View Full Version : The first step is the hardest
I am sure there is a song in the title somewhere, but my point is a serious one.
I completely understand why people come on here and ask for reassurance about symptom a or b, and there is even a school of thought that suggests that this is part of the recovery process. But, for those of you that are posting about symptoms, but have done nothing about your mental health, more than going to the GP and asking for meds (although I do think meds can be a vital part of getting better), I urge you to think about what YOU can do to make yourself feel better.
To use Fishmanpa's analogy of anxiety being the dragon. The dragon's core diet is reassurance, it grows bigger and stronger as a consequence and strives for more. It tells you that the advice you have been given is wrong and you must seek more. It tells you that if you don't, then you will undoubtedly die, probably soon and probably of the disease you most fear. Take it from me that the dragon is tricking you, all he wants is a good old feast, and by constantly striving to reassure yourself that you don't have a, b, or c, you are feeding it from the a la carte menu.
In my opinion, and it is only my opinion, but was somewhat validated by a therapist who specialised in health anxiety, the only way to ultimately recover, or manage anxiety is to cut of the supply. Don't get me wrong, that is insanely hard to do, particularly when behaviours have become habitual. But there are things you can do to make it easier.
The trap that HA sufferers often fall into is trying to control the one thing that we can't - our destiny in terms of health. Now obviously that isn't completely true, as we can exercise, stop smoking etc (somehow perversely something that a lot of us are fearful of), but we cant control the things that we most strive to.
We can control other things though. For example we can control our reaction to things. So when the panic sets in and you feel the urge to go to the bathroom and examine yourself.......don't, just sit with the anxiety and let it wash over you - it cant hurt you, and let's face it, checking one more time will not make a difference. After a while that becomes easier.
When you feel the urge to ask about a symptom on here......don't. Try and weigh up in your mind whether a rational mind would seek reassurance or whether or not you might be over reacting. If you conclude the former, book a GP appointment, or the latter, just sit with it.....it can't hurt you.
Trust me when I say, that I was a compulsive googler. I travel to London a couple of times a week and so I used to spend 5 hours on the train on my smart phone, looking back I cannot believe I did that! But by applying some sensible techniques, living with some of the discomfort and anxiety that created, and being a bit disciplined, things got progressively easier.
The point is though, that each and every one of you here, has it within yourself to get better from anxiety to either a manageable or unnoticeable level. Ultimately the solution doesn't lie in drugs, although that can be part of the picture, it lies within you. You need to want it more than anything else, be more fearful of not living a life than not living, and you have to take ownership of your recovery, not wait for it to happen by chance or circumstance.
If you have time, read the 'Getting there slowly thread'. On there is a collection of women (mostly), who a matter of months ago were all in a pickle. They have supported one another, followed advice from people on here who have been there, but critically they have taken back control, rather than letting anxiety control them.
Have a great night folks, and remember that the thing that you thought was going to kill you yesterday didn't and by the law of averages the thing the you think is going to kill you tomorrow probably won't either :)
That is an amazing post, thank you xxx
That is what trying not to write a business plan does for you :)
Great post Chris!
I must give credit where credit is due. It was TooMuchToLiveFor that coined anxiety the "dragon". I picked up on it and it seemed to have stuck with a lot of folks. It's fitting too. The fire it breathes being the lies and the tools one learns to combat it are for dragon slaying. Also, like the flying dragons in Avatar, they can be controlled.
You're right, the power is within each and every one here to take some level of control over their dragon. If you learn to control it, it becomes less and less of a bother.
I was thinking about this the other day and it's kind of like what my Pixie Bob cat does to me. As soon as I get home and sit down, he's waiting there on the coffee table next to his treats so Daddy can give him some. You ask him what he wants and he'll tap the bag with his paw and give you his paw when you ask to get that little morsel of crunchiness. Of course, he's back 10 minutes later doing it again (like reassurance does) and I'll get the stare down, winkies etc. He'll go as far as to knock the bag to the floor to get my attention. It's comical really. There comes a time when I say "no more", ignore him and he eventually goes and lays down. That's what you have to do to the dragon. He's like my cat wanting attention and while the dragon isn't as cute or lovable, he reacts the same way to your attention, wanting more and more until you ignore him and say "no more". Then he'll go quietly lay down.
You can make the dragon behave. It just takes some inner fortitude and the courage to take the first step.
Positive thoughts
The lesson in that is to put the cat treats somewhere else!
The lesson in that is to put the cat treats somewhere else!
Yeah but it's way too cute and I spoil him rotten ~lol~
Positive thoughts
Hi Chris, Wrote a very similar post this morning (which I lost) so ditto, ditto and more ditto!
