Social Anxiety Hierarchy

A while back in “I can’t drink and drive!” I made a hierarchy of steps for addressing my anxiety about driving.  Due to being without a car after my accident, then in inpatient, then on vacation I didn’t have a lot of time to work on these steps before the deadline for which I needed to reach the final step: Drive to and from location of NAMI classes in the dark.

Well, as it turns out I actually drive there in the daylight and come home after dark, which was step 21, but either way I accomplished the ultimate goal last week when I drove to the class by myself.  I was ready to call this goal completed and strike it from the treatment plan, but Sadie says I need more practice on the intermediate steps and I grudgingly admit she’s right.  This week I plan to drive somewhere new in my own town to pick a friend up for lunch.  She doesn’t even have a driver’s license so I’m quite a few steps ahead of her.

Sadie and I went over my treatment plan in my last appointment because an update is due next week.  One of the aspects that we haven’t touched in the past 3 months is another hierarchy, this one addressing my social anxiety.  Sadie suggested that I spend this week working on a list of steps to include, and I sort of haven’t touched that despite the fact that my appointment is in 26 hours.  Oops.

The problem is I’m stumped.  I guess that I should probably refer back to my DBT materials where there was a section on ways to practice asking for what you want.  Those are all situations I’d find anxiety-provoking, but I also found some of them flat-out rude, like scheduling an appointment then calling back to cancel.  I also could look for example hierarchies online, such as:

http://www.socialanxietywebsite.com/example_hierarchies.html
http://www.succeedsocially.com/fearfacingexamples

I know I need to work a lot on phone anxiety.  I overcomplicate my life a lot with reluctance to make phone calls, and when I finally do bite the bullet and call it turns out to be so simple that I beat myself up over having put it off so long.

Pill Popping

A couple of weeks ago, SassaFrass posted about her Sunday Ritual of filling her pill containers for the week.  I also do mine on Sunday, and last night I finally got around to taking a picture.  Just one, as I was too lazy to do a series like she did, but as a bonus I’ll explain what all the pills are.

medication.jpg

MORN (taken with breakfast or, more likely, the first time I get up in the morning):

Wellbutrin XL 300 mg – antidepressant
BuSpar 15 mg – anxiolytic
lisinopril 5 mg (half a pill, but it’s kind of hiding under that bigger pink one) – blood pressure
fish oil – for lowering triglycerides
B-complex – purportedly good for depression, and it tastes yummy
multivitamin – general well-being, because my eating habits are crap

NOON (actually taken at 11, which is usually with lunch):

BuSpar 15 mg – anxiolytic
Gildess – birth control

EVE (taken with supper):

BuSpar 15 mg – anxiolytic
fiber x 3 – for lowering triglycerides
fish oil – for lowering triglycerides

BED (taken at bedtime):

Latuda 40 mg – antipsychotic, purportedly good for bipolar depression
fiber x 3 – for lowering triglycerides

Lately I’ve also had the random Pepcid AC for my persistent heartburn over the past 6 weeks, and sometimes Aleve for the soreness after my car accident.

Oops, I Did It Again

About a year and a half ago I detailed my first car accident in Life Experiences That No One Needs.  I didn’t need it the first time, and I definitely didn’t need it again.

006_accident-rear-right

To start at the beginning, I went to work at the hospital at 7 am Tuesday.  Around 9:30 the phone rang with a call from an outside line.  I never answer these calls, as they’re never for me, but I was sitting at the desk and happened to glance up at the phone and see that the number was my mom’s cell phone.  I got excited, thinking she’d gotten the call that a kidney was available for her.  The actual purpose of her call was much less exciting.  She said that she had fallen and thought her wrist was broken.  She asked me to come get her and take her to the ER.

I got off the phone and rushed to the back room where a coworker was filling in for the crew lead who is on vacation.  I frantically told her I needed to leave and why, and she told me to drive carefully.  I did, and the 10 minute drive to home felt like it took hours.  I brought mom to the ER, waited around with her for what felt like more hours, and she learned that her wrist was just sprained.  She got a wrist splint and was released.

Mom had been planning to get a blood test redone that day and asked if it was okay if she did that before I took her home.  At this point I’d missed so much of work I figured it didn’t matter, and went with her to the outpatient lab.  I finally got her home and headed back toward work.

A couple of miles from work, I was going around a curve when the car slid on the wet road and went into the other lane.  As I tried to correct it, the car slid the other way, into the grass, and turned sideways and the back of the driver’s side slammed into an electric pole, breaking it in half.  I sat there, stunned, and a moment later someone pulled into the driveway of the nearby church and came running over.

I was shaking too hard to dial my phone, so she called 911 for me and waited until the police arrived.  I had some minor pain in my left knee and left upper arm, but my bigger concern was that I hyperventilated so badly that my entire torso and both arms went numb.

