Comorbid anxiety with depression

“Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging.”

Although depression is a common secondary disorder for people with long term social anxiety I am always surprised that in the vast array of online help I have read that depression is almost always ignored as if completely unimportant. I was first thinking of suicide in my teenage years and have had feelings of chronic misery and hopelessness regularly ever since so some kind of depression has always been there although it was mostly melancholy due to being always alone and society labelling me as a freak. Hardly surprising considering my lack of sex,relationships, friends and no job although i did do 20 years in a manual job I mostly hated which did not help my mental health or get me to be more social. My 20 years of work equates to about 4800 days or 38,000 hours and still it did nothing to rid me of anxiety. Must be all those avoidant strategies and safety behaviours I used otherwise known as being shy! The cure to shyness- stop being shy!

So expecting me to approach strangers and make pleasant conversation tomorrow is about as likely as expecting the neighbours pet Labrador to do so although obviously most dogs get on far better with strangers than me. Maybe I should become hairier and start licking people. Lack of motivation is hardly surprising as age really does matter and older people are much less likely to succeed as most people are ageist and opportunities are much less. They also seem to think that depression is only temporary because of a sudden lifestyle change or event and that you can go back to where you where before which was relatively happy if you just start doing stuff you used to enjoy. Of course I have never been relatively happy for long even as a child and never really did anything or went anywhere anyway as I had no friends. I cant seem to do anything while feeling this low and I feel this low as I see absolutely no hope for the future. As a result I am becoming even more avoidant and leaving the house far less than before.

I think I always knew it would end up this way even way back at school as the sad lonely boy who never spoke much in class although due to everyone being more optimistic and assuming I would just grow out of it I still imagined something good would just sort of happen. It didn’t. Then they blame you for not doing enough which only increases your guilt which makes you want to die even more.  At the same time they say you must learn to love yourself.

 

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The “Passengers on the Bus” go round and round.

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In acceptance and commitment therapy(ACT) they sometimes talk about the passenger on the bus metaphor and this role play supposedly illustrates how your negative thoughts influence your mind.etc etc.  Look at how enthusiastic every body is! Look at the positive comments on Youtube! Yet it makes me feel like vomiting and would certainly put me off doing this kind of therapy even if it was free and available tomorrow. Is this even any good for people with anxiety and especially social anxiety?

I cant imagine doing any role plays or exposures in my present state of mind.  I would just follow him around sort of mumbling and looking awkward as a passenger and giving no feedback whatsoever as I would not care or notice.  They might as well ask me to do a song and dance routine although considering some of the crap I have read about social mishaps I would not put that past them. Its as if in every one of these kind of videos the people say exactly what they want to hear instead of what would really happen as they are all hyper motivated. Would meds change my motivation? Perhaps a lobotomy would be better then at least I would not care any more.. I think this is why 9 out of 10 people with social anxiety dont go for help unless they are forced to and why they think CBT and other sorts of therapy are quite successful as only the motivated and enthusiastic people even do it. What therapy is there for negative, depressed and unmotivated people with social anxiety?

 

If you feel the way I feel

How self help sites and therapists seem to expect you to feel when looking for or doing things to fight your anxiety.

How you really feel.

“Oh I must go out and smile at total strangers on the street, engage in witty banter with shop assistants on the weather every single day without sounding mad or boring and approach attractive women and ask them out even though I have not worked in 28 years and make strange squeaking noises when I speak. That’ll cure me!”

Reality Check

“A common approach shy individuals will take to overcome their anxiousness is take on some big social challenge like going to a single’s bar or walking up to a model-esque woman and striking up a conversation. The problem with this approach is that if you fail to smoothly socialize, you just reinforce the narrative in your head that you’re shy and awkward, that you can’t change, that socializing is threatening, and that the only way to get rid of those threatening feelings is to avoid socializing altogether.”

Yes, now imagine getting that reaction when just trying to speak to a cashier at Tesco or even ordering food or a drink at a cafe and then hearing that these events are supposed to be the easy ones on a hierarchy list.  Thats why everything I do has reinforced my negativity and pessimism even more. I am still trying to find things that I would or could do that would be easy. Remember very shy people dont even get invited to parties so we dont get to choose. Shy, very shy or painfully shy? There seems to be a huge difference which is totally ignored. Then also add depression into the mix.  Perhaps they need different types of treatment for different levels of anxiety. Some hope.  The NHS often shoves people with different types of anxiety into the same group therapy regardless as its cheaper.

“At least once a day I want you to do something on purpose that is just outside your comfort zone. Things that count as being just outside your comfort zone are usually things like: saying one “small talk” sentence to a cashier, calling a relative, inviting a friend to a movie, putting a status update up on Facebook, saying the word “hello” as you walk by a stranger on the street.”

You see here we go again. Speaking to a cashier is 10/10 for avoidance for me. They also always ignore etiquette as if it is obvious what to say when speaking to different people such as male or female, young or older and what is appropriate to say to each may not be the same to the other.  And the most obvious one of all. If I am nervous I COME ACROSS AS A TOTAL MORON. People often dont understand me, I say inappropriate things or  my voice is so weak they cant hear me. All common for shy people and yet all ignored totally on self help sites.

