Hello, friends! In this episode, I answer three really cool questions that are based around anxiety, covering activity avoidance, being traumatized by thought, and postpartum anxiety. Don’t forget to check out the 4th bonus question over on my Patreon.
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Hello Duff, I am four months post partum, emetophobic and general anxiety before the baby and everything has ramped up post baby. My family who I work with does not believe in therapy so i used to see my therapist at night but now my evenings consist of taking care of baby. I’m getting ready to give up and accept this crappy new normal. I’m not sure what to do can people rise above anxiety without meds ?
I’m so sorry that you are going through this. Having anxiety difficulties and emetophobia are tough on their own. Having a new baby is tough as hell. Having both is uniquely difficult. I feel for you and I hope that maybe I can point you in a direction that can help.
Just for the audience – emetophobia is a fear of vomiting. It can lead to some problematic behaviors such as avoiding eating for fear that you might vomit it up. I’m sure you can see how that may be a problem during the postpartum period, especially if you are breastfeeding. I can also see how emetophobia could easily be triggered during the pregnancy by morning sickness when you did have a legitimate reason to fear randomly throwing up. I talked about emetophobia in episode 86 of the podcast, so I won’t go through the treatment protocol for all of that here in this response. I will say that emetophobiaresource.org has some great resources and guides for this. But please also make sure that you are following up with your doctor about any persistent and problematic nausea that you are having. There could be physical reasons behind it beyond just the anxiety. If appropriate, they may also give you medication to help with the nausea or they might suggest other supplements.
The thing that I’m really more concerned about in this whole question if your lack of support. Having a new baby is hard work. Getting inconsistent sleep, not being able to take time for yourself, and feeling isolated because of child-rearing can be super tough on your mental health. You need some support to get through this. I’m sorry that your family is not understanding about therapy. That’s not right. You shouldn’t have to hide something that is not shameful in the first place. I’m not sure what the history is there, though. Are they going to treat you poorly if you decide to get therapy? Are they the ones who would have to pay for it, so you are limited in that way?
I think that a lot of times people that have children are lost in the shuffle when it comes to care. All of the emphasis is placed on the baby, but not the one who will actually be raising the baby. You matter too and it’s so important for both you and your baby that you are able to take good care of yourself. In your case, I would highly, highly suggest seeing a therapist. There are definitely techniques and tools that would help you manage the generalized anxiety and the emetophobia, but I think those are going to be even less relevant than simply having someone to talk to about all of this stuff. I get the feeling from listening to your question that you DO have family and some degree of support, but it also kind of feels like you are on your own as you go through this because you can’t be honest about what is happening.
One way that you might be able to integrate therapy into the equation again now that your nights are taken up by caring for the baby is to pursue online therapy. These days there are a variety of different options for online therapy. You can use apps like Betterhelp or Talkspace. You can also find someone privately – you can find my guide to finding a therapist right here. One of the benefits of doing something like Betterhelp or doing text-based therapy with an independent therapist is that people wouldn’t know what you are really doing. I hate that you feel like you have to hide this, but that might be one good way to do it. I also see that you asked at the end of your question how people can rise above anxiety without meds. There are many strategies for coping with anxiety. If you haven’t yet, it would be a great idea for you to check out my free quickstart guide ebook.
But why without meds? I can certainly understand being cautious about using medications if you are breastfeeding, but there are many differing opinions about this. If you are applying a blanket no meds policy to yourself, make sure you at least first talk to your doctor about it. MANY people take psychiatric medications while pregnant and while breastfeeding. Just talk with your doctor about it. If you have some sort of personal belief that would prevent you from using meds that’s a different story. It could be the case that you don’t need them because you are well able to make the changes and build the coping skills that you need through other resources. But medications can be helpful for sure, especially when used in tandem, as they can give you a little bit of relief and allow you the space to start making positive changes. So just remember that you do have options.