When I first found NMP many years ago there was less understanding of HA and I do not recall there being a lot of advice on how to get better. There was a lot of peer support but no directive and if there was it was more with regards to the physiological over the psychological. We now have more understanding and there seems to be a consensus on How to get better from people who have been in a bad place and are now a lot doing ok. Oh how I wish I had had that - my HA may not have gotten such a grip on me.
Lucia x.
Brill as always, I hope it helps people like your last helped me. Xx like you said, the anxiety isn't under control but the way we react to it is and the less you react, the less anxious you become.
LauraWoo84
07-01-15, 23:25
Absolutely amazing post thank you thank you thank you.
Hi Chris. The thought of confronting my fear was far greater than it actually panned out to be. I put it off for so long because I could not imagine being able to do it. I don't know how it worked for you?
To be honest Lucia, at the time I was so miserable and so desperate that I had to do something so I never really gave myself the opportunity to dwell on it. I just got myself to the GP swallowed my pride and went for it. But, I do have the benefit of not suffering from anxiety more generally. I am socially confident, hold down a senior management job and am quite assertive. I know that not everyone is like that and often HA comes hand in hand with other anxiety.
So I was never really scared of tackling it, i was more scared of failing than anything else.
Excellent posts. I do feel that GPs should be more aware of HA and the need for constant reassurance. Due to NICE guidelines they are obliged to send people for unnecessary scans/tests which only fuels the HA and then another symptom comes along hence more tests etc.
I have a friend with HA who gets sent for test after test (always a negative result) whereas I think the GP should just say no more tests and offer her psychological therapy. Until GPs can recognise HA and call a halt to reassurance/tests then I think that HA will continue to be a massive problem and also a drain on NHS resources.
Ha Chris I was a senior project manager who went home and hid her bra, got dressed in the dark, checked articles of clothing under different lights:doh:
---------- Post added at 22:06 ---------- Previous post was at 22:02 ----------
Pulisa, the 'worried well' are one of the NHS's biggest challenges yet there is still very little understanding of HA.
Great post. What you say rings true for me. After developing frequent palpitations I spent a lot of time paralysed by anxiety. Eventually, when I realised that nothing seemed to work in terms of stopping the palpitations, I made a conscious decision to work on the anxiety. I read several CBT books and did the exercises; Claire Weeks' book became a constant companion.
A huge part of recovery was learning accept uncertainty. No one was ever going to be able to give me the cast iron guarantee about my health that I wanted, so I needed to accept that I had what I had and work on the anxiety instead.
It's learning to deal with doubt and uncertainty really. There's never a cast-iron guarantee with health and we have to accept and learn to live productively with that. Certainly not easy but definitely essential to recover from HA.
Ironically Lucia - I work for the NHS and am responsible for a national programme designed to prevent google doctor :)
MyNameIsTerry
08-01-15, 22:25
Excellent posts. I do feel that GPs should be more aware of HA and the need for constant reassurance. Due to NICE guidelines they are obliged to send people for unnecessary scans/tests which only fuels the HA and then another symptom comes along hence more tests etc.
I have a friend with HA who gets sent for test after test (always a negative result) whereas I think the GP should just say no more tests and offer her psychological therapy. Until GPs can recognise HA and call a halt to reassurance/tests then I think that HA will continue to be a massive problem and also a drain on NHS resources.
This is something I really don't understand about the NHS & NICE.
HA must be one of the most costly forms of anxiety disorder because of the extra GP visits and tests. I realise that there is the concern over whether there 'could' be an issue but it seems that there comes a point where the GP realises that its very unlikely just as you guys on here do as you get more educated about it from talking to each other.
The NHS has constantly complained about expenditure and budget cuts but surely there is a load of money to be saved in tackling HA...which would be great for you guys as it would push them towards more effective treatment for you.
A search of NICE guidelines shows no results. So, is HA just masked inside GAD which is a very different subject requiring different solutions? Maybe this is causing the issue to remain unchallenged? But you see statistics about the emergency call out fees and costs to A&E under the label of 'panic attacks' as a catch all so they must have some idea? Its hardly rocket science to calculate it in a study.
I find this a really interesting subject MNIT, but working with NICE I do have a degree of sympathy, where do you draw the line, every set of guidance must be periodically reviewed etc. I do get the added cost of HA, but actually folk with HA are not the problem in that regard, although obviously they tend to access more diagnostic tests etc than most. The issue with A&E costs probably stem from a combination of factors, one of which is the worried well, but I would suspect a small %. Another is people making inappropriate choices and ending up in A&E when they should be elsewhere. Another is the pressure on primary care and the fact that it is hard often to get a GP appointment, and there are other pressures besides.
