Anxiety with Insight

So, I went to the therapist yesterday. She seems good. I mean, we’ll see how it goes, but so far I like her. I told her that one of the things I find so frustrating about this is that I know what my problems are. I have good smarty-pants friends. We sit around and hash and rehash stuff and try to understand it.

And I have always placed my faith in the belief that knowledge is freeing. So, as you know, it’s frustrated me a great deal that I can’t just think my way out of this or understand it into stopping. And she said that there are two broad general categories of anxiety–anxiety with insight and anxiety without. And basically, I fall into the first category of someone who has given a lot of thought to this and kind of understands how I tick.

But that wasn’t the interesting part (except to reassure me that I’m right to seek help because if this is something I could fix on my own, it would be fixed, because I’ve devoted enough mental energy to it).

No, so I was talking to her about how frustrating and scary it is to be in the middle of a panic attack and to have my rational mind saying “Everything is fine. Nothing bad is happening to you.” and have my body doing what it wants anyway, as if something bad is happening. Because it seems pretty straight forward–you’ve mistakenly thought something bad was happening. You realize your mistake. You stop responding as if something bad is happening. How hard can that be? And yet, that doesn’t work.

But she was explaining what’s actually happening in the brain and it blew my mind! The thing isn’t just that there’s a mistaken bad trigger. It’s that, in avoiding the bad thing, you make a positive connotation with the thing you do to avoid it and then, in doing the thing you do to avoid the bad thing over and over again, it reinforces in your brain how great it is to do the avoidance thing. Does this make sense?

Let me try a concrete example. I have panic attacks when I go up the stairs in my building so I take the elevator instead. I have been thinking of the “taking the elevator” part as having no intrinsic value. But no, the hundreds of times I have taken the elevator without panic have developed in my brain a pathway of positive experience. So, the panic attack serves not just to keep me from the action my brain has decided is negative, but to push me toward the soothing behavior. So, it’s not simply “You can’t take the stairs.” It’s also “Man, wouldn’t this be so much easier if you took the elevator? Isn’t the elevator awesome? No troubles on the elevator, man. Just go for the elevator. DON’T TAKE THE STAIRS MY GOD DON’T TAKE THE STAIRS. But wow, the elevator is cool.”

So, when I’m freaked out about, say, standing on the edge of a drop, my brain isn’t saying “don’t get closer or you’ll fall and die.” It’s saying, “MY GOD WOMAN, STEP BACK SO YOU DON’T DIE.” And then, when I do step back, boom, pleasure and relief.

If I’m understanding what she’s saying, the panic attack isn’t just about keeping me from doing a thing my brain has decided is negative–therefore it’s just a matter of showing my brain that the negative connotation is a mistake–it’s also about pushing me into an experience that is positive–in that it relieves my anxiety.

Now, I think I see why some people believe anxiety and OCD are similar. I do have these kinds of relieving behaviors. They’re not as extreme as “I have to check the lock exactly seven times before I can leave the house or I can’t be sure it’s really locked,” because I usually just have to do one thing once. And it’s not as noticeable as “I have to touch every lamppost or my mom will die,” because the positive action is very closely linked to the negative thing I’m avoiding.

But man, understanding that the panic attacks and the anxiety are not just about avoiding negative outcomes but shifting me toward relief is kind of blowing my mind.  Like, yeah, that makes sense with my experience and it explains why it’s so fucking hard to deal with–there are two things going on, not just one.

Anyway, there is also homework! Which I find delightful, but also, man, trying to figure out what all my triggers are…I mean, just on my walk this morning, I realized I hate walking across bridges on the greenways. And I just don’t do it. Like, I’d forgotten that I just don’t do that anymore. So, I’m going to have to do some digging to see what else I’ve just cut myself off from and then, whew, problem solved, forgotten about.

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