Like so many things in this life, how to treat your anxiety is not a black and white issue. There are no easy answers as anxiety exists on so many levels. It exists in the brain and body, as I’ve mentioned over and over, it exists in our belief systems, and I believe it exists on the level of spirit as well. For some people, it is mild and doesn’t interfere much with their daily lives. For others it is severe to the point that their life revolves around it.  If you have very bad anxiety, attacking it from many directions will give you a better result than if you just sit around wishing it would go away. That never works, I can tell you. You need a large bag of tools to deal with pervasive anxiety.

One of my favorite photos from last summer. You’d never know that later that day I’d be having a panic meltdown. Medication? Yes, please. Thanks.

I went on medication to treat mine, and, of course, I do continuous work on myself and my belief systems. It was a relief when I finally realized that I needed medication to help my brain calm down. It works beautifully for me, and for that I am grateful. I’m fairly certain that after about a year I’ll be able to go off of it and be fine like I always was before.  I probably should have made the decision sooner.

So let’s talk for a minute about medications because there is so much fear and apprehension about this stuff. People really get confused and have strong opinions, sometimes without having much information to back them up. Please realize I am not a doctor and I don’t play one on TV. I am a psychotherapist with 27 years of experience doing assessment and treatment, and referring people to medical providers who can prescribe medication for mental health issues. These opinions are my own, based on my professional experience.

There are two kinds of medications that are commonly prescribed for anxiety. One is the anti-anxiety medications, tranquilizers actually, like Xanax. I’m not going to focus much on Xanax and other Benzodiazipines except to say that they are excellent in the short term for acute cases, but are highly addictive. They are central nervous system depressants and using them with alcohol is dangerous. If you want more information about how they work, here’s a  good article. These medications are not a good solution for long term treatment of anxiety.

Mike is using a lead line to check depth because I thought the water was too shallow. Turns out, this time I was right.

The other is the SSRI (Selective Serotonin Reuptake Inhibitor) anti-depressant category, which also treats anxiety. Depression and anxiety are best friends and frequently walk around together holding hands and sharing the same neurotransmitters. Many, if not most, people who have chronic anxiety also have depression. It’s only a matter of which problem rears its ugly head the most.

After so many years in the mental health business, I am disheartened that we continue to have a serious problem in our country with a belief system about mental health. People continue to be ashamed to say they are on an anti-depressants, as though that means there is something immoral or unethical about them, as though they suffer from bad character development of some kind. It’s okay to say you’re on high blood pressure medications, or antibiotics, or that you take something for pain. We’re not ashamed of taking those things. But suddenly, if it’s mental health medication, there’s an issue.

I can’t tell you how discouraged I get as a clinician when a client who is clearly suffering from a profound anxiety disorder, suffering every moment of every day, tells me that they “don’t believe in medication.”.   It’s disheartening because I know that they are going to suffer for a much longer time than necessary, it’s going to be next to impossible for them to follow through with any of the things I’m going to suggest to them, and that they are going to get discouraged that therapy isn’t the magic bullet they thought it would be.   If you are someone who ‘doesn’t believe’ in medication for anxiety and depression, then please consider your belief system carefully. Why, exactly,  don’t you ‘believe’ in it?

Take a careful look past the aft deck. That’s VERY shallow water covering mud right there. We were just that close to touching bottom. Thanks, Amy.

In my experience the answer to that is usually twofold. First and foremost, the person thinks they should be able to handle it themselves. This is fine for mild cases. Certainly changes in diet, such as how much caffeine you drink, and changes in exercise habits can do wonders for mild anxiety. Even supplements, which I may talk about later, would be a good choice if you want a natural approach. I’ve recommended certain coping skills in this series of posts. And by all means please get a physical exam that includes blood work for thyroid functions, adrenal functions, and other hormone levels.

However, for people who have severe anxiety that truly interferes with their daily functioning, and that is not caused by another medical condition, medication is a good solution and can make the difference between being able to cope and learn new tools and making little progress. In those cases, the combination of psychotherapy and medication is the best bet for creating lasting changes.

Recent research has revealed that the amygdala in anxious people actually has less plasticity than in people who do not suffer from anxiety. This means that once it records an emotional event, it is less likely to be able to differentiate in the future between a neutral event and one that triggers the emotional event. This is a measurable thing using actual science that I am not making up. I think it is important to remember that we are dealing with a physical organ here; one that shows differences in structure between people with anxiety and those without.

Best fun ever. I want to feel like this all the time. At the Owlery in Scotland.

