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DrFee
DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience:  I help people overcome anxiety and enjoy life again.
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Should I consult a psychotherapist for anxiety/insecurities?

Customer Question

Should I ask my doctor permission to consult a psychotherapist if I have anxiety/insecurity even at home? For example, I cannot read on the couch with my siblings or parents in the room without being overly aware/looking at them out of the corners of my eyes. At times, I make them uncomfortable, make them fidget unnecessarily, become tense, or leave the room, which hurts my feelings. I've been like this for at least 9 months. It's much worse when I am in public, at work, at school, and at church. What should I do? Do I have a psychological problem?
If you would like more details, I can tell you that at my worst, I have made even very confident, secure people very tense, in that they suddenly stop smiling, crack their neck to release tension, and try to control their mouth and eyes from showing discomfort. Sometimes I try to avoid the situation in the future once I have created it. But if they walk in the room, I am startled and frantic to look natural but unable to do so. If they walk by, I am conscious of their presence the entire time and I tense up and look awkward (as if I don't want them to be there or would rather be alone) and they sense it and want to get away.

I cannot endure being seated (as in a lecture hall--I am in my 3rd year of college) or being still and listening, at church for example. I feel that I'm supposed to act a certain way, to smile, to nod, and I do that confidently sometimes but it feels unnatural.

I will say that oddly, I am sometimes the most confident girl in the room and can elicit smiles from anyone on my good days. I am social and have friends and am outgoing, but it's dependent on my mood at the time. 
Submitted: 2 years ago.
Category: Mental Health
Expert:  DrFee replied 2 years ago.

DrFee :

Hello! Please remember that my response is for information only, we are not establishing a therapeutic relationship.

DrFee :

It sounds like you have a great deal of anxiety --therapy could be really helpful for you to sort out what it is about.

DrFee :

You mentioned that you are in college, I am wondering if your college has a counseling center?

Customer:

Yes, they do. Actually they have a very good psychological services department (for free).

DrFee :

It would be a great idea to take advantage of that.

Customer:

I think I will make an appointment. Can you give me any specific advice?

DrFee :

I can give you some instructions for abdominal breathing --it is excellent for helping to calm down. Hang on just a minute.

Customer:

thank you

DrFee :

4 x 4 BREATHING EXERCISE


Jennifer L. Fee, Psy.D. & Diana L. Walcutt, Ph.D.


Reprinted with Permission by The Health Central Network


 


This is called the 4 by 4 breathing exercise because you should practice it for 4 minutes 4 times a day to learn to do it well. If you are able, do this with your eyes closed, imagining a pleasant place. This is calming and designed to help you manage stress. There are two important things to learn about breathing:


 


1. Learn how to breathe from your diaphragm (from your tummy area) and make that pattern a part of your daily life.


 


2. Become skilled at shifting to diaphragmatic breathing whenever you begin to feel stressed.


 


Natural Breathing


 


1. Gently and slowly inhale a normal amount of air through your nose, filling only our lower lungs. Place your hands on your tummy so that you can feel it rising and falling with each breath. Count to 5 slowly as you do it.


 


2. Exhale slowly through your lips, counting to 5 as you do so.


 


3. Continue this slow, gentle breathing with a relaxed attitude, concentrating on filling only your lower lungs.


 


4. As you breathe, slowly repeat the word “relax” or “calm” or some other word which means the same to you.


 


If you have difficulty following the above instructions:


 


1. Lie down on a rug or your bed, with your legs relaxed and straight, a book on your tummy and your hands by your side.


 


2. Let yourself breath normal easy breaths. Notice what part of our upper body rises and fall with each breath. Rest a hand on that spot. If that place is your chest, you are not taking full advantage of your lungs. If the book is moving up and down, then, congratulations, you are doing it right!


 


Deep Breathing


 


Deep breathing is an extension of this normal process. With one hand on your chest and one on your abdomen, take a slow, deep breath, filling your lower lungs, then your upper lungs. When you exhale, let your upper lungs go first (causing your upper hand to drop), then your lower lungs (causing your lower hand to drop).


 


Reminder: Too many deep breaths, instead of natural breaths in a row, will produce a sense of lightheadedness. This is not harmful; just return to natural breathing.


 


Practice


 


Natural slow breathing and the deep slow breathing several times each day. Practice natural breathing for a period of at least 4 minutes, 4 times a day. The object is to train yourself to breathe from your diaphragm most of the time.

DrFee :

One key to using this effectively is to practice -- a LOT

DrFee :

I would start practicing at times when you are not particularly anxious --when you get in bed, before you get up in the morning.

