Alexis Schuster

@alexis-schuster | contributor
Alexis Schuster is a high school English teacher living in New York City. She blogs about her experiences with anxiety and panic attacks as a way to not only help her own healing process, but to contribute to the conversation and help end the stigma around mental health. Follow her journey at itsonlyfear.org

6 Tips to Help You Prepare for Family Gatherings When You Have Anxiety

Every few years, my dad and stepmom get all of their family together for Thanksgiving. For our first gathering, we stayed in Tahoe. I remember taking a really long and wonderful walk with my stepmom and sitting in the hot tub under the stars with my niece. The second time, we went to Santa Barbara. It was warm and beautiful, even though one of my stepmom’s sons and his family couldn’t be there. It was also my first holiday season dealing with anxiety. This past year, we visited Ojai. We stayed in a big, old mansion that was built in the 1920s. Everyone was there. I got to see two of my friends and go on a beautiful hike with my partner, niece and nephew. I even got spit on by a miniature alpaca. There are a lot of things about getting together with my family that are awesome. This year, some of us volunteered to paint at Habitat for Humanity, and I got to spend time wearing a pair of coveralls that made me feel like I was about to land on the moon. But there are also some things that are hard. It can be difficult to realize what you need before something happens when you’re struggling with anxiety, and it can also be a scary or difficult conversation to voice those needs to loved ones. Part of why mental health is so stigmatized is that it’s treated as though the person who is dealing with symptoms is doing so purposefully, and thus, their bad mood, sleeping in late or struggle to enjoy themselves is taken personally. For those of you who have experienced it, you may know the fear of judgment that comes when you have to talk about your mental health. It can be so hard to speak up when you need to. One of the things that is particularly hard for me is creating opportunities for myself to be alone and articulating what I need. I struggle to have conversations with my family about how the physical environment, or the feeling that I need to be present with everyone at all times, has a severe impact on my mental health. I also struggle with thinking things out ahead of time. In retrospect, if I had spent some time preparing myself and thinking about what it could, or would be like, during each part of the trip, I could have done certain things differently or not done them at all. I love being with my family, but this past family gathering, I wish that I had been more proactive both before and during the trip. I learned a lot of lessons during that trip about what does and does not work for me, why it’s so important to think ahead, and the ways anxiety influences me even when I’m not conscious of it. Sometimes the combination of anxiety and my natural tendencies leads me to make what I consider to be bad choices, or to be a not-so-great partner, sister or daughter. After those moments, I realize I have to learn from, and think about, the little ways in which anxiety works within me so that I can continue to grow in all of the roles I fill. Managing anxiety is a part of how I take responsibility for my own actions, good or bad, because it’s not the anxiety itself that leads to a choice, it’s the way I react to those feelings of anxiety and my thought processes around it. The next time I have a big gathering, I plan to use the following six tips as a guide to make sure that I don’t end up in tears, feel overwhelmed or miss sleep because of anxiety. 1. Be proactive and think ahead. Set aside some time beforehand to really think about all aspects of a gathering or a trip. What things have the potential to make you feel anxious? What’s the best case response to that feeling of anxiety? What do you think is your most likely response? How can you arrange things to minimize triggers? What strategies can you use to help feel less anxious both before and during the gathering? As I mentioned before, I wish I had been proactive and thought ahead during my last trip, not only because it would have been a better experience for me, but for my partner and my family as well. 2. Schedule quiet time. If you’re a person like me who is sensitive to light and sound, 15 people at the same dinner table or in the same living room as you is overwhelming. I can handle the chaos once, but not multiple times a day for three to four days in a row. The cumulative effect of constant overstimulation is difficult. During my last trip, I became so overwhelmed by the volume and amount of conversations, I spent the whole week taking a steady stream of Advil to manage the headache. I should have purposefully set aside some quiet time for myself, not just a minute here and there whenever I could find it, because that didn’t seem to cut it. So, in the future, I’m going to make sure I carve out time for myself each day to be in a quiet space and away from others. 3. Remember to practice your positive coping strategies. I didn’t bring my yoga gear this past trip because I had no idea what my schedule would be like, and I really regretted it. We went for a hike, which was awesome and gave me a boost of endorphins, but I was basically sedentary for the next four days. Not only was I physically feeling the lack of movement, but my emotional shields became depleted by the time we left because I hadn’t had much time to myself to recharge and work through the things that were bothering me and causing anxiety. And in the future, when I remember to bring my yoga gear but I’m not able to practice, I want to remember to meditate in order to have more consistency and provide myself with an intentional, quiet space every day. 4. Plan an escape route. I’m not advocating suddenly leaving or cutting your trip short, although there is nothing wrong with that if that is what you need. Since it is hard for me to tell my family in the moment that I need space, next time I plan on setting aside some time before the trip to talk to them about my needs and make a plan for some breathing room so that we can all have the expectation of not being together at all times. 5. Speak up. A lesson I am continually learning is how important it is to communicate and set expectations with others. In overwhelming moments, I wish I could say something, but I normally end up waiting until things are pretty bad, like crying in our bedroom each afternoon “bad,” before I say anything — and my crying starts speaking for me at that point. But even then, this past trip, I didn’t say anything to my family. The only ones who really knew what was going on were my partner and my sister. I talk to both of them a lot about how it’s easier, better and less stressful to speak up before you’re at your breaking point; and every time, they’re right. So I’m working on it. 6. Give yourself a break. My partner is always so good at helping me put anxiety into perspective and to not equate anxiety-driven decision with who I am as a person. I’m really hard on myself, and I often don’t look at the whole picture before I start feeling guilty or having regrets and ruminating on those unhealthy feelings. My partner helps me balance taking ownership of my behavior while giving myself permission to make mistakes and move on. He holds me accountable and gives me the space to reflect and make better choices next time. I’m learning how to do this for myself, but it’s hard work. I just keep thinking about what my sister said to me, “Take all of the compassion you feel for [other anxious people] and turn it toward yourself when you are feeling anxious.” She is totally right. When I’m feeling anxious, I have a tendency to be even harder on myself than normal. While I don’t want to let myself off the hook when I do make a mistake or a bad decision, I want to be able to learn and move forward. I have to remember to give myself a break and that I’m not perfect. I have to allow myself to do whatever I need to feel better, even if that means temporarily disappointing some people, or myself. We want to hear your story. Become a Mighty contributor here . Thinkstock photo via monkeybusinessimages