A county sheriff’s deputy asked me to explain what happened and took my driver’s license and insurance card.  The paramedics let me get out of the car on my own and walk to the ambulance, where they just had me sit on the bench seat and buckled me in.  A different deputy brought my license and insurance card back before we took off, and gave me the report # on her business card.  She said that the road doesn’t slope correctly on that curve and there are a lot of accidents there.  After some time to calm down, I wondered if I could file a claim against the state department of transportation due to that fact.

The ambulance took me back to the hospital, so it was kind of like getting a very expensive taxi to work.  I had to put on the sexy hospital gown and the doctor said he didn’t think anything was broken but recommended getting the x-rays anyway for peace of mind.  So I got a couple of x-rays of my knee and a couple of my upper arm, and then the x-ray technician wanted one of my elbow too.

It didn’t take long for me to be released and I headed back to work, where my supervisor asked if I was cleared for duty.  I think she might have asked if I was okay first, but that’s not what stuck in my mind.  I finished out the day and a coworker gave me a ride home.

I didn’t call mom and tell her what happened.  I thought I would wait and say it when I got home, but then I realized I was too scared to tell  her face-to-face so I texted her.  She said, “Seriously?”  As if I would joke about such a thing.

I didn’t freak out too badly until I got home and she reminded me that I needed to report the accident to my insurance.  I did so and had to answer a million questions asked by some foreign lady at a call center, and one of the questions I didn’t know the answer to so I had to call back later with that information.  Then I asked mom a question and she said I should have asked them, so she called them back and I ended up having to talk to someone again because she couldn’t answer his questions.

Juggling our schedules to share a car was a nightmare last year, and finding a new car was even more of a nightmare.  This time will be worse, because the budget is much tighter.  I don’t know how I’m going to survive this.  I was supposed to be working on that driving anxiety hierarchy and can’t make progress on that as long as I’m sharing mom’s car, if I can even get over the increased post-accident anxiety.

Then I had to drive mom to a concert she was singing in.  It was in a city I don’t normally drive in, and it was after dark.  I got almost there before I completely freaked out and had to pull over at a gas station.  She drove the last couple of miles with me having to buckle her seatbelt, start the car, and put it in gear.

The next day I had an appointment with Brent.  My notes already said that I wanted to increase my BuSpar dose, and with this turn of events I felt even more strongly about that.  He agreed to increase it to 15 mg 3x a day, but still prescribed it as PRN and told me not to take it if I don’t need it (but then turned around and reassured me that I should take it if needed and not try to suffer through the anxiety).  He was not willing to make two changes at once and I was still bringing up the idea of Lamictal, so he agreed that when I see him again in a month we will start it then and eliminate the Latuda, if I still want to at that point.

Brent has a bunch of questions he has to ask every time and one of them is “Do you have any thoughts of hurting yourself right now?”  He literally means “right now” – if it was the day before he’s not concerned.  I always say no.  I said no, and then said, “Wait, that’s a lie.”  Last night around the time I was talking to the insurance company I started planning to buy a couple of bottles of Benadryl.  Surely if 40 pills screwed me up as bad as they did, 200 would do the trick.  I didn’t get a chance to buy them because mom was with me, but I was still considering it even when sitting in the waiting room before my appointment.

I kind of spaced out and Brent asked me a question that I swear sounded like something about coffee.  I have a bad habit of not asking people to repeat themselves and just giving a vague answer and hoping it’s right.  So I said, “No.”  The question was whether I would call if I needed help.  Oops.  I didn’t understand the next question either and this time did ask him to repeat it.  He wanted to know if I needed to be in inpatient.  He said he had no grounds for making me go there.  Really?  I just admitted to current suicidal ideation and there are NO grounds?  I would have expected at least tiny ones.

I said I’d avoided going for a year and now was aiming to get through all of 2015.  He asked again if I’d call for help (this time I said yes) and he repeatedly assured me that if I called he’d squeeze me in, even the same day.

Later in the day, I also had an appointment with Sadie.  We focused primarily on the obstacles this development would present for working on my driving anxiety.  At this point mom and I are sharing a car, which means I can only take it for necessities, such as work and therapy.  That rules out doing any of the steps on my hierarchy, given that even when I had my own car mom told me not to do them because they were “too dangerous”.

Sadie said it was crystal clear why I had anxiety.  At another point she said she’d like a session with my mom to tell her to stop sabotaging what we’re working on.

I had committed to doing the first four steps during the week between appointments, and I did complete those, plus three more.  I practiced making left turns onto and off of the US highway, and Tuesday night I drove someplace new locally by dropping off my car keys at the towing company.  Sadie was excited that I managed 1/3 of the list in a week, but I still need more practice at the left turns, and all the other steps on the list are harder and more time-consuming.

I can’t drink and drive!

