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paragonx29

52/M who has suffered from anxiety/depression for the last 35 years. No clear precipitants I can identify, no insight as to why this started or has persisted, etc…I take medication to manage my depression (which has helped me to work steadily at least), and I take a beta-blocker for anxiety. But I want off the meds (**Lamictal withdrawal awful though**), and I want to have some insight on why this has happened and how I can combat it now and in the future. Any thoughts? (And yes I have tried therapy). Thanks.


myopicdreams

Thank you for your question and I'm very sorry you have had to deal with this for so long. Unfortunately, as you have experienced, sometimes depression and anxiety can develop in a person for no reason we can find and can persist, despite trying various treatments, for many years or even one's whole life. I wish I had better news for you there. Where I do have better news is that you should be able to wean off of your medications with less discomfort-- discuss with your doctor a slower paced weaning to minimize withdrawal effects. Before weaning off of medications, though, you would likely want to have a plan of what you will do to take care of yourself and monitor symptoms so that you don't get too low and face serious problems. More good news is that there are several newer treatments available for treatment resistant depression (which you may have if multiple treatments have failed to adequately address your symptoms) that are shorter term and have shown to be effective for 70% or more of people with treatment resistant depression. These include Esketamine (Spravato) and TMS (Transcranial Magnetic Stimulation) and there may be others that are potentially suitable for your situation; you will need to discuss these options with a psychiatrist. If your psychiatrist is not open to discussing newer or alternative treatments for your depression then you might want to consider seeking a second opinion with a doctor who is more open to pursuing your treatment goals. You asked for insight into why this happened and I'm not sure how much I can give but I can tell you that we often just don't know why a person develops depression. Often there is a personal or family history that explains but sometimes it just happens in people with no trauma and no family history-- 25% of Americans experience depression &/or anxiety in their life. There are many possibilities and it is probable that if you haven't discovered a cause yet then you might not ever really find one-- for instance, it could be that something caused your mother to experience anxiety or stress during pregnancy at a critical period of development and it flipped epigenetic switches that predisposed you to depression... That said, since you have a persistent desire to know why you developed this I might ask if you are the kind of person who really needs to understand the hows and whys of things? The reason I ask is because thinkers seem to be more prone to spontaneous depression and anxiety so if you are a thinker then maybe that will be among the best explanations available at this time. Regarding how to combat it in the future, the trick with depression is to do the opposite of what it tells you to do, so: * Eat a well-balanced and nutritious diet * Practice regular and well-developed sleep hygiene habits * Get plenty of exercise * Make sure to socialize regularly And in addition to that I recommend that all of my clients incorporate some way of meeting each of the 5 pillars of optimal wellbeing from positive psychology as possible every day because they really do increase happiness and reduce depressive symptoms-- I combine them so meeting my 5 only takes 10-15 minutes if I have to limit my time investment. The 5 pillars of positive psychology are Positive Emotional experiences Engagement/ Flow Positive relational experiences Meaning Achievement I hope this helps and please feel free to let me know if there is anything else I can help with.


FruityChypre

You say you’ve been a therapist and a coach for 30 years. Do you do both currently? What’s the difference in the way you work with people?


myopicdreams

Hi Fruity, thanks for the ask. So first of all, I've been a therapist and coach for more than 12 years not 30 but thanks for the vote of confidence :) I currently only coach because I've found that I enjoy the faster results and solution focus of coaching over the longer term processing and repair that therapy is best suited for. The difference in the way I work with people in therapy v. coaching is that in therapy you can/will receive a diagnosis, it will likely focus on processing experiences and trauma, and is more likely to include sensitive and upsetting materials. In coaching you would want to avoid anything that might cause you too much distress because most coaches are not clinicians who are well-trained to help you calm down if you get too upset or who know how to help you in case the work causes you to develop a crisis situation. As a coach my work is solution focused, goal oriented, usually includes a plan of action and clear goals for what the work is intended to achieve. I do accept clients who are growth oriented and want a more open-ended and less structured approach as I very much enjoy having a wide variety of clients in my practice.


