A few years ago, my mum told me that a friend of hers had a daughter that was struggling with bad anxiety. This is something that I have been dealing with on a concious level for almost a decade – and subconciously for even longer – and so I wrote a letter to her, to let her know what helped me and to remind her that she is not alone…
For as long as I can remember, I have been anxious. When I was little, my parents just thought I was shy and – given that I had a younger brother who was very noisy and out-going – they assumed it was something I would grow out of. I didn’t like going to new places and preferred to stick to a strict routine, with each day being the same as the one before. As I grew older, I became aware that I was more cautious than my peers and that the things that they did without thinking about, I really struggled with. I didn’t like large crowds, being late or when plans changed at the last minute as it made me nervous and anxious and unable to cope.
Things got more difficult when I left home at 18 to move to Bath for university. Whilst living at home, I was able to manage my anxiety by planning all the tiny details of my life through extensive lists, that would note every activity in the day from making my bed and brushing my teeth in the morning, through to putting my clothes out for the next day and brushing my teeth again at night, and my ‘funny little ways’ were accepted by my family and friends as personality quirks and nothing worse. What they weren’t aware of was how panicked I would become if these rituals were disturbed or if I was forced to do something that took me outside of the norm. I didn’t just get a bit annoyed or stressed if that happened, I would genuinely feel afraid, which would often exhibit itself as anger or aggression. I also started to suffer from anxiety and panic attacks and the list of things that I was afraid of just grew and grew.
Moving away from home is a huge step for anyone but for someone with anxiety – and for me, emerging depression – it felt almost impossible. I basically sobbed my way through the first six weeks of university and begged my mum to bring me home every time we spoke. I just wasn’t equipped to deal with such a huge change and felt like I was in freefall as I tried desperately to get a grip on my new life. Thankfully, Mum was sensible enough to realise that coming home would have been a huge mistake and I was lucky enough to make friends with some wonderful people who guided me through my first term. Eventually, I settled in and went on to love my entire university experience.
Depression also started to set in for me at around this time. For me, depression is a feeling of heaviness, where you feel so low and tired that all you want to do is lay down and not get up again. Mixed with anxiety – which for me is almost a manic feeling where my ‘fight or flight’ urge is at it’s peak – it’s little wonder that I didn’t know if I was coming or going.
It all came to a head when I was 22. I won’t get into the details of what triggered it but I went to the doctors one day, about something completely unrelated, and burst into tears when the doctor asked me if I was okay. All these things that I’d been holding in for years came pouring out and what was supposed to be a ten minute appointment turned into almost an hour long session of me explaining what I was feeling. I’m a very private person and had never said these things out loud before; all the little anxieties, all my routines, all the things that terrified me just poured out. I was very lucky to have such a wonderful GP, she immediately put me on the waiting list for CBT (which I’ll explain a bit more in a minute) and we agreed on an anti-depression and anti-anxiety medication which she started me on straight away. I left the surgery feeling drained and exhausted but also much better for just having said a few things out loud.
I was given three choices of treatment; medication, group therapy and one-to-one therapy.
Although I started a course of medication, I quickly came off it as it just didn’t feel like the right choice for me. I was at a point where I was ready to face up to certain things and I didn’t feel that I could do that fully and properly if I was taking medication. This is not to say that I’m against meds as I’m 100% not, I’ve known a lot of people who have had great success with them – it just wasn’t for me.
Group therapy also didn’t appeal to me at the beginning. It was all still too raw and too difficult to talk about and I knew that I wouldn’t get much out of it because I was likely to withdraw into myself, instead of participating. Ultimately though, I did end up going through a short round of group therapy once I’d completed the CBT and it did help me realise that I wasn’t alone – but again, this is something that I had to be in the right frame of mind for.
One to one therapy appealed far more to me than either of the other options from the start. As I’ve already mentioned, after it all came rushing out in the doctors office, I felt ready to tackle my feelings but wanted to do it in a private and – typically! – controlled way which I felt one to one therapy offered me.