A quick recap: I’ve had tolerable anxiety most of my adult life but just recently (the past 6 months) it has hijacked my life. After a very stressful few months at work which turned into IBS and panic attacks, I one day had a vision of myself committing suicide. Despite months of counselling and doctors visits assuring me that it was just a thought, I obsessed about it to the point where I believed that I could be suicidal. This causes me extreme anxiety (fear that it will come true) and depression (reaction to my thoughts & mental state). I’ve been practicing mindfulness meditation, doing “worry time” as per psychologist’s counsel and am on antidepressants but still deal with the symptoms of obsessive thoughts.
My question is … could a thought have caused me trauma? And what steps can I take to get my life back?
Such a bummer to hear that anxiety has become a stronger issue for you and that despite your best efforts, it’s really sticking around.
Let me start by answering one of your last questions, which was could a thought have caused me trauma? I won’t say that no it can’t have caused trauma, but it’s much less likely that a thought itself could generate a traumatic reaction. Not impossible, but it wouldn’t be reflected in the diagnostic criteria.
When you say trauma, I think you are talking more about a traumatic reaction such as PTSD. So to answer that question, we need to look at whether you are experiencing some of the symptoms of PTSD. With PTSD, you commonly get recurrent distressing memories, dreams, or flashbacks. You also tend to have avoidance of things associated with the traumatic event. Heightened startle response and arousal level can also happen. There are definitely more criteria, but those are some of the big ones. So if you aren’t experiencing those, I wouldn’t say that you are having a trauma reaction. It can be a bad thought that gives you a lot of discomfort, but we wouldn’t exactly use that term for it.
I think the intrusive part of this is really the most interesting aspect. Without trying to diagnose you here, this sounds a lot closer to the obsessions that you see in OCD, rather than something like PTSD. You have this recurrent unwelcome thought that sort of bursts into your brain and hijacks your thoughts. It’s not a delusion because you know it’s out of place, but it’s so incessant and convincing that it can sometimes make you feel like it might be true. It sounds exhausting. This is a scenario that I’ve encountered before several times, though. Certainly with the suicidal thoughts or visions, but I’ve also seen it with a variety of other thoughts, such as I might be gay (for someone that does not feel that they are) or I might be a pedophile. In these cases, I frequently notice that the thought itself is pretty random, but the time that it popped up is not. Maybe the person was going through a really stressful time, a medical problem, or something else that had them supersensitized to anxiety and then that thought crossed their mind and kind of got locked in.
Now what can you do about it?
I think mindfulness is a great strategy, so I’m glad you’re using that. The objective of mindfulness, in this case, is to work on your relationship to this unwelcome thought of suicide. To be less derailed by it and recognize that it’s just a thought that does not have anything to do with whether you will actually try to carry out the act. In other cases, people have obsessive thoughts that they might hurt their family. It would never happen, but bam – there they are. There is a great website called instruvethoughts.org that has awesome resources and even questionnaires to help you determine whether you may be dealing with what they call harm OCD.
In general, the golden standard type of treatment for this would be what’s called exposure and response prevention therapy (ERP). ERP is basically a type of exposure treatment where you voluntarily expose yourself (gradually) to the fear over and over while working to stop yourself from avoiding or engaging in compulsions. So for instance, if being in the presence of knives makes you feel unsafe due to your obsessive thought, you might carry around a plastic knife or pocket knife with you. To gradually diminish the fear. It can be a tough treatment because it requires you to directly face it, but it can be effective and you can do it gradually. The point is not to convince you that you are safe and wouldn’t harm yourself, because that was never really the issue. Presumably, you would know what to do if you were feeling suicidal by now. It’s not about that. It’s about diminishing the fear of the thought that you might hurt yourself. And often what you find is that as you build that tolerance to the anxiety that comes along with not avoiding it, a happy accident is you tend to get less anxious and less preoccupied with until eventually, it is no longer an issue. It’s definitely something you can do on your own, using resources like the ones I’ve outlined here, but it’s definitely going to be more impactful if you can work through this with a therapist, especially one who has experience in this area.
