Explore how anxiety can show up in your life, work, and relationships

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Meredith Arthur 4/8/17 Meredith Arthur 4/8/17

Generalized Anxiety Disorder

This was the first piece I wrote about GAD. It appeared on Medium and the Huffington Post. I wanted to reach people who were Googling the hell out of their keyboards and not finding the information they were looking for. That's how I felt when I was first diagnosed.

objects in mirror are closer than they appear

Note: This was originally published in Oct 2015.

When I was first diagnosed with Generalized Anxiety Disorder (by a neurologist in the middle of a migraine appointment), I thought, “Great! Search terms! Let’s get cozy, Google.”

But I was wrong to assume simple screen time was going to help me find my path with my anxiety disorder. I found little online that informed me in any real way. For one thing, the word “worry” was used again and again. At the time, worry wasn’t what I did or how I identified. Thinking and overthinking, yes. Worry, no.

A few months after my July diagnosis, in Sept 2015, the tennis player Mardy Fish wrote a great essay that captures the experience of anxiety in vivid detail. At one point he sums it up: “I was, objectively, doing great. And looking back, I wish I had been able to tell myself that. But doing great wasn’t something that my frame of mind back then had time to process. All I could focus on was doing better. It was a double-edged sword.”

By the time I read Fish’s piece, he was confirming something I already knew. I’d talked to many people to piece together what GAD meant, found a book that helped a lot, and started to figure out my own particular form of anxiety for myself.

The goal of this short FAQ is to help people like me when they’re just beginning their journey. You may be realizing you have anxiety. Maybe you’ve been told that that you’re exhibiting some of the symptoms of Generalized Anxiety Disorder. If you are Googling the hell out of your keyboard right now and not finding answers to your questions, welcome, fellow mind traveller.

Q. What is Generalized Anxiety Disorder, exactly?

A. You’ve probably been researching this topic, so I’m not going to give you the same bland answer you’ve already seen about how it’s a psychological disorder characterized by excess “worry” particularly about work, finances, and relationships. I will say that some of the people I know with GAD didn’t know they had it for a long time. They didn’t characterize themselves as “worriers.” Books and doctors tell you that GAD means you worry about worry, but if you don’t even consider it worry, that doesn’t help. And if you are so habituated to pushing away the worry as a coping mechanism, then again, talking in those terms just leads to more trouble.

For me, GAD meant that I was overthinking nearly everything in my life, scrupulously trying to figure it all out. If a problem came up, I’d write it down and begin my crazed attack in every direction. It also meant I had a ton of crippling shoulder and neck pain. I’d be nauseated frequently, especially on buses. I’d get dizzy occasionally, almost to the point of fainting.It was the physical symptoms that led my neurologist to know I had GAD.

Q. Can a person have GAD and not know it?

A. Absolutely. It’s common for people who have GAD to see many doctors before they get properly diagnosed. Gastroenterologist, chiropractor, neurologist, acupuncturist, and gynecologist offices are some of the common stops along the path to diagnosis.

Q. Is it hereditary?

A. I don’t know if this is everyone’s question, but it was one of mine. I wanted to understand where GAD was coming from. Yes, there is a genetic component. As is often the case, that’s only one part of the equation. You may have genetic roots and predisposition to anxiety disorders, but they are also triggered by environmental factors. The death of a loved one, divorce, the sudden loss of a job or your house, or a big change in circumstance can bring on episodic fare-up of GAD.

Q: If it flares up, does that mean it’s dormant at other times?

A: My understanding (I’m a patient, not a doctor!), is that you’re predisposed to GAD, but with proper treatment, you can bring your symptoms into check. But since you are predisposed to this condition, when things happen to you, you will be more likely to have bigger anxiety responses than other people. I almost think of it as a GAD sine wave, and the equation is your life, and what’s happening in it.

Q. How messed up are you, exactly? Please be specific.

A. Very recent example:

We have had a few ants in the bathroom lately. They appeared to be coming through the window. “We should probably replace the window,” was my immediate thought, and suggestion to my husband, even though we can’t afford it.

I don’t see 5–10 ants. I see the inevitable 100–200 ants that I imagine will invade and eventually carry off our house. It’s very hard for me to deal with the here and now when I am catastrophizing. (That’s a cognitive distortion. Learning to recognize cognitive distortions is one important element of cognitive behavioral therapy, the best method for treating GAD.)