I think the issue with mental health across the board is the medical model nhs that we have. We treat people as a set of conditions to be cured, rather than personalising medicine to the needs of the individual and looking outside the immediate scope of medication for solutions. When we give mental health parity of esteem with physical health then we might make some strides. I am not sure NICE guidelines would lever the sort of change we are talking about personally.
MyNameIsTerry
08-01-15, 23:07
Yes, I agree. I think when it comes to NICE it should be considered because if the true picture matched this website, it would reveal GAD to be a smaller problem than is currently understood and perhaps it could lead to a more bespoke form of treatment which is unlikely with GAD as it's too unspecified until an individual assessment is made.
For instance, acceptance seems to be more of the core of recovery in HA than it seems in other anxiety disorders (its always an element, I just think other forms may need more of something else eg exposure, attention to self esteem & behavioural activation, etc) so could it cause a shift away from say CBT to ACT?
Perhaps its just because mental health is still second rate that in fire fighting, the attention is on physical health which I guess in many ways is driven by the currentcampaigns eg obesity.
We have at least got the NICE stepped care model to fill in some gaps while budgets catch up, as before it could take forever to very any help, but hopefully they might go back to a person centred care approach.
Sadly I don't think mental health problems will ever enjoy "parity of esteem" with physical ailments despite the clamour for more mental health resources etc. I think those with mild to moderate mental health issues will probably get a better service eventually but that probably doesn't say a lot! Those who suffer from more complex conditions which don't respond (in the allotted NICE period of time) to meds/therapy will probably still be left to their own devices. I speak from personal experience and also from my daughter's experience at the Maudsley and other hospitals. It's very hard to see what else can be done and for us the best option has been to accept this and take charge of our own mental health. I realise that this is not a viable option for everyone.
I can't stand NICE guidelines. In my opinion they are responsible for a lot of NHS cock-ups and I get fed up hearing GPs referring to these "rules" rather than making their own judgements. Thanks to NICE guidelines HA is running amok..
Just my opinion. Sorry if I am speaking out of turn.
I think HA must be very hard for GP's. They have people with a mental health condition, presenting with a physical condition, requiring physical examination and tests which are only going to worsen and perpetuate the mental condition !!!
Yes I agree but when you have people coming back repeatedly with different symptoms on a weekly basis.....? Then I think GP's should bite the bullet and say no more-you need help for HA
So very true and so very well written Cpe :)
So do I Pulisa in an ideal world. A world where the GP would have an understanding of HA and there would be adequate mental health resources and know how to deal with HA.
Surely it can't be too hard to spot a patient with HA?
But what happens the day you dismiss something as anxiety and it turns out not to be?
---------- Post added at 23:12 ---------- Previous post was at 23:11 ----------
Not sure I would like to be making that judgment call.
My gp always takes me seriously as he says its more than his job is worth not to.
But what happens the day you dismiss something as anxiety and it turns out not to be?
---------- Post added at 23:12 ---------- Previous post was at 23:11 ----------
Not sure I would like to be making that judgment call.
Indeed, we may be HA sufferers but we are still fallible and can get ill, so symptoms should be checked and discussed... No one would want to be shrugged off by a doctor, because they have a history of anxiety. I think Some GPs would benefit from better people skills when it comes to working with patients with anxiety - mine have been absolutely excellent at explaining things clearly and knowing when to actually treat me and when not, it makes such a difference, there is no need for me to go back every week even when at the height of my anxiety. That has really been invaluable.
MyNameIsTerry
10-01-15, 07:48
Pulisa,
I think for me, NICE has helped in that there is now a structure that has forced in some interim measures. 9 years ago when I started with anxiety, I was told I was all on my own for 12 months with just a GP who had 10 minutes to offer me every few weeks which was more a check whether I was still taking medication and to issue a FIT note. At least when I relapsed I could access 2 other levels and one of them was pretty quick. I see that as an improvement.
However, it is a double edged sword and I view it as geared towards mild anxiety and CBT is not considered a treatment for complex issues anyway as you say. So, if you present with complex issues, you can get forced into treatments that are not aimed at your issues and if they follow the guidelines you end up waiting several years to access the original system.
In my case, my GP doesn't want to pursue any further treatment and since its a 12 month waiting list anyway, its not much of an incentive to force him to... hence turning to the charities.
