Question: What are you supposed to do when you are in a mental health crisis and you are told that you cannot possibly get an appointment to see a psychiatrist for 9 weeks. Can I just go to a hospital and tell them, in the ER that I feel like killing myself even if I really don’t just so they will be forced to take me on a psychiatric hold so I can get some help today? My issues are PTSD with disassociation.

David Johnson Says...:

I can certainly understand your frustration with the wait. However, there are a couple of things that you can do to get appropriate help. First of all, see a therapist experienced in working with PTSD. There are relaxation exercises and mindfulness practices that will go a long way towards solving your problem once and for all. Talking about your experiences with PTSD is painful and ultimately helpful. Learning to better cope with your symptoms is the most effective treatment. However, it does require time and practice. An important reason to learn to better cope is that PTSD symptoms can come back when triggered by another traumatic event. Learning new skills to cope will help you contain the recurrence.

Medication may also be helpful, but it is not a permanent solution for PTSD. The medications used for anxiety are for help with short periods of time, are addictive, or are primarily used for other problems and only incidentally help with anxiety. And the side effects are sometimes uncomfortable. Medication should be considered as a last resort and only after trying therapy for anxiety. You can talk to your primary physician about prescribing medications. Some are comfortable doing so. Some will consider prescribing after talking with your therapist. 

I wish you the very best.

Question: I am a hugely qualified candidate that is 2 years out of a Master’s degree program and I am still unemployed. The reason: I freeze up with anxiety in interviews. At the worst this has led me to cut-short an interview because I think I was having a panic attack but normally I just freeze up mentally so when they ask questions, even about subjects I am incredibly knowledgeable about, I can’t think of a thing to say and come off looking like an idiot. Unfortunately, I do not get better at interviews with practice… like everyone keeps telling me I will. If anything, it is the opposite. The more I mess up in interviews the more sure I am that I will mess up when going into a new interview and so I walk in feeling already pessimistic and anxious. Here’s the weird thing…I am not an anxious person in other areas of my life. A friend suggested toast masters as a way to relieve my problem and I tried it and had no issue with it, because I am fine with public speaking …it is only this one narrowly defined situation that causes me problems. What do you suggest I do to reverse this?

David Johnson Says...:

I would suggest you see a therapist for a while. There is something about your feelings and/or thoughts about your job of choice or interviewing itself that is triggering your anxiety. Understanding the fears you have about yourself will give you greater self-confidence.
Meanwhile keep interviewing for a job. Anxiety is largely the result of worrying about a fearful feeling. The more you worry, the more anxiety you will have. The more you struggle with with anxiety while interviewing, the more worry you will have. You need to be able to ride through high anxiety and calm yourself while you are interviewing. That will take more practice than you will like. Your therapist also may be able to help you by role playing the interview situation and giving you a lot of practice.
I wish you the very best.

Question: This month I started waking up in the middle of the night with cold sweats and pounding heartbeat and every time I wake up I feel like I am dying and I can’t even think because I am so afraid. It takes my wife a few minutes to reach through to me before I can hear her talking to me. Are these panic attacks? I am under a lot of stress right now. They are horrible beyond any words I can think of to describe how they feel.

David Johnson Says...:

It sounds like you are experiencing night terrors. These are nightmares that include a lot of panic symptoms like you describe. It is very likely that you are sorting through your stress in your dreams, even if you don't remember them. This is a signal that you need to talk about your stress. Your body is warning you that you need some help. I would strongly suggest you see a therapist to talk through what you are going through and the underlying anxieties that are triggered. Your therapist may suggest you see your doctor or a psychiatrist regarding medication. Medication, generally, should be the second line of professional help. Once you make some progress with coping with your stress your night terrors should subside. You may even start remembering your dreams.
Another suggestion is review any medication changes you may have had since the night terrors started. Some medications can sometimes stimulate bizarre dreams. Medication, while often helpful, seldom is the first place to start with your mental health.

Question: I own a quick service meal-salad kiosk that opened a second location in a subway station. I am there 12 hours a day and the noise level at peak times is overwhelming. Sometimes I feel like I can’t take it anymore. Like it is actually driving me crazy. I just feel frantic and an edge all the time. I never felt so affected by noise before so it is not something I ever considered before launching the venture. It takes me hours to calm down after a day off jangled nerves. How worried should I be about this feeling I am having? I am not in a position where I can make any changes financially.

