took one just before, for example, a presentation - back to health anxiety again. 

At the outset, I was on 50mg strength, which is quite a significant amount considering I hadn't had a heart attack.  When I went on these again in 2011, I knew what they were about.  However, I made a fundamental error.  I took my first one at lunchtime whilst at work (I have a thing that I should always take them just after I've eaten, even now) and I nearly collapsed within minutes of doing so.  The reason?  The over-analysis of the effects it was having on my blood and heart, which I had massively exaggerated and which made me feel... well, faint, as explained above.  This was the only time that I was ever driven home from work early as a result of my anxiety condition, and it's all because my brain was playing tricks on me.

My tactic was to switch to having them at home - a safer environment at the time - and after a main meal.  I suppose you could argue that this worked, because I never had the near-fainting experience again.

So I started back on the meds probably in April 2011 and now, over three years on, I am still on them, albeit with a reduced dose from 50mg to 12.5mg.  Yes, the lowest they produce is 25mg so here I go cutting them delicately in half with a tablet cutter. 

So two questions remain: 1) What effect have they had on me, and 2) Why don't I come off them now when I'm, in comparison to 2011, a million times better?

To answer 1).  I think they have helped.  One of my big preoccupations - a cross health anxiety and panic disorder thing - was with my heart rate.  I over analysed it way too much and, of course, in doing so the likelihood of a panic attack increased.  One of my other CBT techniques (see yesterday) which I've purposely saved until today is to NOT CHECK yourself and for me, particularly the heart rate.  I learnt that checking got me nowhere and in fact dramatically increased my anxiety (this would also go with checking other body parts too).  But of course, this took a long time to get right (I still slip back sometimes), but to score it on the same scale as yesterday, not checking would get:

Implementation: 7
Time: A long time
Success: 9

Very successful, then.  But the beta blockers did make this easier; they effectively prevented my heart from beating as fast in unnatural situations, which meant my preoccupation gradually eased anyway.  So overall in this respect it has helped over time.

Where I think they have been more of a hindrance is twofold; one, regarding health anxiety. The so-called small side-effects have been large for me, such is the nature of the condition.  The second, similarly, is around what it actually does to you - back to the original reason I nearly fainted again.  I remember when I first started taking them when I was still having frequent panic attacks; my body felt like it needed a panic attack and the beta blockers were stopping them from going full blown.  I count this is a negative at first, because this was a really screwed up feeling, which then triggered - again - my health anxiety and made the panic attack last longer, albeit slightly less severe.  It was an odd feeling and one I know other people have felt too.

But overall I would say it has had a positive effect in just calming me down a bit and making it so the 'not checking' technique described above became easier.

To answer 2), why am I still on them after over three years - and now probably something like seven years in total.  The real reason - fear of coming off them.  Worryingly, they are like a comfort blanket.  I'm not even convinced I'd notice the difference if I stopped taking them - 12.5mg is minimal after all - but I have in my mind that the psychology of not taking something will tip me over the edge.  I've always looked for excuses for not testing coming off them completely, like 'oh I've got a lot of work on at the moment,' and I fear that if I do it will unnecessarily raise my anxiety again.  Why come off them when they aren't doing me any harm (if they might be doing me harm, please don't tell me, otherwise my health anxiety will kick in again).

The doctor is happy to keep prescribing them and, although I don't for one minute claim that they are mental health experts, at the same time they can't be too concerned that it is having an effect on my physical health, otherwise they'd try and talk me off them - I'd hope at least. 

But this is another reason why I'm not keen on perhaps stronger 'mental health meds.'  One could argue that I have become reliant on beta blockers just to keep me ticking over, to keep the lid on any boiling over, metaphorically speaking.  I would not want to become equally as reliant on a mental health medication and the easiest thing to prevent that is not to take anything in the first place.

My message would be this.  Medication has its place, there's no doubt about that.  But seriously think about whether any medication is right for you, and if so, which medication is best.  It might help in the short-term, but could end up becoming a dangerous burden in the long term.

My next Step to Stability: Friends

Best wishes
Al

Seven Steps to Stability - Step 2: The Techniques

MHAW 2014

Yesterday's blog focuses on why I decided to get therapy and many from this point forward will look at techniques that came about from these therapy sessions.  Some are "techniques" that therapy may have catalysed that I always knew were there - like being around other people, for example - but today's blog looks at those techniques I hadn't appreciated before, that I learnt specifically as a result of my therapist.

I will emphasise at this point that what you read here should not replace anything you're told from an actual therapist, nor may all of these techniques be suitable for everyone with anxiety.  My aim of this blog is to purely share my experiences with aim of giving hope to anyone considering CBT.

