How Social Anxiety Fuels My Depression

I haven’t just been “out of sorts” the past couple of weeks. I’ve been moderately depressed. Tired, sad, unfocused; I spent an entire day watching The Legend of Korra on KissCartoon because I couldn’t get myself to do anything else (and I wanted to know what would happen next; it’s a great story). I’ve also been isolating, having self-harm urges, and occasionally thinking I don’t deserve to live. The abusive voice is back; when he’s feeling kind he just tells me I’m worthless.

I feel like I’m right back where I started: feeling depressed and overwhelmed by the prospect of applying for internships. (And jobs, but if I have to choose between a job and a music therapy internship, I’ll pick the internship. It’s the last major obstacle to starting my career.) There’s nothing else for me to do, nowhere else to run, no excuses. But everything feels wrong. I haven’t been practicing my instruments, it’s been over 4 years since I last worked with real clients, and I don’t have appropriate attire for an interview. I know there are relatively easy ways to fix at least two of those issues, but I’m finding it hard to get myself to do even something as simple as stepping outside for a few minutes to enjoy the sunshine.

It doesn’t help that I’ve been fighting with my health insurance since mid-June. This is a huge trigger for me; I feel like they’re threatening my very existence. We were a couple days late re-applying for our program, so there was actually a temporary lapse in coverage while our information was being processed. Fox was taking half his dosage to make his medication last for as long as possible while we waited to regain our benefits; that made it harder for him to cope with stress and he came home from work even more exhausted than usual. When we finally got our letter confirming eligibility, I rushed to the pharmacy to refill his prescription – only to discover that our HMO wouldn’t resume prescription benefits until August 1st. I didn’t know we could have our medication paid for directly by our state’s program, and I didn’t have his card with me anyway. I got ridiculously angry, started yelling, and had to use all my willpower not to become violent.

The eligibility letter was followed closely by a letter requesting proof of my citizenship and identity. I was furious – for two reasons. First of all, they required Fox to certify my identity and used the term “child” on the form; I found this exceptionally insulting because I’m the one who’s been doing everything to get and keep health insurance for us both. More importantly, the only reason I could think of why they would have trouble confirming my identity (but not Fox’s) is because I changed my last name when we got married. I updated Social Security and got a new driver’s license over a year ago, but for some reason they couldn’t make the connection themselves. It really wasn’t much of an inconvenience to send them copies of my certificates and IDs, but I felt threatened by it anyway. I was born here, I’ve lived here my whole life, we clearly marked that I am Fox’s spouse, and it’s a long-standing tradition for one partner to take the other’s last name when a couple gets married. They should have no trouble connecting my current name to my pre-marriage identity, it should be a normal part of their procedure.

I did nothing wrong, why should anyone question my right to be here?

That’s my problem: I question my right to be here. Bullying; physical and emotional abuse; living in a world that doesn’t want to admit non-binary pansexual people exist; having a body that is hyper-sexualized, censored, stigmatized, and discriminated against; persistent invasive media promoting impossible beauty standards… It’s hard to avoid internalizing messages that I don’t have a right to be here – or, at least, that if I want to exist I must do everything both inside and outside my power to conform. I feel like simply existing day to day (and being honest about who I am) is a radical act of defiance.

Radical acts of defiance take a lot of energy.

I’m tired.

This latest return of my depression – especially so soon after I thought I’d overcome it – proves to me that I must do something to directly address my anxiety. No matter how well I feel in terms of the depression, as soon as I try to start doing things again, my anxiety fairs up. It’s so bad I can’t do anything, so I don’t do anything; the depression sets in again.

It isn’t part of my official diagnosis (yet), but I’m pretty sure I have social anxiety disorder – which is described as “extreme fear of being scrutinized and judged by others in social or performance situations.” It explains most of my functional difficulties that lead to some of my worst depressive symptoms, particularly being late for class and the couple of times I’ve chosen not to show up for job interviews. Even just going for a walk outside is difficult: I don’t want to be seen by anyone because I expect them to judge me harshly.

Fortunately, I have an appointment with my prescriber on Tuesday. She has offered to refer me for individual therapy – I think within the clinic where I meet with her. I can will ask her to refer me to someone who specializes in cognitive-behavioral therapy (CBT) for social anxiety disorder. (CBT is more effective than medication for treating social anxiety.) Hopefully I’ll be able to start with that person right away and gain the confidence I need to finally move forward with my life.

