Returning to work after taking an extended break to work on your mental health can be pretty damn tough. In episode 259, I received a question from a listener readying themselves for their return after struggling with agoraphobia and panic disorder. In this post, I dive into this a little deeper and offer my advice on what you can do to help make your return to work a success.
The question
First off I just want to say I am a huge fan of your show! I always appreciate when your wife is also on the show and discussing her experience with mental health as a mom. It makes me feel a little less alone in this journey.
A little background before I get to my question. In 2018 after the birth of my second child I experienced perinatal mood disorder, or as most people may call it postpartum depression. At the time I hit rock bottom with my mental health and had to quit my job to be a stay-at-home mom in order to cope. I was diagnosed with agoraphobia, panic disorder, and generalized anxiety disorder and did not leave my home for months due to the fear of having massive panic attacks in public. I couldn’t even walk to my mailbox due to fear, let alone go outside. I tried about 8 different medications and did not respond well to any of them, so I turned to natural remedies and found a wonderful therapist who has helped me create a “toolbox” of tricks.
Fast forward to now, 2021, I am still having panic attacks mostly in my sleep a few times a week, and able to go places again. I feel more like myself and mentally stable. I am hoping to return to work soon in order to complete my clinical hands-on hours so I do not lose my medical license that I worked so hard for. I am hoping to find a PRN/as-needed job so I can choose what days I work and for how long. I have been so terrified at the thought of returning to work because I will feel trapped since I cannot leave to go home without completing whatever hours I am supposed to work that day. I still struggle to go into stores due to the feeling of being trapped but it is something I am constantly working on. My panic attacks in the past completely paralyzed me to the point of almost blacking out so that is another concern. I am also nervous about the crippling fatigue I experience when I get anxious so that makes it hard to keep my mind sharp to care for patients. I love my field of work and was really good at my job before I had these issues after I had my daughter.
What advice do you have about returning to work after being out for so long due to mental health particularly for those who have experienced agoraphobia and have a panic disorder? Sending good vibes your way.
My Thoughts
Wow! What a journey you have had. The overwhelming theme that I get from all of this is strength. You are strong AF. I’m super impressed that even though your life totally turned upside down after having your 2nd kid, you kept working at it and trying to find the resources you needed to regain some of your functioning. For you to go from totally agoraphobic to where you are now is very impressive. Kudos to you and your therapist. But now you are up against another major roadblock, which is work. I can totally understand why this would be a challenge for you and something that causes a lot of anticipatory anxiety.
Panic disorder and agoraphobia are often driven by that feeling of being stuck. Having a panic attack somewhere that you cannot escape from. Even though that isn’t often a truly risky scenario, your anxiety convinces you that it would be the end of the world or that it would ruin things for you. Being responsible for other people’s care and working full shifts would definitely tap into that fear.
One of the cool things about this is that it sounds like you are basically at the top of your courage ladder. Your hierarchy of things that you need to gain exposure to. This has to be one of the most challenging ones, which is badass because that means you have basically mastered all of the other steps along the way.
Creating a positive transition back to work
So. What can you do?
First, I think that it could be very helpful to communicate openly about your situation as much as possible. Obviously, this is your own healthcare information so you don’t need to like shout it from the rooftops, but in terms of working with a potential employer, you may be surprised at how much flexibility and understanding a little self-disclosure gets you. For instance, rather than jumping straight into the deep end, maybe you can gradually build up to it by letting your employer know that you are trying to overcome panic disorder that started after your child was born. Perhaps you could even shadow or work with a partner for a while rather than all on your own. I’m not sure what you specialize in, but maybe there is a way that you could start with a less stressful element of your prior work in order to acclimate to being in the workplace again. I have worked with someone through a situation like this before. They were a physician’s assistant that worked previously in ER and urgent care. Rather than just jumping straight back into such intensity, they began by doing more basic screenings and primary care-type stuff. They happened to have good relationships, which helped them craft a good situation for themselves. Maybe something similar could work for you.
Be careful about the fatalistic thinking as well. It sounds like you are imagining this sort of sink or swim scenario where it either works or it’s a terrible disaster. In reality, there is a whole spectrum of outcomes here. It may be easier than you expected, you may have some anxiety, or you may have some full-blown panic attacks. None of those are the end of the world. Those are all situations to work through and adjust to.
Use your skills!
You’ve gained a lot of skills since you last worked in the field, so don’t be afraid to put those to work. If you need to step out for a moment to let some panic pass while you are seeing a patient, then maybe you can simply excuse yourself and do that. If you have a situation where you got in over your head and needed to cancel an appointment or get help from a peer, then you do that and try to work through it a little better next time.
This is one of those situations where there is only so much you can do without actually being in the situation. It can also help you to improve your anxiety tolerance in general as well. You said that you have made a ton of improvement, but you still struggle with certain things like going into a store. This could be a good prompt for you to step up the exposure work a bit. The main mistakes that people make when doing exposure work have to do with duration and frequency. When working through a courage ladder/anxiety hierarchy, people tend to put too much space between exposure sessions and don’t sit with their anxiety for long enough before escaping. If being in stores is the biggest remaining challenge for you, you might need to be going to the store several times per week for at least 30 minutes at a time.
Master internal exposure too
You can also work on your internal exposure more as well. I’ve talked about these techniques a lot recently on the show, but whatever your primary physical symptoms are – you can mimic those and practice working through them. You could even level it up a bit and work on trying to engage in intellectual exercises while feeling physical symptoms of anxiety. For instance, when I feel anxious it tends to make me feel like I’m gasping for breath, which can be evident in my speaking. So I’ve been thinking of using my morning runs as a way to actually practice for that anxiety. I noticed the other day that when I run fast and then switch to walking, the sensations in my chest feel very similar to anxiety. So I could potentially use that state to practice the intro to whatever my next talk is and get used to trying to function while my body is betraying me.
Remember that no matter what you do, you will be alright. Even if you have the worst panic attack ever, you are going to be alright. You can try again or get right back to it when the panic has passed.
So those are some thoughts for you. There are definitely some things you can do to increase your tolerance for anxiety and gradually re-enter into work. But I want to make sure you understand that you have done a great job so far. These are the final stages of your recovery where you are actually going to master the real life experiences that have really held you back. That’s amazing.
You can listen to this on Episode 259 of the podcast!
Thank you for the great question!
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