How My Dog Helps My Anxiety and Panic Attacks

I say all the time that I don’t know how I would have gotten through all of the really intense anxiety stuff without my partner and my sister. And I really don’t. But I also wouldn’t have gotten through it without my dog. There are a lot of things she helped me with that I didn’t even realize until later, and to this day, she keeps helping. 1. She gives me unconditional love. Anyone who has a pet knows how much this matters. There’s a person who I adore who adores me back? Sign me up. This is especially helpful with anxiety and depression. So much of the self-talk that comes up in people dealing with these conditions is negative: something is wrong with me, it’s my fault, I’m broken, I’m a mess, etc., etc. There was a lot of this going on for me when the anxiety stuff first started because I was so used to keeping my emotions to myself, and also because it’s very common in my family to put others ahead of yourself. A lot of the work I initially did in therapy was discovering that anxiety comes up for me in situations I can’t control or when I feel like something has the potential to make me look selfish, incompetent or thoughtless. Having the dog around when I was thinking these things was so helpful because she was always happy to see me, and she showed me so much love. None of it was based on who I was or who I was trying to be; she loved me no matter what. 2. She gives me a purpose. When I got back from  that first trip to Florida , I got up each morning intending to go to work and then ended up sobbing over the sink and dry heaving. It was rough. Physically, I felt awful, and it wasn’t helping that I just kept thinking, “ What’s wrong with me?” My partner was still down at his parents’ house, and I was on dog duty. I hated the prospect, as all I wanted to do was stay in bed and cry and watch Bob’s Burgers, but in retrospect, it was probably the best thing for me during that time. Interacting with her, feeding her and walking her gave me a purpose. It gave me a reason to get up. It reminded me that taking care of people helps me feel like myself, which I sorely needed. And it got me outside. It got me moving. The  science behind anxiety and depression  shows over and over that exercise is really important because it releases endorphins, which help to elevate mood. It would have taken me longer to recover, longer to feel like myself, if I hadn’t had the dog to force me outside. 3. Her level of concern is just right. Anxiety can be maddeningly inconsistent. During one attack you really need physical comfort; the next, you don’t want to be touched. This has been the subject of a lot of conversations for me and my partner, and we’ve navigated our way to having a system for check-ins in place that really works for us. To be honest, that process would have been a lot longer and harder without the dog. Whatever she did always seemed just right, and it helped me to articulate to the dude what I needed and why, which I was really struggling with. The first thing is that it was obvious she cared. She would follow me around with a concerned look on her face, and if I left the room, she was right behind me. She was always in a place where she could see me. She would also sit next to me instead of on top of me, so I got to decide how much contact I wanted, if any. And because she doesn’t speak, she wasn’t asking me a million questions I was in no shape to answer. She let me know she was there, that she cared and then she let me take it from there. Noticing this pattern is what helped me articulate to my partner what went on during an attack, and now he does the same thing except in his own extra special and human way. 4. She motivates me to actively manage anxiety. This one is more subtle than the others. The catalyst for going to therapy was twofold: having panic attacks on our trip to Florida, and listening to my sister tell me that when she looked at me, she saw someone who was in a lot of pain. They’re the reasons I started going, but the reasons I kept going were my dog and my partner. (And also my own stubborn determination to get it figured out, but we’re going to ignore that for now.) I started having panic attacks right around the time when I realized shit was real with my partner, and that was a big motivation for therapy. I didn’t want anxiety to be the reason we weren’t together. But a bigger question for me was if I could parent with this happening: all my life I’ve thought being a parent is the most important thing I will ever do and I was terrified anxiety would end that dream. As mentioned above, I learned I could still take care of someone while I was anxious, and a few months later I learned I could do so while in the middle of a panic attack. I will never forget sitting in the back seat of our rental car with the dog, telling my partner to keep driving as I cried my eyes out, doubled over with nausea, and yet still somehow held up the garbage bag for the dog to vomit into and gave her water. Obviously, an infant is a whole different situation, but having to take care of her in the middle of the attack helped me to see it was possible, and if I kept working hard on treating anxiety, it was a situation I could actually function well in. It blew my mind to realize that. We want to hear your story. Become a Mighty contributor here . Images via contributor