For a start, as I stated yesterday, a critical factor in the success of therapy is how you connect with your therapist and by that I don't mean in terms of the therapy itself, I mean whether you feel comfortable with them and if you don't feel nervous (after a while) about opening up to them.  I was lucky in that I had this and so consequently I was also more inclined to 'believe' what she was telling me was true and to also undertake the various pieces of homework that I was given in between sessions.  I will give a rundown of these now and give each one a mark out of 10 in terms of how difficult it was to implement the technique (0=difficult, 10=easy), length of time it took to implement and a mark out of 10 in terms of how much of a positive impact I deem this technique has had on me (0=no or negative impact, 10=very positive impact).

The main purpose of me doing this is to show that the blindingly obvious is often the best course of action to take when you're suffering.  Things that you may even think you do anyway.  This is all classed as Cognitive Behavioural Therapy (CBT), which is often the therapy that people with anxiety receive. 

Technique 1: CBT as a concept

Implementation: 9
Time: Fairly short
Success: 7

I like to think of CBT as brain 're-wiring,' which in essence, it kind of is... it's about altering thought patterns, many of which are likely to have been embedded for your entire life.  For example, to use a health anxiety scenario:

You feel pain >> you think you're on death's door >> you become anxious which generates more pain >> you think you're on death's door even more >> you become more anxious which generates even more pain >>>>>>>> and so it goes on.

I'm sure anxiety sufferers won't need me to go any further.  CBT is about breaking the cycle at the source, so that when you feel the pain, you DON'T think you're on death's door.  At the very least, if you do, it's about dealing with those thoughts and NOT becoming automatically anxious.  The earlier up the chain you can break this cycle, the more stable you can become. 

I include this as a therapy technique because understanding CBT, or at least forming your own definition, is useful; you know what you want and what you're looking for, and you can create one of the above flow diagrams yourself to fit your situation, so you can track your progress. 

Technique 2: Rationalisation

Implementation: 7
Time: Took a long time to make an impact
Success: 8

This is one of the obvious ones I mentioned.  Rationalisation isn't a simplified name for a complicated technique, it's literally being more rational.  Anxiety sufferers: we're not rational people.  So, it's about realising this and trying to think rationally in a given situation.  So, using the health anxiety example again, when you get a pain in the chest, what could it actually be instead of a heart attack?

Heartburn/indigestion?
A slight muscle strain/pull?
Slight effect of any medication you might be on?

There may be others.  It's about accepting that the likelihood of it being one of the above is a million times higher than it being a heart attack.  Here's another one; because of that horrible advert (you'll know the one if you've seen it; I won't put a link to it), every time I have a minor head pain, I think a stroke is imminent.  Whereas, in fact, it's more likely to be:

Muscle tension/strain/pull
Tiredness
Computer/TV screens
Sinuses

Genius.  Now, accepting these alternatives as an anxiety sufferer - i.e. breaking the cycle - is far easier said than done, and for me took a long time to even begin to get right.  And still sometimes I fail.  It's not just health anxiety either, another example could be thinking that everyone hates me in a social situation.  Is this a rational thought? 

Technique 3a: Mindfulness Practice

Implementation: 4
Time: Not sure it made an impact...
Success: 2

This is being promoted massively amongst various mental health charities and professionals.  I'll let you read an old blog of mine to ascertain what mindfulness is and what it did for me in more detail, but basically it's about being in the present moment and letting all other thoughts of pain, struggle or indeed anything wash away.  Something else becomes a focal point; breathing, your thoughts, sound etc.  I spent months and months religiously practising mindfulness by listening to Jon Kabat Zinn's mindfulness audio books.  It's difficult to establish quite how much effect this had, but I never really got into it.  The period I practised it for was relaxing, but that's not what it was about.  I understood the concept, but against what he reiterated, I just couldn't help but get annoyed with myself when I found my mind wandering.  I'm not also convinced about how much it actually helped me and in the end I stopped the routine as it became and more of a chore. 

Now, this isn't to say I wouldn't recommend giving it a go.  It is a whole new way of thinking and may work for you - as it has for others, I understand. 

Technique 3b: Mindfulness Integration

Implementation: 5
Time: A long time for the penny to drop...
Success: 7

Mindfulness Practice refers to a daily routine of practising the technique.  Integration, which is essence is the aim of mindfulness in the first place, is to do everything mindfully.  That is, focusing on what you're doing and not on anything else.  I don't think I'm very good at this, but I do believe I am better than before I learnt about all of this.  An example would be focusing on other people.  My mind even used to wander when someone else was talking to me; now, I'm much better at bringing my mind back to the present, to them and what they're saying.