David Johnson Says...:

I'd be right there with you. Intense none stop sound can give you hearing damage and rattle your nerves. I strongly suspect that much of the overwhelming feelings is the worry that something else is wrong. Worry without relief has a way of spiraling up and away from reality, but it is very uncomfortable. Clearly, you have to do something and this is what I'd suggest.
Create yourself a hands on menu so your customers can point. Then get yourself a set of ear protection headphones. They can be quite effective and for under $25 you can get the best sound attenuation to 30db. Add a set of ear plugs if you need to and together that will cut sound considerably, so much so you will have to rely on your hands on menu and learning to read lips.  You can spend a little more and get music with your sound control. I bought a set to wear at the Indianapolis 500 this year and it was so quiet I was a bit disappointed at being under-stimulated and so less excited!
The struggle you may have with learning to read lips will be much less stressful than trying to tolerate the noise. Worst case, you may have to take them off for some customers until you figure out how to make it work.
You also may want to look into getting some breaks build into your day. If you have two locations, you must have some help. Trade off shifts if necessary.
Trust your body, it's telling you you must do something for relief. Find a way to make it happen. Good luck with your business.

Question: I want the people I meet (some of them) to understand anxiety. I am sick of people telling me to ‘just relaox’ or try getting a massage or taking the day off to distress. I know they mean well but people really are clueless about what it is like. The problem is every movie or show that I have ever seen that shows mental illness seems to make a joke out of it, or the main character can get better and happy by the end just because someone loves her or something. Do you know of any movies or shows that accurately portray mental illness. I wish there was one that I could just tell people to watch so they would get it.

David Johnson Says...:

Over the years I've heard a number of complaints much like yours. Media will poke fun at anything and anyone without much sensitivity to how it might impact others. Many attribute the continued stigma in the general public to mental illness insensitive portrayal on TV and on the Internet. The National Alliance for Mental Illness has long publicly criticized such events. And they have had some success in changing the minds of production companies. For at least the last eight years, SAMHSA has awarded media events that accurately and sensitively portray mental illness. Please click the links to hear more. I'm sure you will find what you are looking for there.

Question: I cannot pee in a urinal. I can be naked at the gym and be OK with it but if I am at a urinal and another person comes up I just pretend I am done and wait until the person leaves and go back to try again. This is embarrassing. I know this is not totally uncommon but I am not really comfortable discussing this with my friends. How do I overcome this problem?

David Johnson Says...:

I feel for your embarrassment about this issue. I'm glad you found a way to ask for help. The good news is that anxiety can be dealt with, but it will take persistence and work on focusing your mind. The most beneficial approach is to develop a mindfulness and/or meditation practice. Anxiety problems are driven by our reactions to the triggering event and the resulting anxiety. Managing your thoughts and soothing your reactions while they happen will enable you to wait at the urinal until you can finish your business. Leaving and coming back is the wrong tactic. The more you walk away, your anxiety will be worse the next time. You want to find a way to relax to manage your anxiety and quiet your mind. Mindfulness skills with improve many things in your life, such as your test taking skills, your ability to manage a conflict, and public speaking skills. Anyone, but especially someone with an anxiety problem, should have a regular mindfulness practice.

You will find classes available in local counseling centers and perhaps even in community education classes. You can also purchase CDs with mindfulness exercises and work at it on your own. Work on your ability to relax yourself and quiet your mind on demand. Then when you are confident with your new skills, persist at the urinal until you're done. It will not be easy, but eventually you will succeed.

Question: My new job is basically an accounts management position. There is a lot of responsibility and stress. Ever since I was promoted 8 months ago I have felt a lot of stress and anxiety all the time. I thought it would get better as I got into the position but it hasn’t, though I have become adept at my new responsibilities. As I understand it, anxiety is unreasonable fear and worry and stress is worry that is proportional to a situation. My worries are proportional to my responsibilities but when my stomach is in twists at night it feels a lot more like anxiety. As I understand it if it is constant anxiety I need medication or therapy but if it is just too much stress I need to focus on eliminating stress right? I think it is stress but I am not sure because if it is just stress why has the way I feel not changed even though I have become much better at my job? Should I see a psychologist?

David Johnson Says...:

You have asked a lot of questions! I'll answer them one at a time, starting with the most important.

You are wondering if you need treatment for your anxiety. Intense anxiety all the time is not healthy. Unresolved, high anxiety will do considerable damage to your body over time. The first choice for treatment of any mental health issue is to see a licensed mental health professional. I would suggest a clinic with a multidisciplinary team including psychiatry is a good choice for a first time encounter. The problem you describe is probably more complicated than you might expect in that your issue is likely not as simple as job stress. A good assessment and some counseling might be all you need. Then if needed, the therapist will refer you to a psychiatrist.