Rumination and Anxiety: What It Is and How It Affects Me

One of the aspects of anxiety that’s most difficult for me on a day-to-day basis is the rumination. While it’s easy to explain to people how thoughts or topics get stuck in your brain, what’s not easy to explain is why they get stuck there. Or how silly you feel for not being able to let it go. Because, honestly, I’m not actually embarrassed by much, but I am embarrassed about how often I think about some things. Author Brene Brown would point out that I feel shame around my tendency to ruminate, and she is absolutely right. It’s less about the actual ruminating and more about what I’m thinking about, though. It goes back to being afraid to talk about what I want and to ask for what I want and need; since I don’t want to vocalize it, I also feel shame around even feeling it in the first place. In some ways, anxiety has been really helpful in breaking down some of the embarrassment I feel. Because I ruminate — not as much now as when I was in the throes of anxiety horribleness, but I still do — I’m forced to confront both the act of ruminating and the things I’m thinking about. I’ve gotten pretty good at managing the act itself. When I feel myself start to turn a thought over and over, I’m pretty good at reminding myself that I’ll stop thinking about it soon because I’ll get distracted or I’ll sleep or simply have time away from it. I’ve also gotten good at giving the thought the space it so obviously wants, within reason: if something is really on my mind, I’ll set aside what I’m doing at work to give myself a few minutes to think about it, or I’ll do yoga as a way to work through it. Sometimes this works, sometimes not, but it’s always worth trying. One of the things I find hard to articulate to people is that if I keep bringing something up or making jokes about it, that’s an indication I’m ruminating about it. I guarantee you that the amount of times I actually speak about it is a minuscule fraction of how much I’ve been thinking about it. There are some things I have literally been ruminating about for years: some family stuff, do people look at me differently when they find out I have an anxiety disorder, my future with my partner. I kid you guys not, I bring up marriage multiple times per week when I’m talking to my partner, usually in the form of a joke or something one of my students said. It’s not that I’m worried about it – our partnership is amazing and I know we are both committed to each other and the relationship – but I think about it all the time because that’s what anxiety does. This is one of the things I have big shame around: I am so freaking embarrassed that I have pictures on my phone of a few engagement rings and wedding dresses I love. I’m mortified to admit I already know what song I want to walk down the aisle to and what kind of flowers I want. The reason I feel this shame is twofold: one, I pride myself on not being like everyone else and the fact I want all the cliché rom-com what-society-expects-of-women stuff kind of aggravates me (though to be honest I totally want it. I want it so bad. Husband, dog, kids, yard, all of it. And at its heart, feminism is about choice, not about being subversive, and I know it’s OK to want it and no one is judging me but myself). The second reason I feel shame is that in no way do I want the dude – or myself – to feel pressured. Which in itself is great, but I also have a tendency to go too far in that direction and prioritize myself way below where I should be. My conscientiousness is like whoops, better not talk about this thing you want that’s actually really important to you that you’ve spent so much time thinking about because what if you express this desire and that fucks everything up? Just stay quiet and go with the flow. This is a horrible plan. I’m working on it. Ruminating also tends to happen a lot when someone makes some small comment my brain latches on to and analyzes to death. That flippant little joke you made about something I did or said? I’m gonna think about that for hours because you actually hit on one of my biggest fears: that I’m not useful, that I’m not competent, that I’m inconsiderate, that I don’t do enough, that I’m not going to have a partner or child to give all of my love to. My brain is going to take that sentence and chew it and mangle it until it is unrecognizable. It’s taken me a long time to learn how not to do this, and in truth, I haven’t actually learned, really. This still happens often, though not as frequently as it used to. I’m still susceptible to some tiny, offhand thing that someone says or does; my whole mood will shift and I’ll be lost in my head, irritated, angry or worried, depending. I hate this. I hate that sometimes when I wake up in the morning my first conscious thought is about some seemingly (to me) insensitive thing I said three years ago. Like, what the fuck is that? Can my brain just let me live? Apparently, it cannot. I’ve also been working on trying to lower my expectations of myself. They are, as a dear friend pointed out a few years ago, incredibly high. Sometimes that’s great: I can meet a lot of those expectations, and they’ve driven me to be good at school, good at my job and a good partner. My high expectations of myself are what allow me to have empathy for others and give them a break when they can’t give it to themselves – because I know what that’s like. They’ve forced me outside of my comfort zone again and again, and I’m grateful for that. But they’re also really fucking difficult sometimes. I can’t be conscientious all the time. I can’t give to others all the time. I can’t always respond the right way or tell my brain to shut up or let go. High expectations plus anxiety is one of the biggest challenges of my adult life because anxiety ultimately means I will fall short. I know when it rears it’s head I have to listen to it and take care of it, and that always, always means I can’t live up to some other expectation I have of my time, my emotions, or my abilities. This is hard, complicated work. Trying to tease out what’s my personality and what’s the anxiety has been like painstakingly unraveling a wet, swollen, complex knot of rope. I have no idea how I would have done this without the help of my therapist, and to be honest, we didn’t completely untangle everything. But that’s OK. I like the challenge of having a few knots to work out on my own, and knowing there are a few I will never fully unwind. And I also know I can always go back to her for the ones I need help with. All of this is not to say I expect other people to manage this part of my anxiety. I don’t need you to watch what you say around me for fear of setting me into a spiral. I would much rather you be authentic and, if I’m really ruminating about it a lot, we can talk about it. Not that I enjoy ruminating, but I’ve learned to deal with it and I’d rather do that than have people feel like they can’t fully be themselves around me. That doesn’t mean I want you to ignore my anxiety, though. I don’t want it to define me, but I also want you to understand that what you say and how you say it matter. You could say the same thing to me in two different ways, but they will have drastically different consequences: one will cause me to ruminate for hours or days and convince myself you’re mad at me/don’t like me/etc. The other will start an honest conversation. Usually, the best way to approach something — i.e. to help me not ruminate — is to ask. Ask me what I meant or what I think. Give me a chance to clarify. Give me a chance to discover this thing matters to you when maybe I didn’t know that. A question will almost always allow for some kind of dialogue, whereas a joke or comment will usually result in me being mad/disappointed in myself, you, both of us, the world, whatever. As embarrassing and difficult as it can be, I’m finding that speaking up when I’m ruminating has been really helpful. It’s not easy; you feel vulnerable and like maybe you’ll be judged, but if you can push through that, articulating what you’re ruminating about helps to a) dissipate the rumination and, b) help you get some perspective on whatever you’re ruminating about. If you don’t feel comfortable talking about it with someone, I would encourage you to write it out. No one has to read it but you, but it’s helpful to get it out of your head and onto paper or into someone’s ear. To be honest, that’s why I started this blog, so hat tip to you for listening to all of my random ruminations. We want to hear your story. Become a Mighty contributor here . Thinkstock photo via Allef Vinicius

How My Anxiety Helps Me Speak Up for Myself

For most of my life, I have been a terrible advocate for myself. Some of that was me not realizing I needed to say something (not knowing a whole situation, so I felt like I couldn’t speak up); some of it was out of laziness; some of it was because I just really did not know how. In college, it took me over a month to break up with someone who told me they weren’t sure they wanted to be together, but then didn’t officially end things. It took me three years at work to feel like I wasn’t at the mercy of my boss’ every whim and could actually push back a little. I still have trouble, but I’ve noticed a big shift: recently, my default has been to advocate for myself in stead of to say f*ck it, when it used to be very decidedly the other way around. I credit anxiety for this. This is one of those times when, as sh*tty as the anxiety can be, it can do amazing things, too. If I hadn’t gone through this experience, I would still be stuck feeling like I should speak up but not wanting to rock the boat. (In my brain, whenever I thought about speaking up, I kept hearing Nicely-Nicely from “Guys and Dolls” telling me to “sit down, you’re rocking the boat.”) Anxiety has forced me to speak up in my personal relationships because that’s the only way things will get better. Even though cognitively I knew that saying something is better — saying nothing means nothing changes — I had a really hard time putting that into practice. Anxiety has forced me to start acting on that impulse to say something instead of just letting it go, and I’ve gotta say, there have really only been good results. The heart of this, though, is what the advocacy indicates. I’ve always been pretty assertive about my independence, but my Midwestern training to always be considerate of others has kept me quiet a lot more times than I should have been. As most people with anxiety can tell you, it’s easy to think about that time in 10th grade when you should have spoken up for yourself. People with anxiety tend to have long memories, and it’s always about what we could have done differently. Sometimes this is great because it leads us to be reflective about our own actions and maybe start to change something. Sometimes this is hard because we acquiesce for fear of upsetting someone and don’t always hold others responsible for their behavior. But the instinct to advocate for myself shows me that, now, I value more than my independence: my emotional well-being matters, too. I’ve always been pretty confident, but I’m learning now that mental and emotional health are about more than that. It’s important to work to maintain them, as I’ve been doing, and part of that work is saying something when I need help or something feels off. If I don’t, I know from experience that I’ll be wishing I had and ruminating about it for a long time. And I don’t particularly want to live like that any more. This is not to say that advocating is easy. I still need time to process and think about what I want to say and how I want to say it, and sometimes that can take a while. And I still get a little anxious right before I say something. And sometimes I end up crying even though I’m not that upset, that’s just how my body reacts. I still have trouble with it, but I’m glad that I want to, and that I actually do. Image via Thinkstock Images

