Many clients with anxiety describe being in a kind of fog at times, feeling unable to do anything much or using escapes like TV or something else passive to distract themselves. Sometimes they wonder where the time went. I usually ask them to look at what they were thinking before they entered the fog and, if they can tell me, I almost always recognize that they've been engaging in irrational thinking that scares them in some way. Then, the task is to find the more rational thought and it's often one that doesn't make them feel fearful or as fearful. I ask them to write it down and refer to it anytime they feel they're entering the fog again or when they realize that they're engaging in the irrational thought again.

This is hard work for the individual and I've found that some people just can't seem to recognize the onset of the fog or get in touch with what they're thinking when the thought is very disturbing, so then the task is to help them develop mindfulness -- increasingly paying attention to more and more thoughts and learning to trace back from any feeling to a thought, as practice for recognizing when an irrational thought arises.Another way to approach this is to ask clients to focus as much as possible on whatever they are doing, in order to develop mindfulness.

I also frequently ask them to switch whatever they are doing to something engaging -- and to focus on it -- if they find themselves walking into the fog. Other people find that recognizing thoughts and challenging them isn't so difficult for them. This method is called cognitive behavioral therapy (CBT)

We know that this "fog" or unwanted absorption in a mindless, passive state of mind is the brain's way of escaping feelings of fear or discomfort. Unfortunately, in this case, the brain betrays us by only making the tendency to escape more frequent and/or causing worse anxiety. Avoidance of fear or anxiety makes it worse. The only way to overcome or decrease fear or anxiety is to face it.

If you need help to face your anxiety, you may need help to do it. Someone trained in anxiety counseling/psychotherapy can help you recognize when and why it's happening and consistently remind you to face it by using a more rational thought or becoming engaged in an engaging activity, or both. Your brain won't easily cooperate because it has been conditioned to take the usual escape route -- actually physiologically conditioned -- so it may well take its usual route until you intentionally fight back over and over and over again. In time, the tendency will disappear as a new route of neurotransmission is established (or even new neurons are created). This plasticity of the brain is what enables us to change these routes.

Although a serotonin re-uptake inhibitor (SSRI) medication can help a lot while you take them, if anxiety is very high, they are best taken while in therapy where you learn and accomplish this re-routing. Then, when you discontinue the medication, you should find that you can do without them. When people with anxiety don't do the actual work, they usually need to continue with the medication. A caveat here; some people will need them to control the anxiety even after they've mastered the re-routing, usually through cognitive behavioral therapy (CBT). We aren't sure why this happens, but it seems that these are people with especially difficult anxiety, such as OCD, perhaps a more complex anxiety, a dual disorder or some particularly resistant anxiety for an another reason. Even so, changes in life style, development of healthy habits, meditation, changes in attitudes or beliefs and other means can often help.

It's often better to develop a reasonable, written schedule and live by it than to escape from anxiety with various diversions or wandering through the day in a fog. If you find yourself lost in a mindless cloud on the Internet, distracting yourself with TV for hours on end, drinking alcohol, bingeing and purging, or wind up ruminating, perseverating and dwelling on an issue or issues for long periods and wondering what it is you've done with your time, you likely need to bring yourself back to planet earth and get focused on your life. Setting a daily schedule for yourself that includes the things you really need to get done, your regular self-care tasks (like breakfast, lunch, dinner, recreation/exercise, relaxation, etc) and social life can help ground you.

Try to keep your written schedule reasonable. Perfection is not the aim. It won't help you to be overly ambitious and then fail to follow through -- the surest way to end with you chucking the schedule and returning to old avoidance habits. Follow the schedule the best you can. Include such mundane things as meal planning, grocery shopping, doing the laundry, other housework and paying bills.

Everyone needs structure in their lives. It's especially true for people dealing with anxiety (or depression) and particularly necessary for people with anxiety to plan that structure since the avoidance fog can steal life right from under their feet. When we're highly anxious, it's natural to want to escape -- the old fight or flight response at work, or to mull over the source or sources of anxiety in ongoing efforts to figure it out -- with idea that once we find the answer, voila! the anxiety will disappear. If you have a form of clinical anxiety, neither will be helpful to ridding you of it or helping you live a rewarding life. In fact, chances are good that all of these attempts will even make it worse.

Living by a reasonable schedule and seeing a counselor/psychotherapist to address the anxiety directly can save you from hours, days, weeks and even years of painful anxiety and the detrimental escapes, obsessive ruminations and mindless fogs that are futile attempts to escape anxiety.

If you're taking an SSRI (a class of antidepressant), such as Prozac, Zoloft, Lexapro, Paxil or another one, and taking an anti-inflammatory, you might be compromising effeciveness of the antidepressant. Anti-inflammatories, such as aspirin, ibuprofin (Motrin), naproxin sodium (Alleve) or acetaminophen (Tylenol), can interfere with how well an SSRI works for you, according to a convincing new study, "Common Painkillers May Blunt Antidepressants."

If you don't really need the anti-inflammatory on a daily or frequent basis, consider cutting down to only when you really do need it. Otherwise, if you think your antidepressant isn't working, as the article suggests, talk with your doctor about switching to another class of antidepressant. In any case, if your antidepressant doesn't seem to be working, try a different one. 