The second reason is lack of education and information. Somehow many people continue to associate anti-depressants with illicit ‘drugs’. I mean, like ‘uppers and downers’. They continue to call medicines like Prozac and Zoloft ‘happy pills’.  And this could not be further from the truth. These medications do not ‘make you feel happy’. When they work correctly, they make depressed and anxious people feel normal. There’s a big difference.  People aren’t out there getting high on Prozac and Zoloft.

I have a little educational talk, complete with bad drawings that I do on the fly, that I give people who really do need medication but don’t understand how it works and are at least open to information.  Instead of giving you that talk, I’ve found a video that does a better job.

A final point I’d like to make is that many of the folks I’ve talked to who won’t entertain the idea of using medicine to treat their disorder actually are self-medicating at an alarming rate with alcohol, or pot in the wrong form. (Actually, pot in the right form can be a very good anti-anxiety medication for some people.) So, what they are telling me, really, is that using alcohol all the time or smoking pot every day is more acceptable to them than taking a pill. Unfortunately, in the long run, self-medicating with alcohol can make anxiety worse. And it definitely makes depression worse.

I hope that if you are a fellow anxiety sufferer this post gives you food for thought about using medication as one of your tools for treatment. I’m not going to sit here and tell you that medication is going to completely ‘fix it’.  It’s not likely to be the only tool you will need.  Does it help everyone? No.  Does it come with risks? Almost certainly, but so does continuing to have high anxiety. Might you have side effects? Of course you might, but you might not.  Do you still have to do your own personal work in conjunction with medication? Well, it does work better that way. Will you have to take it for the rest of your life? I don’t know. That depends on your history and on your particular set of circumstances. Like any other kind of medication or treatment, there is a cost/benefit analysis that must take place in the decision making process.

Just joined us in this A to Z Blog Challenge on Anxiety? Want to read from the beginning? Go here.

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We are in the fifth year of our 5 year plan. These last months have been months of what I am calling “hurry up and wait” time. We are at the threshold of leaving an old way of life behind, but have not yet made the leap. We are living in the liminal space, the space between. It can be very frustrating, this time of waiting and not making much headway. This is giving me lots of time to practice just being in the here and now, rather than always thinking of the future.

We know the comings and goings of the birds and their seasons in our yard.

Being present in the here and now is a skill that should be developed by anyone that has anxiety because anxious people are always looking at the ‘what if’, and the ‘what will happen when’ rather than allowing themselves to be fully present in the moment. They miss a lot that way. They also increase their level of worry by doing that. We all know that worrying is pretty much a useless way to spend time and energy, and yet we do it.

I am trying to stay firmly rooted in the present, living each day realizing that I have no idea how all of these plans-in-the-making will come together, trusting that they will, somehow.  I accept that we really have very little control over how things pan out. We make our plans, we do our part by putting one foot in front of the other day after day, and we see how those plans begin to take shape as we live our way into them. But the details of that? They are a mystery until they emerge in the present moment.

Take our house, for instance.  If there is one big thing that makes me anxious about moving forward in our plans, it’s what to do with the house. I know I’ve written about it before. That’s because it is literally almost always somewhere in my conscious awareness. When I think about signing our house away to someone else, and then not owning it anymore, I wish I could say I feel a sense of freedom and relief. But I really feel like this: 

To me, it feels counter-intuitive that at the stage of life we are in, after years of working to create a comfortable home, we would just sell it and never come back. After all, we do not know our future plans. We do not know if we’ll be sailing for a year or two years, or whatever. What if something happens and we have to come home, as so many cruisers do? We would have no place to come back to.

Mike is much less worried about this than I am. He feels like we can buy another house if we want it. I wonder exactly how we would do that, considering we are unlikely to get enough from the sale of our house to pay for another home. A down payment, yes, but to pay for one outright, no. He would have to find another job, houses here are expensive. I can’t help but think about where we will live in our old age. Still on a boat? Unlikely. Anyway, I get pretty spun up on this subject, but frankly, not as much as I used to. I am coming to accept that I just do not know what will happen with the house and if we have to sell, then I will try to be at peace about it. Still, this would be a really long post if I wrote all the things I think.

My morning coffee place.

The questions the anxious mind comes up with have no answers in the now. They are only questions that create more worry. The answers lie somewhere in the future and will make themselves known when the time comes.  So when I start going down the dark hole of perseverating on a future I cannot see, I have a mantra to help me stop and come down to earth. Maybe you need one, too. Mine is that I just say, “You are fine today, right here and now. All is well right now in this place.”  That helps remind me that I may as well not dwell on the future. Just do today’s work and the future will emerge soon enough.

If you, too, have a brain that likes to get into the worrying cycle, here are a few tricks that can help.

