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Hello I believe I can help you with your concern
I am sorry that you are going through this anxiety, I can imagine how distressing it is for you
it's very distressing
when I'm fully distracted I feel normal
when I'm not i feel pretty bad
Have you and you therapist figured out a reason why you are concentrated on having a heart attack?
eh so so, she thinks when my work stress/outside stress kicks up my mind goes to look for something internal that could be causing the mental anguish that would make sense like something having to do with my health
for as long as I can remember I would fixate on certain illnesses (well since about age 14 or so) but then those would go away but years down the line something else would come up and then I could go years without anything
this one has been the most persistent
Okay and what type of therapy are you currently in? (e.g. CBT, DBT, etc...)
Okay and have you used the thought record to help you with these negative thoughts?
yes they are literally immediate as soon as I get up in the morning so mornings are usually uncomfortable
it's always "what if I have a heart attack"
and then I start to scan and focus on my heart rate
or what If I'm alone and I have a heart attack
Alright so it seems like the CBT therapy helps somewhat, but the persistent and compulsive thoughts may be too much for therapy to be as effective as it can be
I agree with that
You mentioned taking Ativan, but it is only partially working. What dosage are you taking?
.5 mg if I start to get really panicked
they have offered zoloft but I'm not overly thrilled with the idea
Well Zolofot helps a lot with OCD behavior, so it can help with the compulsive thoughts
the ativan works well when I'm doing a project and distracted and need something to take the edge off. On a weekend day it doesn't work as well
the zoloft idea is definitely on the table
I haven't shut the door on it but when I started to feel very good over the past couple of months I figured I may be on a good path
and now I've had a resurgence
The Ativan is definitely a low dose, you can ask your physician if you can take it at a higher dose during the weekend.
Why do you think you had the resurgence?
does that help with thoughts
well I'm juggling a lot right now professionally and socially
Ativan will help with anxiety and can help lessen the persistent thoughts
sometimes when My mind is going a lot of different ways my anxiety kicks up
I have to work hard to compartmentalize the different pieces so that they seem less like obstacles
So you are stressed and that is what led to the resurgence?
when I write tasks down the stress lessens
sometimes I feel like this is something that's just going to be part of me and I have to deal with it
I don't know if something necessarily causes it
Well stress causes an increase in cortisol, which can lead to an increase in anxiety.
but why the focus on the heart attack?
I think that's such a weird fixation
I haven't had anyone around me have one of those
and I am not at a risk at all I'm 32, 5'1 with low cholesterol, 100 lbs, non smoker, non drinker and normal blood pressure
perhaps the uncertainty is upsetting
I'm not great with uncertainty
I'm a very careful , safety conscious person
and diligent about my health
Well you mentioned that you have always had a fixture of thoughts on health concerns since a young age, you could have saw a young person have a heart attack on tv and that has subconsciously created these recurring thoughts to cause your anxiety of this one particular issue. Because you are sensitive to health concerns, there are a lot of triggers out there that can cause your anxiety.
you are right I am sensitive to health concerns
I am surprised that the thought record has not helped you more because you said when your write things down it usually helps
I think an increase in your medication may help you respond more to the CBT therapy
well my record is just writing down the negative thoughts and then I review them
is there a next step I should take
Yeah there is a next step, let me show you a link to one of my thought records and see if it is similar
You put the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want you to come up with an alternative thought for the situation (more positive and plausible). This will help you change your way of thinking to be able to think more positive and not automatically go to a negative type of thinking.
Coming up with the alternative thought is very important to a thought record because that is what helps transform your automatic negative thinking to be more positive
what would be an alternative thought for I think I'm having a heart attack?
"It's probably not a heart attack, but my anxiety again"
(as it usually is)
Does that seem more probable then having a heart attack?
it's more probable because that's been the way its been for a year plus I've gotten a clean bill of health from the cardiologist after running all the tests
And there you just put evidence to support your alternative thought and evidence against the original negative thought. You do have great insight on your mental health and you can recognize that it is your anxiety, but this thought record is supposed to help your subconscious get that insight too. Once this becomes routine to you, your subconscious (e.g. that first thought of a heart attack in the morning) will not longer think negative thoughts and your anxiety will lessen.
Did you therapist teach you any relaxation techniques to help when you are really anxious, like deep breathing and visualization?
ah ok so that is the right way to fill it in
so this? becomes clear to my sub conscious
I'd like to get out of this thought loop
it's super distressing
Yes this is the best and most complete way to fill in a thought record.
It will take time to get out of the thought loop, but it will happen
ok and do you see distraction as also being a good method
at least for some relief
Distraction is a good method for temporary relief
today I couldn't find much distraction
even when iwas out
Here is a link for other relaxation techniques for temporary relief at the moment too
but sometimes the tv helps
TV can help definitely, so can taking a walk or a jog too. Sometimes listening to music helps as well.
yes for sure
I love music
thank you for all of your help. I really appreciate it. It is extremely annoying to be a successful functioning person but to be dealing with this in the background of my life
I understand, but so far you are taking the right steps by going to CBT therapy and getting some medication help as well. Like I said it will take some time and effort, but I am confident that you will get a hold of this and you feel immensely better for the long term.
I am glad that I was able to help you today
Thanks so much!!!
I will give you a great rating
and may reach out again in the future
If you ever have any other questions or concerns, please feel free to contact me again at anytime
have a good weekend
Thank you and I wish you the best of luck
Have a great rest of your weekend too