When I commit going to a family event, 99% of the time I want to bail due to severe anxiety. I make myself go during the holidays but other events such as going over for a football game, dinner, etc I usually end up not going. They’re always expecting me to go because I usually/always say yes! Then when the time comes, I want to bail last minute. Is it ok to cancel plans without an explanation? I’m afraid they’ll look down on me because they do know what is going on with me. Is avoidance ok sometimes? Is it ok to say no, even if it is avoidance?
I think that this is a really good question and one that has to be considered on a case to case basis. Definitely you can fall into the pattern of avoidance which fuels anxiety to get stronger and stronger. However, it can also be exhausting to constantly push yourself to stand up to your anxiety all the time. Even if you understand that you are not in actual danger and it’s okay if you go somewhere and are anxious because of it, you might just not want to invite that significant anxiety into your life at that exact moment. For instance, if you have a lot of work to get done over the weekend and going to a family function is going to be so anxiety-inducing to you that you will be essentially taken out of commission for a while, it might not be a good idea to push yourself. I think that it is totally valid to take a break and acknowledge that you may not want to spend time in situations or with people that are really going to challenge your anxiety.
It sounds like you are already doing a little bit of prioritization in this case. Pushing yourself to go to the holidays and important stuff, but skipping on some of the less important events. That is a good strategy. However, when you think about it, some of the smaller things might be a little less anxiety-inducing since they aren’t a whole huge affair like a holiday can be. I think that taking breaks and listening to your body is important. You just gotta watch the balance of it. And also maybe there’s something that you can do aside from simply paying attention to when you go and when you avoid get-togethers that could help on a more basic level. In other words, is there a way that you could reduce the overall anxiety so that these get-togethers are less of an issue in general.
I’m not sure what you have worked on already, but there are many coping strategies that can make you feel more confident in your ability to face situations like these, which would hopefully lead to less avoidance and greater anxiety endurance so to speak. Being a little more flexible and less all-or-nothing about things can also be helpful. You can always try out an activity and see if you can cope with it. You might even establish a certain threshold that you are willing to put up with before you give yourself the chance to bail. Or you can always leave if need be after going.
As far as what you do or say, that is totally up to you. If you are operating under the assumption that your family would not understand without even checking, you might want to challenge that assumption. If there’s a chance that they would be much more understanding after you explained your issue with anxiety, that would be great. It can also help them interpret your behavior. They could be assuming that there are other more personal reasons for you not going to certain events and hearing that it is anxiety would be almost a relief to know that they didn’t do something wrong. And it may even go a long way in helping them adjust things to help you and keep an eye out for you.
So in a nutshell, the answer is yes, I think that sometimes it is okay to not go, even if you know it’s avoidance, but I think it’s important to not fall into the trap of doing that all of the time and that balance is going to be different for everybody. Pay attention to your body…if pushing yourself so hard in this instance that isn’t all that important is going to stop you from being able to make progress in other ways, then maybe you need to keep that balance in mind and not do that thing. And again, with the holidays and big events like that, if going to something and pushing yourself really hard is going to have a good role over effect, then maybe you’re going to want to do that and that’s a worthy thing to push yourself for.
Bonus Patreon question:
I have pretty serious anxiety and growing depression as a result. I am lucky that I am being considered for a psilocybin study to take place at a university hospital in the next couple of months. I hope to get the drug, but I realize there’s a 50% chance I will get the placebo and, as a backup plan, have been researching alternative treatments for anxiety. Also, I listened to the podcast with Eric Osborne, who said that the treatment—at least in his clinic—was not as effective in patients with anxiety. I was very disheartened to learn that, even though the protocol that will be used in the study I may participate in is different from his. It has made me realize how much hope I have placed in a treatment that I might not receive and that might not work for my condition even if I do. In researching other novel treatments, I have found and listened to your podcasts about ketamine with Dr. Steven Mandel. I am curious about this drug and its efficacy in the treatment of anxiety. I have found very little online about its use in the treatment of anxiety—the experts all focus on depression. Can I assume then that it has very little effect on anxiety? Can you point me in the direction of reliable information regarding the use of ketamine to combat anxiety?
If you would like to hear my advice on this week’s bonus question, check out my Patreon!
This episode of Hardcore Self Help is sponsored by BetterHelp.
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