The therapy process starts with an assessment and in my case, that was at a hospital in Bristol. For someone with a fear of going alone to new places, this was stressful on it’s own. I remember sitting in the waiting room, feeling like I was going to have an anxiety attack and wanting so badly to leave. I’m not sure what made me stay, but I’m glad I did. One thing I would say, is that if you’re ever in that position – take someone with you. At this point, I hadn’t admitted to anyone that I was being assessed and I wish I had – it would have been good to have had someone to hold my hand. The assessment took about two hours and involved me filling out a questionnaire beforehand, which asked me to rate my reactions to certain questions – it’s basically to try to work out your mental state. Then I had to talk through everything with a mental health nurse who was very helpful and thankfully had a good supply of tissues! Again, I left there feeling raw and exhausted but also lighter for the knowledge that help was on its way. I then had a very long wait – I think three months is typical – until a slot became available with a therapist in Bath.
My initial assessment had lead to a diagnosis of depression and borderline OCD (obsessive compulsive disorder) but I was uneasy with the label of OCD, having done a lot of research into it online. Given that I had to make such extensive lists in order to feel in control of my life and that I had a number of rituals that had to be done in a certain way, it’s easy to see how that conclusion was reached during my assessment but I’ve never had a fear of germs or done things out of fear that not doing them would cause something bad to happen. Regardless of my thoughts on my diagnosis, I went to my first session with my therapist, hopeful that she would be able to help me.
The kind of therapy that I had been recommended was called Cognitive Behavioural Therapy (CBT). I had no idea what this entailed and I purposely didn’t research it online before my first session as I didn’t want to influence my expectations or my reaction to it. It’s a form of talking therapy, which involves exposure to the things that cause anxiety and the overall aim is to retrain your brain to react differently and to teach you how to spot the difference between something that is an actual danger and something that is an anxiety.
My therapist was brilliant with me and quickly changed my diagnosis to depression and generalized anxiety disorder (GAD). People with GAD basically have a lower tolerance to anxiety and stress and struggle to cope with it in the same way as other people. She likened it to having a lower pain threshold than others and it’s a comparison that has always helped me explain it to the people in my life. It doesn’t make you weak or less able than other people, you just have to find ways to cope with it, just as you would if you had a tendency towards migraines or poor eyesight. As soon as I read about GAD online (Wikipedia is surprisingly useful for this!), I felt like a light had been turned on – everything that was listed was something that I identified with.
CBT is split into three phases.
The first phase involves talking about every part of your life from childhood, up to the present day. This was tough as it meant talking about things that I’d buried for a very long time and, as I’ve already mentioned, being such a private person I found it very difficult to do. The length of time this takes obviously varies from person to person but it took a good five weeks (at two hours a session) for me to work through all of her questions. In some sessions, I couldn’t stop talking and would come out with my voice almost gone and in others, I barely said two words and we would sit there quietly until the session was complete. The good thing was that my therapist was incredibly patient and knew that sometimes I needed to talk and sometimes I needed to be quiet. Coming home after these sessions – whether I’d talked at a mile a minute or just sat and watched the clock hands move – I would be completely exhausted and feeling very raw. CBT is tough. It’s emotionally demanding and it stirred up things that I had held down for a very long time. I had nightmares and my anxiety actually increased in the first few weeks as everything was spinning through my mind. I wanted to give up many times but I was lucky enough to have people around me who supported me, picked me up when I needed it and kept me going. And that initial pain was more than worth it, I genuinely think that CBT saved my life and stopped me from falling any further into the darkness.