Today Sadie asked me which part of my treatment plan I want to start working on first.  I stalled.  I asked if we could post it on the wall and throw a dart at it.  I begged her to choose something for me.  Ultimately I was forced to make a choice, and as a result I chose the thing that seemed least difficult.  Well, aside from “graduate from DBT group” as that’s just going to happen on its own without any intervention from Sadie.

We proceeded to spend the rest of my appointment creating a hierarchy of steps to work through in an effort to reduce my anxiety about driving.  We started with the ultimate goal of driving 45 minutes on the interstate to attend the NAMI Peer-to-Peer classes, then made a list of other steps and then organized them from least to most anxiety-inducing.  This will be rather cryptic since I don’t want to include the real place names, but here’s a rough idea of what we came up with.

  1. Drive to the bank down the street in the dark.
  2. Drive to Kroger in the next town in the dark.
  3. Drive to White Castle by the interstate in the dark.
  4. Drive to a friend’s house in the next state in the dark.
  5. Drive all the way around the interstate loop around the nearest metropolis, with occasional passing and lane changing.
  6. Make left turns off of US highway when not at an intersection.
  7. Make turns onto US highway crossing traffic.
  8. Drive somewhere new locally.
  9. Drive somewhere new in town where doctor is located.
  10. Drive somewhere new in town where dentist is located.
  11. Drive somewhere new on the interstate.
  12. Drive somewhere new locally in the daylight and come back after dark.
  13. Drive somewhere new in town where doctor is located and come back after dark.
  14. Drive somewhere new in town where dentist is located and come back after dark.
  15. Drive somewhere new on the interstate and come back after dark.
  16. Drive somewhere new locally in the dark.
  17. Drive somewhere new in town where doctor is located in the dark.
  18. Drive somewhere new in town where dentist is located in the dark.
  19. Drive somewhere new on the interstate in the dark.
  20. Drive to location of NAMI classes in daylight.
  21. Drive to location of NAMI classes in daylight and come back after dark.
  22. Drive to and from location of NAMI classes in the dark.

I have expanded the list of steps and reorganized it a little since the version I gave to Sadie this afternoon.  There were only 15 steps in the original, but I realized as I was typing it that I had missed a few things.  My deadline for completion is January 25, 2016, as that is the date of the first class.  In the slightly over a week before my next appointment, I have committed to completing the first four steps – driving to familiar places in the dark.

I have actually driven to all those places in the dark before, but wanted to include them here as they still make me anxious and I need to practice having cars behind me in the dark and not completely freaking out.  I always think they are going to either run me off the road or follow me to my destination and kill me, so I end up driving faster trying to escape.  At times, I’ve even considered driving past my destination and circling back around, although I do manage to overcome my paranoia enough to avoid doing that.

Sadie and I discussed DBT skills I could use during this process.  I named off TRUST first – trusting myself to be able to do it.  Then Opposite to Emotion, because I’d be acting opposite of the anxiety by making these drives anyway.  ABC (the “Coping Ahead” part) to prepare for things that could go wrong, like car trouble.  Sadie reminded me that I’d just called Square Breathing my go-to skill for anxiety.  Then she suggested Self-Soothe.  My first thought was soothing music, as music tends to distract the part of my brain that worries about what could go wrong while driving.  Her suggestion was taking a soothing drink along.  I exclaimed, “I can’t drink and drive!” and she dissolved in a fit of laughter.

A Change in My Change in Perspective

In my last post, A Change in Perspective, I commented that a small part of me wanted to go hide in inpatient.  That has become a very large part of me.  The hypomania from Monday-Wednesday started to fade on Thursday.  I still had energy, but wasn’t bouncing off the walls, and I would almost say I felt normal.  Then I went to the final night of the haunted cornfield.

The past two years I was out in the cornfield scaring people, but last year the medication I was taking at the time made me very anxious about standing out there in the costume and mask and waiting all that time, never knowing when a group would come through.  This year I’m not on that medication anymore but still didn’t feel comfortable with the idea of being out in the cornfield so I worked in the shop, selling tickets and souvenirs.  I had a coworker in the shop, Roberta, who is sort of kind of dating the owner’s son.

Roberta and I had some disagreements on how things should be done, and I also shook my head in amazement at things she didn’t know about running a cash register.  In previous weeks I brushed these thoughts off, but on this final night everything was on my nerves.  I particularly got angry with her when she was judgmental about a complaint some customers had – that one of the actors had grabbed his daughter’s arm.  After they were gone she kept ranting about how stupid it was that they were complaining and I wanted to be brave enough to chew her out over it.  We told customers there would be no touching.  An accidental bump in the dark is one thing, but actually grabbing the customer is a big no-no and they had every right to be upset.  If that happened to me, I’d probably have an anxiety attack and have to be escorted out.