The Problem With Wishing Away My Anxiety

I’ve written before about my love/hate relationship with anxiety. I love that it keeps me organized and conscientious of others. I love that it has heightened my sense of empathy. I hate that it makes me feel nauseous. I hate that I can’t always enjoy important moments. I hate that it makes simple things really difficult. My biggest fear when I started to deal with this was: What’s going to happen in the future? Am I going to be able to walk down the aisle without having a panic attack? What about when I have a kid? Am I going to be able to handle parenting when I’m crying and feeling nauseous and like I’m not myself? Those thoughts scared me a lot because I just wanted the anxiety to go away. I didn’t want to have to deal with it anymore. My main goal was to figure out how to get rid of it once and for all. I wanted to get back to life without anyone knowing. Anxiety felt like a black hole had taken up residence in my chest. It was only a matter of time before it turned me into someone unrecognizable. (Or until Matthew McConaughey tried to use it to send a message to his daughter.) While this attitude gave me the motivation to start therapy and read as much about anxiety as possible, this is not a healthy way to approach it. Wanting to eradicate anxiety is a form of resistance. It leads to more tension and more anxiety. It’s the classic fear of fear. I was so worried about having an attack in specific situations that I didn’t realize I was keeping myself on alert in every situation. Thus, I was making things worse for myself. My therapist asked me last week what my ultimate goal would be in terms of my anxiety. She said, “What does the best possible outcome look like?” Well, that’s easy. It’s completely gone. I don’t want to approach it with that attitude because it will make me feel like I’ve failed every time my anxiety shows up. I told her what I really want is to have a set strategy in place. This way when I feel it start to get bad, I will know exactly what to do. I want to approach this like I’m going to live with it all my life because I probably am, one way or another. Knowing that it’s not going away actually helps me cultivate the accepting attitude that’s so important in anxiety and panic management. Assuming I’ve got another 60 or so years of this ahead of me, helps me to make room for it. Maybe what’s most important is it normalizes it. I want to get to the point where, when anxiety pops up, I’m just like, “Oh, it’s you,” and go back to whatever I was doing. I’m definitely closer to this than I was a year ago. One of the things that’s been really helpful has been learning how to depersonalize the anxiety. This is helpful in trying to be an outside observer. It allows me to view anxiety as something that is happening to me versus a character flaw. While my reaction used to be, “Oh my god, What the f*ck is going on?” — it’s now more something like, “Oh, well this is annoying but I’m pretty sure I’ve got this.” Honestly, I’m pretty darn proud of that. It’s been a long time since I was crying uncontrollably and feeling like I was going to puke at any second. These days it’s mostly some nausea (sniffing peppermint oil is an amazing help for that by the way), a rapid heartbeat and some tightness in the chest. If I can’t get to a quiet place, then it can escalate. Usually, I can make that happen or at least stand in the back of my classroom and breathe for a minute or two while my students work. Perhaps, I need one more really big anxiety-producing experience, akin to meeting my boyfriend’s parents or traveling somewhere I’ve never been. This way I can really see where I am. I’m sure this will happen in due time. I feel good most days though, and I’m really proud of that. I’m almost where I want to be. It feels really good not to have that black hole hanging out in my chest anymore. (But if Matthew McConaughey wanted to hang out there, then I’d be OK with that.) Image via Thinkstock.