The second phase was the toughest for me as it involves exposure therapy. Part of the first stage is to establish what your anxieties are, where they come from and what triggers them. Stage two is then geared towards confronting and dealing with as many of these anxieties as possible so that you can start to train your brain to react logically when you’re confronted with them, rather than with the fight or flight reflex. I had a whole host of anxieties that governed my entire life but the biggest ones were social anxiety, fear of new places, fear of large crowds, anxiety around eating in public and a fear of public transport. My therapist started by talking me through these anxieties, asking me to imagine certain scenarios and asking me to explain the reaction I was having as it was unfolding in my mind. Just talking it through in the safety of her office would make my heart race, my palms sweat and I once had an anxiety attack during one of these exercises, when she asked me to imagine eating out alone. This went on for several sessions, until my reactions became less violent and more controlled. She taught me how to breathe through the anxiety and reminded me over and over that I was safe. From this point, she then started setting me ‘homework’, which involved physically going to do the things that triggered my anxiety. The exposures started off relatively small – such as walking into the supermarket, doing a single lap of the shop and then walking out again – and gradually grew into bigger, more difficult ones – such as catching the bus into town and back again, something I had avoided for years. Again, I won’t lie to you, this was hard. Most of the exposures she asked me to do alone, so that I had to rely on myself and the training I’d already had to control my reactions. At the same time as the exposures, she also asked me to start making changes to the way I dealt with my life in general. I gradually reduced my lists, broke out of my very strict routine and pushed myself to try and do a new thing every two weeks. It was difficult and it was stressful but I very quickly noticed a change in both myself and how I was feeling. I think the point of the first phase is to make you face all the things you’ve been avoiding so that when you reach the second stage and start having to push yourself, you’re not still carrying all the heavy baggage. By this point, I felt lighter and more capable and just…better.
The final phase is all about setting yourself up so that you can cope with anxiety outside of therapy. Sian taught me several techniques for coping in a difficult situation as well as how to spot when my anxiety is getting bad and starting to restrict my life. That was when I realized that this wasn’t something that could be ‘cured’ as it’s a part of who I am – I just needed to learn how to manage it. Eight months after I started, I had a final session with Sian and was then discharged from the service. That was probably the scariest bit, finishing therapy. As difficult as the whole process had been, working without the net of Sian was a daunting prospect. However, I soon found that the CBT training had really taken hold in my head and, although my anxiety was still there, I was able to manage it much better. And once my anxiety was reduced, my depression began to lift as well. I also know that I can call on her if I need to and that, should things get bad again, I would be able to do a self referral and wouldn’t need to go through my GP.
I wish I could tell you that there is a cure for anxiety but there isn’t. I still have days where all I want to do is hide under the covers and I still get sweaty palms when I have to do something for the first time. I can tell you that it does get better though. Since I finished therapy three years ago, I’ve managed to get my life to exactly where I want it to be. When I was low, all kinds of things spiraled out of control but these are now all back into place – namely my finances, weight and my job. My confidence has never been stronger than it is at the moment and I even dared to take a massive step up the career ladder this year, something I would never had done if it wasn’t for the help and CBT that I received. Like I said, I still have days and I have to be careful not to slip back into old, negative habits. But that’s why I have good people around me and I keep a close watch on myself as I don’t want to go back to how things were before.
I’m not sure if any of this will have been of any use to you but I guess my main reason for getting in touch is to say this; you’re not alone. I’m no expert, I don’t know if you’re struggling with depression, GAD or something else entirely but whatever it is, whatever you’re feeling – you’re not alone. There are always people to talk to if you want them, either in person, over the phone or via the internet.
I also wanted to say this you; be gentle with yourself. Some days you might feel strong and those are the days to push your boundaries and challenge yourself. But some days, you might feel fragile and it’s okay to just do the things that make you feel better. For me, that involves shutting off my phone, curling up under the covers and watching something comforting until the feelings pass. Find what works for you and do it – never feel guilty for taking care of yourself.
If you’re feeling the way I think you might be, just know that it doesn’t last forever. When you’re ready for it, help is always out there.
And most importantly; you are not alone.
This letter was written four years ago and I have been lucky enough since then to be able to control my anxiety and get it down to an almost non-existent level. I have a number of different posts that I want to write around mental health – self care, places to find help, how your relationships change when you are ill and when you recover, how to spot signs in someone else – but this felt like the starting point.