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Debate - When Anxiety doesn't come down


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Prompted by one of Daisy's posts

Psychologists state that anxiety will always fall. In the text-book version we expose ourselves, sit with the anxiety and it will naturally recede, we will learn no harm is to come and abracadabra, problem solved!!!!

My experience, and clearly hundreds more here find the opposite and excruciating levels of anxiety can maintain for days, weeks or months.

So what are we doing wrong? What can we learn? What can we change?

Personally, I think it's the resulting, internal self-talk that maintains the anxiety.

It's something worth thrashing out and trying to identify "what we do" and how that can be changed more effectively.

Discuss (as they used to say at College) :)

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Thank you Caramoole for starting this thread,as I said my anxiety just doesn't come down and it will be interesting to see what others feel about this,and what they do to make theirs come down x

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Thank you Caramoole for starting this thread,as I said my anxiety just doesn't come down and it will be interesting to see what others feel about this,and what they do to make theirs come down x

I think it should be a helpful discussion.....because there's clearly a huge difference between experience and theory. It's something we could all do from learning from.

I do expose myself constantly, I rarely avoid situations.......Exposure should be my middle name! And yet, like many.......anxiety frequently remains, I just live alongside it and do my best to deal with it.

Legend often says "Get comfortable with being uncomfortable"........Nice Sound Bite but personally, I don't avoid discomfort, I face it and yet anxiety has remained a problem for me for four decades.

I'm quite lucky because as Sh ite as it can be sometimes, I do manage it, deal with it, face it and live a life with perhaps less restrictions than others, simply because I refuse to allow it to dictate what I will or won't do......it doesn't stop the anxiety, that's something I endure, live with and do things "despite" it. There's a big difference.

One thing I say to my Husband and would wish for Professionals too, is that I wish there was a drug that could let them experience a tenth of the anxiety that OCD/GAD sufferers have and see how much their opinion would change.

That said, I still feel that it is probably our response that is feeding this.....we just need to fine tune better ways of how to handle this

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One thing that keeps my anxiety up is when I leave the door open to compulsions. So something might happen and I know I could check or wash or avoid or think about it later. That gives the problem a value it doesn't deserve and usually maintains my anxiety.

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Yes, thank you for starting this thread, Caramoole. It will be interesting to read the replies. :original:

The text books say anxiety will always come down because they take heart rate as a gauge of whether you are feeling anxious or not. Well, the body can manufacture only so much adrenaline before depleting it's stores of the fight-or-flight chemical, so in 100% of cases, heart rate will, sooner or later, fall. Nature guarantees it.

However, as many people on the forum will testify, a reduction in physical arousal doesn't automatically equate to a reduction of mental anxiety. As you suggested, the inner self-talk (the little voice in your head) maintains the anxiety because the perceived danger hasn't gone away.For some people the anxiety actually increases with response prevention. (A bit like still being faced with a lion about to eat you, only now you're hands and feet are tied and you can't run away or fight!) :lion: For people of a certain (more passive?) disposition ERP (exposure with response prevention) works well. For people with a 'control-is-everything' personality it's your worst nightmare come true. Neither personality is better than the other - we're all different and every personality has its benefits in life. But I believe that's why some people swear by exposure methods and some people can't cope with them at all.

So back to Caramoole's question: what are we doing wrong, and what can we learn?

We need to change what that little inner voice is telling us. We need to learn how to rewire our brains so we are capable of thinking differently. (Normal people and have an annoying habit of assuming everybody's brains are wired the same!)

Whether it's easier to re-programme your thoughts during and after exposure (when further adrenaline response is disabled and you're physically drained) or to tackle the thought processes that create the anxiety separately to any exposure is, I believe, a matter of trying each and see what works best for the individual. Sadly most therapists have been trained in the text book route and insist upon exposure as the only method of dealing with the anxiety even though the latest research has shown this isn't true.

What can we do differently?