Good Things Thursday

Last week Wakana suggested I make a list of all the good things I do. I wrote my list as a blog post draft that I updated daily. I loved doing it so much, I’ve decided to try making it a feature. Enjoy!

Wednesday

  • Realized I’m at least partially responsible for how others treat me and committed to learning more adaptive behaviors
  • Tried to go to class
  • Practiced self-care by coming home when my symptoms interfered with my ability to attend class
  • Waited on my way out of the parking garage so someone could pull out of their spot
  • Played with my pet rats, gave them a puzzle to solve, taught them their names, & set healthy boundaries
  • Skyped with Banji & worked on my paper instead of playing The Sims 3
  • Got gas for my car

Thursday

  • Worked on my paper
  • Played The Sims 3 for a reasonable amount of time
  • Took a shower
  • Relaxed
  • Engaged in respectful discussion of a difficult topic despite someone twisting my arguments
  • Met with the instructor of my piano class, attended class, role-played for a classmate, and asked useful questions
  • Used supportive self-talk to cope with difficult emotions in class and get home safely
  • Requested a paper extension (assertiveness)
  • Received & appreciated support from Mom
  • Practiced piano
  • Enjoyed “family time” with Fox and our pet rats

Friday

  • Enjoyed a few quiet moments when I first woke up
  • Let Fox sleep in on his day off from work
  • Spent the day with him talking about our life goals and other things that are important to us
  • Dealt with dirty dishes
  • Enjoyed spring weather & celebrated Beltane

Saturday

  • Practiced piano
  • Had a good conversation with Fox’s sister
  • Posted supportive comments in response to posts about difficult topics on Facebook
  • Provided supervised outside-the-cage playtime for my rats when they seemed to want/need it
  • Emailed my instructor with specific questions to help prepare for the final exam

Sunday

  • Spent the day composing and practicing piano
  • Cleaned the rat cage
  • Gave the rats a tunnel to play in
  • Asserted that it was “family time” after giving Fox some time to unwind following a late shift at work
  • Worked toward my personal goal to (regularly) eat more fruits and vegetables

Monday

  • Reworded the preceding “good thing” to reflect that it is a personal goal. Different people have different nutritional needs; each person’s food choices are their own.
  • Made conscious decisions about how to spend my time
  • Took pleasure in simple things, like hearing my rats eat
  • Realized that “listed the good things I’ve done today” should be the penultimate item on each day’s list
  • Followed by “re-read the whole list and felt happy/proud”
  • Decided on my (potential) thesis topic and thought of one (potential) means of researching it
  • Answered the question I was going to ask my instructor by thinking about it in more depth
  • Continued composing and practicing piano
  • Enjoyed the beautiful weather
  • Went out for dinner and a movie with Fox

Tuesday

  • PIANO!!!
  • Started clicker training my rats
  • Set & kept a boundary with Mom
  • Helped make dinner
  • Realized I was over-practicing one song for my piano final and took a break from it
  • Played The Sims 3 for a reasonable amount of time

Feel the Burn(s Depression Checklist)

I’ve been using the Burns Depression Checklist to track my depression symptoms every day for the past month. For anyone who doesn’t know, the Checklist is a list of 25 symptoms, such as: “feeling unhappy or blue,” “loss of motivation,” “feeling tired,” and suicidal thoughts. It’s been about a year since I last used it.

To complete the Checklist, I rate each item on a scale from 0 to 4 – where 0 means I didn’t experience the symptom that day and 4 means it was “extremely” present that day. I find tracking my symptoms daily to be helpful because it’s hard enough to remember everything I felt, experienced, and did in one day – never mind trying to do it for a whole week! I add up my ratings on all 25 items to determine my score, a numerical representation of how depressed I was that day.

Ziya's scores on the Burns Depression Checklist from July 16, 2014 to August 17, 2014

Ziya’s scores on the Burns Depression Checklist July 16, 2014 to August 17, 2014

My scores (blue line) are usually in the mild (11-25) or moderate (26-50) ranges; my average for the month is 30. Days when I score above a 40 are particularly bad and I notice impairment in my functioning beyond feeling tired and not wanting to do anything. It’s like I can’t do anything.