The whole point of this, of course, is to stop your mind wandering onto unwanted - or anxious - thoughts and I can certainly see that if it is well implemented it could be an incredibly powerful tool.

Technique 4: Breathing

Implementation: 5
Time: Fairly short
Success: 7

Another award for stating the bleeding obvious.  As you may have noticed, when you're anxious, your breathing often becomes shallow and fast.  The opposite is, of course, meant to help calm you down in an anxious situation and most importantly, in a panic situation.  I have sinus problems which doesn't help me with this one, but generally, when I remember to focus on my breathing (back to mindfulness again) when I need to, it does help.  Breathing slowly in through the nose and out through the mouth. 

It can feel very forced and unnatural at first and in the first few breaths can actually feel like it's making your panic attack worse.  But I've found that if I stick with it, it tends to improve.  It can also help in less severe anxious situations; just when you're feeling 'stressed out' and anxious about something, breathing deeply often helps to calm the situation.

Technique 5: Planning

Implementation: 9
Time: Instant
Success: 7

By planning, I mean events, both in terms of logistics and in terms of organising logistics to minimise stress or panic and in terms of (again) rationalising.  If, like me, going anywhere further than a five mile radius of home was a massive challenge, in doing so I needed a contingency plan, for example:

- I have some mindfulness with me on an mp3 player
- I know what time the train is there and back
- I have a map showing me where to go
- I have food and plenty of water with me
- I have my meds
- I have a list of techniques I can try if needed
- I have a book
- I have my phone
- Someone knows I'm going
- I will take myself away from the situation if the anxiety becomes bad by calmly excusing myself (the hardest one)

The point here is that by organising yourself and by having appropriate items with you, it will help to minimise the likelihood of a panic attack happening in the first place.  This helped me tremendously when I first started catching trains again; knowing that I didn't have to worry about logistics and knowing that, if things did go wrong, I have people to call and I can escape.  I'm lucky in that I'm quite an organised person anyway in this respect, but for someone who isn't, being so could have a big impact.  Again - seems blindingly obvious.

 
So there you go; just some examples of techniques that I learnt as part of my CBT therapy, which individually had mixed but an overall positive impact.  Collectively, I think they helped me massively and I continue to use them over time.  I also continue to monitor them so I can remind myself every so often that I should be doing something more, if necessary.

Not all of these may be appropriate for everyone - I emphasise this again, and this does not replace professional help.  If you're taking help from me Lord help you all.  But hopefully what it does show - and this is my aim - that sometimes it's the really easy and obvious stuff that can really make a difference.

But that, of course, doesn't mean it's easy to begin with.

Tomorrow's blog: medication

Best wishes
Al

Seven Steps to Stability - Step 1: The Therapy

MHAW 2014

Clearly, the key to my Stability after the horrific incident of March 2011 was the professional help that I received.  I simply couldn't cope with everything going on around me; at the time, I struggled to even leave the house and day to day mundane things proved to be close to impossible.  Socialising was a no-go and going to work was also very difficult, albeit something I persisted with.  I was crying a lot and perhaps unsurprisingly having to cope minute in minute out with severe anxiety made me feel very low and constantly exhausted. I must have looked unwell at times; I remember people asking 'are you okay?' or saying 'you look tired.'  Of course, I never told anyone what was really happening, which of course did not help one little bit.

I was very ill and very worried about myself - which of course fuelled the anxiety even more.  I struggled to eat, sleep and even speak coherently at times.  I pushed people away almost accidentally and was slowly becoming a recluse, bar going to work.

At this time, it didn't feel like I was going to get out of this hole without significant intervention.  I'm against medication for mental health unless it is a last resort, but having had fairly poor experiences with counselling before, I was almost considering this as an option. 

This was, indeed, one solution I did take, in the form of beta-blockers, an analysis of which I shall include later this week.  But I still wasn't keen to go onto something more specific to dealing with anxiety.  I needed therapy again, but I needed it now.  My previous experience with NHS therapy was poor for two reasons: 1) it took well over a year from initially being referred to therapy to actually receiving it, and 2) the person in our area is not a particularly pleasant therapist.  His methods, shall we say, are somewhat blunt and as a person I couldn't warm to him at all.

