Anxiety Avalanche!

This past few weeks I have felt like I have been on a crash course on anxiety. Not personally but through my work I have facilitated a group on Anxiety, and was handed clients with an array of anxiety disorders including Generalized Anxiety Disorder, Panic attacks, Obsessive compulsive disorder, and post-traumatic stress disorder. 

We all can relate to experiencing anxiety in our lives.  I only recently wrote about feeling anxiety in regard to interviews I had gone through.  In this regard, experiencing a feeling of anxiety is a normal part of our stress response that enables us to respond to life’s challenging situations.  For example, a woman that is assaulted by a particular man may wisely flee the scene when he comes toward her again. 

Increased heart rate, sweating, and other symptoms of anxiety prepare us for these flight or fight responses that have helped us through the ages in survival.  Now we get these same responses in our everyday technologically oriented lives in response to anticipated event, but also in response to thoughts and feelings about these events.

Those with anxiety disorders are characterized by avoidance anticipatory fear- or more simply fear of experiencing an event or a feeling that has not happened (yet).  

Instead of accepting or experiencing fears or unpleasant emotions with an anticipatory event will use methods to avoid these events and control their emotions or thoughts, but unfortunately these only exacerbate anxiety symptoms. 

A funny example told in the book I am currently reading on Acceptance and Commitment therapy for anxiety disorders tells the story of how one woman after an accident would try to avoid to take left turns due to having been in an accident where she was taking a left turn.  You can imagine how much time and inconvenience it would add to her life and how this increasingly complicated route could cause even more stress in her life as she increasingly revisits her fear of left turns in avoiding them in turn also strengthening her anxiety.

There is a strong physiological component in anxiety, in addition to the usual mix of thoughts, feelings and behaviors that contribute to the cycle of anxiety. Anxiety can result in panic attacks which can be mistaken as a heart attack, headaches, and other bodily symptoms. As a result anxiety sufferers may spend a lot of time trying to figure out what is going wrong with them before they consider anxiety as a possible culprit.

One unanswered question about anxiety is why some people go on to develop anxiety disorders and others do not.  For example, the majority of people who experience traumatic events do not develop long term PTSD.  We know what makes someone’s anxiety response disordered or problematic but that does not help us with what is behind an anxiety disorder.

In this book Acceptance and Commitment Therapy for Anxiety disorders (Eisert and Forsyth, 2005) they believe that what makes anxiety disordered is a rigid control and non-acceptance.  This is most obvious is obsessive-compulsive disorder where a person usually realizes that their actions are irrational and can easily identify alternative action or thoughts but is unable to accept a lack of certainty (“I may have not checked the lock, I better go back, even thought I likely did”).  They propose that simply helping someone be better at controlling their emotional regulation and thoughts will not be adequate to help those with anxiety disorders as anxiety sufferers already interpret these negative emotional states as “bad” and needing to be managed and controlled at all costs. They acknowledge that it is important to confront fears by not avoiding, but also recognize that it is important to learn to live with anxiety, rather than flee the actual emotional state.

So that’s my crash course on understanding anxiety in a nutshell!  Now how to deal with it in therapy- another post altogether!



One week

After one week immersed full-time in the world of mental health therapy I am in love and energized.  The day I arrived I had a dozen cases already assigned to me, including both initial assessments and clients who were already long-time clients of the woman I was filling in for.  

The experience of being with someone suffering from anxiety or depression and literally seeing relief and reduction of symptoms as the session went on was satisfying.  I really got to use my whole self in the process and be genuine. What an experience.  And on top of that to try and understand the complexity of people’s lives, thoughts and beliefs and how and when they manifest into “symptoms”.  

I have a fantastic supervisor who herself absolutely loves working with people and doing therapy and who has spend time with me to introduce me to clients and give feedback on the direction of my cases.

I feel as if it is an answer to a prayer I was almost too tentative to pray.  



Gardening: a new season.

Yesterday  I came home and found myself sitting by one of our raised beds weeding a garden next to my toddler.  It was the most peaceful experience I have had in a long time. I was able to breathe and let go.  It was also my first day of work at the mental health team I have joined. I was thrown into my new role with an ample caseload with appointments already booked for me throughout the week.

As I sat by the bed running my hands through the dirt sifting out weeds I thought of the therapeutic process in relation to the cultivation of gardens.  There are a couple different kinds of weeds in my garden.  There are surface weeds, that are easily removed on a routine basis and there is the beast of our garden, morning-glory.  Morning glory is a vine that produces the most beautiful flowers but twists around our desired plants and chokes them out.  Its root systems likely go 6 feet deep and are very difficult to remove; some say only removed by burning or  raising the Ph level (making an inhospitable environment). Each year we dig deeply to remove as much as we can only to find it regrown within a couple of weeks.  The only alternative to burning or killing the soil is to put a liner on the bottom of the bed which keep it at bay for sometime.

Morning glory is like severe mental health issues .  Beautiful, with some purpose but utterly destroying desired functioning; prohibiting positive growth needed for nutrition and substance.

What can we do?  Very rarely is it safe or even advisable to take drastic action as then you end up burning not only the weed but other positive plants. You can teach someone some weeding and digging skills which will keep them at bay; teach them to let a few weeds go and accept their beauty and sacrifice some functional needs.

Or you can put a liner on the bottom of the garden .  This however requires knowledge of the garden itself: its borders and its depth and also requires a lot of digging and usually is a job for more than one person.  Even with this some weeds eventually get through.  This is therapy that is more intensive and even long-term, but even with this there is not guaranteed success the weeds are hearty and have existed long before the gardener arrived. All of this comes with some experimentation; and there is always the risk that weeds will grow in from outside of the garden from nearby fences.  Ah the battle.

But despite this the gardening itself is a pleasurable activity: to appreciate the beauty of both the weeds and new plants- to watch with is newly planted grow and take up space that the weeds used to dominate the garden space.  To have the joy of working in the soil and tending a living thing.  That is the joy of the therapist.



Entering the world of work

This past week I had two interviews, received all of my grades, and was offered and accepted my first job with an MSW. I will be working as a mental health therapist at my former practicum site.

One of the questions that the interviewer asked me was what I felt about safety: both mine and clients’.  At first I thought of this question mainly in terms of my own personal safety; I felt relatively little unease or concern regarding that.  However the interviewer’s wanted to know how I would deal with clients safety,  more specifically how I would deal with the responsibility and the emotional challenges of the dealing with suicide and client self-harm.  As I was studying for this interview I had been madly reading everything I could on suicide risk assessment. As I did so the responsibility of my future role started to weigh on me.  I began to become worried that I would miss something important and then I would lose someone.  It is important to have that sense of responsibility but what the examiner’s wanted to know more than anything (as they could see I had read up and knew suicide risk assessment fairly well) was whether I could handle someone whom I had done everything possible to help and protect them…dying.  The interviewer candidly related how she had experienced this in her career in mental health.  I related how important self-care and seeking good family and social support would be for this job.  However, I have to admit that the thought of someone committing suicide on my caseload scares me- as it probably should- and I think it would be an incredibly difficult thing to deal with as a social worker.  Nonetheless I am determined to plunge into this work and field with courage, skill, and openness to learning.

My question to you, fellow professionals (social workers, counsellors, etc): how have you dealt with risk/difficult situations (whether it be the difficult call to remove a child or not, or to hospitalize someone, or have someone on your caseload die). How have you learned to cope keep strong even with the huge responsibility you carry?

Let me know- help me be prepared for the disappointments and challenges ahead.

Also: how has your faith helped you through such challenges?