Wednesday, November 12, 2014

Worry...Leave my mind alone


Well, as I predicted, several people contacted me after the blog that I wrote for Dr Psych Mom (dealing with postpartum anxiety and my experience). There were a few common questions so I figured it was worth trying to answer them here. Once getting through them, though, I realized that this seems like a really weird and self-focused post. So forgive me for that!

I get why you didn't but...why didn't you call/tell me?!?! 
This is tough. I mentioned this in the original post; it was a Catch-22. It was difficult to feel the anxiety but I also felt like all of the things I was worrying about would come to fruition by talking about them. Again, this is a tricky place to be as a psychologist because I fundamentally recognized that this was anxiety's irrational trick. But it was quite the hurdle. I feel like I occasionally left little bread crumbs in conversations but I wasn't able to come right out and describe it and my little nuggets were so vague that no one really could have followed them to see what was going on.

How did you "get over" it?
I definitely wouldn't say that I'm completely over/through it (more about that later); however, I hit a turning point in March. I really hadn't been sleeping, A had recovered from another stomach virus, and her cough suddenly was bad again, particularly in the middle of the night. One night, it was particularly bad so I woke Chad up and explained what I had been experiencing. Although I had been feeling completely overwhelmed with the feelings of panic, I had been functioning fairly well. I went to work every day; I didn't talk about the anxiety; I was teaching and doing research, writing 2 grants, and keeping up with the house. So no one had noticed the anxiety but I was irritable a lot at home (I don't think that had gone unnoticed). So Chad was quite surprised to hear what had really been going on and he agreed that it didn't sound typical, or like something I should struggle with on my own. The admission alone lifted an enormous weight. It allowed me to recognize this was a problem and I needed support. I slowly started admitting it to other people, while also looking for resources. I blurted it out to my friend who is an anxiety researcher, on the way to lunch one day. I felt like just saying it, outside my house, needed to be done. And it was great. We talked about potential exposure exercises, mindfulness activities, and acceptance strategies and why they hadn't been working previously. I mentioned it to one of my mentors at lunch the next day and got lots of validation and suggestions for other ways to cope. Those three 'moments' of admission are what seemed to turn things around for me.

How are you doing now?
The most common question I got from those that contacted me was concerned with wanting an update on my current functioning. I'm doing quite well. Baby A has had several viruses since the spring (yay, daycare!) and I have handled it pretty well. I definitely have had my moments, though. Once we took A to OKC to play with Ben, Grace, and Avery at the water park and A vomited in the car. It turns out it was just car sickness but this set off several hours of concern that it might be a bug that would get the other kiddoes sick and lead to missing work. I have had to stop drinking caffeine entirely. Prior to graduate school, I could drink a mountain dew and then go to bed and sleep soundly. However, I stopped drinking it (as well as soda more generally) in 2008 for health reasons. Over the years, I started having an occasional Ale-8, sweet tea, or coca-cola and noticed that it really negatively impacted my sleep. Within the last year, though, caffeine would bring on a full bout of panic symptoms. Caffeine-related anxiety is fairly common. So I just avoid it. Again, a job hazard is recognizing these pit falls (technically, shouldn't I drink *more* caffeine so that I can engage in interoceptive exposure?) along with a number of safety behaviors I've picked up (I'm embarrassed to admit that taking A's temperature daily became a thing). But now I am better equipped to recognize thoughts as thoughts, and can notice them without letting them have such an impact. Like many parents, I've been pretty hypervigilant about EV-68. Recently I had one evening of heightened concern but, given A's history of breathing problems, I think this is actually pretty good for me to have kept it fairly under control. Admittedly though, I did engage in some reassurance seeking behaviors. I knew what I was doing when I did it, though.

Why did you decide to share this?
The unspoken question here is "Weren't you afraid of how people would perceive you?" and I think the answer is yes. Samantha had indicated some folks were interested in hearing thoughts about postpartum anxiety and she needed someone to write about her experience. So I said I would do it. The thing about mental health stigma is that we all say that we want to reduce it--as long as it doesn't touch us or our close family. Because I ultimately decided to keep this a public blog, anyone can see it. I often share it on Facebook for friends and family because a few have requested I make it easier to see new posts (here's my plug for subscribing to an RSS reader or email subscription!). This means that, if they were so inclined, colleagues and former students (& professors!) can see my posts (& it seems they do, given the comments and likes that I occasionally receive from them). So, on the one hand, I want to help to educate others and share my experience, but on the other, I didn't want it to negatively impact my professional persona. I'm pretty sure that's more evidence that we aren't where we should be in terms of stigma. In a sense, it was a little impulsive when I agreed to it. But I think it was an okay decision.

Funny enough, in my mind, I just knew that there would be other questions. There were a few that I 'feared' coming, which I think means they need to be addressed. ;)

Why didn't you get treatment? 
The fact that I described postpartum anxiety symptoms but didn't go to a psychologist for therapy or a psychiatrist or PCP for medication almost caused me to question talking about it at all. It seemed professionally irresponsible. Frankly, I don't know if I actually could have been diagnosed with PPA (or any disorder) but treatment likely would have been a good idea. At one point I looked into it and saw that there are only a handful of potential providers here in town that I could be interested in seeing. Of those, I personally know or am professionally connected with 75% of them. I actually don't have a PCP (though I'm working on this as I finally have scheduled an appointment with a doctor for a well check!) so medication seemed out, without a lot of work. I really did consider it and do grapple with my feelings that it seems irresponsible to tell others that they should seek help when I didn't myself. At least not in a traditional sense.

What do you mean prayer/exposure/mindfulness didn't work? Does that mean it/they don't?
I thought a lot before I included that statement. Nothing worked for me in those moments of panic but now they are really helpful. There has been evidence of the effectiveness/efficacy of each of these strategies and obviously I am a firm believer in evidence [and of course, I was trying to use them on myself which is probably pretty ill-advised for the therapy strategies]. It's still how I what I would recommend for a client if they presented with anxiety.

I thought you weren't anxious?
Me too. 

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