Strategies for Calming Anxiety

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Reader’s Question

I was hoping I wouldn’t have to go to a psychologist, but things really aren’t going well for me.

Several months ago I escaped from living with my overbearing mother and moved in with my brother several states away. It was great for the first two weeks. I wasn’t jumpy at all. I felt okay living with him, even though he wasn’t perfect. I finally got my very first job (despite my later age) and that’s when things quickly nosedived.

During work, I’m fine. I try my best to do what I can and learn what I have to. When I get out, for the first hour I feel happy and proud of myself for getting through the day. And then I don’t. I feel terribly self-conscious. I want to cry and I feel terrible for not being able to do my job as well as other people. I can’t sleep at all. I feel really, really terrible. Sometimes I find something to obsess about. I get really sensitive to everything my brother says and I’m terrified that he’s going to tease me about it (which he does, because he’s my brother and brothers do that — it’s not in a way that’s intended to hurt me). It’s gotten really, really bad. I want to be able to have a job like everyone else, but I just feel so terrible about myself that I’m literally sick to my stomach. And to be honest I think I’d feel that way even if I were doing well at work. It would just happen.

I don’t know what to do, because I’m the cause. But I can’t just snap my fingers and feel better about everything. Also, my brother teases me about getting a psychologist. Plus, I don’t really have the extra money. Just for interest, I used to have a psychologist, and he said that I had an anxiety disorder (not surprisingly).

Psychologist’s Reply

It sounds as if you are feeling very trapped in many parts of your life, and finding an escape from one situation provides only short-term relief for you before the difficulties start again. You have already made some difficult, yet positive choices for yourself by leaving your mother’s house and getting a job, despite how challenging these new situations must be at times. By recognizing that things aren’t going well and reaching out for help, you have already taken the first step in making things better.

The interpersonal sensitivity you describe, as well as the guilt you express for even having self-conscious feelings, may be indicative of an anxiety disorder, such as Social Phobia (or Social Anxiety Disorder). Often, anxiety disorders can go hand-in-hand with a depressive disorder — too much worry can certainly make us eventually feel helpless, trapped and depressed. The good news is that anxiety and depression may be effectively treated with a course (research suggests between 8 and 12 sessions) of Cognitive Behavioral Therapy and/or proper medication. Other therapeutic orientations that are supported by research to treat depression and anxiety are Interpersonal Therapy, Mindfulness-Based Cognitive Therapy, and Dialectical Behavior Therapy. It is most important to find a psychologist or licensed therapist with whom you connect, and who has experience in treating anxiety and depression. Given that you’ve already seen a psychologist, you may have an idea of what kind of therapy and therapist are a good fit for you.

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I see that there are barriers to getting the help you need: money and the worry about your brother’s reaction if he were to discover that you sought treatment. Let’s address the money dilemma first.

In most communities, there are university training clinics or other mental health centers that provide free or sliding-scale therapy. On the web, you can search ‘sliding scale mental health’ in your community, search the website of a local university that offers graduate school training in counseling or psychology to see if they have a community clinic, or use the term ‘sliding scale’ in your criteria to search for a psychologist on APA’s Psychologist Locator website or on the National Register’s psychologist finder website.

Given that you already experience heightened sensitivity with your brother’s reactions, I would recommend making an appointment during a time when you would normally be at work or out for other errands or social events. As a consenting adult, you are not obligated to share your health information with your brother (or anyone else) — the privilege of confidentiality is yours (with a few rare exceptions that would be discussed before you consent to treatment). Once you have an appointment with a mental health professional, during your first visit, you could address the concern about your brother’s possible reactions and discuss strategies with your therapist to help you feel safe and/or find ways to discuss your feelings with your brother. You might also schedule an appointment to share these symptoms with your primary physician, who may be able to provide referrals and support for you as well. In the meantime, you may find some practical exercises found in The Anxiety and Phobia Workbook [Amazon-US | Amazon-UK] by Edmund J. Bourne, Ph.D. I often recommend it to clients who experience symptoms similar to those you have described.

I wish there were a way to snap one’s fingers and make all the painful feelings smaller and more manageable. Since you’ve been dealing with these feelings for a long time, it will probably take some time to find new ways to manage them and discover new strategies for thinking, feeling, and acting in situations. Finding the support of a caring, skilled psychologist or therapist may be a great relief to you once you take the chance to start therapy again.

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