1.  Give your mind something else to do. Give yourself something to think about that is positive. A mind left to its own devices is like a toddler left unattended in the kitchen. No good can come of it.
2. Breathe deeply and focus on your physical surroundings. Take note of what is registering with all of your senses, focusing first on sight, then sound, smell, taste, touch, then hearing. Bring yourself firmly into your body awareness.
3. Use your best ‘firm and directive’ parent voice inside your head. Say, “STOP! STOP NOW! THAT’S ENOUGH!”. Then re-direct yourself to a different topic. Remember the mind is like an errant toddler. Telling it once will not be enough.
4. Ask yourself what’s the worst, realistic thing that can happen. Make a plan for dealing with that.
5. Write. Just write or type it out with word vomit. Just get all the words out of your body.
6. Talk out loud about it, even if you are alone (especially if you are alone). Sometimes hearing the words out loud will help put things in perspective. You might find yourself realizing how ridiculous your mind sounds, even to you.
7. Learn to meditate. 

In case you are wondering, our rental idea for the house is not working out. It was the wrong idea, apparently. I have no regrets about trying it. We’ve lost nothing in the trying, and we are enjoying the fruits of our labors clearing out the house.

Our son would like to live in the house with his girlfriend and another young couple. We would love that so much! It would be a great place for him to launch his adult life and career from. If he finds a GIS job in the Tacoma area, that’s what will happen. Know any good entry level GIS jobs for a young man with a Bachelor’s in Archaeology/Geology and a certification in GIS? He graduates from that program in June.

What are your biggest challenges in staying in the present? We’d love to hear from you in the comments section.

Just joined me in the A to Z Challenge? You can read from the letter A here, then hit ‘next’ to keep going.

“Ironically, the quest for aliveness can sometimes put one in closer proximity to death…” Tom Robbins, Tibetan Peach Pie.

See where the Fear-o-Meter is registering? It’s slightly past the middle, which means that I struggle to stay in touch with my rational mind on this one. Why? Because I’ve learned through experience, that’s why. Some of us were born curious about the world and ready for adventure, but not very good at realizing how limited we really are while living in a human body. That tends to get us into trouble. I’m not naming any names here.

When I think about being able to judge my own limits, I get pretty worried.

In spite of never in my life being what you might call ‘sporty’, in that actual ‘sports’ are of absolutely no interest whatever to me, I have frequently found myself answering physical challenges in the outdoors by just going for it and dealing with the consequences later. Sometimes those consequences are pretty scary. Like climbing up a rock side and not being sure how to get down. Or hiking a bit too far because I forget that I also have to hike back. Or paddling my kayak too far, and then having to paddle against current to get back. (Sun going down, miles to go, all that.) On the whole, that has worked okay for me. After all, I’m still here with all 4 limbs and I get a sense of accomplishment when I survive in one piece. But as I get older, my body betrays me more frequently.

I often seem to go just a little too far.  I always want to see what is just around that next corner. I can’t tell you how hard it is for me to resist this stuff. Where is my anxiety when I really need it? That’s what I want to know. Why doesn’t Amy G. Dala warn me in advance about what could be real dangers, not dangers that don’t even exist.  (Mom, seriously you should probably stop reading this right now. Please do not call me to scold. I promise I’m typing this safely from my home.)

This is sometimes the reward for just going for it. Being rewarded like this only encourages me!

I think it’s great to be curious about the world and I don’t understand people who are not. The problem  is that sometimes I can get so caught up in what I am doing that I actually can put myself in danger. It’s not that I mean to. It’s just that the world is so interesting, so entertaining. I forget to be cautious and my anxiety doesn’t seem to kick in when it could actually be helpful. Or even when I think I AM being cautious, I am not cautious ENOUGH. No, it’s as though Amy G. Dala is asleep on the job, and this causes me grave concern. I kind of don’t trust myself.

Here’s a classic, if dramatic, example: in 2010 I almost got eaten by a sea cave on Tzartus Island. Why? I just really wanted to explore inside there. Caves are so cool! Never mind that the sea is a wild beast. Never mind that I probably should have asked local people about it first. I mean, what’s the worst thing that could happen? Well, apparently I could die. That would probably be pretty bad. But I didn’t actually entertain that thought. I figured if I just went when the sea was calm and serene, it would be OK. And that’s where I was wrong. Terribly wrong. Even though I knew to be very cautious,  I underestimated the sea, and I over estimated me. That’s a bad combination. Don’t even bother chastising me. I already know.

The story is a cautionary tale, but it’s also an excellent example of Post Traumatic memory and how to get over it.