A friend put it well: “I realized that I did everything in a rush. Even simple things like brushing my teeth or making coffee. And 80 percent of what I do on a typical day does not require hurrying and rushing. That creates a lot of stress and worry throughout the day.” I know exactly what he means. I sometimes have the feeling that if I don’t get whatever small household task done at any given moment, the world might end. GADs are not known for their patience.

The worst era of my anxiety disorder was the time before I knew I had it. I knew something was wrong, but not what. I desperately wanted to figure it out. I’d go down every known avenue trying to get an answer. My diagnosis was one of the best things that’s ever happened to me. I am very thankful for it.

Q. If I have GAD, how do I make it go away? Does it last forever?

A. Here’s my thinking on it. The ideal situation is that I’m able to ride the wave. Maybe even get to the point where I can hang in the lull for a long time with little anxiety. When stressful things happen, I expect that my particular gremlin will poke his head out of the wave’s crest. Knowing what to do with him and that I’ve survived his visits before helps a lot.

Meditation. Medication. A moderate amount of reading and learning (in other words, don’t overdo it). Communication.

Q. Can anyone develop it? What’s the line between having it and just being a regular stressed out American?

A. Right now, I am seeing the world through anxiety-tinted lenses, so I tend to see anxiety in a lot of people around me. Ultimately, though, the difference between regular anxiety, stress, and GAD comes down to degree. Most people aren’t fainting or getting up in the middle of the night. Most don’t need neck rubs every day. And most aren’t negatively predicting the outcomes of regular social interactions in a way that adds extra stress to daily life.

One of my friends, who learned through my experience that he has GAD too, said, “I tend to project into the future as I experience almost everything. And I’m often planning how to deal with some negative turn of events that might happen in the future, but most likely never will. So I’m worrying in the present about something that will never happen in the future.” If that sounds familiar, you might want to read more about Generalized Anxiety Disorder.

Q. Is this what has been wrong with me?

A. I can’t tell you that, but I can tell you that if anything that I’ve said has rung true, a great place to start is the book The Worry Cure. Don’t think about the title too much and don’t think about the word “worry.” Just investigate your physical symptoms through the lens of your thoughts, and see if what this book has to say relates to you. If not, then you don’t have GAD.

Q. Will I ever feel better?

A. I believe that you will feel better if you have GAD. This is a hard won statement coming from me. I am a skeptic and not one to placate you, reader. But I think that simply the fact of you reading this means that you are going to feel better.

Q. How do you know?

A. Times are changing. People are talking openly about depression, anxiety, and other forms of mental suffering in a way that they never did when I was in my 20s. I’m so glad to see it on behalf of my 5-year-old daughter. The more people speak openly about the spectrum of mental conditions, the more they can be helped earlier on.

I wouldn’t have dreamed of writing something this personal just one year ago. I now feel as though my anxiety needs to be an integrated part of me in order to be managed in a healthy way. I hope that others will feel that way too.

Q: What should I do if I’m a friend or family member of a Gaddie?

A: I feel for you. It’s not easy to deal with an anxious person, especially at the high pitch levels that people with GAD specialize in.

Yeah, I could see where Bob was coming from.

It’s hard to avoid the role of friend-therapist. You might find yourself talking your friend down and trying to give them a more realistic view of their surroundings. The goal is to help them build those muscles for themselves without exhausting yourself. Bottom line: get the oxygen mask on yourself first.

On the other hand, it can also be confusing because GAD often presents as perfectionism, or invulnerability. How do you help someone who doesn’t seem to need help? Take in the information you have and tune in to your instincts. Is the person talking super fast? Are they in a lot of physical pain? Do they seem complainy? If so, they may need to learn to tune in to how they are responding to the world around them. As a friend, you can help by gently encouraging them to go easy on themselves and stay grounded in the moment. Send them a link to this piece. Do it with love.

Originally published on Oct 15, 2015 on Medium and Huffington Post. Updated April 8, 2017.

Meredith Arthur 4/7/17 Meredith Arthur 4/7/17

The Fidget Cube and 5 Ancient Ways to Goof Around in a Relaxing Way

A lunchtime discussion with my coworkers about the Fidget Cube (which is kicking ass on Kickstarter) and the role of fidgeting in stress & anxiety.

Together we discussed these methods — most of which have been around for centuries — that help with busy hands, busy minds.

Also, just updated! Now includes photos and videos of the fidget cube in action.

