Comment by dccooper | Hacker News Reader

Comment by dccooper | Hacker News Reader

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One of the most common frameworks to thinking about anxiety is CBT (Cognitive-Behavioral Therapy). Basically there are both things that you’re doing and things that you’re thinking that trap you in a cycle of anxiety.

The symptom tsunamifury talked about is what we call Catastrophizing – that is you over-estimate / over-value negative consequences over positive or neutral ones. It’s not just “If I stop working or slow down, I might not make as much money,” it is instead, “If I even take time to slow down, all my peers will be better than me or I might miss that one opportunity that’s going to make or break my career and then my professional life will be over and I might as well spend my time making software for businesses in the middle of Oklahoma.”

What I’d try and get patients to do is to rationally evaluate the evidence that any or all of these might happen. Is one missed connection really going to make or break your career? Is one failed pitch? Do you know of any founders/devs who failed big and recovered? What makes you think you couldn’t do the same.

If you want to know more, here are some good places to start – mix of websites and articles. (Apologies in advance for the potato quality on some of these links – I’m slowly dragging my field into the 21st century.) I’d also recommend going to see a therapist – even if it’s just for a few sessions. It might be helpful to get an outside viewpoint on your current situation.

https://www.psychologytoday.com/blog/in-practice/201212/cogn... http://www.getselfhelp.co.uk/step1.htm http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/ http://www.apa.org/helpcenter/anxiety-treatment.aspx

(Source: Me, I'm a psychologist who's done therapy with clients and now makes mobile apps. I tried to make this as HN-oriented as possible)

Thanks! Should I look for a particular type of therapist?

I'm not a medical professional but a fellow sufferer, so you should probably take this all with a grain of salt. It's more than likely you'll see a psychologist who will administer cognitive behavioural therapy; essentially the rational examination of your thinking as described above. Although specific treatment modalities somewhat depend on the nature and severity of your anxiety disorder.

If your anxiety is more 'phobic' in nature (i.e. it spikes when you're exposed to specific stimuli) , a therapist might inter-weave elements of 'gradual exposure therapy' in as well. For instance, if you have severe arachnophobia, you might start off standing on the other side of the room to a large spider in a glass cage. Then you might stand half-way across the room. Then next to the glass. Then touching the glass etc. But CBT is the workhorse of modern psychotherapy, and can be quite effective for anxiety suffers.I'd also suggest steering well clear of any therapists that use psychoanalysis/psychoanalytic theory in their practice. It's arguably a non-falsifiable pseudo-science.

Unless your anxiety is so acute that you can't function on any normal level (like the time I didn't leave my house for about 2-3 weeks), I'd hold off on medication and try your non-chemical options first. To be clear, I'm not one of those people who thinks that 'unnatural drugs are bad maaannnnn', and have in fact been prescribed (and taken) meds at various times. In certain circumstances, for certain people, they are the only option and they can be a god send for some. But in my experience the pharmacological options for anxiety are are pretty poor. There are really only two mainstream choices: anti-depressants like SSRIs/SNRIs, which are rarely effective for anxiety and take 6-8 weeks to have any effect. So you end up on a very long-term course of trial and error.

The other pharmacological option has traditionally been benzodiazapines (valium, kloponin etc.). Again, unless your illness is extremely acute, I very strongly urge you to never go down this path. They're very physically and psychologically addictive in the medium to long-term (sudden withdrawal can even result in in grand-mal seizures), and you will experience 'rebound' anxiety when you stop taking them.

Lastly, although not a cure, a few lifestyle changes can vastly improve your quality of life while you're seeking out profession treatment. The big three are exercise, regular sleep and mindfulness meditation. It's difficult to start at first, but if you can make even 1 or 2 or those a regular habit you will see an improvement in your life.

Anyhow, I really wish you all the best. Anxiety sucks, but fortunately there's a growing number of ways to make it suck less.

I'd like to offer a counterpoint to your views on medication. For those who suffer from acute, short-term anxiety over a specific event, for example an exam or an interview, beta blockers such as propranolol can be really helpful - as I understand it they interrupt the fight-or-flight adrenaline response to stop you working yourself into a panic. They were wonderful for me during exams and graduate interviews, and now I barely ever need them. I still suffer from chronic anxiety, but that acute performance anxiety is not a problem for me anymore.

> For those who suffer from acute, short-term anxiety over a specific event, for example an exam or an interview, beta blockers such as propranolol can be really helpful - as I understand it they interrupt the fight-or-flight adrenaline response to stop you working yourself into a panic.

Thanks for the recommendation. My girlfriend thinks she needs benzodiazepenes for anxiety. The doctors give her just enough to get addicted, then take them away.

Looking around just now, it seems like Clonidine is another anti-adrenaline drug that would be useful for acute anxiety. It's commonly used for smoking withdrawal too.

Wow, I can't believe I forgot beta-blockers... Especially since I have a long running prescription for them. I agree with all you've said and would even go a little further. They're quite safe to take on a regular basis and are especially effective for 'panic' type anxiety reactions (i.e. 'physical' anxiety symptoms). I still remember the first time I took these. That day, I spoke up in a large work meeting with a bunch on unfamiliar people. And for the first time in my life, I was not a shaking, sweaty mess afterwards.

The only very minor risk with them is if you're taking a fairly high daily dose and then suddenly stop. From what I understand this is really only a problem if you have some sort of pre-existing coronary disorder. Also contra-indicated if you have asthma (as it basically does the exact opposite of what those ventolin puffers do).

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