I first approached the cave at high tide. The sea was too rough and I turned back. Not to be beaten I approached at low tide. Still too rough. So I figured that slack tide would be the best bet. At this point I had a ‘thing’ going with this cave. It seemed like maybe the cave was telling me ‘no’. I’ve never been good about taking ‘no’ and moving on gently. 

I approached at slack tide. It seemed fine. The swells were gentle and regular. I floated outside the entrance paying attention to the waves and getting a general feel for the situation. Really, I did think I was being careful! I entered the cave and it seemed fine. The walls were covered with sea stars,  the ceiling like a vault reaching to the heavens.

Then, very suddenly, a big swell came up behind me and pushed me deeper into the cave, fast. The walls were too narrow to turn the kayak around. The water thundered on the sides of the cave, white water everywhere. I was terrified and back paddled furiously. Cormorants were screaming and diving at me. I could see a light at the far end of the cave, but it was down pretty low and it looked altogether like the light at the end of the kind of tunnel I wasn’t quite ready for. The last thing I really remember is screaming out for divine intervention, something I rely on fairly regularly. I believe I screamed something on the order of, “Angels! Get me out of here right now!”. Belief is a good thing at times like that.

The next minute, I was out of the cave and truly, I’m not sure how. It’s not the only time my butt has been saved by the hand of the Great Unknowable. All I know is that one minute I was terrified, the next I was floating gently on the approach to the cave, catching my breath, looking at it with great loathing and awe. I actually felt as though the hand of God had reached down through the rock, grabbed the back of my kayak, and pulled me out in one swift motion. Damn. My heart starts beating hard just thinking about it.

I floated outside the entrance for a minute, catching my breath and counting limbs. Then I turned the kayak around and paddled out beyond the rocks and sat there on the peaceful sea, just looking at the place.

Here. Let’s all just catch our collective breath by appreciating this lovely Sea Otter.

Of course, the first thing I wanted to do was hear Mike’s voice. He’s truly my anchor in this life.  I radioed him, safe and secure aboard Moonrise, at the next cove.

Me: “Paddler to Moonrise. Paddler to Moonrise.”
Mike: “Moonrise here”
Me: “I just wanted you to know that I am OK.”
VERY SERIOUSLY LONG PAUSE.
Mike: “What did you do?”
Me: “Nothing. I’m fine. I just wanted to hear your voice and let you know I was OK.”
Mike: “What did you do?”
Me: (jabbering) “Well, there is this sea cave, see, and I was very curious and, and, there were cormorants diving and screaming at me and it was dark and I yelled for angels to rescue me and I’m fine. Really. Not a scratch. And hey! Did I tell you there was also a humpback whale right behind me?”
Mike: “LUCY……!!!”

Yeah. That’s his special name for me when I’ve done something really dumb and he’s pretty irritated. Too bad he doesn’t play the bongos. We could have our own show.

I went back to the boat, mad at the cave for being uncooperative. Mad at me for knowing better but doing it anyhow. Still mad at the cave and telling it in no uncertain terms that it and I were not done yet. I was too busy being grateful to be paddling back to the boat to really let sink in what a narrow escape that was.

Here’s the view from inside a safer sea cave. We all went together to explore this.

So let’s fast forward from this little fun party time to a vacation in the Gulf Islands. I’m thinking probably 2012ish, a couple of years later. We were at Cabbage Island and I was going to go kayaking. Cabbage Island faces the Strait of Georgia. There is excellent, protected kayaking there on the inside of the island, but it can get rough when the tide comes in and over the rock reefs. Slack at high tide is a great time to kayak there. You can skim over the rocks, which are underwater, and see crabs and all kinds of little fish. I love it. I’ve kayaked around the island many times and find it to be a wonderful combination of peaceful and exhilarating. You may see grey whales feeding close by.

So I get out my kayak and I’m padding peacefully approaching the reefs, which are under water at this point. As I approach the reefs, I realize my body is getting anxious. I am uncomfortable over the rocks, preferring to stay in the deeper water, which means I can’t really see much. My heart is pounding, every muscle is tense. I’m kind of not having a good time. At all.

I try paddling over the reef again, and the tip of my kayak gently touches one of the rocks. It was nothing at all to be alarmed about, but my body instantly reacted by panicking. I’m thinking, ‘Huh! That’s a strange reaction.’. I am almost having a full blown panic attack.  I check all the logical things. Tide is almost slack. Rocks under water by a couple of feet or more, waves are gentle. No problem. Should be fine. I’ve done this many times!  But I am definitely afraid. Actually, I am close to being terrified. 