Another point for me is that how someone with HA presents to the GP may be an issue. Those of us with GAD or PD can experience physical symptoms so is there a difference in GP response? Perhaps not at first, but I know my GP never considers any form of test because he knows I have anxiety disorders. On several occasions its been medication problems for me and my GP dismissed it as anxiety and I had to consult a pharmacist to get answers on it.
So, I think there could be an issue with a lack of consistency here as well.
Mindknot your doctor sounds spot on.
Pulisa I just thing there is more to it that the GP being able to spot HA. Mindknot's doc sounds like they have got it right but I have on ly experienced one doctor like this in 10 years. When you have variables such as:
Doctors who have no UNDERSTANDING of HA
transient doctors or locums
litigation
doctors with little insight into mental health services
doctors aware of the lack of mental health services
doctors taking the easy route.
realistically it's not that easy.
My gp always takes me seriously as he says its more than his job is worth not to.
There is obviously now a greater fear of litigation if the GP fails to carry out tests regardless of whether they are anxiety-induced and this is a big problem.
It would be great if all GP's were as clued up as mindknot's but they aren't and they mostly just refer to NICE guidelines and act accordingly. I've had many symptoms put down to anxiety which in fact were not and this is the other side of the coin. It's very hard but a good GP should be able to spot an obvious case of HA in my opinion. A GP taking HA seriously is another issue and I think this needs to be seriously addressed.
MyNameIsTerry
10-01-15, 08:57
Yes, I agree Pulisa but less from a knowledge point of view and more from a financial point of view. They are always unset pressure to reduce costs, seen on here regarding medication changes for a start, and I question why GP's would over test in cars of HA when it would mean they would need to be doing it for everyone when they often don't because there is sufficient evidence from the discussion phase.
Another issue to consider could be GP lack of time but I guess it would be a question of costs the most? But I thought they were monitored over their tests & referrals, like many non medical sectors.
---------- Post added at 08:57 ---------- Previous post was at 08:53 ----------
Another question I have links back to my point over whether the problem is masked by being possibly inside GAD.
Who makes the diagnosis if a GP is not adequately trained to do so? My OCD had never been formally diagnosed and my therapist suspected OCPD elements but advised she was not allowed to make the diagnostic.
So, if makes me wonder whether a diagnosis is possible without accessing level 4 which brings the psychologists into play?
This might be a contentious view but I think that we, as anxiety sufferers need to take ownership of what we are experiencing. It must be incredibly difficult for a GP that is presented with someone demonstrating physical symptoms to identify the issue as a mental one. GPs are generalists and whilst I am broadly supportive of the primary care system, are for the most part gatekeepers of the specialist system and also create an opportunity to look at people differently rather than just as a nose, a heart or whatever specialism.
In terms of mental health there is a historic imbalance and also chronic underinvestment in services as a low level and also the level between low level mental health and the most specialist. With this in mind it must me tricky for a GP to know what to do especially given that everyone with HA is different and has a different attitude to what will help them, never mind the group of people who don't fully acknowledge they have HA and so chase diagnosis - when presented with that it is a tough ask.
I think we know that in order to recover from anxiety we first have to acknowledge that it is at least a part of the issue. Then I think we have a role to play in deciding how best we can be treated and supported and we can help the GP out. So for example when I got to grips with the fact that I had anxiety my first conversation with the GP was that a) she much take me seriously, b) she must refer me for tests unless she objectively believed hey were necessary and c) we should have an appointment every six weeks to discuss any physical concerns and to discuss mental health. I drove that because I thought that structure might work for the way I think and it was actually one of the best things I did.
I think we need to view the NHS differently. The health service isn't there to cure us and mend us. We are responsible for our own health and the NHS is one of the tools we have at our disposal. There are many many more when it comes to mental health though and I believe that we have to play a big role in self managing our conditions with the support of the NHS rather than looking to the health service for all the answers.
Mindknot your doctor sounds spot on.
Pulisa I just thing there is more to it that the GP being able to spot HA. Mindknot's doc sounds like they have got it right but I have only experienced one doctor like this in 10 years. When you have variables such as:
Doctors who have no UNDERSTANDING of HA
transient doctors or locums
litigation
doctors with little insight into mental health services
doctors aware of the lack of mental health services
doctors taking the easy route.
realistically it's not that easy.
Have to admit, I've been very lucky, since seen on the surgery's website that it seems nearly all of the practice staff have stated an interest in mental health! Must be the area where I live... :) I doubt that everyone has the same experience despite that, for me it works, they've not pushed medication on me, and taken time to listen and just been so nice... - perhaps then it's just a feature of my personality that they sort of overwhelm me with doctor logic and I skulk away feeling like a bit of d**k... whereas I'm sure other health anxiety sufferers might not get on so well with this approach.