What To Know If You Know Someone With Anxiety

In trying to make more of a commitment to seeing my friends (hey, guys!), I’ve been thinking about what I want to say if the topic of anxiety comes up. I’m fortunate enough to have a really supportive, empathetic group of people in my life, but I know that’s not always the case. I know, too, sometimes it feels rude to talk to someone about their mental health. Even if they bring it up, you might be unsure of what to say. Here are some things you should know about the people in your life who deal with anxiety: 1. It’s not our fault. This is not a personality flaw or something we’re doing intentionally. This is not us trying to get attention, that’s the last thing most of us want. This is not us trying to passive-aggressively tell you we don’t like you or our friendship is over. This is something our brains do to us without our consent, not an extension of who we are or a choice we make. Even though it might feel personal to you sometimes, it’s really not. It sounds like it’s just an excuse but sometimes we honestly just can’t. Our brains interpret discomfort as danger, and often times the things we think will help actually perpetuate and strengthen the panic over time. 2. We still want to see you and hang out with you. Even if we say no to your invitations, we still like to be invited and we still want to see you. Maybe we’d just rather have dinner with you than try to have a meaningful conversation at a work happy hour. When you don’t invite us because you assume we’ll say no, you inadvertently increase our feelings of isolation and the sense that something is “wrong” with us. We know you don’t mean to do that, but it still hurts our feelings. Inviting us, even when we say no, helps us to understand we are loved, people do want to see us and we are not broken. 3. When in doubt, ask. If you’re unsure about how to talk about anxiety, curious about what it feels like for us or have no idea how to help, ask us. Asking shows empathy and compassion. We hate it when people say things like, “Don’t worry about it,” “You just need to get over it,” or “Calm down.” None of that is helpful. If you find yourself wanting to say one of these things because you think it will help or because you don’t actually really know what to say, then try asking questions or validating. Things like, “That sounds really tough,” “I’m so proud of you for dealing with this,” or “How can I help?” bring us relief and a sense of belonging. They make us feel like you understand and you’re not just brushing this off as regular stress. There is actually something fundamentally different about our brains we can’t control, and it makes us feel invalidated when you compare it to everyday stress. 4. Be patient with us. It can be really hard to understand anxiety and the need for down time, especially if you’re someone who likes going at a million miles per hour all the time. Truthfully, we’re probably working really hard, even if you can’t see it. Anxiety management takes a lot of time. I spend about an hour and a half per day meditating and doing yoga. That may not seem like much, but most of us also have full-time jobs and relationships that need our attention, too. Add to that the decompression time we need and there is little time for a social life. So please, be patient with us when you want to get drinks tonight and we say we have plans. It is not your place to tell us that watching television, reading or whatever are “not plans” and we can “skip them.” They are plans. We need that time to relax, to work on understanding ourselves and to use preventative practices that help keep our anxiety low. Keeping us from it or making us feel guilty about it make the anxiety worse. Just because that’s not how you would spend the time doesn’t make it any less important or valid. 5. We are still us. While anxiety can be really overwhelming and hard to deal with, it’s just one aspect of our personalities. We are still the complex, wonderful people who you love. We still have hopes, goals and skills. We’re still interested in stuff. We love when you check in with us, and we appreciate it. We also want you to treat us like the multifaceted people we are. Anxiety doesn’t wipe out our personalities. It may cause us to hide for a while, but we still want to talk with you about how ridiculous Trump is or this book we just finished that we loved. We still care about your life and what’s going on with you. We don’t have to spend every minute of our time together talking about the anxiety. 6. We’re learning a lot. Odds are we’re in therapy or at the very least having a lot of thoughts about why this is happening and where it’s coming from. We’re learning a lot about ourselves, about what we need and about what we want. Some things about us might change or we may react to something differently than you expected. If there’s something that’s difficult for you or an issue, talk to us about it. We can explain our thinking and come to an understanding together. 7. We love you, and we are grateful for you. Ultimately, even if you find yourself saying, “Don’t worry about it” or feeling like you don’t really know us anymore, we still love you. We love that you want to be part of this journey with us, even if you don’t really know how to engage in the conversation or how to handle some of the things we’re going through. Chances are we are struggling, too. We probably don’t say it as much as we should, but we’re so thankful for you. We are thankful you are willing to stick with us as we figure this out. We appreciate your support in whatever way you try to give it. This is a lot of information, and I know it may not all apply to you. Please, don’t feel like you have to try to remember all of it all the time. This is a process. We’re learning, too. While I generalized here, we’re all different. So it’s important to talk to your person who deals with anxiety and/or panic about where they are in their journey and what works for them. Maybe none of this stuff applies to them, maybe some of it does or maybe they were nodding along to every word. If you really want to know how best to support them, ask.