However you go about it, it's all about learning new ways of thinking. Research has shown depression is mainly linked to just two thought pathways: self-blame and negative ruminations. They are still researching the core thought pathways that maintain anxiety (and obsessions), but while we haven't yet got neat labels (like rumination and self-blame) for OCD, it does come down to the same idea. Our brains learn very early in life how to respond to the demands of an uncertain world. The brain finds a thought pathway that works (a way of interpreting events as perceived by the five senses, sight,hearing etc) and sticks with it. Unfortunately sometimes those pathways aren't as helpful as they first seemed and we get stuck in a rut of thinking that leads to OCD or other anxiety disorders. (In anatomical terms, neurons in the brain find the fastest route of communication between different problem solving areas and then take that motorway route every time rather than travel any B-roads.)

Changing your thought pathways (the hard wiring of how your brain cells talk to each other) isn't as hard as you might first think. The brain is amazingly plastic (capable of adapting) and with practise the new ways of thinking become ingrained in place of the old (OCD) ones.

'Thought reprocessing' is a relatively new idea and only now being accepted as the way of the future in psychology schools. But it's coming, and I for one believe that for many of us with resistant OCD it is the answer we've been waiting for. No more bashing your head against a brick wall trying to stop your brain from thinking OCD thoughts. :wallbash: No more soul-destroying exposure that ingrains the anxiety rather than removing it. :eek: With thought reprocessing you simply train your brain to adopt the same thought pathways that normal people take for granted.

Meanwhile, until cognitive processing becomes standard practice, your therapist should be familiar with CAT (cognitive analytical therapy), which is a sort of stepping stone to the ideas involved in learning new cognitive processing pathways. It can be worth trying for some people.

But in case you think adopting new thought processes is an easy option folks - it's not. It's just as much work as exposure therapy and you have to want to change even more than you do to follow the Four Steps or other methods.

Each to their own, whatever works for the individual, I say. But Im delighted to see alternative solutions being discussed. :original:

Edited by snowbear
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I have found that, take looking at my nails, I will look at them, my mind cannot process the colour properly and when it finally does it is after a huge spike in anxiety, then I am anxious, I do something, distract myself and it goes off until my mind is not distracted again. I think that normal people their anxiety relaxes because the threat it removed but with OCD the threat is never gone, give minutes later we are back to what ifs and so the anxiety never relaxes for long.

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Caramoole, what an important topic. Thank you for starting it. You wrote: "I do expose myself constantly, I rarely avoid situations.......Exposure should be my middle name! And yet, like many.......anxiety frequently remains, I just live alongside it and do my best to deal with it."

I could have written those words. I'm not perfect and ruminate a tiny bit at times, but I honestly don't avoid many situations I'm afraid of and I've tried doing SO much ERP but the thoughts that have been lurking in my mind for the last five years continue to bring a great deal of anxiety. The books say it will come down over time, and I suppose that's true over one exposure session, but then why am I hit so hard by the same obsession the next day?

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What an interesting topic.

When I look at the 'textbook', I see that one is supposed to be at a 'normal' level for anxiety. The obsession strikes, one's anxiety level spikes. Then over time it returns to a normal level again. When I was in the throes of OCD, however, my normal was something like 6 on an anxiety scale of 1 to 10. It would spike up to a 9 then settle back down at a 6. It is a very similar situation to many people on the forum. The can identify that their anxiety level goes up after an obsession but, when it goes back down, it doesn't go down very far. Our background anxiety levels are elevated all the time. But that we could have had a respite from OCD and have our anxiety reduce to a 2 or 3 on the scale after an obsession strike. It would be like a gift to be that relaxed in between obsessions.

As snowbear pointed out, the textbooks say we can't stay anxious forever. There's only so many hormones to pump out at any given time and we are designed to return to a passive anxiety level once the 'threat' we face is gone. So when the obsession is over, we should go back to a normal. But our normal is way higher than other people's. We stay up there all the time. So what's going on?

I think there may be several things going on . First, I think at least some people with OCD (or maybe the majority) are predisposed to have a higher than normal background anxiety level. We truly are anxious all the time. Second, through compulsions and general worry, we keep our elevated anxiety levels higher than they should be. In other words we cause ourselves to be more anxious than we should be.

In a perfect world while still having OCD, our anxiety should hover at a relatively low number, spike quite high at the onset of an obsession and then slowly dwindle the further away we get from the obsession, until the next obsession hits. I tend to think people with high anxiety fill in the space between obsessions with other worries and compulsions, artificially keeping anxiety levels high.

