This is an email interview I conducted with Justina, my friend who has an anxiety disorder.
1) Tell us a bit about yourself.
Hi, I’m in my late 20s. My hobbies are reading and playing videogames. I have worked full time since graduating from polytechnic and consider myself very fortunate that I have never needed to be warded.
2. How did you realise you suffer from anxiety?
I have been timid, shy, a worrier and socially anxious since childhood. So much so that I and everyone just presumed it’s my personality.
I managed to get full-time jobs as a graphic designer and web developer that are all quite “back-end” in nature. However I joined the civil service, and for the first time in my working life, I had to regularly answer my phone, go to meetings, talk at meetings and socialise with colleagues at staff events.
I had a lot of trouble. My colleagues realised that “small” things such as speaking up at a meeting made me extremely nervous, and that my face would go pale with anticipatory anxiety at the prospect of a meeting. They also noticed my anxiety over making phone calls or picking up the phone. One day, they confronted me in the lift and I tried playing everything off as “just shyness and introversion.”
“That’s not introversion, it’s something more” one of them replied, and I knew he was correct, because my introverted colleagues were quiet, but NOT anxious about everything like I was.
I ended up googling “anxious in social situations” and as I read the criteria for Social Anxiety Disorder, it made a great deal of sense. Still, I wanted to be sure so I wrote down a list of situations in which I had anxiety, and how it impaired me socially and at work. It was quite a long list.
3. How did you decide to see a psychiatrist for it? Do you go to a public hospital or private clinic? Why?
While I suspected I had social anxiety, and because I realised I needed to heal it in order to perform “acceptably” at work, I was afraid to see a psychiatrist. I did a lot of googling and hoped that brief counseiing would be enough.
I looked at polyclinics and at that time, NHG Polyclinics had a “health and mind” clinic where a family doctor would assess you for mild depression and mild anxiety. I made an appointment.
I saw a family doctor and brought in my list of symptoms. He questioned me, and gave me a diagnosis of “Generalised Anxiety Disorder. He also sent me to the in-house psychologist for “a few sessions” of counselling. I saw the counselling psychologist for 4 sessions spread out over several months. I was extremely visibly anxious in all my sessions and despite rehearsing the relaxation techniques learned in counselling, taking up exercise and working through a Cognitive Behavioural Thearpy (CBT) self-help book that I found on my own, the psychologist deemed I was worsening and that I also fit criteria for Social Anxiety Disorder.
He said I needed psychotherapy and likely medication so he sent me back to the family doctor for a referral to a hospital psychiatrist with a confirmed diagnosis of “Generalised Anxiety Disorder” and a provisional diagnosis of “Anxiety Disorder – Not Otherwise Specified” (although they strongly suspected Social Anxiety Disorder).
4. How did you start seeing a psychotherapist? Is it in a public or private setting?
Now I go to a public hospital, due to the polyclinic referral. The psychiatrist assessed me as having Social Anxiety Disorder and referred me to the clinical psychology department. That’s how I started seeing a psychotherapist. I also started medication, but only after some reluctance, after a staff event where people noted my hands shaking.
5. What do you usually do in your sessions with your therapist?
I had CBT with a clinical psychologist for a year. With CBT and the relaxation techniques I learned from counselling and self help, my functioning at work improved really well. However, I still struggle in my personal life because of emotional issues.
So she referred me to her colleague who does ACT (which focuses on Accepting your emotions), mindfulness, and schema therapy.
My current therapist and I work together on mindfulness and grounding exercises. I find mindfulness very good for calming me down when I am anxious.
Currently, my therapist blends ACT and schema therapy.
6. You have an app you use to manage your anxiety. What is it called and how does it work?
I use 2 apps, both recommended by a friend. They are “Stop, Breathe and Think” (free) and “Calm” (free and paid version). They are both guided meditation apps where you can choose different meditation tracks.
SBT has a “emotion check in” so you can select how you feel and it will then suggest several guided meditations for you.
Calm is sorted by effects that you want – eg improve focus, sleep better, reduce anxiety. Calm also allows you to select from several background “scenes” which play different ambient sounds and music such as rain falling on leaves or waves on a beach.
7. What other coping strategies do you have?
I use a lot of mindfulness and cognitive strategies learned from CBT and ACT as well as relaxation exercises.
8. How does anxiety affect you at work and at social situations?
At work, I am much better now — I am now able to do things I have never dreamed of, such as lunching with colleagues as a group or with one or two others. I am far less anxious in work meetings and staff events, and have received comments that I’m “a lot less shy” now, as though I had a “personality change”. I believe that it’s really the “real me”, no longer hampered by crippling anxiety.
Socially, I am still working on it. I am able to hide my anxiety much better, but socialising is a lot more complex and scary than working for me. I work in IT as a project manager, where introversion is common, talking is task-focused, and there is little pressure to be chatty and outgoing.
9. What would you like to say to people who suffer from anxiety?
I would encourage people with anxiety to seek professional help if self-help is not working for you. Very often, people think “everyone has anxiety in social situations” or “everyone worries” but if it is impairing your life, it is good to seek help.
Other conditions such as PTSD, OCD, agoraphobia etc are also treatable even if you have comorbid diagnoses which complicate things.
Stories in the ebooks by IMH and the books by Club Heal, and stories from other peers will show you that you are not alone.
10. Do you take medication for anxiety? Why or why not?
I do take medication. For example, I am on a low dose atypical antipsychotic which augments my antidepressant and reduces my racing thoughts. My brain is literally “quieter” and so it is easier to implement coping strategies such as mindfulness.
My antidepressant boosts my mood, as depression is common when you have anxiety disorders.
I am also on a low dose of a benzodiazepine to be taken shortly before high stress situations at work such as a meeting with senior management.
I feel that medication is one leg of the chair which supports me, and the coping skills I have learned being another leg. Lifestyle such as a good diet with enough sleep etc is another leg.
I plan to reduce and stop medication if possible, but am okay if I can’t as long-standing anxiety (more than 2 decades before treatment for me!) may be chronic and may reoccur over the lifespan.