My experiences of private therapy weren't much better; yes I got seen quickly, but I realised retrospectively that the therapy I was getting wasn't actually Cognitive Behavioural Therapy (CBT), typically the most common type of therapy to help with anxiety.  The counsellor was more concerned about how I had become the way I had, rather than trying to help me through the anxiety.  I'm not saying history isn't important, but CBT is all about dealing with the symptoms and the here and now, with history merely helping the therapist to understand over time.

Also, in both the private and public experiences, I was limited to less than ten sessions, which almost felt like there was pressure on to start improving.

So these, frankly, inadequate experiences prior to 2011 meant that I perhaps didn't get on to organising therapy as quickly as I should have done, simply because I'd lost a little bit of faith in it.  But I'd simply got to a point where action was non-negotiable.

So, as is the modern way of things, I did some research online and it took less than five minutes to come across Anxiety UK, a charity whose audience were people like me.  I actually spent quite some time checking that they were genuine; it, perhaps naively, never even dawned on me that such an organisation could exist.  They were willing to offer therapy not only quickly, but from someone who has had experiences of anxiety.  They were willing to offer unlimited sessions and even therapy via webcam, should a therapist not be practising in my area.

Needless to say, once I realised this was all legitimate, I phoned them up.  This took guts back then; to even pick up the phone to anyone was a challenge but I knew I had to try this.  I looked online and found that my nearest therapist was based about 20-25 miles away, which especially given I don't drive was simply not feasible at the time.  Work, about four miles away, was my limit in terms of travel.  So I filled in the application and opted for the webcam therapy.  Despite a couple of minor administrative errors, I had spoken to my therapist within a few days and organised an appointment within two weeks of making first contact with Anxiety UK.  It may have been even shorter had it not been for the minor errors. 

Don't get me wrong, at the time I was still sceptical.  "Just because it's gone well so far, doesn't mean the therapy will."  I also didn't know whether the impact of the therapy would be weaker via webcam than face to face.  But I knew I had to do this. 

My next blog will provide some more details about the actual content of the sessions, in terms of techniques I learnt and have practised.  The things that actually got me on the way and have helped maintain my stability.  But just to put things into context; I had 50 sessions with this therapist over the course of about 13 months.  Yes, fifty.  Five Zero.  She was human, she could empathise, she could understand and she gave good advice.  As long as I put the work in in-between sessions then progress could be made.  But I could tell she genuinely cared about me and my progress, got to know me as we went along, shared her experiences and wanted to me to make good progress.  She was, in fact, an NHS therapist up in Scotland, but helped a few private patients out of hours (of which I was one) privately.  And the webcam thing, bar the odd technical failure aside, didn't hinder the progress at all.  I would certainly recommend this if you cannot get help in your area. 

Now I grant you, I spent exactly £1,000 on this treatment (£20 per session).  I also appreciate some people would not necessarily be able to afford this (although it is worth pointing out the Anxiety UK charge dependent upon total household income, so it should be cheaper the less you earn).  But I fail to have seen any free service that you could get that would provide you with as many sessions of this, especially that are high quality. 

What this also proves is how much help I needed.  Fifty sessions at probably an average of 50 minutes per session is a lot of time.  But without it, I dread to think where I could have ended up.  There is a lot of talk about crisis care and how few people get the adequate support they need when they are in crisis.  I am reluctant to say that I was in crisis as per the definition, but it felt like it at the time.  And I can say whole-heartedly that I couldn't realistically have expected to get a better service, albeit I was willing to pay for it.

Ultimately, the therapy I received didn't just help me after this 2011 event, it helped my wider, more chronic anxiety conditions and made me learn a lot more about them.  It was the key thing towards helping me with my stabilisation and many of the rest of this week's blogs that detail things that have helped were triggered by things that I learnt during these fifty sessions of CBT.

Some of the more psychological techniques that I learnt will come tomorrow.

Mental Health Awareness Week 2014: Are You Anxiety Aware?

Best wishes
Al

MHAW 2014: Seven Steps to Stability

MHAW 2014

It isn't much, but for Mental Health Awareness Week (MHAW), which starts tomorrow and runs up to and including Sunday 18 May, I am going to write a blog each day that I am collectively naming 'My Seven Steps to Stability.'  So called, because a) it's alliteratively pleasing, b) seven blogs in seven days hence why it's seven and c) 'stability' because the blogs will reflect the seven key things that helped me after I had my worst ever panic attack back in March 2011.  I use the term Stability, not just because of the alliteration, but also because the word 'recovery,' which is the word I started using, almost makes it sound like I have recovered completely from my anxiety.  This isn't the case, although as you'll hopefully grasp, there is an argument that without this horrific incident in 2011 my anxiety now may be worse than what it actually is.  Short term pain for long term gain and all that. 