A Whole New Level of Fidgeting

The Fidget Cube in action.

A lunchtime discussion with my coworkers about the Fidget Cube (which is kicking ass on Kickstarter) and the role of fidgeting in stress & anxiety.

Together we discussed these methods — most of which have been around for centuries — that help with busy hands, busy minds.

Go to the bottom to see more of the Fidget cube in action!

1. Baoding Balls: Here’s what they are. And this video shows some crazy baoding action.

2. Worry Stones: Many different countries have some version of this, according to wikipedia.

3. Dorodango: What are dorodango, you ask? Glad you asked.

4. Worry Beads: They’re a Greek thing. It’s interesting how every photo of a Greek person shows them “doing” the worry beads behind their back. Would like more info on this.

5. This cool Zen Stone.

Note: Keep your fidget things in Zen singing bowl. Every time you put something in it, it makes a lovely sound.

6. The Fidget Cube

My coworker's new fidget cube. He contributed to the Kickstarter, so this is almost like a prototype.

Now that the fidget cube is a real thing being used by real hands, it's interesting to hear feedback about the feelings that the different elements give a fidgeter.

My friend and coworker JB mentioned that he like the "zen stone" side for chilling out, whereas the bright green switch, though great for anxious fidgeting, is a little loud. You can see him in action (along with another coworker, Lucas) in these little videos from Snapchat.

Originally published September 9, 2016 on The Beautiful Voyager Medium publication. Updated April 7, 2017 when my coworker got the Fidget cube and started playing with it!

Recommended Reading List for Anxiety Newbies

Meredith Arthur 4/7/17 Meredith Arthur 4/7/17

How I Used Google My Maps to Help Me Connect with Other Overthinkers

I'm creating these step-by-step directions for other people who may want to help me add lighthouses in the Google My Maps Lighthouse Map in the future. This is a true grassroots effort!

Bonus: You'll also learn how Google My Maps works!

I'm creating these step-by-step directions for other people who may want to help me add lighthouses in the Google My Maps Lighthouse Map in the future. This is a true grassroots effort!

Bonus: You'll also learn how Google My Maps works!

STEP 1

I add your email address to the "approved editors" list.

STEP 2

I pass along a new lighthouse that needs to be created.

I get this info via email from the form on bevoya.com/map.

STEP 3

Look up the place in the search bar.

STEP 4

Add a generic marker in that location.

STEP 5

Time to style your marker so that it looks like a lighthouse. Use the good ole paint bucket.

STEP 6

Name your styled lighthouse.

Name goes at top, lighthouse name goes in description.

FINAL STEP

Time to add an image!

This part is fun. I randomly choose a lighthouse from the state.

Meredith Arthur 4/3/17 Meredith Arthur 4/3/17

Upping My Air Traffic Controller Game

It’s a hell of a lot easier to focus on the needs of others from the comfortable perch of my meditation pillow than in the middle of the chaos of daily life. When the airplanes of my own thoughts are taking off alongside everyone else’s, air traffic control can become an issue.

Dear fellow BVs,

The familiar British voice of the meditation app I use reminds me:

Meditation works best when we focus on others, not ourselves.

I’ve experienced it. Focusing on the emotional needs of my husband, daughter, friends, family, or coworkers helps me escape my own head and ultimately creates a positive feedback loop .

But, but, but...

"Everyone I know has a big but. C'mon Simone, let's talk about your big but."

How I deal with it.

Because I have a tendency to get scattered when I’m in the air traffic control hot seat, I’ve learned that I need to clear the runway by slowing down my thoughts. I use tools like phone dictation or notepad in order to hold them for a more appropriate, clear-runway time.

I don’t force out this newsletter in the middle of an air traffic jam. It needs to wait for a clear runway, too.

It's worth it, though.

It takes effort. But the effort pays off when I see my thought airplanes take off successfully and peacefully. More importantly, I see my conversations with others glide along in better, more helpful ways to happy destinations.

Clearing the conversational runway helps you be a better friend, parent, and colleague. Who doesn’t want to be a hero?

I know I do,

Originally published in the Beautiful Voyager newsletter on April 3, 2017. Subscribe here.

Kathleen Coffee 3/31/17 Kathleen Coffee 3/31/17

Goodbye, Chronic Migraine?!?

