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This week I will answer an email from a reader who is struggling with anxiety all of her life.
I have emailed to see if you can help. I am looking for guidance. I’ve suffered with anxiety all my life but never really knew.
I just thought I was shy until I was about 17. Then it hit me hard and I struggled for two years. I struggled on and went to third level but I never got help and ‘grinned and bared’ it. Often I was overcome by shame and guilt.
I thought that a new start would do the trick and I went to Canada. Unfortunately my anxiety worsened and I had to come home. I was devastated and it triggered three years of suffering.
I’m almost 30 and just about got my life going.
In the past few months I feel like it’s creeping back in on me slowly but surely. I mainly suffer intrusive thoughts which leave me feeling paralysed with shame and guilt.
I’m looking to deal with this problem. I want the life I always dreamt of and know I deserve it, but I can’t do it if I don’t face this problem head on.
Dr. Eddie’s Response: Mary, I really appreciate you writing to me and trusting me with your story. A number of things come to mind and I will go through these. You talk about experiencing anxiety all your life and then other moments where you were overwhelmed and then the quality of your life deteriorated.
Too often we can forget that GPs, who are in the community, can play a role in identifying appropriate pathways for help including mental health.
In addition, they can do a physical and blood work up as well. In the context of starting out with mental health interventions, be it psychology, medication or counselling, I think a quality assessment is critical.
The benefits of assessment
Accurately diagnosing mental health presentations can be challenging, even for seasoned clinicians, and this has meaningful implications in terms of providing effective care.
Psychological assessment may be especially useful in situations where diagnosis is not immediately clear and/or may involve multiple clinical considerations.
Psychological assessment can also be extremely helpful with adults who may be struggling in different areas of their lives, particularly in situations where past treatments have been sub-optimal or ineffective.
These evaluations provide important information, not only about where someone may be struggling specifically.
What Keeps The Problem Going
Anxiety treatments are really open to Cognitive Behavioural Treatments.
In modern psychology we really like to focus on what keeps the problem going?
Targeting the thoughts and behaviours are key.
What are the intrusive thoughts?
This sounds key to the moods of guilt and shame that you are experiencing.
Remember you are not your thoughts. All human beings have intrusive and upsetting thoughts, however your challenge is to learn a tool kit to manage these via the CBT.
This is where you will learn to recognise and challenge these thoughts, or using some other therapy models you will recognise the thoughts, but don’t engage with them.
Mary your thoughts are thoughts, not facts. These intrusive thoughts could be associated with Obsessive Compulsive Disorder (OCD), however I strongly advise assessment. Check out www.ocdireland.org.
For some people with OCD they can struggle with compulsions — i.e. behaviours for example excessive hand washing.
For others, possibly yourself the obsessions are the struggle. These are unwanted and intrusive thoughts. Your challenge is to take back control of your intrusive thoughts.
Step 1: See Through OCD’s Scare Tactics
OCD is the fear network of the brain sending a signal that something is wrong and needs to be done now.
OCD works by feared consequences that are important to a person. Believe me, somewhere within an obsession is the flip side of a core value. If OCD taunts you with images and thoughts about offending god, then religion must be important to you. If OCD reviews all the ways your family could be hurt, then your family is clearly one of your top priorities. There is checklist of common intrusive thoughts that I find helpful to share with my patients. There are numerous thoughts on this list regarding losing control and acting out violently or sexually. Several research studies found that when this list is shown to a non-clinical sample of people, approximately 90 percent of those surveyed will agree to having experienced some of the intrusive thoughts.
When the non-clinical sample is asked how bothered they are by experiencing these intrusive thoughts, they are most often only mildly bothered by them.
In contrast, when this same list is shown to individuals diagnosed with OCD, a similar percentage of the sample will agree to having experienced these intrusive thoughts, but the big difference is how much distress these thoughts evoke for the OCD sample.
For those meeting criteria for OCD, there will be a much higher level of emotional distress when these same intrusive thoughts surface.
What keeps OCD alive and well is not the experience of intrusive thoughts, but actually one’s reaction to them.
The more one dislikes experiencing intrusive thoughts and then tries to repress or fight thoughts, the greater the frequency of intrusive thoughts one will experience. The very act of trying to “not have” a bothersome thought guarantees its resurfacing.
Finally to be human means one will experience deeply upsetting, intrusive and odd thoughts.
Freedom from OCD is not about stopping the mind from offering up strange and occasionally disturbing thoughts but learning how to recognise spam versus urgent mail versus engaging in the real world.
Dr Eddie Murphy runs a psychological and counselling service in Portarlington, Co Laois. If you are organising a speaker or training for school, community, voluntary, sporting or work groups, call Dr Eddie on 087 1302899 or go to www.facebook.com/ dr.eddie.murphy.psychologist, twitter; @dreddiemurphy