Hello, friends! Sorry for anyone that missed last week’s episode. I messed up a little with the technical side of things. We should be all back track this week. If you don’t already, please subscribe to the podcast on iTunes or whatever podcast player you use, so you never miss out.
I clinically don’t know what I’m suffering from but i believe it to be depression and ptsd. two years ago i was hospitalized for having suicidal thoughts and was referred to a Therapist and psychologist and i was going to them for about two months but the cost of going was too much so i stopped. Now recent events has cost me my job and the lose of my car because i was having traumatic flashbacks and had an accident. Talking to friends and family has helped a little bit along the way but it hasn’t stopped me from getting regular sleep and traumatic flashbacks, not eating and now I’ve developed the habit of cutting my self/ hurting myself just to get me through the day and the thoughts of my head. I’ve tried researching doctors and called them but with no insurance it’s really hard to get one. i really don’t’ want to die but thought of it seems to be the only solution to a permanent fix.
Thank you and keep up the great work you do.
I’m glad that you wrote in and I’m glad that you’re alive. It’s super unfortunate that you’ve been suffering so much and I really do hope luck changes for you. It does sound like you are experiencing PTSD or at least some form of traumatic reaction. Some of the cardinal symptoms of PTSD are flashbacks, which are vivid memories where it is as if you are re-experiencing the trauma that happened to you. These can be triggered by cues in your environment such as a certain location or smell. You may also be on-edge and easily startled. Depression and isolation or anger are also common as part of the reaction.
You are absolutely at a level that is clinically concerning and our goal here should really be about trying to connect you to services and get you help. Your current path isn’t sustainable.
I wanted to mention to the audience why someone in your position might start cutting/self-injuring. The purpose behind cutting is different for everyone. However, commonly, it’s a way of coping with overwhelming emotion. It gives a sense of momentary clarity and euphoria. The only thing you can really focus on is the sensation, so it gets you our of your head. It can also be a form of control. Drawing a line in the sand and having some degree of control over your own body. I don’t judge you for cutting, but I want you to stop when possible. It’s not sustainable and there is a high risk of accidentally doing heavy damage to your body.
So let’s actually address your question here. How do you get help when you don’t have a job, insurance, etc. Some of this is going to depend on where you live and what resources are in your area. If you were in my area, given the limited funds and the severity of your situation, I would try to connect you with county mental health. In America, many counties have local mental health resources, which are low cost or free, depending on need. They are also often capable of dealing with higher risk cases. Just google your county or town and “mental health” or “behavioral health”.
You could also look into sliding scale therapists in your area. You could google sliding scale therapists near your city or zip code. Alternatively, you could look at the website for individual providers or call them to see if they do sliding scales. Sliding scales are basically need-based assistance with the price of therapy. Generally, the provider will have a range that they work within and then determine where you fall in that range depending on your current income. The last one, which may or may not be the most appropriate for you is universities. You can often get low cost or free treatment from local universities that have therapy training programs. The downside of this one for you is that you have strong symptoms and an active traumatic reaction.
In some cases this could be beyond the scope of the student therapists there, BUT you don’t need to make that assumption. You could call and ask – if they can’t help you, they should have a list of resources in the area that they could refer you to.
And of course in addition to all of this, pumping in as much self-help and positive content into your life will be helpful. There are online communities and sites such as 7cups that allow you to receive professional or peer support online. If you are actively suicidal, meaning you are intending on killing yourself and have a way to do so, you can just call your local emergency number or go into the hospital. Even if you are involuntarily hospitalized, they can help get the ball rolling in the right direction. So hopefully those tips give you some areas to follow up on. I won’t promise you that things are going to get better, but I CAN say that things have the capacity to get better. With some effort on your part and the right resources, it’s possible to pull out of this. You can do it.
This episode is brought to you by Blinkist. Blinkist is an app and website that packs the key info from thousands of best selling nonfunction books into summaries that you can either read or listen to. For me, the listening part is key. I probably get the majority of my information passively through listening to podcasts and audiobooks. I tend to listen while I’m in the car, washing dishes, or scoring assessments that I’ve done. I don’t have a lot of time to read and listening to information helps me make the most of my time. I’ve done some exploring of blinkist and I think it’s something that I’ll continue using. The best part for me is that you can use the app or your web browser. Sometimes I like to take in information while playing games on the comp and this would be perfect for that.
Blinkist currently has a special offer for our audience for a 7 day free trial. Go to blinkist.com/hardcore to get it.
I need tips for when I’m anxious and my emergency anxiety med (lorazepam) isn’t helping.
Short and simple question here, which is awesome. A question that I’m sure many listeners can relate to. Lorazepam is also known as Ativan. It’s a sedative medication designed to reduce the physical symptoms of strong anxiety and panic. So it will lower your heart rate and breathing rate, it will loosen up your muscles a bit and help you come back down. The question is asking what can be done when the medication doesn’t seem to help. So you take the ativan and you’re still feeling super anxious.
Well first thing to remember is that under most circumstances, the physical symptoms of anxiety are not actually dangerous to you. They are uncomfortable, scary, and maybe even painful, but they are not going to truly hurt you. So when you medication doesn’t seem to help, you are still okay. I know it can be scary, though – you can get even more freaked out when the medication that’s supposed to help isn’t seeming to do its job. It can make you wonder if you are having a heart attack or going crazy for real this time. If you haven’t yet, bring this up with the doctor that prescribes your Lorazepam. It could be that a medication change or a change in dosage is called for. Ideally, you would see a psychiatrist for this, as they are best equipped to help with the meds, but even if you’re just getting it from your primary care, you should let them know.