That said, my own background anxiety level is quite low now. Sometimes I get so relaxed I'm just one step above coma, which isn't an altogether good place to be.

My advice would be to take relaxation exercises seriously, consider meds to lower your anxiety level, work on stopping compulsions and work to not jump to the next thing to worry about. The less you fill those spaces between obsessions, the lower your anxiety level will be.

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My therapist always said the text book version about it too. The body and mind cannot maintain anxiety at a high level.

It's true, however once I allow it to come down by sitting it out, my OCD is constantly trying to latch onto the next thing to worry about, that alone keeps anxiety high. Then sure enough it will find something, and up goes the anxiety again, cycle repeated.

I honestly can't remember the last time I had low anxiety.

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Very interesting and useful discussion I have found my anxiety does not fade if I do something that worries me for a long time or til something else happens then I forget the other worry and get anxiety about the new one. My husband said it is better to be anxious while getting over and trying to beat the worries than being anxious and bad with ocd and not trying but he does not understand how ill it makes you feel, Even though I think he is right lol.

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Important also that we dont just treat the ocd we treat the big picture !!

All very well doing exposures etc , but often there is or maybe other problems running alongside the ocd , like a traumatic event in the past , depression , ptsd etc so

i found that i didnt only have to address the ocd , i also had to look at me like looking down at a cake that had been sliced in different segments and treat each

slice , and i found that by doing this it kind of helped the cbt

There is lots we can do , in relation to exposures and allowing anxiety to increase , as long as we are treating the big picture also , because if we dont , that could

possibly hinder the cbt possibly

How do we get rid of anxiety , even though we have exposed ??

anxiety always decreases eventually , but if that anxiety is still there along with the attached thoughts , then perhaps a new approach may help ?

Anticipation and acceptance was the key for me re getting better , then once done , i had to dig deep and blatantly refuse any engagement with ocd

Edited by Legend
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It's a great thread.

I am sure that the self-talk in our brain has a part to play.

Negative - and OCD - self-talk that doesn't stop won't help.

Rewiring our brain away from this can. This is something our forum friend PolarBear touched on the other day, and with which I concur.

Finding ways to start up new positive beneficial neurological pathways certainly helps, and understanding how and why the brain does what it does.

I think that the mindfulness-based CBT for OCD that I learned during my last therapy sessions has some good explanation and tools to aid this.

The Mindfulness Workbook For OCD by Jon Hershfield and Tom Corboy, which I was encouraged to use, uses mindfulness together wIth CBT to help us refocus out of those unwanted thought patterns.

I also realised from this that my ERP would not be successful unless I was in a calm and assured state going into it.

Once the therapy put me in that place, the ERP started to work!

Edited by taurean
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The role of that Demon self-talk :devil2:

Old-fashioned as her books may be, I don't think anyone sums up anxiety and all it's nuances any better than Dr.Claire Weekes.

She says : Anticipate, accept and let time pass

: Don't add second fear to first fear

When we have all these awful anxiety symptoms, tight muscles, palpitations, racing heart, tension, shakiness etc, do we truly accept them? The chances are, not. It is more likely that a conversation is going saying

"I feel awful, why has this started again today, what if I always feel like this, how can I cope when the anxiety's so bad, what if someone notices, people will think I'm a fool, I can't stand this, what if it just keeps building up, why won't it stop?" etc etc

That isn't true acceptance, that's the second fear.....the fuel for the fire. Can anyone recognise themselves doing this? I know I do.

As Polar Bear mentioned it's also about the point your scales are balanced at if Side A is calm and Side B is anxious and B is currently sitting nicely down at No.3.........you can add spoons of sand onto Side A before it starts to have a troubling effect, it takes some time for it to happen. But if Side B is already at a No.7 it only takes a couple of grains to tip it over the edge.....a door slamming, the phone ringing.....even tiny things can tip the anxiety.

So she's saying "Accept" the cause of the anxiety symptoms, don't try and wish them or push them away, wait, know the enemy.....they won't stop immediately, let some time pass without heaping on the second fear.

Most anxiety is a fear of fear

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The role of that Demon self-talk :devil2:

Old-fashioned as her books may be, I don't think anyone sums up anxiety and all it's nuances any better than Dr.Claire Weekes.