The really upsetting moment though was when a customer asked if we got paid to scare people.  Roberta said, “Donna’s an employee, but I’m a friend of the family.”  I thought I was a friend of the family.  Maybe I’m not.  Maybe that explains why I always feel so excluded, because I’m actually that employee who doesn’t catch on that she’s hanging around too much.  There was a party after the closing and I went inside for it, but wasn’t there 5 minutes before I slipped out to my car and drove off crying.  I felt out of place and in the way, and was way too fragile to be handling a big crowd.

I got home and mom was surprised to see me so early.  I told her I didn’t want to talk about it, but as we sat there on the couch the story gradually started spilling out.  I wanted to go out somewhere, which leaves three choices at that time of the night, and hinted to mom that she should go with me.  I thought she was planning to go but then she started watching House Hunters.  I curled up on my bed and cried, and thought maybe she’d go after the show ended.  Instead she headed to her bedroom.  I went in there and ended up saying that I guessed I’d go alone, and that’s when she said, “Oh, you wanted me to go?”

Mom got dressed and we went to Steak ‘n Shake.  I was trying to work up the nerve to talk to her about some serious topics, and finally managed to start blurting things out in the car.  In some order, I explained to her the mood shifts of the past few weeks and told her that I had e-mailed my therapist Friday saying that I was seriously considering inpatient.  I didn’t think I could hold out nearly a week to see Brent, and then longer to adjust to whatever medication change he might make.

Sadie knows I am trying my hardest to avoid inpatient, so the fact that I was considering going should have set off some alarm bells.  She gets off work early on Fridays but I thought I might get a quick response from her before she left the office.  When I didn’t, I started worrying that she had instead called the cops to come get me.  I spent the rest of the day looking over my shoulder for men in uniform.

Throughout yesterday and today I’ve tried repeatedly to hold conversations with mom about this subject, but everything I say gets a brief response that in no way furthers the conversation.  I began getting more depressed over that, and tried reaching out to some friends via text message.  Then mom went out for her choir rehearsal and I finally changed out of my pajamas and started driving to White Castle.  I’d been desperate to talk to someone and couldn’t bring myself to call the on-call therapist, but on my drive I had nearly decided to text Deputy Wayne and beg him to please call me.  Tell him I really needed help and was too scared to call anyone.

My best friend, who I had texted, called at that moment.  I couldn’t answer while driving, but called her back as soon as I arrived at White Castle, and ended up sitting in the parking lot talking to her for about 45 minutes.  For a while it felt really unhelpful, with the conversation focusing on something that seemed like the biggest concern but really wasn’t.  It did eventually shift to what was really upsetting me, and by the time we got done talking I felt better enough that I didn’t think I needed to talk to anyone else at this point.

However, I came to a conclusion, which she supported.  When I finally see Brent on Thursday, I am going to tell him that he has to change something, and that if he doesn’t I’ll be going to the ER and trying to check myself into inpatient.  He has to know how serious the situation is.

Can’t Sleep, Clowns Will Eat Me

I commented to another blogger recently that my therapist and psych APRN have no idea of the extent of things that make me anxious.  They know I’m not good with crowds or social interactions, but that’s about it.  So I decided to make a list.  I started it the day before a therapy appointment and thought it was pretty well complete.  Then I awoke suddenly in the middle of the night and a dozen more anxieties popped into my head.  I kept getting out of bed to add them to the list, and then my fear of making mistakes took over and I laid awake for hours obsessing over things I’ve done wrong.

My therapist got the completely random and illogical original version of this list, but I’ve tried to reorganize it so that related fears are together.

spider

* crowds
* having people behind me
* hospitals
* going to appointments, especially sitting in the waiting room
* standing in line
* mirror mazes
* haunted houses
* elevators
* tunnels
* asking for help
* making special requests
* talking on the phone, especially when someone can overhear
* risking rejection
* conflict
* talking in a group
* committing to anything
* being hit on
* auditions
* eating in public
* hearing languages I don’t recognize
* risking failure
* change
* trying new things
* job hunting
* thoughts of mom dying
* dogs
* pictures of insects
* heights
* ladders
* walking on snow and ice
* uneven terrain
* fire
* lightning, especially when in a car
* crossing the street
* motor noises, such as vacuums, blenders, etc.
* driving, especially in bad weather, on unfamiliar roads, or with passengers
* roller coasters and most other amusement park/carnival rides
* men
* going inside banks
* the woods
* being followed on the road
* cell phone battery dying
* security guards
* police officers
* managing money
* shopping

When I shared this with my therapist, she commented that some of these are completely reasonable fears.  I agree, to an extent.  What made me sad about making the list was recognizing just how much of my life I’ve missed out on by trying to avoid these things.  I currently take BuSpar (10 mg 3x per day) and it has helped reduce the completely paralyzing anxiety that was afflicting me, but I still avoid the things on this list as much as possible.