There are some other pieces of the puzzle that are important to consider. Your medication is never going to fix everything for you. As always, it’s important to get some lab work done to look at thyroid etc to make sure there isn’t a physiological issue that’s causing your anxiety to be so persistent. If there are things in your life that are a constant source of anxiety and stress, those aren’t going to be medicated away, and while the medication can help you cope on a moment to moment basis, it could be that you are going to be thrown right back into the anxious spiral once the meds are out of your system. On the topic of meds, if you are only using the emergency medication to manage the anxiety and you’re not on an SSRI or other long-term medication, that may be something to look at. SSRIs and similar medications are taken daily to reduce your overall reactivity to anxiety (and depression). Many people use those in conjunction with the emergency medications to manage things. I often liken it to my situation as someone with asthma. I have a daily steroid that I take to strengthen my lungs and then an emergency inhaler to take when I’m having an active attack. Of course therapy is another tool that I am always suggesting, but you probably know about that already.
One of the most helpful tools that you can develop is a strong relaxation breathing exercise. I talk about this in episode 60 of the podcast available at duffthepsych.com/episode60. Basically, you will want to pick an exercise that you like. It could be anything, but it should involve a strategy for taking deep, full, belly-breaths. Often there is also a counting component or something like that, which serves as a good distraction. However, the most important part is that you practice the exercise. You need to repetitively go through the exercise during times when you aren’t already actively panicking to teach your body what it feels like to initiate the relaxation response. I talk way more about this in my online course and of course there is a ton of content on my blog etc.
A grounding exercise may also be helpful to help you come back down to earth when you are feeling scared and disconnected from your body. My favorite is a simple exercise that I call sensory bingo. Basically, just actively engage each of your senses one by one. Find something in your environment that is interesting to look at, listen to, smell, etc. I could go on and on and talk about all of the ins and outs of anxiety, but that would be a verrrry long episode. If you aren’t already all caught up on my various content, I would suggest you take a look at all the resources on my website. I have info about breathing strategies, exposure activities, getting therapy, and more.
I really love your podcast and it has helped me a lot. I struggle with circlitic thinking and your thinking traps episode and the one where you talked about obsessive thoughts really brought me peace. Anyway, my question is about having children. I am a 26 year old college student in a long term relationship. Right now I feel very pressured by those around me to have children. I am very on the fence about the future but as of now I have no aspiration to do so. My boyfriend wanted kids and we almost broke up for that reason only. After some soul searching he decided he didn’t in fact want kids as he struggles with anger issues due to his upbringing. He feels like hes going to be like his father. Back to me- i have no deep seated want to have children but I worry about happiness in old age if i don’t. I love my boyfriend and i think he would be unfulfilled in life if he doesn’t have kids. I don’t know what I should do to solve any of these problems and have been struggling for years with it. Any insight would be appreciated.
Alright, so as usually I’ll talk about my bias/point of view. Your body your choice. I consider myself a feminist, I’m quite socially liberal, and religion plays zero part in my moral code.
I personally think that society places way too much emphasis on the importance of babies and doesn’t adequately consider the happiness and success of people when they become adults.
If you want to have kids, that’s great and you should think about that and consider what you need to do to make that happen, but you have no moral obligation to do so and your happiness matters too. I will say that in general, it doesn’t always work out so well when you have a child out of fear that you will want one at some point. A baby is a big undertaking and a huge commitment. In general, people are waiting later and later to have children. Obviously there is biology to consider, especially for the one who will be carrying the baby, but there are also a lot of kids out there that could use adopting and of course there are other medical options that are available in this day and age.
It’s absolutely normal to feel some pressure to have children with all of the friends you have that are having baby showers and birthdays and all of that. Your facebook feed is probably inundated with kids, but that doesn’t mean that you are doing something wrong by not having them right now. I will say that there is no perfect time to have kids. There’s always something that will make you feel somewhat unsure about the decision, but there are better times than others. You are the judge of those times. You are certainly allowed to get feedback about your thinking etc. but it’s your choice. Honestly, given the context of your question – it sounds like your relationship needs some work before kids are a consideration. You said that he almost left you because you weren’t sure about kids and then changed his mind because of his anger problems. These are things that are primary issues. Having kids is not going to solve these problems for you.
I would suggest that you work on the relationship and yourselves as individuals first. As I said before, maybe biology is something to consider here and having kids is important to you, but just don’t use kids as an instrument for another goal. You are allowed to want kids and to have them, but try not to let that cloud your judgment about the situation if you decide to remain with your current partner. When I worked with someone who had pregnancy phobia, the point was not to make sure she got pregnant. The goal was to eliminate the barriers that made her feel like she couldn’t get pregnant. I think we may want to take a similar approach here. Maybe you can keep the fact that you think you want kids in the back of your mind and work toward eliminating the barriers that would make you uncertain of that. So focusing on improving trust in your relationship, working on your own personal mental health etc. Again, things don’t have to be perfect for you to have a child – they never are – but it sounds like the motivations are a little backward here.