Psycho-Babble Medication Thread 14715

Shown: posts 1 to 7 of 7. This is the beginning of the thread.

 

Uncommon issues in anxiety treatment [long]

Posted by Phil R. on November 6, 1999, at 23:51:14

Hi. I realize the following two issues are somewhat out of the mainstream of this board, but I've received some encouragement to toss them out anyway. The questions themselves:

1. In psychotherapeutic treatment of anxiety disorders, being able to create and then use a relaxation response is usually essential to the patient in reducing anxiety. But some (generally small) percentage of patients have a paradoxical response when they try to relax: they instead become more anxious! I just found out this is a known phenomenon called relaxation-induced anxiety, and I've looked up a few medical journal articles on it. But actually treating relaxation-induced anxiety appears to be mostly a mystery. I'm curious if anyone here has any experience or knowledge with this problem, and if there are any suggestions as to how to deal with it so that relaxation can then be effectively employed to combat anxiety problems.

2. For PTSD and other trauma-based disorders, psychotherapy is usually considered an important component of treatment. But some (again small?) percentage of people with these disorders are pretty much on the edge already, and it's known that psychotherapy can sometimes, at least initially, be somewhat *destabilizing* to them. I've read first-person stories from people whose black-outs or self-destructive behaviors, etc., got worse when they tried therapy. Given this precarious edge, how can someone in this situation begin the therapy which will hopefully be helpful in the long run, but threatens their stability, or even safety, in the short run?

FYI, I do indeed have a personal interest in these questions. I have a range of emotions, but for years I've had a strong need to remain somewhat emotionally guarded, and avoid just letting feelings (especially warmer feelings) just happen. When I do even begin to relax, let my guard down and let feelings just happen, I'm abruptly hit with varying feelings of anxious distress, usually accompanied by actual behavioral agitation, like I'm losing control. At times, the agitation has escalated to unsafe behaviors. Afterwards, I can be more vulnerable for several days.

I was in therapy for many years, but never got very far with it, despite my best efforts. I could never really let my emotional guard down (it felt too unsafe), and I think that's why therapy usually stayed up in the avoidant intellectual realm without much personal growth.

(Diagnoses have included "anxiety disorder not otherwise specified", and possibly PTSD. I also have recurrent major depression. I've been on a lot of different meds at different times: 12 antidepressants offering occasional help, 3 mood stabilizers, low doses of 6 antipsychotics for agitation, 3 anti-anxiety, and 4 "others". The base agitation problems don't seem to be a side effect of any particular medication.)

So I relate to my first question in that relaxation produces an anxiety/agitation response for me. I relate to the second question in that even though I've been in therapy, I was afraid that facing the stillness and emotions was going to be destabilizing and unsafe for me.

I've looked at this from lots of angles over the years. I've decided that it boils down to that I need to find a way to let my emotional guard down and relax without experiencing the distress and sometimes unsafe behavioral agitation. That's the core of it. Learning that skill should enable me to work on other things more effectively. If anyone has any experience or information related to my 2 questions, I'd be very interested. (I apologize that I'm usually not able to check this board every day, but I can every few days.) Thanks all.

- Phil R. (not the other Phil)

 

Re: Uncommon issues in anxiety treatment [long]

Posted by Noa on November 7, 1999, at 9:49:23

In reply to Uncommon issues in anxiety treatment [long], posted by Phil R. on November 6, 1999, at 23:51:14

Phil, I could see how one could become anxious about doing relaxation exercises--I think of it as a performance anxiety, the fear that one is going to mess it all up. Also, you talked about how letting your guard down is scary--getting relaxed might be a form of letting the guard down, and who knows what might come to mind then.

I think one thing that could help is a therapist who will be very supportive, and not make you go at a pace that is too fast. Opening up difficult topics in therapy can induce anxiety and other symptoms, so you would need a therapist who would let you control the pace and who could talk with you about the anxiety you feel in the therapy itself. Finding a therapist with whom you feel very very comfortable and who is very very patient would be helpful. It would also help if you could sort out your meds and find one (or a mixture of several) that help take the edge off the anxiety. Good luck.

 

Uncommon issues / uncommon treatments?

Posted by Bob on November 7, 1999, at 14:50:25

In reply to Re: Uncommon issues in anxiety treatment [long], posted by Noa on November 7, 1999, at 9:49:23

Hi Phil R! Glad you finally put your question up.

I've brought this up a few times before, but I'll say it again -- hypnotherapy. Find a therapist who also has training as a hypnotherapist. I'm not talking about past-life regressions or anything out on "the edge" like that. The way my hypnotherapist put it is like this: that your conscious mind and your subconscious mind both want what's best for you, but they do not necessarily agree. Hypnotherapy is a means of tapping the unconscious to discover the nature of the disagreement and bring the two back in synch.