Soon I am making plans for what I can do to save myself if my kayak suddenly gets a mind of its own and dumps me into the water. I reassure myself that the water is actually pretty shallow and that I can hang onto the rocks if I had to. Sure, I would get cut up on the barnacles, but if I had to crawl over rocks to get to shore, I could do it. There were people on shore. Surely they would see me.

Now let me reiterate. There was really no possible way I would dump my kayak unless I did something like try to get out of it in the middle of the water. The water was calm. Tiny swells. We are talking perfect kayaking conditions, no danger. None. And yet, I was actually terrified.

This is not an enjoyable way to go kayaking. I wanted to go home. I knew tears were going to be next.

Kayaking in calm water is terrifying, but this is fun? Yes it was way fun!  Goodbye Fran ‘The Frontal’ Cortex.

It struck me like a bolt that what I was experiencing was a true post traumatic response. At first my mind was not afraid, but my body was terrified. Soon my mind caught up.  It took me awhile, but I finally realized it had to be caused by the sea cave encounter and that just made me plenty mad. At myself, my brain, and at Amy G. Dala for doing her job just a little too well. I determined that I would reteach my body that kayaking was safe and fun. I made a point to go out in the kayak even though I found many reasons not to. That helped marginally. But the fear didn’t go away. And I really did not enjoy kayaking.  I worried that I had ruined kayaking forever.

The following year I took a professional training in EFT, the tapping technique that is useful for anxiety. This technique, which uses accupressure points, is a treatment modality for anxiety, similar to EMDR. I took a two day seminar that had been approved by the American Psychological Association and Washington State for continuing education units to keep my professional license. I put that in here because if you look up the technique, it looks like some woowoo  metaphysical stuff. I want you to know that it isn’t. (Not that I wouldn’t use woowoo metaphysical stuff, because I totally would and have. I use whatever works.) I have actually used this technique with clients and found it overall to be effective. I’m not sure, exactly, why it works, but I suspect it has something to do with refocusing the mind and forming new neuronal connections when remembering traumatic events.

Kayaking D’Arcy Island last summer. What’s not to love?

During the class we divided into groups to practice the technique. After much internal arguing, I allowed myself to work through the trauma associated with my sea cave experience. What I had not realized (it’s hard to analyze one’s self)  was that the reason I could not remember getting out of the cave was that I had dissociated that particular part of the experience. Remember how I referred to that part of the story? “The next minute, I was out of the cave and truly, I’m not sure how.”  I literally could not remember the sequence of events between the white water crashing around me and being outside of the entrance.  That is common in trauma. The moment where you believe death is eminent is frequently ‘forgotten’ because it is lodged in memory in a different way, apart from the rest of the experience.

By going through the process,  I was able to pinpoint the exact moment when the fear that I might not get out of there alive happened. It was a emotional and difficult session, but it helped enormously and while I am certainly more cautious now, it’s out of a sense that I need to recognize my own limits and be a little less curious, not out of fear. I don’t want to put my family in a position where they have to recover my body from a sea cave. That’s just not fair.

Let’s be clear that there are any number of ways to psychologically process a traumatic event. EMDR is one. EFT is one. There are other, what I call ‘doing it the old fashioned way’ techniques that work with the traumatic memory bit by bit until there is a complete narrative that is coherent and doesn’t trigger extreme fear. These all work. Some take more time than others. And it’s very important, when doing trauma work, to get to that moment when the fear of death crystalizes. Most people skim over that. This type of trauma is, at its core, a spiritual experience. The take home is that if you have experienced a traumatic event, and it is compromising your enjoyment of life by creating anxiety, working through it by bringing all the memories together in one place may be in your best interest.

I’m relieved to report that I really enjoyed kayaking this summer when we were in Barkley and Clayoquot sounds. I wasn’t the least bit anxious about it. But I also did not have the least desire to enter that sea cave again, even though I had the opportunity. I kayaked in that same area and was not triggered by it. I actually saw the cave again and made peace with it by remaining outside. And remember, I actually had a ton of anxiety during that trip because this was before I went on medication. So I’m pretty impressed with the outcome of that EFT session.

Just say no. Which is too bad.

I tested my new found rational thinking about my own limits by allowing myself to say ‘no’ to kayaking through a hole in the rocks that I happen to know lots of people kayak through. I was by myself, though, and decided it would be safer if I had a companion. (We’ll be getting Mike a kayak before we leave the dock.) The challenge just wasn’t worth it. In a way, that makes me a little sad. It feels a little bit like a loss.

On the other hand, I had actually just finished exploring an abandoned house on the island. By myself. Maybe that was enough excitement for one day.

Just joined us for the A to Z Challenge and want to read from the beginning? Here’s a link to the first post. Just click on ‘next’ to go to the next post.