Anyway, I have written about this incident on this website before; please check out previous blogs here and here to find out more about it to help put it into context.  In summary, a long train journey triggered a panic attack that lasted about 14 hours, which then had longer-term effects that included severe anxiety for months thereafter.

I hope that this will help just a few people (realistically) to understand the things that helped me.  Some will apply to everyone, so won't or can't, some will be harder than others to implement, depending on your own experiences.  But I suppose my message is this: hope is out there.

Are you anxiety aware?

Best wishes
Al

Ravaging our Countryside?

Cannock Chase :)

As a human race we seem to be intent on destroying our green and pleasant land.  I love walking and I've been privileged enough to have grown up near to some beautiful countryside.  Luckily much of this land is protected and development in or around it is prohibited, but this doesn't apply to all of it and moreover there are many other areas that don't have similar preservations.  Areas that aren't as 'rich' from a biodiversity perspective but that are not used for agriculture are often deemed as pointless and the first fields to be approved when it comes to building new housing or other developments.  This is often in the face of protests by local residents, usually on road congestion grounds or pressure on services.

But alongside this, my protests would be twofold: 1) I'm a bit of a tree-hugger at heart and when humans decide that they want to hack trees down or tarmac over large green areas it just leaves a bad taste in my mouth.  2) To bring it back to the point of my website, walking in the countryside and getting out of the chaos of towns and cities is a necessity to help to deal with anxiety.  The life of a standard MEDC-resided human, regardless of class, seems to be busier these days, whether it be work related or simply the pressure of keeping groceries on the table.  People are more stressed generally and we all suddenly wish we had more hours in the day. 

Now I emphasise - or indeed stress - that stress is not the same as anxiety.  The way I view stress by definition would be a period of your life where something(s) are causing difficulties or challenges beyond what would normally be accepted or deemed reasonable... but when this challenge is resolved, it dies down.  This isn't anxiety, as anxiety is usually more intense, lasts for longer (or indefinitely in many cases) and doesn't necessarily have to be caused by a challenge.  Anxiety can happen whenever it bloody well likes, trust me.

But stressful periods are increasing, and my vast knowledge of mental health science (cough) tells me that it makes sense that more stressful incidents in someone's life could lead to a longer-term anxiety condition, if they happen frequently enough. Moreover, cases of actual anxiety seem to be increasing, if you read most of the statistics.  People don't have time to go for a walk in the countryside or park these days, bar perhaps to drag the dog because they know they have to, and if they do, such green spaces are being increasingly threatened by our collective - but not exclusive - love of all things human. Buildings, transport links and the like. 

So to me, the likely construction of more housing on the green belt and in the countryside is bad news.  I know more housing is needed, affordable housing at that, but surely not all of this has to be of the detriment of our beautiful landscape?  When I catch the train, the amount of derelict urban land I go past where nothing is happening where they could build things is huge.  I appreciate there will be reasons why some of it is derelict; not all of this land would be suitable for construction for whatever reason, such as contamination, but much of it would be usable I'm sure.

Then there's HS2.  Without going into a political rant, I am vehemently against HS2 for numerous reasons, one of the main ones being the widespread destruction it would cause our countryside.  A whacking great railway line that in my opinion would serve no benefit to the country is to plough through not just the 'insignificant' fields I mention above, but even preserved areas aren't standing in the way of this.  And HS2 and many other developments are all about materialism.  That's another issue, wider than this blog, that really gets my goat.  

My point relating to anxiety is this.  Our countryside, where we can free ourselves, relax and take our minds away from the hustle and business of the city, is gradually being eaten up by our apparent desire to tarmac it.  We need to keep our countryside and all of our green spaces so that we can go somewhere to take ourselves away.  Walking, I've found, is one of the best things to do to help clear the mind, but NOT walking along a busy urban highway.  Walking on an isolated pathway, away from the gaze of society, is crucial to mental health healing, in my opinion.  Mind's Ecotherapy programme highlights this.

As you may have ascertained, our gradual paving over of our countryside is an issue that bugs me in more ways than one.  Helping to a better and calmer mental health is one of many issues I have with this.  But it's a very important one and, from experience, I can be certain when I say that living near to the countryside for much of my life has sometimes provided the escape I've needed from my life and myself.

Best wishes
Al

PS >> Next week is Mental Health Awareness Week.  I am going to aim to write a short blog each day that reflects my 7 days of recovery from my worst panic attack back in 2011.  As you know, I don't tend to refer to anything when I'm writing my blogs, so trying to think on my feet about this won't be easy... but worth a try!!