Progress on Several Fronts

Standard

I met with my therapist today.

We talked about the last two weeks – about the SCA event over the weekend, about how I managed to avoid much anxiety, how much fun I had, and how glad I was to be getting back into an area of the SCA that I used to enjoy very much. She was very pleased to hear about everything, and when I was quick to give credit to having the Zoloft on board she was just as quick to correct me. She said that most of what I did over the weekend was me, and not the medication. The Zoloft might have taken the edge off, but the complete lack of panic leading up to the event and the relative low amount of anxiety I felt during the event was because of my progress over several months and my own efforts were what kept the panic attack at the event at bay.

We also talked about school, and she mentioned that my classes over the weekend will go a ways toward preparing me for my classes in the fall. She was concerned that I was going to be doing four classes at once, but she was relieved to hear that I would be doing them sequentially. I told her that Austin Community College offers an associates degree in Health Information Technology that would expand on the learning that I would receive through the certificate program, and that the associates degree transfers to the Health Information Technology program at Texas State University for a bachelor’s degree. She asked if I could go back to Texas Workforce Commission and ask if they would greenlight the associates degree instead of the certificate program. It’s six semesters versus two, but it would open more doors for me at the end of my education, and presumably increase my asking salary. I told her that I have a new counselor at TWC and that I’d send something over to her tomorrow.

We also touched on my fear of dying. I mentioned that it had come up in the book that I’m reading on her recommendation, and that the entry wasn’t very helpful. The end result of that conversation was a little surprising. She wants me to do some soul searching to arrive at what I believe happens when we die. I’d never given it much thought beyond “if there is something, living a decent life on Earth is the best way to secure a happy afterlife, and if there isn’t something, living a decent life on Earth is its own reward.” But I suppose that over the next couple weeks I’ll be deep in thought about this so I can report back to her.

It was a good session today.

Medicate Me

Standard

Just like yesterday was a big day in therapy, today was a big day in medication management. I met my new psychiatrist today. We had a good session, I talked both about how I got to the point that I’m at and also my more recent successes over my anxiety. He pointed out that my anxiety seems to be more social, with the exception of driving, and that makes sense. It’s not the laundry room that causes panic, it’s the thought that I might be in there with a stranger who’ll judge me. It’s not the store itself that I have a hard time with, it’s the people that fill it. With the exception of my issue with driving, almost every one of my anxieties can be traced back to being in a social situation. So we’re going with a diagnosis of social anxiety rather than generalized anxiety disorder.

He also took me off the medication that I was taking for anxiety, at least, on a regular basis. He explained that the effects of the medication in question only last about four hours, so it’s not designed to be used as a preventative. He likened it to taking Tylenol to keep you from getting a headache. He also mentioned that long-term use of that medication seems to have a tie to dementia, something that runs in my family and that I would prefer to avoid if at all possible. So I’m now only taking that medication when I actively feel anxious.

In its place, he put me on a new-to-me antidepressant that’s indicated for anxiety maintenance. As is typical with antidepressants, I’m starting with half the target dose for a week and then ramping up to the full dose after that. I hope that it’s going to help with the anxiety. Because of how I was taking it, I never really felt anything from my current anxiety medication, and I hope that this changes once the medication has been in my system for about a month.

I’m due back in his office in five weeks – four weeks after the full dose has started. We’ll take it from there and see where we go.

And I’d like to close by pointing out that seeing a male psychiatrist is a huge step for me because of my PTSD. I got a bad case of dry mouth because of the anxiety of being in his office and my blood pressure reflected my nervousness. I hope that gets easier as time goes on.

Therapize Me

Standard

Today was therapy day. We started the session talking about rotten eggs.

Apparently there was something in her hot water tap that gave off a strong odor of rotten eggs. When I first went into her office, I went to the restroom, and noticed the smell right off as I was washing my hands. So our session was delayed while my therapist turned the fan on in the restroom, lit a scented candle, and closed the door so we wouldn’t gag on the smell.

So here’s what I’ve managed to accomplish in the last two weeks, without really intending to.

I socialized in person with three friends within a week’s time. Two of those instances were at my suggestion. It’s been weeks since I last socialized with friends.

I drove home from the airport on Friday morning – a trip I’m not intimately familiar with, with a considerable amount of traffic that I was uncomfortable driving in, and managed my panic.

I went out to dinner on Sunday night at a crowded restaurant where there was a wait list. I cannot recall the last time I did this. It’s been at least six or seven years.

I braved the laundry room, a space for which I have a completely irrational panic, long enough to wash and dry a full round of laundry.