She says : Anticipate, accept and let time pass

: Don't add second fear to first fear

When we have all these awful anxiety symptoms, tight muscles, palpitations, racing heart, tension, shakiness etc, do we truly accept them? The chances are, not. It is more likely that a conversation is going saying

"I feel awful, why has this started again today, what if I always feel like this, how can I cope when the anxiety's so bad, what if someone notices, people will think I'm a fool, I can't stand this, what if it just keeps building up, why won't it stop?" etc etc

That isn't true acceptance, that's the second fear.....the fuel for the fire. Can anyone recognise themselves doing this? I know I do.

This is where is struggle with the OCD text books'. I get the racing heart etc, but never think 'I feel awful...' etc. I don't do this, at all. :no:

Where others describe fear when they perceive danger, I feel anger when I perceive a threat from the outside world. In place of the internal 'what if' and 'why'...narrative, I clench my fists and go straight into , 'F* the universe'. If it was within my power to do so I'd tear the universe apart and leave no atom intact. It's rage, fury, a desire to hurt and destroy whatever was trying to hurt me. Sure, it began with fear and a perceived threat, but my response and internal thoughts are quite different to what you describe, Caramoole.

My rituals are all about defusing the anger. Sure, I can stop myself doing them, but then I turn nasty. :furious: I hurt people, I hurt myself. I smash things. Very quickly I no longer want to live. I'd cut off my nose to spite my face in that mode and nobody is safe from my anger, not even people I love. And the anger persists until I do a ritual or until I've done some damage - physical, emotional, other people or me, it doesn't matter to me what gets destroyed so long as something 'pays the price'.

Being told to 'accept the anxiety' just makes me lash out and tell whoever told me to relax to F* off. I'm sure I can't be the only OCD sufferer who turns their fear into anger, but none of the self-help books ever address anger as an issue.

Anyone any thoughts on that? Anyone else turn their initial fear response into anger?

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but my response and internal thoughts are quite different to what you describe, Caramoole.

Hi, sorry Snowbear......I suppose I was addressing background anxiety in general there, rather than OCD as such.

I suspect it's not discussed in the books because probably 95% plus experience anxiety, unlike your anger. Tricia mentions hers as disgust.

Does your anger provoke self-talk, an internal dialogue that sustains the anger just as others sustain the anxiety?

And don't shout at me, will ya? ;)

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Hi, sorry Snowbear......I suppose I was addressing background anxiety in general there, rather than OCD as such.

I suspect it's not discussed in the books because probably 95% plus experience anxiety, unlike your anger. Tricia mentions hers as disgust.

Does your anger provoke self-talk, an internal dialogue that sustains the anger just as others sustain the anxiety?

And don't shout at me, will ya? ;)

Nah, I won't shout, I'm a cuddly kinda bear at heart. :D

Interesting that Tricia mentions disgust. Disgust and fear both generate anger in me and set off the rituals.

My self-talk usually takes the form of warning the universe (or god, or the powers that be, however you view whatever governs the world) to back off and not upset me! So yes, I think you could say it sustains the anger. :whistling:

That's where learning new ways of thinking helps because I can laugh at myself and remember that (a) the universe isn't listening, (b) if it had ears it wouldn't care, and © I'm powerless to carry out my threat of destroying the universe anyway.

Oh to be sane instead of crazy... :crybaby:

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What does a ship without a rudder do? It goes round in circles - can't resolve the directional errors.

It needs a rudder to regain control.

For us, acceptance that we have a problem is a natural precursor to finding a "rudder".

Identifying the cause of our problem is next, and tackling it using the correct therapy.

Believing we can improve if we do........ is important. We can't commit to making changes if we have no belief.

Snowbear, resentment and anger are destructive emotions and will make things worse - a large dose of acceptance, then refocusing prior to anger and resentment taking hold will help.

Back to control. I am aware of the sources of Daisy's anxiety.Somewhere inside her I think OCD is denying her believing she has no fault - since the disorder insists she has guilt.

We could be down to the OCD basics of it insisting on proof and 100% certainty - there is therefore perhaps a need to accept overall probability that it is OCD consistently raising guilt in the mental chatter - I believe the "rudder" is belief and overall probability.

Dealing with anxiety that arises for no apparent reason, then the brain scans for something to attach it to is a reverse situation to the norm.

