My persistent and treatment-resistant depression, generalized anxiety disorder (GAD) and social anxiety disorder have graciously allowed me to function just like anyone else outwardly. I have a good job, I’m married, I have a house and a dog and my family and social circles are more than fulfilling. Although unpleasant, challenging and frustrating because these illnesses result in a low quality of life internally, I was getting by. It was all inside, no one else could see it, so I always put one foot in front of the other and just kept going.
Until my first full-blown anxiety attack the Sunday before Thanksgiving.
The Friday prior, while we were both working from home and wrapping up our work days, my husband confronted me. He told me I hadn’t been “myself” the last six months — I was unpleasant, distant and work was my top priority. Because of that last point, everything else in my life was impacted and received very little (or none) of my attention, including him. I agreed with it all, as this was not a new trend for me. I’ve continually found myself in roles with endless to-do lists and heightened pressure and stress, and would work myself into the ground in an attempt to complete every task on that unattainable to-do list perfectly.
I had originally planned to work the next day, Saturday, to try and keep my head above water, but I realized this was not a smart decision after the conversation my husband and I had just the night before. I opted not to work, thinking in my head I could always sign in on Sunday in between my 5K race in the morning and an early Thanksgiving gathering with family. We had a nice day, got some things done we’ve been wanting to for a while (but have been ignoring due to, shocker, work), had an early dinner out and grabbed a drink with friends afterward. Things seemed to have smoothed over, and all was well.
The next morning, Sunday, I woke up and didn’t have the heart or motivation to make it to my race, so I skipped it. I did try to get a few things done around the house, including some ironing, but when the stubborn material I was attempting to smooth out wasn’t cooperating, the tears started to fall. My husband found me in the basement crying over the ironing board, desperately trying to get the creases out. He helped me finish, and after that, I got back in bed and never made it to the family get-together. The depression had taken over, and I just couldn’t do it. My husband went alone while I stayed home and slept, watched movies and wallowed. I almost expected myself to try to get some work done, but didn’t, which only increased my anxiety over the to-do list that wasn’t shrinking (and in my daunted mind, likely getting bigger somehow).
That evening, after going to bed, the anxiety heightened. It was building, and I started to feel panicked. Tossing and turning got my husband’s attention, after which it all came out. The hysterical, uncontrollable crying, heaving and breathlessness, pounding chest and shaking lasted about ten minutes, but felt like an eternity. I’ve never had that experience before — as mentioned, all of my struggles could be buried and hidden. In the couple of months prior, I had noticed very mild panic, inability to focus (more than my normal poor concentration), taking much longer than normal to complete tasks and confusion, but I could still get by, function and perform. The attack I experienced changed all of that, and was cause for concern. These new manifestations of my anxiety were physically leaving my body, and my successful, decades-long streak of carefully suppressing my feelings had blown its top, quite literally.
We both called out of work the next day, spent it together and discussed our next steps. My husband got me an appointment with our primary care doctor the next morning, to which he called out of work again to take me. After 45 minutes with the doctor, I left with a referral to a partial hospitalization day program at a nearby hospital and a note out of work. Two days later was Thanksgiving, for which I easily (and almost automatically) buried the situation back inside myself and donned my usual “all is well” mask in front of my extended family.
I started the program the following Tuesday, and it ran from 7:45 a.m. to 1:30 p.m. every day. It was centered on acceptance and commitment therapy (ACT), and consisted of three group sessions facilitated by a therapist, one “interpersonal” group therapy session run by the patients and lightly steered by a therapist and meeting each day with your “treatment team,” once with your therapist and once with your psychiatrist.
The first day consisted of an intake that felt like an inquisition, and then I began the actual program the next day. The first three days were a total blur. I struggled to comprehend what put me there, accept I needed to take a leave from work to get help, get used to the daily schedule of the program and absorb any of the content. On Friday, I went home feeling defeated, frustrated, exhausted and even more confused about what had become of my life.
The following week wasn’t much better. As the fog lifted slightly and I was able to process some of the content, my underlying issues (even more buried down, way past the day-to-day depression and anxiety) began to emerge. Adversity during my childhood and teenage years, and the resulting destructive behavior and thought patterns, all of which were never properly addressed, began popping up like whack-a-moles. And what’s our first reaction to unpleasant thoughts and feelings? Get rid of them! I started to clobber the moles, and quickly found myself getting worse. I was in an intensive program and was being given the tools I needed to get better, so you can imagine how frustrating and scary it was to feel like I was going in the opposite direction. But one of the first things I learned in the program, very quickly, was we can’t repress feelings or get rid of thoughts or run away completely. It only makes things worse — and it’s one of the reasons why I’m nearing 40 and still struggling.