Do your thoughts lead you to spiral out of emotional control? Do you have a lot of distressing emotions? Are you prone to negative thinking? Are your thoughts just about anywhere but here, right now, in this moment? Do you wonder where you've been and what you were thinking as hours have gone by? Do you feel like like you're on automatic pilot a lot of the time? Do you discount the good that happens to you? Do you lack direction or purpose? Do have intrusive, irrational thoughts? Do you fly into temper tantrums? Do you use food rules to control or escape? "Yes" answers to these and related questions could mean you'd benefit from learning mindfulness, particularly mindfulness cognitive behavioral therapy (MCBT) -- meaning mindfulness+cognitive behavioral therapy (CBT) -- and even simple breath awareness meditation.

Nowhere in the western world today does Buddhism influence western culture more than in the modern psychotherapy movement towards integration of Buddhist practices of mindfulness and meditation, particularly in the CBT practice sector. While CBT is about catching thoughts, challenging their rationality and changing irrational thoughts to more rational ones -- and changing behaviors to more rational ones -- mindfulness is a practice of attention that helps us to recognize when our thoughts are about to lead us astray. Breath awareness meditation, and most meditation, in fact, reinforces our learning of mindfulness. It also relaxes us.

As good as that news is for people who have anxiety disorders, including OCD, generalized anxiety, PTSD, social anxiety, phobias; depression; eating disorders; and some personality disorders, there's even more amazing news. In the past 10 years or so, neuroscience has found evidence that these practices can actually change the functioning and physiology of the brain for the better, an idea that very few took seriously in the past. This refers to "neuroplasticity," the capacity of the brain for change, a scientific concept that has been steadily gaining ground as the technology has developed to show us evidence of this phenomena.

To learn more about mindfulness, MBCT, meditation and the brain, I recommend these resources; "Meditation Alters Brain Structure," "Meditation for Anxiety - It Really Works!," "Mindfulness Meditation,"  and "Meditation and Mindfulness for Stress Management."

Scientists have recently discovered that there's a place in the amygdala that seems to act as a switch that can turn anxiety on and off, according to the journal, Nature.  Pulsating light was used to stimulate certain circuits in the amygdala region (what is often referred to as the reptilion brain, the back of brain region just above the neck, nuclei  within the medial temporal lobes) in mice. There's apparently reason to believe this may lead to new treatments for anxiety in humans.

If it turns out that it does work in humans, one of the challenges, before it could be used as a treatment, may be how to avoid endangering the individual as this procedure in mice seems to turn off fear altogether. We need some of this function to know when fight or flight is actually necessary. Then, there are questions too whether other functions of the amygdala would be affected and development of a non-invasive procedure possible.

For now, though, most of us can learn to turn down the heat that emanates from the amygdala by taking a calming, diaphragm breath, getting organized to face the day rationally, with a manageable to-do list, and turning away from potentially upsetting situations until we have time to rationally plan a reaction, if it's even needed. With practice, we become able to decrease these uninhibited cortisol secretions, the responsible hormone in the amygdala, on what can become an automatic basis for most situations.

We know that prolonged or frequent cortisol secretion can wreak havoc on our health, leading to; high blood pressure, peptic ulcers, diabetes mellitus, low white cell count, depression and heart problems. It certainly impacts our lives in other ways, too; irritability, rage and unreasonable fear that can lead to all kinds of interpersonal and self-concept issues that can affect our employment, relationships and much more. It's never too late or too early to develop habits that can help us overcome anxiety, fear and rage, or to make sure we don't go down the dangerous cortisol level road. Here's a bit of what I've incorporated to take control of it:

Daily meditation;

Do the opposite when I start to feel inclined to snipe or rage;

Simplify, simplify, simplify my life in as many ways as possible and acceptable to myself;

Write down the priorities for the day and do them first;

Remember to breathe from the diaphragm;

Get in a good walk or pilates every day;

Look at my garden;

Tell my partner about all the good things that happened that day;

Choose rational alternative thoughts when my negative thoughts start to upset me;

Pet a cat or dog;

Contemplate a view of water;

Do an oil painting or something else I enjoy;

Talk to a friend;

Get enough sleep; and

Don't work too many hours.

What's your list? If you don't have one, you may want to develop one and incorporate it into your daily life. It doesn't have to look like anyone else's list; As my father-in-law always said, "It's important to have the proper balance of work and play." Beyond that, whatever it takes -- that's not addictive or otherwise unhealthy -- to keep the cortisol at reasonable levels is a wise part of self-care.

 

 

Individuals with eating disorders and obsessive compulsive disorder frequently suffer as much from loss of self-concept as much as they do from the more obvious symptoms of their disorders. This is only one way in which these disorders are similar, but one that can easily be overlooked by friends and family because it's often difficult for the client to admit feeling empty inside or not knowing who one is: This is a lack of self-concept. See the article here.

Click here for the article; http://www.selfgrowth.com/articles/when-anxiety-makes-it-difficult-to-work-on-your-anxiety

This is my new blog, so don't be surprised to find just one entry of any substance here -- but, come back!  I'll be working on it.

- Jolyn Wells-Moran, PhD