That said, I've never discussed with my doctors the form of my anxiety... and they've never asked or attempted to diagnose the mental side of it - I think they've probably guessed that health anxiety is part of it due to the sudden increase in my visits and the type of concerns I bring up, but they've also never said "you have health anxiety, therefore we will/won't test you some more..." i.e. like any other GP they are not touching an area that they don't have the knowledge about - for that I've been referred of course - I would honestly put a lot of it down to the correct synthesis of the GP-Patient relationship and sheer bloody luck.
I may have painted this picture a little too rosy if I'm honest though, this has worked for me because it's gone alongside the regular hemorrhaging of a shed load of money to private practitioners of various kinds - i'm lucky enough to have held on to my job through all this so that that is even possible, otherwise I'm sure the situation would be somewhat different by now - as this whole time, I'm still waiting for my therapy to start.
I don't know too much about the NICE guidelines, apart from the parts where it's directly affected me of course, but it does seem to me that although costs are always going to be an issue within the NHS, a large part of it also seems to be, sadly, led by what looks good in the public eye. That may sound somewhat cynical, but mental health is, as we all know, not widely understood, it's not easy to publicise and presumably very difficult to quantify. Whereas when you need public funding, cancer always has some nice straightforward stats to attach (funding -> research achieved -> results)... There should be a heck of a lot more done to raise awareness of mental health nationally whether by the NHS or charities or both - same as there should be more awareness of general health (exercise, nutrition etc) but... it's tricky I suppose, because it's so personal to each individual... hmmm... I'm thinking now about the cultural aspect, maybe we have a terribly British approach to mental health, the ol' "stuff it under the carpet" attitude that needs to be busted open.... okay getting too philosophical to write coherently (it may not even be on topic in the first place, sorry am such a scatterbrain...) so going to wind this up now.
Happy Saturday everybody.
---------- Post added at 11:28 ---------- Previous post was at 11:26 ----------
This might be a contentious view but I think that we, as anxiety sufferers need to take ownership of what we are experiencing. It must be incredibly difficult for a GP that is presented with someone demonstrating physical symptoms to identify the issue as a mental one. GPs are generalists and whilst I am broadly supportive of the primary care system, are for the most part gatekeepers of the specialist system and also create an opportunity to look at people differently rather than just as a nose, a heart or whatever specialism.
In terms of mental health there is a historic imbalance and also chronic underinvestment in services as a low level and also the level between low level mental health and the most specialist. With this in mind it must me tricky for a GP to know what to do especially given that everyone with HA is different and has a different attitude to what will help them, never mind the group of people who don't fully acknowledge they have HA and so chase diagnosis - when presented with that it is a tough ask.
I think we know that in order to recover from anxiety we first have to acknowledge that it is at least a part of the issue. Then I think we have a role to play in deciding how best we can be treated and supported and we can help the GP out. So for example when I got to grips with the fact that I had anxiety my first conversation with the GP was that a) she much take me seriously, b) she must refer me for tests unless she objectively believed hey were necessary and c) we should have an appointment every six weeks to discuss any physical concerns and to discuss mental health. I drove that because I thought that structure might work for the way I think and it was actually one of the best things I did.
I think we need to view the NHS differently. The health service isn't there to cure us and mend us. We are responsible for our own health and the NHS is one of the tools we have at our disposal. There are many many more when it comes to mental health though and I believe that we have to play a big role in self managing our conditions with the support of the NHS rather than looking to the health service for all the answers.
Also, i agree totally. :D
I know that my GP wouldn't sanction appointments every 6 weeks to monitor my health anxiety, cpe. I think that you've been fortunate in this respect. I really think-as you do- that we do have to take responsibility for our own mental health in terms of HA and that GPs should refuse further tests on serial surgery attendees when money has already been spent on initial tests which have proved negative. There has to come a point where enough is enough-just look at the numbers of people posting with HA of some degree or another?
My surgery has no GPs with an interest in mental health so I have made the decision to stay away and make my own decisions. I know that it's within my capabilities but of course it's very hard work on a daily basis. I've had enough of hearing about NICE guidelines from them:D
I think that those of you who have understanding and compassionate GPs should make the most of them but sometimes they must be tough in order to help the HA sufferer. Ultimately as cpe says it's down to us.
Then if I were you I would change GP. They sound awful.
They have in fact helped me unwittingly but I realise that this approach wouldn't suit everyone. I just don't want or need to over-analyse my HA symptoms because they are powerful enough already.
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