Here’s what else I learned:
1. Acceptance and commitment therapy (ACT) is not rocket science and doesn’t consist of any surprising concepts.
Much of it is familiar, but when all brought together in a daily and intensive setting, it becomes clear what you need to do and how you need to live your life to successfully manage mental illness.
2. The anchor of ACT is values.
These are defined solely by you and represent who you want to be. They can change as your journey of life progresses, and don’t have to match your current behavior — they’re something to shoot for. For example, one of my values is connectedness with others. I don’t feel like I successfully connect with whoever I’m with at any given moment, as my social anxiety has forced me to keep others at an arms distance, always. I want to feel more connected to others, so I value this, and use it to make decisions. For example, going out to meet friends versus staying home and isolating.
3. Under your values, you set goals, but the focus is less on lofty goals.
As those of us with anxiety know, if our goals are too big and become too overwhelming, we respond negatively, usually by avoiding. In the program, you’re encouraged to break goals down into very small, achievable tasks.
4. Mindfulness is key.
One of the most hard-hitting concepts for me was the amount of things I’ve missed due to being wrapped up in my own head with anxiety and on autopilot all the time. Whether it’s beautiful scenery, lunch with friends, quality time spent with family — anxiety only allows you to be present for a small percentage of the time, and you wind up missing so much because of that. Mindfulness practices can break the autopilot and help you be more present. One of the ways to do so is through meditation, which can be tricky, but only if your perception is that it should clear your mind. The point is actually the opposite: Thoughts, even negative, destructive ones, are perfectly acceptable in meditation. The real task is what you do with those thoughts when they do arise.
5. You can either “fuse” to your negative thoughts by accepting and actually believing them, or learn techniques to “defuse” them.
Negative thoughts will always be there, they’re an inevitable part of life. Instead of spending our precious energy trying to get rid of them, defusion is a way to accept they’re there, separate yourself from them, see them for what they really are (incorrect!) and simply let them pass by, like clouds in the sky.
6. Your core schema (for example, social isolation, failure or hypercriticism) is important to identify.
This helps you better understand your resulting thought and behavior patterns. Learning and understanding what makes you tick was my single most important takeaway of the program. Mental illness is confusing, and doesn’t give you clear answers or reasons. Most of the time, it tells you the wrong things, like you’re not worthy, you’re incapable or disliked. A program like this challenges that, and although it’s really hard work, it’s needed to start thinking differently. Once I learned my core schema, I was then able to actually pinpoint my negative thought and behavior patterns. Not instructed to do so during the program, but knowing it would help me get a better grasp on how I was operating, I took a scrap piece of paper and listed out my core schema (for example, unrelenting standards), thought patterns (“I’m not good enough”), behavior patterns (avoidance or overcompensating/overachieving) and feelings (shame). Once complete, this helped me to really see what was going on, and then take steps to address it.
7. I’m a perfectionist.
This isn’t new, I’ve always known this and shrugged or laughed it off, but never understood its negative implications and the harm it was bringing me. Wanting to do everything perfectly, including keeping up with an impossible to-do list at work, led me to overcompensate or work more and more, eventually resulting in that full-blown anxiety attack. I learned I needed to take my perfectionism more seriously and take steps (aligned to my values) to make sure I’m not constantly striving for perfection.
8. Once the program ended, the real and more difficult work began.
I didn’t have the daily structure and support of the doctors from the program anymore, and had a lot of time on my hands as I transitioned to new outpatient doctors. Perhaps feeding the part of me that tries to overachieve, I signed up for weekly ACT group therapy and an eight-week mindfulness-based cognitive therapy (MBCT) program, in addition to my therapy and psychiatry appointments. It’s been helpful to have these appointments and classes to stay accountable to the work I need to do to get better. It’s like learning a completely new language and undoing the decades-long wired thought and behavior patterns that are so easy to fall into.
Overall, although unpleasant, hard work, draining and at times feeling like I was backtracking, the program was necessary and just what I needed at this point in my life. Through my anxiety attack, my body was telling me I needed help, and I’m so glad I listened to it and completed the program. I had the time to dedicate and fully engage, which doesn’t happen when working full-time and only seeing a therapist once a week, at most. All other distractions aside, I was able to give myself the time and attention I needed to heal. It’s given me the tools to properly address my illnesses, the values to lean on to make decisions and the motivation to live a better life.