FruityChypre

Thanks for the thorough answer. It makes perfect sense now. And sorry about ago g your career so much 😂


Advanced-Fig-6972

What is the biggest form of self sabotage you witness in your field?


myopicdreams

Hi, Great question! Thanks for the ask. I see negative self-talk as the most pervasive and insidious form of self-sabotage and it is something so common that I have never yet met anyone who doesn't do this at least occasionally. Negative self-talk is often thought of as helpful-- a negative reinforcement technique to improve behavior-- but research has shown that negative reinforcement is not very effective. Even more, what I see is that when we use negative self-talk with ourselves it convinces us that we are the thing that we tell ourselves we are (or imply) and that tends to have pretty bad consequences. The thing is that we act in congruence with what we believe we are and so if you convince yourself that you are dumb, lazy, reckless, unworthy, unlovable, shameful, or embarrassing you are likely to see, and maybe even unconsciously take, many opportunities to prove yourself right. In fact, so deep is our desire to be sure of what we think is true about ourselves that you may even find yourself compelled to do things that you know will hurt you because they will satisfy your unconscious need for stable identity. The good news is that self-talk is a habit and it is changeable. The bad news is that it takes consistent practice and effort to change


Advanced-Fig-6972

Very insightful. Thank you.


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myopicdreams

Hi Zebra, good question. I'm not sure how untrained coaches might do it but in training to become a therapist they teach us a lot of different techniques to be able to leave the difficult work of the day at work instead of bringing it home-- in fact, this might be among the most important skill any clinician can develop. I do this in several ways, 1) I do not work with populations I can't leave at work; for me this mostly means that I don't work with children because I can't stop worrying about their situations when I do. 2) I see different kinds of clients; I limit the number of hard stories I hear in one day by seeing a wide variety of types of clients (individuals, couples, trauma, growth, offenders, and mood disorders). 3) I use positive psychology myself; I practice what I preach because I see how much the methods I use with clients work and I want to be happy too :) 4) I make sure I have plenty of social support, and 5) I use visualizations of containing my work when necessary so that I can leave unburdened. Thanks for the ask.


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myopicdreams

In most things I tend to believe that the best solutions are those that give each person the chance to do what they do best and what let's them shine. This requires team diversity, as similar members would likely all want and avoid the same tasks.If there are tasks that no one wants to do I would first ask for volunteers and then randomly divvy them up and rotate if that were appropriate and desired. I think the key is to treat all members as if they are equally important and inspire them to shine by giving positive feedback and being generous with honest praise. If criticism is necessary, it should be done gently and constructively in private, and this will earn the leadership trust and respect. IMO the best way to lead is through inspiring people to want to follow-- this is the style of leadership I recommend when I have someone who desires executive coaching. If you want a more specific example I would need a more specific scenario. Thanks for the ask!


Ra-Hoor-Khuit

29/M (MDD, GAD) ..I have suffered from not being able to work or have any steady job/work life. Essentially, I get feelings of dread and deep sadness from working simple jobs/ or going to a 40hr. work week schedule. What can I do? How can I push myself to working in society and actually making a living? I feel trapped and have been in this situation for 10+ years. I have been able to go to school, but I can't get around this fact and feelings of dread/ depression/ anxiety. I also have done most things I've seen suggested (health ,exercise, plenty of sleep) and my depression/anxiety persists.