What Causes Panic Attacks: Triggers and Underlying Causes of Anxiety

There is a subtle but important difference between the triggers and underlying causes of anxiety, and sometimes it can be hard to recognize this difference without help. Triggers are usually small, specific instances that put you on alert. Underlying causes are more about why you’re feeling the anxiety — what you’re actually thinking about. Clues to these can often be found in the ruminating or racing thoughts you have when feeling heightened anxiety or panic. For many of us with anxiety or panic disorders, our underlying cause(s) have something to do with control. For instance, I tend to experience anxiety when I feel my behavior can influence the outcome of a situation. I had a panic attack when meeting my boyfriend’s parents because I believed if I wasn’t (or didn’t appear to be) good for him they would tell him they didn’t approve and it would lead to the end of our relationship. This was a particularly big deal to me because I’d started to realize I was in it for the long haul, and I’d never really felt that before. I can’t even explain how important it was to me that my boyfriend and his family felt like I belonged with them. And, to be clear, never, ever did my boyfriend or his family put any kind of expectations on me. They were and are nothing but kind, empathetic, and a joy to be around. I realize now there are multiple levels on which these thoughts were not accurate. But that’s what happens with anxiety: something triggers it, and then your brain ruminates or races and you end up spiraling into this place where your thoughts feel real and inevitable and like the worst case scenario is automatically the most likely scenario. It takes a lot of work to get to the point where you can recognize your anxiety is running away with your thoughts and even more work to learn how to reframe those thoughts. But it is possible, and it is worth it. When you’ve put in the work, you get to the point where you feel a little anxious, a thought like that pops up, and instead of seizing it and spiraling it, your attitude is just kind of oh, you and then you move on. To get to this point, I highly recommend three things: Therapy The Headspace pack on anxiety the “Panic Attacks Workbook” by David Carbonell These three things helped me immensely, and even using just one of them is a great start. For a long time, looking back on the experience of each of my panic attacks just brought up those feelings again, which is natural. It took a lot of work to distance myself from the experience of anxiety and to really learn it is not part of my personality; it’s part of my body. It’s biological. This depersonalizing is essential. The difference between “my anxiety” and “the anxiety I feel” is so incredibly important. If you do nothing else, I’d recommend talking about the anxiety you feel in this way. Now that I have this perspective, I want to take the time to really break down that first panic attack and talk about triggers versus underlying causes. This process — thinking through the timeline and anatomy of a panic attack — is one that has been really helpful in identifying my triggers and underlying causes. It’s also helpful to do in the middle of an attack because you’re not distracting yourself (and making the problem worse next time), you’re giving yourself a focus and stepping outside of the experience of anxiety while still addressing it and dealing with the feelings and symptoms. A panic attack functions like this: I’m sure you’ll be able to see in my description below how my thoughts followed the panic loop, but I’ll try to also be clear about which step I was experiencing at each time. I woke up early, feeling what I considered a “normal” level of anxiety with regards to traveling. I’d been feeling this for a couple of years, so nothing seemed unusual or more heightened. I felt nauseous but also like I needed to go to the bathroom, so I spent the morning alternately sitting on the couch shaking my leg and leaning over the sink or toilet. Again, this felt “normal.” I didn’t recognize this initial feeling of anxiety as a trigger (step 1) because it had never escalated to a panic attack before. I was assuming once we got to the airport, I would be fine for the rest of the trip. Now, though, I see the waking up early as a trigger and I know this is my cue to start belly breathing or meditating. Once we got to the airport, things felt better. Going through security was familiar, as was the flight. They both occupied my mind and I could sort of forget about the anxiety I was feeling. I was sure it was done and this was going to be an awesome trip. The next thing I knew, the flight attendant had announced we’d started our final descent, and I was crying quietly in my seat with my headphones in. Again, I didn’t recognize this as a trigger (step 1) because I didn’t know then that anticipation is a huge factor for me, and I didn’t know about control of my own behavior being one of my underlying causes. I hadn’t really thought through why meeting the parents was such a big deal this time, and I didn’t understand how high my expectations of myself were. I let myself cry, thinking that was it, and hoping my boyfriend’s parents didn’t notice. Everything was fine for the rest of the day because I had enough to keep me distracted. The next morning, I was up at 4 something hurrying as quickly and as quietly as I could to the bathroom. The trigger here was actually something that we all have — the left side of my brain was alert because I was sleeping in a new place — but I didn’t know that (step 1). I wasn’t expecting it. My racing thoughts were as follows: W hat’s going on? Why do I still feel like throwing up? What if his parents can hear me crying? What if this doesn’t stop and I can’t go out and do anything today? Are they going to think I’m doing this on purpose? Are they going to think I’m like this all the time? Oh my God, what if they think I’m like this all the time — they won’t want him to be with me! What will I do if he thinks they’re right? What if I can’t get it together and he doesn’t want to deal with that and this is the end of our relationship? (step 2) All of those thoughts happened in about 30 seconds. Unbelievable, right? But this is what your underlying causes do. They hijack you. They make you panic and worry and think everything is controllable and your responsibility when it is not. They force you to assume the worst thing you can think of is the thing that is absolutely without a doubt going to happen. Mine — the need to be in control of my own behavior and fear of losing someone important to me — were out in full force. Anxiety tricked me into believing my actions, and more specifically my ability to hide how I was feeling, were all that were keeping me from doom. Add to that the intense physical symptoms like nausea, crying, or shortness of breath, and you are in the second circle of hell, in the middle of a storm with no hope of rest. This is a panic attack. It sucks. Eventually this subsided, as panic attacks always do. I was able to stop crying, shower, and my boyfriend and I went out shopping at the outlet malls while I slowly drank some coffee and a protein shake. By the end of the day, I felt more calm, if not entirely myself, but I was left wondering if this would happen again and definitely scared of the possibility (steps 3 and 4). This cycle of events happened every morning I was there. It was hard to break because I was surrounded by triggers: unfamiliar places, unfamiliar people, not knowing what was expected of me. Add to this the expectations I placed on myself because of my underlying causes of anxiety, and I consider it a miracle I even made it out of the bedroom, let alone made some jokes at dinner. I was trapped in this cycle for the entire trip, and then for a few days after I got home. Once you’re in it, the panic loop is incredibly hard to break because it’s self-perpetuating. Most of a panic attack is not about whatever the initial thing that triggered your anxiety is. It’s about your fear of losing control in a public place or your fear that you’re going “crazy.” And then you start to fear having another panic attack, and you end up keeping yourself anxious all the time and actually giving yourself panic attacks. The important thing to understand here, though, is that people don’t do this on purpose. People don’t say “you know what, let me have a panic attack right now.” (And if there are people who fake a panic attack as an excuse to get out of something, f*ck those people, those people suck). It’s important to understand panic is a physical, biological response, so when I say “give yourself panic attacks” what I mean is that you haven’t yet learned the tools to break the panic loop and so it continues. I don’t mean you’re intentionally doing this to yourself or that you are purposefully escalating your anxiety; I just mean your body feels something weird, your instincts respond a certain way, and that leads to more panic. I had about four or five months of what the f*ck is happening to me?! before I was ready to dive in and really start looking at my triggers and underlying causes. Then it took about a year of work to learn when I could expect to feel anxiety and how to work with it when I did. It was hard, but I have never done anything so worth it in my life. If you’re still in your WTF phase, it gets better. I promise. It’s horrible AF now, but you can do this. You are not alone.

Therapy on TV: 'Parks and Recreation' and 'Unbreakable Kimmy Schmidt'