I helped my wife through a very rough couple of days without trying to step in and fix the problem – I let her experience what she was going through and supported her through it. (To be fair, we were in different time zones, so I didn’t really have much of a choice but to just be a shoulder; there was literally nothing I could do to fix anything.)

That’s a lot of progress between therapy sessions, at least, for me.

I spent the vast majority of the session explaining all the things that had transpired over the previous two weeks and didn’t really realize I’d done all this stuff and how big it really was for me. (If you’re reading this blog for the first time, I’m on disability, and essentially agoraphobic at this point. We’re trying to break me out of that little by little, so that’s why these things, which seem fairly simple to a lot of people, are such a big deal to me.)

There’s homework that I have to do in future, something that I’ve been asked to add into my regular activities, and I need to talk to my wife about it. But once this starts up, I’ll be tackling one of my panic-inducing situations head on so it hopefully won’t be panic-inducing anymore. Wish me luck.

Fight! Fight! Fight!

Standard

Okay, not really, the fight was Sunday. Therapy was today, and that’s what we talked about the majority of the time.

I was honest that I couldn’t remember what started the fight. I couldn’t at the end of the day Sunday, and I’m even more clueless about it today. I think it was me reacting poorly to something that my wife said, and she got frustrated at me putting myself down, and I got defensive about that, and she got more frustrated, and then I started getting frustrated, and the next thing you know we were yelling at one another’s symptoms again.

Our fights tend to follow a pretty cut and dried format. Once we’re actually fighting, almost always following the pattern above, we will move rapidly from topic to topic. Topic A is directly relevant to topic B, which is directly relevant to topic C, and so on – but topic A hardly ever has a thing to do with topic C. This is why we think that we can’t ever remember the thing that started the fight – we get so distracted from the original argument that we never can remember how to get back to it to resolve it, and so we individually sit and seethe all day, knowing that we haven’t resolved anything and are very prone to getting right back into the thick of arguing and fighting.

It’s important to note that we hardly ever have a rational argument, much less a fight. I can count on one hand the number of rational, lucid fights that we’ve had in 17 years. It just doesn’t hardly ever happen. My therapist understood the issue about our symptoms fighting one another though, so that was a good thing.

We arrived at two realizations, that kind of go hand in hand. Generally when we fight, we’re each trying desperately to fix the complaint that the other person has, rather than trying to reflect their emotional state back to them. An example of this would be “It seems like you’re feeling really down on yourself, do you have any idea why?” The other part of this is that when we argue, we don’t need to be right, although we’ve erroneously thought that was the case for me most of the time. We need to understand what the other person is experiencing.

It was recommended that the next time we have a fight, we stop for a moment at the beginning and ask ourselves “What is it that I need to understand about you and what you’re experiencing right now?”

We also covered the progress I’m making on my checklists, and she’s really pleased with the progress that I’ve made so far. She wants me to keep it up, though, and she’s fine with me changing the goalposts to achieve a check mark, like I did yesterday with my back, rather than just blowing it off. It’s important to continue hitting full marks rather than allowing myself a cheat day, because one day off will lead to two, then three, then the next thing you know I’m off my checklists for another couple months again.

So that was therapy in a nutshell today. I went into the detail that I did this time because it’s important that I remember all this stuff for future reference, and it’s easier to put it here in the blog than write it down for me to try to remember another day.

The Lighting Guy Was Great

Standard

I went to see my therapist today.

I told her about the addition to the family (who, for those keeping track, is now using both legs fairly well!) and about some issues with Mom that I haven’t talked about here. (Nothing serious, just dealing with someone who’s very unhappy about where she is in life and is willing to do almost anything to change it. More on that in a future post.) I also talked about what I’ve been covering in The Anxiety and Phobia Workbook, a recommendation that she made to me. I told her about my ideal scenario and we discussed that in earnest and detail.

There were a couple of changes that she wanted me to include in there, which I’ve done – those curious can follow the link above to see the edits. But there was an epiphany of sorts in today’s session.

We were talking about the concept of self-generated anxiety, and I told her that I know that I bring some of this on myself, so I asked her how much of this is stuff my own mind is making up and how much of this is a direct result of the experiences that I’ve had in my life.

She said she believes that 90% of it is self-generated. That’s not to say that I’m making it up, but rather my experiences have led me to create the anxiety that I feel in so many situations – but ultimately it was my own reaction to the experiences that caused the anxiety.