I also dont have any relatives I know at all, my one and only friend lives in another city, I dont use Facebook as I have no friends and would not want people I used to know from work to contact me as I have been unemployed for many years and saying hello to strangers on the street I still find absolutely ridiculous as strangers dont speak in city centres.

Humiliation Guaranteed

After several days of waking up early I relented and took a sleeping tablet again. It worked as I did not get up until 10.30 but of course it made me feel groggy all day. I wonder if they also affect my moods as I have quite an overwhelming urge to self harm again although that could be as I was looking at self help sites on social anxiety and they always make me far more depressed as they never ever offer any hope or way out without a long painful struggle with humiliation guaranteed. YOU MUST DO THE HARD WORK OR YOU ARE A COWARDLY CISSY WHO DESERVES TO SUFFER!  I could do hard work after 20 years in the same manual job easily. However hard work is not acting shy and being ridiculed endlessly in the hope of getting used to it. Did people who were beaten ever get used to it?

I come across things all the while. Like the advice of making conversation with a co worker on Monday and telling them about what you did at the weekend.  I spent virtually every weekend for 20 years watching TV and maybe later doing some gardening. I never did anything or went anywhere as very shy people dont have any friends or do anything. There’s lots of advice like this and even though you have social anxiety and its so bad you have gone for therapy still assumes you have friends and go out and do things like normals all the time.Makes me think again if therapy is really for people with moderate shyness and anxiety and that they still have no idea of what very shy is really like.

However I really want to find out how they treat social anxiety and depression combined which I think is quite common. If they make no account for a depressed state of mind although I have no motivation and still expect you to do normal CBT exposures for social anxiety then I think they really have no idea and no one has even bothered to do any research into it yet. Considering some British doctors have not even heard of social anxiety and have to look it up on Wikipedia then nothing would surprise me.

PAINFULLY shy!

So here is a video from the private therapy clinic in London on social anxiety I saw on YouTube. I know its on about avoidance strategies but I think its interesting that at one point she brings in another person and says “Talk for 2 minutes!”  Of course she does fine and that’s the point but it also begs the question that do some therapists and so called experts have any understanding of crippling social anxiety at all?

I say this because I have seen videos on group therapy and they just expect people to speak on random subject for so long or for homework approach strangers and make random conversation as supposedly easy tasks. As said previously perhaps only motivated people who have recovered to a certain point are even able to go to therapy and in which case why would I go to the doctor for help if the therapy demands a certain level of recovery before you are even able to try doing it.

You see, just bringing in a stranger and demanding conversion on a random subject may even now have me completely struck dumb and my brain freeze up entirely. This often then creates the classic nightmare of blushing and sweating and a full on anxiety attack.  The thing is I am better now than I used to be. When I was in my twenties I blushed, stammered and had anxiety attacks almost uncontrollably and especially around attractive girls so even the most basics of simple conversation were excruciatingly awkward and any coherent sentences close to impossible due to the physical manifestations of shyness. Speaking to a girl I liked and assuming I would really be OK or that no one would notice(IF ONLY THAT WERE TRUE!)was not even close to my reality.

Of course I was F**king avoidant! The humiliation was so intense I was contemplating suicide and punching myself in the head while sitting in the toilets! Can you imagine the embarrassment of acting like that in front of girls and other people ridiculing me which as I was in a crap manual job full of blokey ignorant young men was a common event for anyone even slightly different. What the flying F**K is is about intense humiliation that therapist dont get? Is it just because they have never experienced it themselves? You would do ABSOLUTELY ANYTHING to avoid it.  So the idea you go to a therapist and deliberately make a list of your most anxiety inducing situations and then agree to go and do them is not even a remote possibility for many people.

And then if you do go and force yourself to speak to people they assume things are usually much better than you imagine is yet more absolute lies.  Avoidance may not be the answer but neither is extreme humiliation which traumatises you for years. When I watch all these experts and read the self help books they never seem to even consider that anxiety can be this bad and that exposure therapy is a straightforward task to recover from if you just practice hard enough. I wonder if they have ever even treated somebody who is really cripplingly shy.

 

 

 

 

 

A million to one he said

I actually got to the stage where I was about to visit my GP for the first time ever about my anxiety. This  apparently often happens  because of something else which in my case is depression which has meant that I have become so avoidant I am only leaving the house to shop at Tesco and have given up doing everything else. However I made the mistake of looking online at all the types of treatment available.  Sounds reasonable? However realistically many GP’s dont even offer therapy for older people with anxiety and depression and just hand you a leaflet. Great, that will cure me!  Then there is about a year, yes one year sometimes even 18 months to wait to get therapy on the NHS. And finally……….. I have read the UK anxiety forum and lots and lots of people who took therapy for social anxiety said their therapist was a complete moron and it actually made them worse or no different at best. Yes, there is loads of help for social anxiety! Online advice anyway, in real life its almost non existent.

Getting help for anxiety or depression in the UK reminds me of the Drake’s equation for the chances of finding intelligent life on another planet. Several million to one or more.There are just so many factors to be taken into account before anything gets done. The next problem is that I have read countless CBT manuals for anxiety online and self help books and they all pretty much say go out and EXPOSE yourself!  No not in a naked kind of way but expose yourself to fear inducing social situations so you get used to them and get better. Then do more harder ones for ever and ever and ever!

I cant even think of easy ones I feel I could try to start of with.