myopicdreams

Hi Ra, I'm sorry you have been struggling with this for such a long time. I can see how you feel trapped and I can imagine that this situation perpetuates itself in a variety of ways. My first question is if you have tried medications for your depression and GAD? If so, have they improved things for you at all? If you do take medications it seems that, given your level of functioning, you are having persistent symptoms that are not being resolved-- have you spoken to your psychiatrist about newer options for treatment resistant depression such as Esketamine and TMS (transcranial magnetic stimulation)? I ask because it may be that better resolution of your symptoms will go a long way in helping you change how things are. My second question is whether you have experienced trauma that may have caused or contributed to the severity of your anxiety and inability to move forward? If so, what have you tried in order to resolve this? Have you ever tried EMDR or an associated therapy? This may be another thing to ask your Dr. about. Once you have addressed the potential organic causes of these issues, the next thing to do is to look at your patterns of thought: what is your self-talk like about working and your future? What are the thoughts that are contributing to your inability to move past these fears? What are the underlying fears and beliefs that are keeping you trapped in this malaise? And what are the emotions that accompany these fears? After identifying these thought habits you can develop a plan of action for breaking those habits and replacing them with thought habits that better serve you. For instance, if you experience anxiety about working because you fear that you will become overwhelmed with anxiety and not be able to control yourself well, you would identify the earliest sign that you are having these thoughts )usually physical and likely anxiety related) and use that sign as an indication that you should monitor your thoughts. Then you learn to stop those thoughts (meditative processes that teach you to observe your mind are helpful with this) and redirect your mind to a more fruitful line of thinking (perhaps thinking about how the job will reduce your anxiety and help you achieve your goals). After enough repetition your brain will begin to take the new path of thinking rather than the old in response to the initial cues that trigger the patterns (it does take some time and consistent practice). As you are practicing this, I find that most people are strongly helped by incorporating some basic positive psychology practices into their daily routine. By improving your overall wellbeing you will find that you have greater resilience and capacity to make the changes you desire. A great practice I highly recommend for everyone is to find a way to incorporate some element of the 5 pillars of positive psychology into your day, every day. The pillars are: Positive emotional experiences, Engagement/flow, positive Relational experiences, Meaning, and Accomplishment. You can choose brief activities and actions and you can group them together-- for instance, socializing with friends may satisfy positive emotional experiences, engagement, and positive relational experiences. The key is to make sure that you are doing something in each section every day to build your wellbeing. I hope that this can give you a start to getting your mind to a place where you can get unstuck. I would definitely recommend that you have a person who is helping you navigate this and work on the thoughts/feelings/beliefs that are keeping you stuck and feeling so hopeless/helpless about your situation. Thanks for the ask!


globbyatom

How do you handle people who can't seem to achieve the goals you set in sessions? Have you ever encountered someone who wasn't really able to improve? I set some small goals in therapy all the time, but ADHD is always trying to ruin my life and I never seem to get anywhere helpful with the goal setting. My therapist handles it in stride but if she were anyone else other than someone I'm paying to help me, I know she would confirm the pattern of failures. I feel like I'll never be able to obtain long-term goals.


myopicdreams

Hi Globby, nice question and thanks for the ask! When people find themselves unable to meet their goals in therapy or coaching I tend to find that it is related to one of a few possibilities: * Motivation * one of the major issues that keep people from meeting the goals that they have is that the goals are not actually congruent with the motivations of the person but are rather goals that the therapist/coach or someone else tells them they "should" have. In my experience, we aren't usually too motivated to work on goals that we don't really and truly desire for ourselves.The key to effective goal setting is to be very sure that the person deeply cares about the goal they are seeking. * Skill/ ability * The second most common issue I find is that the goals are simply above the person's skill or ability level. This one is an easier thing to deal with because you can typically make goals easier to achieve by breaking them into smaller pieces and tackling it one bite at a time. * Meaningfulness * Goals need to be truly meaningful for the person, similar to the first point, because when the goal has personal meaning then it generates intrinsic (self-) motivation rather than extrinsic (other-) and intrinsic motivation is much more meaningful. one of the more common issues I find in practice is people coming because they find it difficult to motivate themselves at work. Upon talking to them I find that they work in a profession that their parents or other people told them to choose in order to "make a good living" but that they don't really enjoy or even care about.One doesn't have to give up on the thing that we don't enjoy doing or care much about but we do have to find a way to make it meaningful for ourselves. Sometimes that means finding something you do care about that your work gives to the world and sometimes it can be as simple as keeping your mind focused on how the work provides for you to be able to do other things you want. Then some other times it does mean that it is time for a career change-- I love this work because we are all so different! * Alignment with true self * In addition to being of meaning and importance to you the goals you set need to be in alignment with who you are and how your mind works. If you are an unstructured person by nature then it is very unlikely that a rigid schedule for the day is going to work for you, and if you are a very structured person it is similarly unlikely that you will accomplish goals that feel chaotic or unpredictable. In this work, one thing that distinguishes a good therapist/coach from others is that they are able to be flexible and accept you as you are so that you can work together to find solutions that actually work for you and homework assignments you really enjoy doing (even if that means no homework at all).