Now, at this point of the story, I feel obligated to tell you a little bit about the layout of her office. As you walk in, there’s a large leather couch to the left of the room, and across from it, on the right, is her chair and a side table that she keeps her calendar and phone on. (The phone is important, since she uses Square to take credit card payments.) Facing her chair from the couch, her desk is over to the right in an alcove almost specially designed for the workspace. On the wall on the far side of the room from the door is a window, there’s another window by her chair, and there’s a third over in front of her desk. The blinds are drawn on all three windows, but they’re thin enough to tell when the sun’s out and when it’s cloudy.

As I asked her this question, the sun was behind some clouds, so it was a little dimmer in the room than usual. But when she gave me her answer, and the truth of it dawned on me, the sun came out from behind the cloud cover and it became notably lighter in the room, as if the light over my head had literally come on.

We had a good laugh about it – I complimented her lighting guy and she referred to the little remote that she keeps in her chair for just such an occasion – and that’s when I told her something that I’m proud of. Unless I’m well and truly irrational, my sense of humor is usually right there on the surface, and it helps keep me sane.

We talked about a few other things in the session – she wants me to turn the goals in my ideal situation into SMART goals (specific, measurable, achievable, relevant, and time-bound) so I’ll be working on that in the coming days in a further blog post. She also wants me to do some checking into Mom’s situation – more on that later too.

It was a good session.

A Repeating Theme

Standard

I went to go see my therapist today.

We had a good session, talked about the streak of full marks on my checklist (today will be day 37, incidentally), and discussed one of the books that I’m reading, The Anxiety & Phobia Workbook by Edmund J. Bourne, PhD. The exercises at the end of the second chapter had me identify factors that might be helping to maintain my particular brands of anxiety, rank them from greatest to least influential to my life, and then identify the three of those that I wanted to seriously work on over the next month. I identified avoidance of phobic situations, lack of assertiveness, and lack of meaning or sense of purpose.

The first one is easy enough: Get out in public more, since I’m more or less agoraphobic. That means trips out to coffee shops, trips to visit with friends, trips to the grocery store, pretty much anything that will get me out of the house. The lack of assertiveness is something that I’ll be working on with my wife, since a lot of times she tends to just do things, like driving, because I’ve let her for so long. The third is going to be a little more difficult.

My therapist has recommended that I find someplace to volunteer for some time now, and there’s always been something that’s prevented it – fear of the unknown, juggling schedules with one vehicle, you name it, it’s come up. Today we once again discussed my need to volunteer with an organization that does work that I believe in. I initially offered my future career as my sense of purpose, but she argued successfully that it lacks a “why” element to it, beyond “it pays the bills.” She wanted me to find something that I’m passionate about and commit to spending time with that. I offered the SCA, but while I’m passionate about it, it lacks the direction of volunteering with a nonprofit, something that is a passion of mine in its own right. So after some going back and forth, we decided that I would get in touch with the local chapter of the ACLU and donate some time to them.

Today I got so far as to find the volunteer signup webpage, but haven’t filled it out. I’ll be leaving that for tomorrow.

Quarterly Report

Standard

Went to go see my psychiatric medication manager this morning.

She had an intern sitting in with her, which I was fine with, and she wanted to know about the fatigue that I’d been experiencing during my last visit with her. I told her that I think there’s a combination of my prescriptions that’s conspiring to make me drowsy in the morning, and we discussed the potential of adding Provigil to my medication regimen to offset that. I’ve been on Provigil before so I know that I’m not allergic or anything, although I don’t know about contraindications with current medication. She referred that question to my sleep specialist in April, and we moved on.

She was pleased to hear about my recent socialization and my very gradual tendency to be more comfortable in social settings, although I have to admit I’m still a little nervous in them, especially if there are people that I don’t know. I neglected to tell her that since my last visit with her I’ve socialized twice with people I hadn’t met in person before and that I’ve been to multiple SCA events and didn’t even have a panic attack before the most recent one, but I did let her know that I’m getting out of the house more often and that Pokémon Go is a help with that.

She’s especially pleased to hear that I’m going back to school in the fall, and she believes that the additional structure that will accompany that will be beneficial to me, and especially with regard to this rut that I seem to feel I’m in lately.

She also noted that two sessions ago I could barely keep my eyes open, and she’s overjoyed to see that I was alert and much more participatory in my session today. I confessed that her front office had a lot to do with that – one more cancelled or late appointment is likely going to end my relationship with the practice, so I tend to get there very early now, and today I got there almost an hour ahead of schedule, so there was a little bit of a nap in the car before I came up for my appointment.

She thinks I’m making good progress, although I think it’s slow going. But slow progress is better than none at all, or worse, regression, so I’ll take it. New appointment at the beginning of May has been set and I made plans to work out an issue with my account.