In contrast, days when I score in the teens or low 20s are my good days, when I feel like I can get my life back on track and I want to do everything. They are days when I’m the most active and social… and (usually) spending time with Banji. Both of the days when I scored below a 10 (July 27th and August 2nd) were days I spent with Banji doing some of our favorite activities.

My scores oscillate wildly from day to day; a change of 10 points or more is not uncommon. I’ve even had the score jump almost 30 points in one day! (August 3-4: I was sick, but pushed myself to spend the weekend with Banji and other friends anyway. I needed the 4th as a day to say “fuck you” to the world and stay in bed. I ended up playing The Sims 3 for most of the day.)

To try and compensate for the oscillations, I had my spreadsheet calculate a 7-day average value for each day, using the scores from that day and the 6 before it. The 7-day average values are marked on the graph above as a dotted green line that never drops below a 16.

Ironically, my low 7-day average score of 16 occurred on the day of my psychiatric evaluation – probably the one day I’d want to exhibit depressive symptoms so they could be observed and evaluated by a professional. It’s been rising since. There are definitely other factors involved (well, mostly visiting Banji), but I think my hope that the advanced practice nurse (APN) would be able to help me reduced my depression leading up to the appointment.

[August 20, 2014 Update: Actually, my low 7-day average score of 16 was 2 days before the psychiatric evaluation – on the day I came home from visiting with Banji.]

In the time since that appointment: I have not been on medication, I’ve been unable to schedule the sleep study the APN requested, I’ve stopped taking the supplements that seem to help but cost more than I’m comfortable spending while I lack income, and I haven’t been doing music therapy with Wakana because she’s on a business trip. Most importantly, I haven’t seen Banji since August 3rd.

I’m also a bit stressed out about the summer class I’m taking, which is awesome but requires me to go out into unfamiliar social situations and be professional and on time and do independent research for a paper due in less than 2 weeks. It’s sending my anxiety through the roof! My responses to anxiety tend to be depressive symptoms: feeling hopeless, inadequate, ashamed, and guilty, criticizing myself, avoiding people and activities, eating like crazy, and my sleep cycle is a total wreck. It’s a bit overly simplistic to stay that my anxiety causes my depression, but it definitely contributes to it.

I have noticed a cycle where I start to feel better, start making commitments (applying for jobs, registering for this course, etc.), feel very anxious about keeping the commitments, fail to keep the commitments, feel depressed, don’t do anything for a while because I’m too depressed, rinse and repeat.

Where is this anxiety coming from? Well, our friend David Burns and other cognitive behavioral psychologists would say it (as part of depression) comes from distorted negative thinking, particularly about myself. I hate myself; I think I’m no good and I don’t deserve to live and it’s only a matter of time before other people figure it out. It doesn’t really matter where I got this belief; exploring its causes won’t help me feel better and will only open up an ugly can of worms that’s best thrown out. It’s in the past. I live in the present; in the present what matters is replacing the belief with something more realistic and healthy… at least, that’s my understanding of what cognitive behavioral therapy is about.

I’m ostensibly holding a key to overcoming my depression in my hands as I write this: the book Feeling Good: The New Mood Therapy by David Burns. It’s where I got the Checklist and its scoring chart from and I’ve read parts of it, but I have yet to fully absorb its wisdom – obviously, or else I wouldn’t still hate myself. I’d love to use the excuse that I need to focus on my class so I can’t also read this book, but let’s be realistic. I’ve been wasting time on random things that I could easily divide between schoolwork and doing things that benefit my mental health and have time left over for fun and/or social activities. The number one “random thing” is an online free-to-play “game” that some friends got Fox and me into.

I need to kick my computer addiction, but I don’t even know where to start… especially since I need my computer for things like the class I’m taking! Aarrgghh!!!!!

I wish it were as simple as deciding that this other stuff is more important and doing it, but if that were the case I wouldn’t have depression. I need some kind of support; I feel like a broken record because I don’t even know how many times I’ve said it since I started this blog. I’m having trouble focusing, deciding what to do (which causes me overwhelming anxiety), mustering the energy to go do it… I don’t know. I’m stuck. I’m just going to stop writing now.