Out of all of the things I have read and watched in the last few years that address mental health, I feel two shows handle it in a way that showcases the struggle, and breaks down the stigma of seeking help. The first is Chris Traeger’s journey on “Parks and Recreation.” I love that therapy for him is a clear place of healing. His sessions and his work show how helpful therapy can be when you’re dealing with a mental health issue. For Chris, therapy is the thing that helps him process and come back from a series of really intense episodes. It mirrors my own experience, and it’s so nice to be represented. While they do kind of poke fun at how emotional he is during this time, it’s not mean-spirited. It’s actually super helpful to be able to laugh at how overwhelming and irrational anxiety can make you feel (best quote: “I’m so happy. And so sad.”), and it gives the other characters the opportunity to be encouraging and supportive about his choice to seek help. That last bit is so important; rarely do we see characters congratulating someone on going to therapy and that is such a wonderful way to break down the stigma. I also really love season 2 of “Unbreakable Kimmy Scmidt,” because, for Kimmy, there’s not a clear breaking point. Kimmy goes to therapy because she’s a normal person dealing with her experiences (yes, I know, not everyone is kidnapped and kept in a bunker for 15 years, but hear me out). She does the same thing we all do: she pushes down her feelings and hides them from others in an attempt to look well-adjusted and emotionally stable. It’s a coping mechanism that works well for her in the bunker, so she sees no issue with applying it to life after while she’s trying to cope with post-traumatic stress disorder. Her emotions find another way to surface. She starts hitting a guy that wants to kiss her. She denies she’s angry. She burps every time she starts talking about her past. She is all of us — not because of the PTSD, but because of the way she tries to hide and avoid confronting it. Kimmy’s journey in therapy is so groundbreaking and wonderful because she’s the everyman. She’s someone who has a clear sense of who she is and is capable and independent and she still benefits from therapy because it helps her realize a lot of things about herself and gives her a new way to process not just her trauma, but her emotions. Her therapist Andrea lays down the most amazing truths, like this exchange: Kimmy: “I guess I just did it ‘cause I’m nice.” Andrea: “And that makes you happy?” Kimmy: “Yeah! Happy as a clam.” Andrea: “So, like, clenched up tight, full of grit, and if you get pried open you’ll die?” This is who I was for a long time underneath all of the anxiety stuff, and it really hit home for me. This is hilarious, but it’s also super true: so many of us are like this, so fiercely protective of ourselves that we think we don’t need therapy because the thing we need it for is the thing we see as a strength. We think holding it in, keeping it together, whatever you want to call it, shows we are mature and adult and in control. The ironic thing is we want other people to be vulnerable; we just don’t want to be vulnerable. The first time I had a similar realization in therapy, it blew my mind. Equally awesome is the moment when Andrea tells Kimmy she’s entitled to her anger. I spend so much time trying to tamp mine down that watching this scene was like a revelation. In the same way I’m entitled to my joy, my sadness and my panic, I’m entitled to my anger. I’m allowed to feel it, and I’m allowed to be mad at people. I rarely allow myself to be angry because, for me, it has to do with control. I don’t want to be angry because I know how intense my temper is and I worry I will say something unforgivable. So rather than learn how to channel and process my anger and use it to build better relationships, I spent a long time pretending it didn’t exist. Like my anxiety, I felt my anger was something that didn’t belong in my world; it was something I needed to get rid of, to stop feeling. But really, it’s not. And that’s the beauty of “Unbreakable Kimmy Schmidt.” It normalizes therapy because Kimmy uses it to help her with “normal” issues. It showcases therapy’s wide range of uses and breaks down the stigma because Kimmy is just like all of us: she’s learning how to process her emotions and her experiences and that there are some things she’s been using as coping mechanisms that actually aren’t such great strategies. I also really love how Andrea is a mess. Some people are critical of that aspect of her nature: she’s super healthy with strong boundaries during the day, and she’s a promiscuous alcoholic at night. But that’s what I love about her. She’s a real person with issues. She’s not some unattainable, intimidating ideal of what a people think a therapist should be — completely put together with everything figured out. She’s human. She’s messed up. And I think that actually makes her better at her job; she can empathize with Kimmy because she knows what it feels like to be trying to cope and not be able to. She knows what it feels like to feel out of control. We still have a lot of work to do to break down the stigmas around mental health and treatment. But what is progressive and awesome about Chris and Kimmy is that, in both cases, they were encouraged to go to therapy by the people closest to them and supported in their work. They weren’t treated like something was wrong with them. The suggestion for therapy came out of love and friendship in Chris’ case, and, for Kimmy, Andrea’s recognizing that Kimmy wasn’t OK. These two characters are a huge step forward in eliminating the stigma surrounding therapy and seeking help, and I hope that — now that characters on network TV and streaming services have done this — we will start to see not just more characters getting the help they need, but a variety of them, too. I feel represented because Kimmy and Chris are both dealing with issues similar to my own, but there are other people whose mental health struggles are still not represented — or represented positively — in main stream culture. And people who struggle with their mental health come in all colors, shapes and ages. We need to see characters in therapy who are kids, adults, South American, black, LGBTQ, plus size, you name it. Everyone deserves to be represented in this battle because it touches all of us. We need to talk about it.  And we need to show it: art imitates life, and we cannot act like this is not a part of life. Speaking as someone who has benefited from therapy and who knows multiple people who have likewise done so, this is perhaps one of the most important parts of life. I will never not be proud of going to therapy. I will always be glad I did. And we need to see more characters who are like that, too.

When Anxiety Gets Better: What to Know

Something important has happened. My boyfriend is out of town this week, and I went to work every day he was gone. I know this seems like duh, why wouldn’t you go to work? But in case you haven’t been following my story for very long, I have a history of having to take a day off while he’s gone because of anxiety. But this time, I went to work every day and I am so pumped. Seriously. On a scale of one to curled up in a ball on the floor of the bathroom sobbing and alternately going to the bathroom and puking my guts out, the most I felt this whole time was a two. I woke up 45 minutes before my alarm yesterday with some tightness in my chest and some rapid heartbeat, but it was gone by the time I left for work. And this morning? Nada. I woke up early, cuddled closer to the dog, and the next thing I knew my alarm was dragging me from the depths of sleep with its stupid incessant chiming. It was glorious. I know that to people without anxiety this might feel like a weird thing to celebrate. But to me, this is huge. This is the first time I’ve been in a situation that has caused me intense anxiety in the past and not felt any. It’s crazy. I feel like I’ve leveled up in a big way. I was telling my therapist about it during session yesterday, and she goes how did that make you feel, to know this might go away? And, to be honest, my answer to that question might not be what you think, because it feels like I’ve been dealing with this for so long. Two out of 30 years is not actually that much, but it’s been so intense it feels like it’s eclipsed the not-having-anxiety years. When I think about not having to deal with it anymore, I’m kind of torn. On the one hand, it’s amazing. It’s like I can finally see a future where I’m not dreading traveling, I’m just excited about it. And it feels like I’m getting back to me, to being able to do more and experience more and be a little busier and not need as much downtime. I can see a life with my boyfriend where my anxiety is not something that keeps us from doing things. That’s so awesome, and I’m so excited about it, and it’s nice to be excited. I haven’t been this excited in a while. I also kind of don’t want it to go away completely because, in a weird way, anxiety also makes me feel really grounded. It forces me to care for myself in a way I never really have before; I always just kind of barreled ahead and told myself I would deal with things later and then never did. Anxiety doesn’t work like that. I have to be in the moment; there’s no way not to be when the physical symptoms are so intense. And I have to be mindful of it every day. I’ve changed my life to accommodate things I know help, and that has been great because it means I’m accepting it by making room for it. I’m not fighting it. I still have those moments where I really don’t want to go to the gym or set up all of my yoga stuff — still working on looking forward to exercise, ugh — but each time I’ve reminded myself that this is part of accepting anxiety’s place in my life. That going to the gym is helpful not only because the endorphins are great for my brain, but even more so because it means I’m making space for anxiety and I’m practicing noting its presence and then letting it go. Which is awesome for when I’m actually feeling anxious — it’s so much easier now to be like oh, hey, my chest is kinda tight. Let me belly breathe for a minute and then go about my day. I cannot explain how freeing that is. What a huge sense of relief I feel. It’s kind of like when you’re playing a video game and your character dies again and again and then finally you start playing the level that gives you trouble and all of the information from your past lives clicks and you beat the boss. I feel like I just kicked the boss’ ass and now I don’t really care what I have to deal with on the next level because this one was so hard.  Beating it has made me feel like I can take on anything. And I know, too, I won’t always feel like this. That I will probably still feel pretty anxious on our next trip, and I will still feel like throwing up on my wedding day, and I will still want to hide from everyone sometimes. And that’s OK. It’s even good — those feelings tell me I’m highly evolved and I care. It’s weird to realize I’ve actually kind of come to love my anxiety a little bit, and to know I would (only slightly) miss it if it went away completely, because it helps me cultivate my empathy and compassion not only for others, but for myself. And it’s made me healthier because now I go to the gym and own a ton of workout gear and that is not ever a thing that I thought would happen. Anxiety has made me proud of myself in a way I have never been, and that is such a wonderful, unexpected result of my time in therapy. Follow this journey on It’s Only Fear.

