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!!

Drunk from Anxiety

If I ever talk in depth to someone about the anxiety I have experienced, I usually tell them about the three 'strands' of anxiety that I have dealt with over the years.  One is health anxiety, one is panic disorder and the other is social anxiety.  The latter is something I have blogged about before, from a lack of confidence with other people point of view, but there is another element that, for me, also heightens anxiety in social situations.

I don't do this too often...

Much of it is around peer pressure when it comes to alcohol.  People I know and, perhaps to stereotype, most people between mid-teens and mid-thirties today, seem to be in the mindset of 'if you don't drink when you go out, you're not having a good time' or 'you're no fun.'  Drinking is apparently the thing that makes the night out good or otherwise, whereas in my experience it's often the opposite.  

If I drink too much alcohol in one night (which I never do these days), then it has been known to cause some adverse effects on my heart rate, i.e. increase it significantly.  My usual pattern of a drunken night was:

Go to bed and fall asleep quickly at say 1am > wake up at 5am with my heart pounding really fast and nearly have a panic attack > get over this by about 7am, then fall asleep briefly again and wake up feeling horrific.

This would happen after only say three pints - I was barely drunk really, and didn't get a hangover.  It was just the effect alcohol had on me and no-one else I know has ever experienced this thing with the heart rate.  If I had even more drink than this, to the point where a hangover also set in, then the same thing would happen but I'd also be hungover in the morning, which then of course had an additional effect - triggering my health anxiety. 

It was all this that stopped me from drinking too much on a night out.  The slightly good feeling you experience when having had a few drinks wasn't worth the hours of hell I went through afterwards, which to me seems perfectly reasonable.  Of course, explaining this to someone isn't something I have done much of (it's not exactly a conversation to bring up when out drinking), meaning that I can't use this as an excuse as to why I may not be drinking much when I go out.  Many people who I've been out with several times over the past few years have kind of just accepted that I don't drink much, compared to most people.

But as I said earlier, getting drunk is compulsory for most people when they go out... if they aren't drunk, the night is crap.  In reality, if for some reason they aren't drunk, they almost automatically refuse to believe that a night can be a good one, and hence turn miserable for the rest of the night.  Because of this strange mentality that young middle-class citizens have developed (in my experience - I emphasise, I'm sure it's not like this everywhere), it then means that if their friends aren't equally as drunk as them, they are not having a good night, or they are making their night miserable because they aren't getting drunk with them.  It's crackers.

Some of the best nights out I've had have been ones where I've been stone cold sober.  I actually enjoy clubbing to an extent, mainly for the music rather than the overcrowding or state of other people around me (yes, usually from alcohol), but I love music and the euphoria I find it can bring. One night I was out in Birmingham with a couple of friends seeing some DJs that I particularly liked.  The drinks were really expensive (£5 for a bottle of lager for e.g.) and the place was so packed that getting to the bar was a task, let alone waiting for the barman to serve you.  So much so that we didn't bother and having only had a beer with a meal beforehand, I was totally sober.  And yet, because the music was great and the atmosphere was electric, it was a great night in good company and frankly alcohol may have only clouded this.  That's before the inevitable health impacts that would have subsequently set in.  

But social anxiety comes when people start badgering you to drink; in some cases, buying you drinks when you have been adamant that you don't want one.  You feel pressure initially and this intensifies if, as I do now, you stand your ground.  People start making comments about you not drinking and this makes you feel like you're a burden to the night out.  This, of course, is particularly prevalent when everyone you're with is getting increasingly rat-arsed, and the problem with being the sole sober person is you can't have a coherent conversation with anyone.  You're aware of things, no-one else is.  You're aware that people, by and large, turn into idiots when they are drunk, people you don't want to be around, and people that in their drunken state you'd only appreciate... if you too were drunk.  

So your night becomes miserable and you feel lonely and boring.  It's not good and gives you a complex.  This is where, of course, it begins to fuel the low confidence feelings too, that I experience in most social situations anyway, regardless of the presence of alcohol.  It's a downward spiral from there.

I'm pleased to say that some of my closest friends are like me in that they don't need alcohol to enjoy themselves.  Most of them drink, some of them get drunk, but they don't feel that a night is a hopeless one if they haven't.  It's merely a laugh and a comment the morning after - 'haha, you were pissed last night.'  This I don't mind, and I can appreciate the benefits of being drunk.  If I'm being blunt, I'd probably drink more if I didn't have to face the health implications a few hours later everytime I went over my rather low threshold.  

It's unlikely society will change.  More and more pressure is being heaped on young people from a social perspective from the social media phenomenon and drinking isn't likely to decline anytime soon.  The whole world of modern social behaviour is not good for someone with social anxiety and sadly, in my opinion, I don't think it's likely to get any better in the future.

Best wishes
Al

Ooh, tetchy

One flaw of my anxiety condition over the years has been the inability to deal with criticism.  This is understandable, and obtaining criticism is something that can easily cause anxiety if you don't take it well.  If I ever get criticism for something, usually work related, I often turn moody with the individual who has given me the criticism.  I'm probably worse if I know they're right because then I also feel like a failure, which is the ultimate in self-esteem crushing.

Slightly OTT but you get the idea

What I feel legitimately annoyed about, though, is when people comment on certain aspects of my life.  For example, I'm not the world's best cook (neither are any of my family before me - it's rare that the oven or microwave isn't used to cook at least part of a meal) so I keep it simple.  I vary my diet but I can't make dishes that some people themselves would call 'simple.'  Anything that involves ingredients causes me real problems.

So like I say, I keep it simple.  When people, over time, notice this (I'm obviously referring to people I live with because who else would necessarily know?!) and then make comments such as:

"I assume you need the oven" or
"Are you having that again?"

... it annoys me.  Why does it annoy me?  Especially when such comments are usually in jest and I can give it back just as much.  Well, I put this down to a chronically low self-esteem; I effectively take such comments as criticism, which is the first problem.  It isn't really criticism, and even if it was, why should I care?  Why does it bother me so much that someone has pointed out what I eat?  

The underlying answer is I HATE it when people psycho-analyse me (if this is the right phrase).  I hate it when people think they know me when they comment on these sort of things.  There are other examples too, I don't want you to think food is the only thing, for a fear of clouding the food issue with another food issue I've had in the past.  It could be anything that people observe about me.  Another example could be if I talk about something quite often, or do something often, like watch football.  I love watching football, again as a result of my family, but then people make comments as though me watching football is me wasting my life.  

Now it could be that people's observations are sometimes true.  I could do more with my life than spend all daytime weekends watching football.  I could try to cook more adventurous things.  But even if they do have a point, I let it bother me that they a) think they have a right to point it out when I could easily make likewise comments to them about some of their traits and b) that they should care about what I do when it doesn't affect them.  I know, it sounds petty and tetchy, I can hear it.

So why does this bother me so much?  Like I alluded to earlier, low self-esteem is one thing.  In most situations (especially socially), I have horrendous self-esteem issues and often find it difficult to make myself feel good about myself in front of others. I think people making what seem like derogatory comments about my life, even if they're not derogatory, just emphasises this self-esteem and further damages confidence.  This then fuels anxiety and makes me feel worse about myself, and so the spiral continues.  

As with many things, including the chicken and egg, which caused what?  Did the anxiety cause the self-esteem issues or did the self-esteem cause much of my anxiety?  Hard to say and as also with many things, I think it's a bit of both.  As a result I just hate psychoanalysis, and it makes me feel like things I do are odd, even though everyone has bizarre traits.  It's just that most people can take it when they are told about it.

Just another aspect of how anxiety has contributed towards element of my personality.

Best wishes
Al