Customer:

Alright, I will try it. Can you give me any tips on what I should be focusing on/thinking about when these sorts of feelings come up?

DrFee :

It's easiest to do lying down, harder while sitting, harder yet while standing until you really have it down. As far as whent he feelings come up -- try asking yourself, "What just happened?" What's going on in my environment that's triggering this?" I will give you some general categories of things that trigger anxiety --

DrFee :

I've divided them into 2 categories --external triggers and internal triggers

DrFee :

External triggers occur outside of ourselves, but they must be linked to an internal trigger --as you will see in a minute.

DrFee :

External triggers include anything perceived by the senses -- sights/smells/sound/touch, Overstimulation (too much going on -- noise, people, lights, crowded space) Understimulation (not enough going on --boredom, waiting, standing in line) and even florescent lights.

DrFee :

Internal triggers include: thoughts, feelings, memories, images, bodily sensations

DrFee :

being too hungry, tired, or hot as well ----

DrFee :

Triggers can happen very quickly, be linked together and can be very subtle.

DrFee :

Thoughts, for example can happened rapidly, and just below the surface of our conscious mind--we call these "automatic thoughts"

DrFee :

So, a song on the radio can trigger a memory, which triggers a thought/image, and perhaps a body sensation and anxiety can result without you even being aware of what's going on.

DrFee :

So --what you want to do is try to slow the process down by asking all the questions --"What's going on?" What do I notice that could be bothering me?

Customer:

that makes sense. yes, sometimes I feel that I need to slow down and take a moment to think/reflect even when I'm being hurled so much information/overstimulation/noise, etc.

DrFee :

You sound like you are a reflective person --so I think you will notice a lot if you do start to pay attention.

Customer:

thank you. I'm saving this advice and will put it to use! Can you give me some thought guidelines, for example, how to think more positively if I happen to make someone feel uncomfortable or make a mistake or start to act insecure? Am I explaining this question well?

DrFee :

I think so -- in a nutshell, it has to be OK to make a mistake and to even be where you are at --so you've got to say things like: "I am human, all humans make mistakes." "I'm experiencing some anxiety, if someone feels uncomfrotable, that's really their issue to deal with."

DrFee :

You aren't going to believe it at first, probably --

DrFee :

so be patient, and keep saying it everytime it happens --"Nothing bad is going to happen because I made a mistake."

DrFee :

You'll need to come up with your own wording on these things...these are just examples.

DrFee :

You don't have to be super positive, just not negative --compassionate and accepting.

Customer:

okay. that is a good balance. it's terrible being on the roller coaster of being super confident, and then super insecure. I'd really just like to shoot for neutral or just being calm rather than a person who just exudes self confidence and security.

DrFee :

Try to be patient. Once you have a better understanding where all this is coming from, you'll probably be able to balance yourself out a bit more.

Customer:

I do have a very specific question--probably the one I struggle with the most--and that how can I better focus on something (usually something important) when I am with others or in public? I am easily distracted by other people's presence or movements...and once I am aware that I am aware (a little redundant but yes), I become tense and distressed. I feel as if I cannot keep myself from looking at others through the corners of my eyes or subconsciously watching them. I have noticed that there is also a dialogue going on in my mind as these things are happening, and it usually negative. Any advice to keep my eyes less tense and focused? what should I think about if I realize I am getting distracted?

DrFee :

What is it about them that compels you to keep watching them?

Customer:

I am wondering if they are aware of me the same way I am of them. (and my odd behavior often makes this a self-fulfilling prophecy!)

DrFee :

People, generally speaking, are very self absorbed --we are very concerned about what's going on with us, and less so for everyone around us --so yes, your odd behavior is going to attract attention, whereas if you didn't do it, people would notice you and then "move on" so to speak. So, another place to talk to yourself, "I don't have to keep looking at them. They see me, I see them, but they are moving on to something else."

DrFee :

You could say things like "No one really cares --about what I am doing (whatever you are trying to focus on)"

Customer:

that makes sense. sometimes it helps if I intentionally zone out and then realize that I'm in my own world

DrFee :

Yes, that's a good idea.

Customer:

last question--by the way, I really appreciate you taking the time to answer my questions, it's really helped so far--should I still consult the school psychologist? what can I expect from them?

DrFee :

You are welcome. I would encourage you to do so. You may need some support as you try to impletment the ideas that we talked about. There may be important issues that got all of this started that could be very helpful to address.

Customer:

yes, you're right. I will practice what you detailed and will seek further help. Thank you again for your advice!

DrFee :

You are very welcome. Take good care.

Customer:

you too. have a good night

DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience: I help people overcome anxiety and enjoy life again.
DrFee and other Mental Health Specialists are ready to help you

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