Bob

 

Re: Uncommon issues / uncommon treatments?

Posted by Victoria on November 7, 1999, at 20:00:02

In reply to Uncommon issues / uncommon treatments?, posted by Bob on November 7, 1999, at 14:50:25

Two thoughts:

Maybe relaxation exercises just aren't right for you. Maybe exercise would work better to discharge anxiety and leave you more relaxed without feeling so vulnerable.

I second Noa's suggestion that finding a therapist who can make you feel safe is crucial. I too have a bad reaction to feeling too good (I tend to disconnect) and I've realized that, in my family, my feeling good made me vulnerable, a target to be "shot down." I'd recommend trying therapy again, and take your time finding one you can feel safe with (or at least imagine feeling safe with). Good luck!

> Hi Phil R! Glad you finally put your question up.
>
> I've brought this up a few times before, but I'll say it again -- hypnotherapy. Find a therapist who also has training as a hypnotherapist. I'm not talking about past-life regressions or anything out on "the edge" like that. The way my hypnotherapist put it is like this: that your conscious mind and your subconscious mind both want what's best for you, but they do not necessarily agree. Hypnotherapy is a means of tapping the unconscious to discover the nature of the disagreement and bring the two back in synch.
>
> Bob

 

Re: Uncommon issues / uncommon treatments?

Posted by ed on November 10, 1999, at 6:14:06

In reply to Re: Uncommon issues / uncommon treatments?, posted by Victoria on November 7, 1999, at 20:00:02

I have found inducing a relaxation response is greatly beneficial. Certainly there can be (and there is, for me) increased anxiety and physical tension at first, but you get past that after a while, and the relaxation response takes over. I believe invoking the relaxation response is essential to reducing anxiety-related complaints and, at least for me, meditation has been very helpful.

 

Re: Uncommon issues / uncommon treatments?

Posted by Phil R. on November 13, 1999, at 3:11:20

In reply to Re: Uncommon issues / uncommon treatments?, posted by ed on November 10, 1999, at 6:14:06

Thanks for all your comments. I agree that learning how to invoke the relaxation response is important in learning how to deal with anxiety, and I've seen others who successfully use relaxation techniques to ease their anxiety. I do equate relaxation with letting my emotional guard down, and it's even beginning to let my emotional guard down that triggers my anxiety/agitation response. I'm not sure whether, for me, relaxation "performance anxiety" plays a part. Hypnotherapy is a fascinating proposition. My only concern is that I thought in order for hypnotic trance state to work, one must enter a more relaxed, unguarded state, which I can't currently do.

Once I related my own situation to the known phenomenon of "relaxation-induced anxiety", I talked with a counselor friend who mentioned that the local university medical center's behavioral health department has a well-regarded anxiety disorders clinic that might have some knowledge or experience with this phenomenon. I used to have a psychiatrist contact within the behavioral health department, so I wrote to her asking for a referral. She talked with a few others there and came back with two recommendations, one to get myself on their long waiting list (though I'm not yet clear on what treatment approaches they're thinking of), and another to consult with a particular therapist in the area who does EMDR (the eye-movement thing for trauma and other disorders).

I've met once with the EMDR guy, who thought that EMDR might later be applicable, but that I wasn't yet ready for EMDR itself. A few exploratory sessions might help determine a treatment plan. The guy seems good, and he understood that I've already spent a lot of time learning to cope better with the fact that I have these limitations, and that I'd like to focus on finding a way to actually reduce those limitations.

When I get to the top of the waiting list, I'll consult with the university mental health folks and try to compare their proposed plan with what the EMDR guy decides. I'm not going to pursue the two paths simultaneously, but I already let the EMDR guy know that I still want to just consult with the university people to see what they think might be a good treatment plan for me.

So (dare I say?), I'm feeling just a little bit of hope for some progress on this.

- Phil R.

 

Re: Uncommon issues / uncommon treatments?

Posted by Bob on November 13, 1999, at 22:00:05

In reply to Re: Uncommon issues / uncommon treatments?, posted by Phil R. on November 13, 1999, at 3:11:20

You sleep, you probably drive on autopilot, so you're probably already familiar with what some consider self-hypnotic states already. The nice thing about working with a hypnotherapist is that she can get help set your focus on something that could be entirely distracting from the feeback loop that probably triggers your "relaxation anxiety" in the first place.

Moving on to other uncommon treatments, have you considered acupuncture?

Bob


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