I’m afraid to say it. I’m afraid if I say out loud that I’ve found my “cure” – however incomplete, however temporary it may be – I’ll jinx it. Cross my fingers, knock on wood, throw salt over my shoulder, whatever it takes, but … for today, migraines are not the boss of me.

What I tried, and what worked for me.

Shhh … but, I think my chronic migraines are … not so chronic anymore.

I suffered intractable, near-constant migraines starting in 2011. They affected everything: my job, my parenting, all of my relationships (note to self: call friends and ask if they remember me). I thought this “new normal” would define the rest of my life. But certain therapies, which I discuss below, seem to have forced the clouds to part. I am starting to see a rainbow. I know that this disease could come roaring back, but for months now, I have been able to function like a person without serious disability. I’m sharing my story in case you, or someone you love, suffers chronic migraine. Maybe you’ll want to talk to your doctor about one of the therapies below; or maybe they have all failed you. But the most important point is: I am proof the cycle can abate. THERE IS HOPE.

A caveat: My migraine treatment hasn’t been a careful, scientific endeavor to suss out what works. I begged my neurologists to throw everything at the wall, to see what sticks. It’s impossible to know if my half a decade lost to migraine would have resolved without intervention. Disease processes can regress to the mean. But I think I noted some significant improvement after the introduction of a couple of key therapies. (The most useful ones are toward the end of the list).

Morphine and Phenergan

This was Day 1 stuff. I had never had a migraine, and did not know what it was. I could only report to the ER docs that my head was broken and that I was seeing things. Elaborate, colorful things. Additionally, I assured them, I planned to vomit shortly. They dosed me up, took some blood, and took all sorts of images of my broken head. The morphine helped, but only for short periods. The Phenergan helped my nausea, but put me to sleep. Helpful stuff; but you can’t take it daily and go put in a good day’s work. And morphine is horribly addictive. Not good long-term solutions.

Amitriptyline and Magnesium

My “little yellow pill” was the first thing my neurologist tried, along with magnesium supplementation. This combination seemed to reduce the frequency of headaches a little, so I have continued taking them. As you may have read, however, a study in JAMA showed that drugs like Amitriptyline, called anticholinergics, have been shown to cause brain atrophy. That study looked at older adults (a mean of 73 years old), but it made me nervous. My neurologist agreed to reduce my dosage to 25 mg., and I have not noticed any increase in migraine activity.

Butalbital (Fioricet)

This combo of acetaminophen and caffeine with a barbiturate seemed to make my headaches worse. Maybe because caffeine is a trigger for me? I tried a version of this medication without the caffeine, and it helped some as an abortive med, if only to help me fall asleep. In the early days, all I could really do to come out the fog enough to partially function was to sleep it off. I used it enough that rebound headaches became an issue, and it made me too sleepy to work. Definitely not a good long-term solution for me.

Sumatriptan

Triptans make me feel like my scalp is crawling with icy ants. The feeling is strange enough when I take the pill, but when I use a faster delivery method, like the auto-injector, it hits me really fast, as if I’m performing an ice-bucket challenge. But they sometimes seemed to help me wake up more functional. Again, triptans are only abortive, so they didn’t help with the ultimate goal: preventing migraines from starting.

The one that makes you lose your words

How appropriate that, even now, I have trouble coming up with the word “topiramate.” At this point in my treatment, I was still losing a couple of days a week to migraine. My doctor was starting to talk about Botox, but first we had to satisfy my insurance company that I had failed one more drug. So my doctor, somewhat reluctantly, put me on topiramate, asking, “Just how important is the use of language to your job?” It turns out that topiramate causes "language disturbances" in a fairly large number of migraine sufferers. Well, I am an attorney who at that time was clerking for federal judges who would, it turns out, quite like their orders to be coherent. Using the word “squirrel” when “statute” would do was a nonstarter. I’m not sure I did experience language disturbances, but the stress of possibly sending a judge a word salad – and not being able to recognize it – terrified me so much it gave me migraines. (Note: I’ve read that side effect abates after a month; maybe I should have given it more time).

Botox

Thank God for Botox. It is painful as hell, and once made a terrible fool out of me, but it works. I can feel it blocking the migraine as the pain spreads across my scalp. It’s like the pain hits a wall and can’t go any further. It reduced the number of migraine days by half, and reduced the severity of all the migraines. Once upon a time, I always felt like I had some degree of the illness active every moment. The Botox changed my life.