Perhaps if the team looks at it from that reverse angle, we might find a breakthrough

.

Edited by taurean
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What can cause anxiety?

Rational fear

Irrational fear

One of the ten negative cognitive thinking distortions

Stress

Disgust

In Tricia's case, and some others with contamination issues, we are dealing with a disgust source emotion not fear.

Our resolution therefore is to look to reframe that emotion so it doesn't hit the alarm button but a benign reaction occurs - the sufferer has come to terms with something that cannot be conrolled - and the false message of disgust is rendered ineffective.

A mental "rudder" that accepts it is a false message, leaves it be and refocuses is the path I think.

Edited by taurean
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Hi SnowBear. I have a good friend with OCD who has completely different symptoms from my own, and they seem to be more like yours and Tricia's. She has a lot of anger in her regular life apart from OCD but her emotional contamination OCD leads her to feelings of disgust, not anxiety.

Arrgh. OCD is just too complicated sometimes to fit into a neat little package with simple treatments that work for everyone! Good luck in your recovery.

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This is a great topic and an insightful discussion.

Although others have mentioned it, I want to underline the fact that for my OCD, anxiety is just one of several unpleasant sensations that I struggle with. Yeah, I know the very classic "intrusive thought --> anxiety --> compulsions" cycle and do agree that with time, the anxiety fades to some extent, but very often it can stay high for several days. And even when it's down, I have an irrational and constant feeling of guilt and constant negative thinking to deal with. So while as per clinical definitions I might not have anxiety all of the time, I also very rarely feel at peace with myself. I can imagine that this is something that others experience as well.

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The technical definition of ocd is obsessions that cause 'distress' that leads to compulsions. Distress is a general term. Most people describe their distress as anxiety. Others say it is guilt, shame, disgust.

in cbt they address the way ocd makes one feel as well not just the "anxiety" it can cause many other things , esteem , feelings of disgust, etc etc , so you work

at the cognitive side , and the way it can make one feel etc re thought process , then application of exposures ?

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Prompted by one of Daisy's posts

Psychologists state that anxiety will always fall. In the text-book version we expose ourselves, sit with the anxiety and it will naturally recede, we will learn no harm is to come and abracadabra, problem solved!!!!

My experience, and clearly hundreds more here find the opposite and excruciating levels of anxiety can maintain for days, weeks or months.

So what are we doing wrong? What can we learn? What can we change?

Personally, I think it's the resulting, internal self-talk that maintains the anxiety.

It's something worth thrashing out and trying to identify "what we do" and how that can be changed more effectively.

Discuss (as they used to say at College) :)

I am not sure why some say that.

With the fight or flight response it’s a relatively short term response, cortisol our stress hormone is released in greater quantities but it may become depleted after the event and we may feel tiered then. With general anxiety and OCD we suffer long term stress so cortisol may keep being produced and this can make us feel depressed, lower our sex drive, make our OCD worse and effect our mood such as being angry, it can also affect how serotonin is used which also effects our mood.

So if we are facing our fears and sit there waiting for our anxiety to fall it may not happen if the stress of being in that situation is to great, and with OCD so many other things can cause us further anxiety. I try not to do this, and do things everyday but gradually so the stress of doing it is not as great and I can build on that and my cortisol level does not remain high.

The other thing is when we are stressed and experiencing high levels of anxiety then a couple of chemicals flood the front part of our brain so that it cannot function as it should. This region helps us see how our behaviour at the present time may have some relevance on our future behaviour as this helps us find the balance between something positive we do or something negative. It also helps us from doing things that are not appropriate responses. Yes, these chemicals may get depleted but they replenish themselves, and with long term stress then the front of our brain may cause us to perform impropriate responses and we may not be able to make clear decisions on what is the right responses to make. How many of us have got stressed and we panic as we just don’t know what to do and then we fall back on our OCD to help us cope in some way.

I think sitting there with our fear waiting for our anxiety to fall may only cause us stress which will then not help our OCD. I think that to improve our OCD we have to reduce the stress first and we can only do that by regular and gradual exposure to what we fear. If we don't find that helpful then we may have to look at our overall stress in life as I think stress is a big factor in further worsening OCD, and then OCD causes us more stress, so it's very difficult.

Edited by Arrow
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