How can I beat my crippling anxiety for good?

DEAR DR EDDIE I AM A 39-year-old single woman who has always suffered with low confidence. As a child I bit my nails so badly that they would bleed and seeing my hands bleed like this was a relief.

I didn’t understand what was wrong with me. As a teenager I was bullied at school on and off, which resulted in me taking a whole load of pills. I was prepared not to wake up the next morning, but I did.

As the years went on I went to work in administration in a good job. At this point I was drinking a lot and arriving at work with a hangover a lot of the time. I still don’t know to this day how I was able to hang on to my job. I was a hard worker and I put a lot into my career.

My drinking worsened and I was depressed. I didn’t realise how sad I was. I drank to block out the sadness. This kept the pain at bay. I continued like this for years. I wasn’t able to talk to anyone about how I was feeling — and I’m still not able to do this. I didn’t understand the sad feelings. I was terrified of them and blocked them out. I would shut down.

After a bad breakdown two years ago I was referred to a psychiatrist. I was terrified. I didn’t know what was going on. I agreed to go for treatment for alcohol dependency but drinking, I discovered, was a smoke screen. I had to deal with all the emotions I had been blocking out for years and I felt alone, although I had my family to support me. I was diagnosed with major depression.

Two years on, I am doing much better. I don’t drink any more, thank God, but there are days when I really struggle. Getting out of bed is more than tricky at the best of times. I’ve been on prescribed medication for two years which helps, but I have to take it on time otherwise I’m jittery.

I also struggle with my emotions. They can be so unbelievably strong and too much to cope with. I can’t breathe when they come on. My anxiety has also come back.

I don’t want to go back to the way I was. I’m struggling and I don’t know what else to do. I am so unhappy and have no confidence. I hope you can help me.

SINÉAD

IHAVE read your letter many times, Sinéad, and what strikes me is the level of distress you have experienced and are still experiencing.

Like many people you used alcohol, self-medicating away and numbing your strong emotions. Thankfully you got help for this and are not drinking now. When I hear this I immediately think of your strength to maintain sobriety and your ability to bounce back.

It’s always difficult to assess situations from afar, however in an assessment process I would focus on the level of anxiety you have experienced from childhood and whether social anxiety was/ i s present (did you use alcohol to cover up social shyness?). I would al s o be i nterested i n your self-esteem. For many, sustained low mood over decades is not depression but chronic low selfesteem associated with negative fundamental beliefs — core beliefs — about you as a person e.g. I am unlovable; I am bound to be rejected by others; I am defective so others will not love me. Beliefs are beliefs. They are not facts and new beliefs can be worked on.

Here’s the thing, Sinéad: in addition to medication, it’s equally important that you build tools to help you tackle dominant emotions and flawed core beliefs. Just because you believe them does not make them true.

Tackling the dominant emotions in your life — fear (anxiety) and

sadness (depression) — is the next step and Cognitive Behavioural Therapy (CBT) can help you do this (for a list of therapists, see

psychologicalsociety.ie).

From here you will be able to tackle the fundamental question: ‘what keeps my difficulties going?’ Pervasive fear-based and negative thinking sustains low moods, hence your need for new skills.

You may consider a mindfulnessbased stress reduction (MBSR) course (see mindfulness.ie). Here you will learn coping skills to be in the present and have a more compassionate view of yourself.

What also strikes me is your strengths, resilience and resources. You have taken steps regarding alcohol dependence and have seen a psychiatrist who manages your medication — so now it is time for therapy. This will give you a space to figure out how you operate in the world, what you avoid that keeps your anxiety going, tools to tackle strong emotions and opportunities to create healthy core beliefs such as self-worth.

Here you will be able to recognise the ‘tripwires’ of your emotional life and step over them. Here you can create a future of hope and wellness.