Butorphanol

Though the Botox helped a lot, I continued to suffer some knock-me-on-my-butt headaches. In frustration, I asked my current neurologist for something to just put out the migraine fire, something more powerful than butalbital. She gave me a nasal inhaler which delivers a synthetic opioid, butorphonol. I feel like I’m snorting a line of morphine up my nose … because I basically am. I have found that if I use it in conjunction with a triptan, I can wake up without a migraine. It is no long term solution, of course; we have an opioid crisis in this country, and I personally can’t function on the stuff. It makes me simultaneously high and agitated. Yuck. I appreciate the danger of this kind of addictive drug, and use it only on the rare occasions that I can’t function anymore. Thankfully, I have not needed it in months, due to the addition of the SPG to my regimen (below).

B Vitamins

My neurologist said there is some evidence that certain B vitamins can help prevent migraines. I am currently using L-methylfolate and hydroxocobalamin (B-12) after she suggested that I use 23andme to determine my MTHFR gene mutations, in case that could help us identify the right supplements for my body. I did the test, then looked up which B vitamins worked best for my compound heterozygous C677T and A1298C genes. I’m not sure I got it right, but so far, so good.

Sphenopalatine Ganglion Block

The SPG, a/k/a the Holy Freaking Grail, is simple: the doctor uses a device called the Tx360 to thread a little tube up my nose, and squirts some non-narcotic medication up there that, somehow, calms down my migraine machinery. IMMEDIATELY. The only side effect is a slight bad taste in my mouth. My neurologist used the SPG at first to abort a few acute migraines. They worked. So she entered me in a study in which she used it three times a week for six weeks, to see if SPGs could retrain my migraine machine. This was months and months ago, and it seems to have done the trick. Not only have migraines become very infrequent – there have even been thunderstorms I rode out unharmed, and those are usually my biggest triggers – but I don’t have the extreme sensitivity to light and odors that I had developed, with such acuity my daughter insisted I must be some sort of vampire.

My experience is purely anecdotal, and definitely does not constitute medical advice. There is no telling if the same interventions will work for you. But I hope that this chronology is useful to someone, if only to make your journey feel less lonely. Questions, concerns, suggestions? Hit me up on Twitter @MadMigraineMom or on the blog at katcoffee.wordpress.com.

Meredith Arthur 3/27/17 Meredith Arthur 3/27/17

Use This Word 3 Times Today

I learn something new every day from the good people of the Beautiful Voyager Slack channel.

Today’s learning was a word. It was so good, I had to create this little illustrated definition to share it. Cwtch is a word I definitely want to start incorporating into my vocabulary. I what Urban Dictionary says about this word: 'There's no literal English translation, but its nearest equivalent is "safe place". So if you give someone a cwtch, you're giving them a 'safe place.'"

Thanks to my new Welsh friend for sharing this great word with me. I will be using it regularly and enjoying the nice warm dose of love that simply thinking about a cwtch gives me.

How to use it in a sentence:

Jewish grandma-style: "Get over here and give me a cwtch."
Happy-hour style: "I only want to go to a bar with a cwtch. I'm tired and want to lounge around."

Meredith Arthur 3/16/17 Meredith Arthur 3/16/17

How Thinking Can Be Like Moonwalking

Something my husband said sparked the insight.

It happened in the middle of a difficult conversation. Not a fight. More of a How-do-I-make-you-understand-me talk. I was stuck, fixating on the details of how one thought led to another. Then suddenly, something he said unstuck me.

"Remember the story Forever Overhead by David Foster Wallace?" he asked. "Remember how the whole thing took place in just two minutes?"

(I did remember. It's a great story from Brief Interviews with Hideous Men. You can hear DFW read it himself here.)

My husband continued,

A person can fill any amount of time with an unlimited amount of thoughts.

That's when the insight struck in a felt way. The difference between The Stuckness and The Glide.

The times I've been happiest, my thinking glides. I'm not overly-self conscious in those moment. I don't try to track every thought. I'm not living in the DFW story.

I know what the glide feels like.

I realize now: everyone can get hung up in stuckness. It comes and goes.

Getting stuck in your thoughts does not make you unusual.

The key is to focus on the glide. Remember what it feels like. Look for it again, and reinforce it when it happens.

Build on the glide, and you'll be good.

This was originally published on Oct 16, 2016 in the Bevoya newsletter. Subscribe here. I'm publishing it on the blog in response to a post I just read on Medium that reminded me about this insight. How quickly we forget!