What Therapy Did for Me as Someone With Anxiety

A few weeks ago, I had my last therapy session. It is wild to me that this is where I am. For so long, especially when I first started, I didn’t see myself ever stopping. Therapy is just so awesome. I’ve never experienced anything like it. It was helpful in ways I probably haven’t even begun to realize yet. When I started therapy, I felt so completely bewildered and disconnected from myself. I had the firm, ingrained belief anxiety was a thing I should be able to control. If I couldn’t control it, then something was wrong with me. I walked around carrying the pressure, the tension and the feeling of not knowing myself anymore. It was really hard. Asking for help was hard, too, because in my family you do everything yourself. You’re never not capable and you always keep it together. In the last few years, we’ve all, my parents, my sister and me, been working really hard to give each other the safe space to not be OK. I’m so proud of us for that. I’m proud of us for encouraging each other, for being open about our struggles and for really digging into our separate issues. It’s made this process a lot easier for me. Therapy did so much for me it’s hard to put it all into words, but I want to try. I feel so grateful I’ve been able to go through this process with someone who has such a wonderful balance of empathy and questioning. My therapist was consistent about encouraging me in my efforts to manage anxiety. She was really good about asking me questions and giving me challenges in order to help me really get to the roots of why this was happening. Therapy is, by and large, one of the best things I have ever done. There are multiple reasons for this. I could write about it forever, but instead of boring you guys, I’ll just make a list of all the pros to therapy: 1. Therapy gave me a place to be lost. It was always unequivocally OK to be lost, overwhelmed and hopeless. Those feelings subsided over time but that was a lot of what I felt the first six months. It was always OK. More than OK, it was welcome. 2. Therapy let me go at my own pace. My therapist never rushed me or made me feel like she had an agenda to accomplish. She let me talk about whatever I wanted to talk about in my own time, and for however long I wanted. This doesn’t mean she let me be all over the place. Sometimes I was, but she would gently nudge me back to center with a question or an observation. 3. Therapy held me accountable. Because of how I am, I would have felt super ashamed of walking into therapy and not doing anything to fix my own problems. My therapist knows this about me (as she should) and she was really great about checking in with me about what strategies I was trying and how they were going. She never made me feel like a failure, and she always encouraged me to keep trying. Just by asking, she helped me stay accountable and get to know my particular brand of anxiety inside and out. I also had to show up. I had to be physically present in order to get the help I needed. Committing to this week after week helped me to follow though in other areas of my life. 4. Therapy challenged me. If you’re really working at it, therapy is hard. There were so many times when our conversation necessitated me talking about something from my past I didn’t really want to talk about or realizing some things about myself that were tough to admit. Some things, like how stubborn I am, I will be the first person to tell you about. Other things, like the fact that I cry every time I feel almost any strong emotion or am in conflict with someone, made me feel ashamed and were really hard to talk about. Therapy let me work through that. Now, I know I’m not crying because I’m weak or too sensitive. I’m neither of those things. I cry because that’s how my body reacts to stress and that’s OK. 5. Therapy helped me accept my “flaws.” First of all, Leslie Knope said it best, “One man’s nightmare is every other man’s total package.” Aside from that, therapy helped me realize anxiety is not a flaw. It’s biology. It’s not something that’s wrong with me. When I realized this and started trying to manage it, I learned how to make room for anxiety and accept it as part of my life. I assumed, and still assume, it will always be something that happens to me and so I’ve made space for it. It has a little corner of my heart where it lives. It’s always going to have a home there and that’s a good thing. 6. Therapy made me give zero f*cks. Seriously, once I got through all of the crazy “WTF is happening to me!” times and realized anxiety isn’t a flaw but just a thing that happens to me, I stopped caring about what people think about it. I just do not care. Again, anxiety is not a personality trait and it is not a flaw. It is biology. It’s genetic. It is not something you can chose to have. So f*ck anybody who thinks about it like it’s a choice and who looks down on those who are dealing with it. Screw those people who choose to judge you and us on something we can’t control. Anxiety doesn’t negate that I’m a capable, hard-working and a conscientious human being. Anybody who thinks poorly of me simply because I struggle with this, in the same way that someone struggles with other conditions, can get out of my life. 7. Therapy allowed me to find myself again. OK, so that sounds kind of corny, but it’s true. Anxiety is so isolating sometimes you start to wonder if you were always this “crazy” person and you just didn’t know it. It can be so disorienting and it can make you feel a big disconnect with who you thought you were and this “anxious person” you seem to be now. In particular, I had a lot of trouble maintaining my sense of self in different environments. In work, I was really outspoken and confident. With my friends I was funny and entertaining, but with my family, I was quiet and barely talked at all. Therapy has helped me rediscover the cornerstone of who I am so that I don’t feel like I’m five different people and scattered in a million directions. It has helped to ground me and to feel like I’m myself even when I’m anxious. If you’ve started therapy, good for you. I hope it’s going well and you’ve found a therapist who helps you meet your goals and who you have a good connection with. If you haven’t started therapy yet but want to, then that’s awesome. Go you. You can look on Psychology Today as a starting point. If you’re in NYC, you can message me privately as I know a few awesome therapists and would be glad to put you in touch with them. If you feel like something is wrong but you’re not really sure what it is and you’re not really sure you want to go to therapy, that’s OK too. I encourage you to go. I know without a doubt my relationship would not be as joyful, fulfilling and resilient as it is without the work I’ve done in therapy (and also my boyfriend’s magical, unicorn presence). I wouldn’t be as close with my family, and honestly, I wouldn’t be happy. I’ve learned to manage and accept all of my emotions, not just the good ones.  I’ve learned not to think poorly of myself when I’m not happy. Please, consider therapy if you are at all feeling like something is off. It make take some time and you may have to meet with more than one person to find the right fit, but it can change your life.