So, let’s begin with a disclaimer. I am not a mental health professional. It’s really, really important to seek out the right treatment and therapy for you. This post is about something that has worked extremely well for me, but it’s important to keep in mind that I also take medication to manage my anxiety, as I discuss at length in this post.
Even if you don’t have a clinical anxiety disorder, the strategy I’m about to discuss also helped me immensely to manage pain during the birth of both of my children, and at times of extreme discomfort during my pregnancy. It also helps me deal with moments of anger that only a parent can understand!
When I first started learning about anxiety, the phrase “fight or flight” came up again and again. When faced with danger, our body’s natural response is to either fight (say, bust out the bear spray) or flight (say, shimmy up a tree and hope the bear can’t climb). When you have an anxiety disorder, your body and mind react as if there’s a hungry mother bear in front of you… except… there is no bear.
When I used to have anxiety attacks, they would very quickly escalate into lengthy episodes during which I would spend months at a time feeling constantly as if the bear were in front of me, poised to strike. My quality of life and overall health diminished greatly (a sure-fire sign of a disorder, rather than just a bit of nerves before a stressful event). There were often triggers, such as stress in a relationship or stress at school, but the anxiety was beyond what was reasonable for any given situation, and didn’t resolve even when the initial cause of the stress disappeared.
My reaction to my anxiety was always one of fight or flight:
Fight: My “fight” instinct manifested mainly in the endless, self-destructive dialogue in my head: You’ve got to stop feeling this way. You can’t feel this way. This feeling is terrible, it has to stop.
Flight: My “flight” instinct was both mental and physical. Mentally, I would try to flee the anxious thoughts by distracting myself, by trying to push them out of my brain: “Don’t think about it. Don’t think about it. Don’t think about it. Snap out of it!” Outwardly, I would avoid the things that triggered my anxiety. I would stop engaging in activities for fear that I might feel anxious.
So I’d just like to take a moment to explain what one of my main anxiety triggers has been in the past so that I can better explain why my “fight or flight” response was not working for me.
My anxiety leans very heavily towards a type of obsessive compulsive disorder known as “primarily obsessive.” It’s a lot like the kind of OCD we all know about, such as someone who is so worried about germs on their hands that they wash until their hands are raw, but still don’t feel clean. This type of OCD has a very obvious compulsion to it (hand washing). In my case, my main symptoms are entirely invisible and involve endless and debilitating mental checking and reassurance seeking in an attempt to get relief and stop my thoughts. In my mid twenties, the focus of my obsessional thoughts was my relationship with my husband. Despite absolutely no proof or reason to consider our relationship in any kind of turmoil, I became obsessed with the idea that I didn’t love him anymore and we were going to get a divorce. I would devote hours of my day to trying to prove to myself that we were not, in fact, in any danger of getting divorced. I would be constantly online, reading articles about healthy relationships, trying to seek proof that ours was a solid one. I would scan my body and my mind for any symptoms that might indicate I was falling out of love with my husband. “Am I enjoying this date?” “What if I’m not enjoying this date enough?” “What if we have kids and then we end up getting divorced and I have to move out with the kids and my kids hate me and… and… and…” I would become utterly consumed by these thoughts and scenarios. So I started trying to avoid anything that could trigger these thoughts. I tried not to look at couples on the street. I averted my eyes from magazine headlines about celebrity break ups. I refused to watch movies or tv shows that showed a break up. Forget listening to the radio! I was so consumed by this irrational fear that I lost twenty pounds (I couldn’t eat, I couldn’t sleep, I caused myself a great deal of gastrointestinal distress) and my life was sheer misery from the moment I opened my eyes until I finally got off to (an often medicated) sleep.
I tried to fight my thoughts, I tried to flee them. They only wound up having more power over me.
Back to the bear.
TRY NOT TO THINK ABOUT A BEAR.
Seriously, just close your eyes, and tell yourself not to think about a bear, and see how well you do.
Not so well, right? What about if you do the opposite? What if you try to just make yourself think only about bears, JUST bears for ten minutes? What happens is you get bored. Your mind wanders. You stop thinking about bears.
See where I’m going with this?
ERP, in a nutshell, involves exposing yourself in ever-increasing degrees to that which causes your discomfort until you actually become bored with it, and the fear response fades away. (Your typical response, be it hand washing or mental checking, is prevented.) No fighting or fleeing, but actually running towards the threat (since the threat is not real). ACT is less direct, but involves a willingness to sit with and accept the discomfort caused by anxiety, to acknowledge it and let it be there without judgment (it’s a kind of mindfulness).
Concretely, the way ERP worked for me (with the guidance of my therapist) was that I was no longer allowed to not think about divorce. Honestly, to start, I had to expose myself to the word itself, just as an arachnophobic patient might start by just exposing herself to the idea of a spider. No avoidance. No looking away from a celebrity divorce scandal headline. I had to read Eat. Pray. Love. (since it’s about divorce). I had to record myself explaining in excruciating detail my most feared and anxiety-provoking narrative, then listen to it over and over again. I stopped devoting all my energy to not thinking about the bear. I started inviting the bear to come play with me. I started deliberately provoking it, daring it to attack me, daring it to take a swipe.
More along the lines of ACT, I also worked on acknowledging my emotions without judging them. I accepted them, even the most uncomfortable ones.
It’s basically the classic reverse psychology we use on our children. You want them to take a bath? Tell them you really don’t want them to take one.
Results were, of course, not immediate. I was basically re-training my brain, trying to change patterns of thought that had been in place since I was very little. (Fundamentally that pattern of thought was: It’s bad to be scared. Don’t be scared.)
I knew it was working when I started to go for longer and longer stretches without the repetitive loop of anxious thoughts. When a thought would pop up, I became more and more adept at saying “hello” to it rather than “go away!” I would sort of dare it to get worse, mentally slapping my two hands to my chest and saying, “Bring it on!”
Bring on the bear.
In childbirth, I used these same techniques to manage pain. Instead of reacting to pain by thinking, “I can’t! It’s too much! It hurts too much! I can’t handle it!”, I would think, “Bring on the pain. I feel you. I am working through this. I accept this.” I know it might sound crazy, but changing the way I was reacting to my pain actually alleviated it.
After Little Miss Cub was born, I started feeling the creeping, sinking sensation of anxiety pulling at me. The “what if” thoughts and the self doubt were starting to lead to panic gripping at my chest.
So what did I do? For one thing, I didn’t deny it for a single second. I told my husband what I was feeling and I let out some tears (pretty normal for any post partum woman). And I didn’t fight it, I said, “Bring it on!” And I didn’t flee. I immediately started doing the exact opposite of what my anxiety was telling me to do. It was telling me to retreat. It wanted me to go online and start searching out miracle anxiety cures. It was telling me that small tasks were too overwhelming, that phoning the mechanic to book an appointment for the car was too scary. (Yes, anxiety makes mundane tasks feel like Mount Everest.) I was not feeling in top mental shape for a couple of days, but it was potentially my shortest bout of anxiety to date.
I let the anxiety in and I tricked it into leaving by telling it to stay.
If you’re curious about the form of OCD discussed in this post, I recommend listening to this Invisibilia podcast. Until I heard the story of the young husband who feared he would stab someone, I had never heard someone talk about the same kind of OCD issues I have dealt with.
Some books that helped me:
[affiliate links to Amazon.ca]
Acceptance and Commitment Therapy, Second Edition: The Process and Practice of Mindful Change
Freedom from Obsessive Compulsive Disorder (Updated Edition)
Full Catastrophe Living (Revised Edition): Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness