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Anxiety

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A friend posted a while back about anxiety meds greatly improving their quality of life. And some of the anxiety issues they described really resonated with me—those issues weren't nearly as strong for me as they were for my friend, but the flavor of them felt really familiar.

(I've always been at least a little anxious and neurotic about various things. But some of the specific anxiety got a lot worse after my father's death. It's probably somewhat better now than it was right afterward, but still hasn't returned to pre-2005 levels.)

So I eventually started looking into it. (It took me a while to get past my anxiety about the idea of taking steps to deal with anxiety.)

One of the first things I came across when I started poking around online was the Liebowitz Social Anxiety Scale. The online test has 24 questions, each asking “how anxious or fearful you feel in [a given] situation [and] how often you avoid the situation.” My score on that test was 56, which is apparently in the mild or context-specific social anxiety range. No idea how useful that online test is as a diagnostic tool, but it gave me some things to think about. (I also tried another online test, which I've lost track of, that gave me similar results.)

There were two questions in particular that unexpectedly really resonated with me; it had never occurred to me to connect these things to anxiety, but they're definitely strong anxiety/avoidance triggers for me:

  • Working while being observed. (A separate item was “Writing while being observed”; that's similar for me, especially since most of my work involves writing, but that phrasing didn't elicit nearly as strong a gut recognition reaction from me.)
  • Expressing disapproval/disagreement to people you don't know well.

I'm not sure what the being-observed thing is about for me, though I've always been tense about being observed at anything (fear of being judged? self-consciousness? memory of an old sf story about someone being observed all through childhood by a guy from the future?).

But the disagreement thing is obvious; it's part of conflict-aversion.

And that's what most of the rest of my most-extreme anxieties are about, too. Fear of conflict. Fear that the other person will be mad at me, or upset with me, or say something mean, or even just be impatient.

So I think that's the core of the worst of the anxiety for me. Something for me to think about.

When I went in for my annual physical a few months ago, I talked with my doctor about the anxiety stuff. I brought it up very hesitantly; I expected her to say something like “Well, that's a psychiatric thing, you'll have to go make appointments with therapists and stuff.” But instead, she took my concerns seriously, she asked me a bunch of questions about what exactly my anxiety was like and what problems it was causing, and she told me I had a few options, such as:

  • Talk therapy.
  • Meditation.
  • Meds.

What I really wanted, though I knew this was unrealistic, was a magic bullet that would cause the problems to go away, or at least would take the edge off enough that I could work through stuff on my own, without costing me a lot of time or energy. So, after some further discussion, I went with the meds. More on that later.

During that discussion, my doctor said something (in a kind and gentle way) about my having too-intense reactions, which I think is fairly accurate. My response is disproportionate; for example, when I receive an angry email, it can ruin my evening or my whole day. A while back, I started avoiding potential-major-conflict email until after eating, or until morning, to prevent low-blood-sugar overreactions and loss of sleep; I think that was reasonably sensible, but it continued from there, and I eventually started getting tense and avoidant about any email (or phone message, or whatever) that might involve conflict.

I think that for me, some of this stuff is also related to shyness and/or introversion. Interacting with people costs me energy; interacting with people I don't know well costs me more energy; even sitting in a public space with them costs some energy. Just being in a city is draining. And a lot of that is because of the unpredictability. I'm never sure what people are going to say or do; someone could suddenly be in my space and demanding interaction with me, and I might do something wrong. I might not be able to come up with the right social-interaction script in realtime. So I sometimes try to avoid such interactions.

All of that led me to looking into avoidance behaviors. Turns out there's even an avoidant personality disorder; I only match a couple of things on the list of criteria in that article (and Wikipedia is not a diagnostic tool), but thought it was useful/interesting to know about anyway.

I also found a couple of pages of advice about interacting with conflict-avoiders and advice about how to deal with conflict better. Neither of those pages entirely works for me, but I found them both interesting.

As noted above, I eventually went on anti-anxiety medication. My doctor prescribed a low dose of Zoloft (for some reason I kept thinking “Flomax” whenever I tried to remember what it was called), even though that's more commonly an antidepressant. (I've never had depression issues.) She said that it probably wouldn't start taking effect for two or three weeks. I figured I would give it a try for a month and see how it went. I was hoping that it would take the edge off of the anxiety and let me deal with various projects and such that I had been avoiding.

Unfortunately, it had essentially no noticeable positive effects during the first month. But then a friend who's a medical professional told me that it might take more than a month to start really working, so I renewed the prescription and continued on.

By a couple of months in, the Zoloft was having a couple of significant sexual, digestive, and sleep-related side effects. None of them were awful, but all of them were a little annoying, and the drug still didn't seem to be having any positive effects at all; the anxiety wasn't any better. I talked with friends—the abovementioned medical professional and a couple of people who take psych meds of various sorts—and the general rough consensus seemed to be:

  • It usually takes at least two tries to get the right medication at the right dosage.
  • Zoloft isn't an anti-anxiety med per se, though it can have that effect.
  • Meds would probably be most effective if I took them in conjunction with other methods (like talk therapy or meditation), rather than focusing only on the meds.

And at that point, I gave up. The anxiety issues don't make it impossible for me to get stuff done; they just impede things and make stuff harder. The amount of time and work that it sounds like would be needed to really try to address this feels like more than I really want to deal with at the moment, though I might try again in the future.

I subsequently tried some guided meditation: UCLA's mindful meditation series of audio recordings. I've liked the ones I've listened to, especially the emphasis on observing physical sensations and on setting aside stuff that comes up rather than trying to keep the mind entirely blank; I find them fairly pleasant and fairly relaxing, but I'm not sure whether they have any effect on my anxiety, and I've only listened to a few of them.

I'm in favor of talk therapy in theory, and my one experience with counseling, after my father died, went pretty well. But for no good reason, I'm still uncomfortable about the idea of trying it for anxiety stuff. Maybe someday, but I think not now.

For now, I'm leaving it alone and continuing to muddle through.

The funny thing is that, despite the ongoing anxiety, I've done quite a bit this year to catch up on stuff I've being avoiding dealing with for a long time, sometimes years. I'm by no means caught up on everything, but it has been really nice to remove a few of the things that've been hanging over my head or taunting me from my to-do list.

I'm not sure what's made me more able to move forward with things this year than I've managed in the past. I think part of it has been self-reinforcing; knowing that I've made some forward motion makes it seem more possible to make more. But that's clearly only part of what's going on. Another part may've been figuring out some workarounds; in a couple of cases, for example, I made phone calls and asked people for help in resolving some things that I'd been avoiding in email. But that's not all of it either.

It may just be that I'm currently in a space where I'm more open to change than usual. Maybe I change myself as much as I can before that openness goes away! Or maybe I should acclimate myself slowly to the idea of making changes, to keep the openness from going away. Dunno.

(Wrote most of this in March, got anxious about it (of course), didn't post 'til now.)

(See also Facebook thread for this post.)

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