One of the hardest things to get my head around is that I am not in control.
I suppose we all realise that at some point in our lives. Serious illness or injury forces us to confront the fact that our bodies are just going to do what they want at times. They’re vulnerable. We do what we can to prevent injury or illness, and when we suffer, we seek treatment and therapy, but we can’t really control the outcomes.
But when it’s a problem in my brain…that’s something I thought I could control. I know, or thought I knew what to do. Cognitive behaviour therapy has taught me how to challenge my unhelpful thinking and reframe my thoughts. There are a wealth of cognitive strategies that make a difference and help us to become resilient.
This belief that we are in control of our minds has become pervasive. Positive thinking quotes show up in my Twitter feed daily:
‘You can’t lead a positive life with a negative mind’
The idea that positive thinking strategies work is comforting. It gives us a sense that we’re not helpless, that each of us has the ability to change our lives and to create our own happiness.
But, it’s only part of the truth – we run much deeper than our thoughts.
I can’t begin to describe the shame I felt at having a breakdown that rendered me incapable of working for over 2 months.
I felt it was my fault, that if I had enough discipline I should have been able to re-frame my thinking. I’d allowed myself to become broken. I had the wrong mindset. I’d done it to myself.
Only that wasn’t the case.
Traumatic experiences aren’t just stored as explicit memories. They are also stored as implicit memories, and according to my psychologist, while I may have processed the explicit memories of trauma, those implicit memories remain stuck, not fully processed, stored in my brain’s amygdala.
Innocuous things, like a sound, a colour or a movement trigger associations with past trauma. Consciously, I know I’m safe, but the amygdala identifies it as a threat and takes over. It’s a survival response which floods my body with ‘stress’ hormones charging me up for fight or flight.
The amygdala shuts down my prefrontal cortex – which does all my reasoning. Again, this is a survival response, designed to allow humans to act quickly and instinctively in extreme danger, rather than thinking things out. But it also means that cognitive strategies aren’t going to work.
And, according to my psychologist, its not a matter of using cognitive strategies in a preventative way. Those strategies work on the reasoning part of my brain, but they aren’t likely shift the physical and emotional memory stored in my amygdala.
What she has recommended is exposure therapy, where I am re-exposed to those trauma memories in a safe environment, and am helped to process them properly. This should mean they are no longer stuck, and no longer trigger a fear response. But, exposure therapy takes time, and to be honest I’m terrified. Our attempts so far have only had limited success. I become so distressed that I resist, and so we’ve spent our sessions circling around issues as I use every strategy I can to avoid confronting the past.
Since being triggered just over two months ago, I’ve been in an almost permanent state of high anxiety and distress. If full-blown panic attack is around a 10, I’ve been operating on around a 7 or 8. My body is so full of stress hormones that it doesn’t take much to push me back up to a 10, and every time that happens more stress hormones flood my system, making repeat panic attacks more likely.
I can’t prevent the trauma triggers, as they are unpredictable. 2 nights ago, for example, I had a nightmare induced panic attack. I couldn’t see that coming, I can’t prevent what I dream about. Sometimes I’m triggered by a sound, or a movement. The other day I was triggered by the prospect of doing a research masters.
Pretty much all I can do is focus on reducing the frequency and intensity of the anxiety.
To reduce the level of adrenaline, I have to move. When I was on leave, I walked for around an hour each day. Now that I’ve returned to work, I do a 40 minute walk to and from walk, as well as a twenty minute walk each lunch time. If I drive instead, I make sure I’m home early enough to go for a run. It relieves the pressure that constantly builds inside of me. Last week was raining however, and this limited what I could do. I could jump on the cross trainer at home, but I couldn’t ease the pressure by taking lunchtime walks.
I meditate daily. I’m learning to create a mental space between myself and the anxiety. Instead of thinking “I’m anxious” I’m learning to just note and observe the feeling – “that’s anxiety”. Somehow this space seems to make it less overwhelming. It’s not a cure, however. Earlier this week, just 15 minutes into meditaton, the anxious knot in my stomach exploded without warning. In an instant, I was overwhelmed with an urgent desire to escape, gasping for breath, shaking, adrenaline coursing through my limbs. But the daily mindfulness practice does help me throughout the day. If I notice myself becoming stressed, I bring myself back into the moment, and focus on my breathing, the sounds and the sights around me. This doesn’t prevent a panic attack, as when triggered, they occur instantly and without thought. But it does help reduce the level of stress in my system and therefore the likelihood of an attack.
Medication is helping too. I’d naively hoped it would make the anxiety go away completely, but it doesn’t. It has however reduced its intensity – taken the edge off so to speak, and it is my and my psychologists hope that this might enable me to relax more in exposure therapy and give it a greater chance of working.
Finally, I’m trying to focus more on my impact on others than what’s going on inside of me. The saying ‘ people don’t remember what you say, but how you make them feel’ has resonated with me strongly recently. I’m trying to be conscious of this in my interactions. I want to listen, to support, to show interest and compassion. I may be feeling crap inside, but that doesn’t mean people can’t feel better for being around me. Being other person focused keeps my mind off my own pain.
Progress has been slow, but I’ve finally been able to return to work. Teaching children is a fascinating and joyful experience, full of meaning and demands my full attention. When I’m working with them, I’m completely immersed and I don’t notice the unease that sits inside of me. It’s the lunch breaks, the meetings and the admin times where I become aware. I’ve a growing knot of tension in my stomach, quite painful and nauseating at times. By the end of the school day, the pressure has become unbearable, and I leave as early as I can to walk or run it away. But I’m getting through each day, and making a positive difference. I have to be happy with that.