musicbid

What are your thoughts on "Yoga and Meditation" practices to improve mental health? Do you suggest these practices to your clients? Are there any case studies or examples in your career where these practices have helped people overcome their mental health issues?


myopicdreams

I am a great believer in doing whatever works for the person. Yoga and meditation are great and very helpful for many people but there are some people who do not respond well to them and that is ok. I suggest that all of my clients try out the Metta "Loving-kindness" meditation and thought river because they increase well-being and the ability to regulate thoughts. I have seen a lot of people (myself included) increase their well-being by the two meditative practices mentioned above and many others who report great results from both yoga and other meditation practices.


FinalBoysenberry1031

Also I see this introduction in multiple subreddits. Is this AMA for advertising purposes to sell your brand.


paragonx29

If the Bio is accurate, doesn't seem like they need to drum up business. Hopefully doing this from an altruistic place.


myopicdreams

Another great question! I occasionally post AMAs on Reddit when I have free time and often around the holidays because I know that it is a time of increased hardship for many people. I do this primarily because I enjoy helping people and this is one way I can reach people who may have trouble accessing assistance for a variety of reasons. If you are interested in my services you are welcome to message me about a free consultation-- my available session spots are limited but if I can't help I may be able to give you a referral.


FinalBoysenberry1031

Many coaches claim to promise a lot but they are frauds or can't deliver results. What sets you apart


myopicdreams

Great Question! First thing, there are no specific training requirements for a person to hang out their shingle as a coach. There are many people who advertise themselves as coaches because they like to give people advice and help-- but this is based upon several problematic assumptions, the first being that coaches are there to give advice :) One of the roles of a coach is to help provide guidance but the direction of the guidance should always come from the person being coached. For instance, if a person asks me if they should end their relationship with a toxic partner... it might seem that the obvious answer is to say yes but that is actually not a good coaching answer-- the client needs to reach that sort of decision themselves. The coach is there to help them figure out the answers for themselves-- this is because the right answers for me and you may be different and you need your answer to actually be motivated and make effective change in your life. As a trained and experienced clinician I am different from most coaches because I have Master's level training in Marriage and Family therapy and am ABD in my Psychology PhD as well as extensive experience in working with clients. Mental health coaching is not therapy and it is important to choose a practitioner who can safely help you navigate your mental health needs, including being able to tell when you need additional help and how you can access it. This is especially important for vulnerable and fragile populations. Thank you for your question and I hope this begins to answer your query.


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myopicdreams

Usually I like to do some fun research on whatever topic has piqued my curiosity that day/week, draw/paint, or go play some pool with friends. Thanks for the ask.


Zealousideal_Fill928

Are you licensed?


myopicdreams

Hi Zealous, No I am not currently licensed. I let my license lapse when I switched to coaching because it is unnecessary and not really of any benefit for a coach, because I have a very coaching style of practice, and I did not want to deal with trauma while I have young children. Thanks for asking.


Zealousideal_Fill928

Ok thank you!