This is part two of a series of articles about living with diabetes and anxiety. For part one see here.
I dreaded my second appointment with the psychologist so much that I cancelled and rescheduled just because I didn’t want to go. I felt like the psychologist hadn’t given me anything to work with in the first appointment, which left me weakened, frustrated, and rough around the edges.
My second appointment began like this:
“When was your last anxiety attack?”
“This morning,” I said with a chuckle. “Oh, and yesterday I had one, and two the day before that.”
“How about we choose one event and talk about it?” the psychologist suggested.
The event we talked about stuck out in my mind for many reasons, but mostly because it was so awful that weeks later I was still thinking about it. The psychologist started asking very specific questions.
What were my symptoms?
Nausea, shortness of breath, dry mouth, dizziness and lightheadedness.
How fast did the symptoms come on?
Slowly over the course of the night. It was cumulative.
What was I thinking about right before the panic set in?
I couldn’t really remember.
More important than anything else, what was I afraid of?
At first I didn’t know as I thought back to that night. Then the answer hit me: nausea. I was afraid of nausea.
Why was I afraid of nausea?
Because nausea is stomach upset and stomach upset could mean vomiting.
What was so scary about that?
I’m afraid of vomit. Once my nausea gets triggered it starts a very real very big adverse psychological reaction.
He kept asking why. I kept responding because.
I was getting annoyed, like he wasn’t taking me seriously. Slowly, though, I came to understand that it was all part of the process to pick apart the cause and effect. When the psychologist felt like he had enough data he showed me what he was writing and explained the vicious circle of anxiety. At that point the psychologist was literally on the edge of his seat with excitement because we were figuring something out.
Anxiety, he explained, starts with a misinterpretation of thoughts and feelings that transfer into perceived threat (the trigger stimulus). That then causes apprehension as well as a psychological and physical response, which perpetuate the initial perceived threat. The heightened initial perceived threat causes more apprehension and an even stronger mental and physical response, so on and so forth, thus completing the circle of an anxiety attack.
I have a myriad of anxiety triggers. Talking to people and crowds are big ones for me. Other triggers are loud noises, bright lights, and anything that overwhelms my sensitivities. Planning events and organizing things are also at the top of my trigger list. Diabetes is a huge one that I have, for the most part, ignored. Worry in itself is anxiety-inducing, and with diabetes I am constantly worried and feeling guilty for every high and low reading that I get. The apprehension I get from the numbers make it hard for me to not regret decisions I’ve made. I get a lot of nausea with my high and low readings, and those trigger anxiety attacks.
I have determined that the anxiety causes nausea, and the nausea causes the perpetual panic because I am absolutely terrified of vomit.
Vomit may seem like no big deal to most people, but it scares me to my core. I wish for death when I am nauseated. I’ll do anything in my power to stop the nausea. From what I’ve learned about anxiety that seems to be where my problems lie. The anxiety causes nausea which causes panic which causes anxiety which causes more nausea….
The psychologist helped me piece together my triggers. He helped me understand what exactly anxiety is and how it manifests. He then taught me how to breathe. I’ve always known that breathing is a good way to help ease the anxiety and I’d been trying it for months, but what I didn’t know is that I was doing it all wrong. The psychologist taught me diaphragmatic deep breathing. I learned to breathe from my belly and not my chest. I knew this though. As an athlete I practice it all the time, but never thought to take it off the bike.
Since the second appointment I have been able to diffuse my anxiety attacks much sooner simply by breathing properly and understanding what’s actually happening. The attacks still happen daily and often a few times a day. Hopefully over time I will be able to pacify my anxiety to the point where I’m not overwhelmed by attacks. That’s the problem with generalized anxiety disorder, it’s generalized. Everything and anything is a trigger. I feel like I need to rewire myself.
The psychologist asked me what I aim to gain from therapy. At first I didn’t really know. Then I said, “I want to be normal. I want to integrate into society and be able to socialize. I want to enrich my life with friends the way I see everybody else doing. I don’t want to automatically avoid every possible situation simply because it’s more of a burden to me.”
These thoughts carried me home and through the next couple weeks. I kept them in mind with each following anxiety attack. I am missing out on a lot of the joys of life, and I want it to stop.