Generally treatment of anxiety by therapy is pretty effective. Medications specifically for anxiety do not provide a long term solution. Benzodiazapines, the most effective medications in the short run, are addictive. They include Klonapin, Ativan, Xanax or Valium.  Even if you don't abuse the prescription, tolerance builds up and they become less effective without increasing the dose and thus increasing the risk of addiction. Worse, they train the brain to stop producing it's own chemical assistants for anxiety. In other words, benzos can make the problem worse over time.

So go see a psychotherapist and get started.

You have some creative definitions for anxiety and stress. Anxiety refers to the body's activation in the face of stress in the environment. Anxiety can be the result of many different situations and emotions. Fear, guilt, shame, anger to name just a few can result in anxiety, especially if you are unclear how you feel. Stress is anything in the environment that makes you feel anxiety. Worry, which can be described as thoughts stuck in your head spinning like a car in a rut, often results in anxiety about a future event. Regret is similar, but about past events.

I wish you luck in addressing your problem.

Question: I have a strong phobia of spiders and bugs. If one lands on me I will scream and panic….(I bug out! Haha…that’s my fallback phobia joke) I have 2 young children and I am clearly teaching them that bugs that a normal person would not consider dangerous are things to be deeply afraid of. I have given up hope of ever living normally with insects but I do not want to pass my problem on to my children. The challenge is that even though I say flies or beetles are not dangerous the way I react when I see one in the house teaches them the exact opposite. They are too young to understand phobias (they are 3 and 5). How can I safeguard them?

David Johnson Says...:

It's great that you recognize the power of your behavior and emotions with your children. However, I don't think that your fear needn't transmit to your children. Even young children are more astute emotionally that many adults assume. They feel everything. Feelings in many ways make more sense to them than abstract concepts.

It sounds like you are trying to keep your reactions at bay in front of them. Even if you react, that won't necessarily teach your children to do the same. Relax about it, share your foible with your children by being open about your initial startling fear and following embarrassment. They understand fear as a feeling and will recognize that you get afraid and then laugh. Then talk to them when you react, let them know that you believe that you have an irrational fear. They will learn an important lesson that what scares them needn't be that way forever. And they may laugh with you in adolescence telling stories about mom's reactions to spiders.

Question: I started to feel really stressed out a couple of weeks before Christmas. I get really anxious about spending time with my family. I got through it Ok but I still feel really stressed and worried all the time. I feel like I am scared of something all the time but I don’t know what I am scared is going to happen. Should I be worried that this feeling is not going away even though I am back in my own place again now?

David Johnson Says...:

You don't provide a lot of detail, but I notice you seem to leave out some details. I'm going to assume you believe you have a difficult problem to face, one that you're reluctant to talk about.
Planning is a critical skill for a successful life, and key to personal growth. However, planning can easily become excessive worry. If you believe regular worry helps, you can get lost in the intensely negative feelings, effectively spinning your wheels. This can be destructive to self-esteem and self-confidence and interfere with your ability to carry out your plans.
Some people are more prone to worry than others. But everyone can develop a self-destructive habit of excessive worry. The purpose of worry is to alert you to risks in upcoming events. But once you are aware of that risk, the distraction of the emotion can interfere with planning, or worse, can lead a person to believe that planning is a never ending process. Chronic worriers at some level believe worry is the only way to minimize the risk of things going wrong. This is not true. Worry can exhaust your resources and make you less prepared to face difficult challenges. Self confidence is needed to clear your mind to be alert enough to face a major challenge with sufficient awareness to allow quick judgments about alternatives actions available. A chronic worrier facing this challenge can be much like a deer caught in the headlights of an on-coming car. Worry slows your reaction times and shuts down critical parts of the brain that allow quick rational judgments. Instead you react purely on emotion, the classic fight or flight response set, or worst freeze you in your tracks.
Understanding that worrying is a problem is the first step towards solving the problem. Next you must build self-confidence in your ability to respond and practice the skill of clearing your mind. This is something that will take time for many. Some people may be able to make the shift by recognizing the futility and self-destructive nature of worry. Others may need to practice regularly to build a new skill. A mindfulness practice can be very useful with a significant commitment of time to build a new skill of clearing the mind and refocusing on the task at hand. (More on mindfulness.)
If this feels like an impossible task, you should see a counselor for help. You may have to learn anxiety management skills and build self-confidence with the help of a counselor. Then if there are circumstance here you are reluctant to talk about, that is where you need to share it. Keeping secrets when you need help can prevent successful coping.

Question: Would you recommend EFT? I have problems with anxiety and phobias and I often self medicated with alcohol and valium as a way to deal with my anxiety. I am interested in the way EFT seems to cure people of their anxieties quite quickly because I have not had much luck with CBT. It sounds a little weird though and I am not sure if I should take it seriously or not.

David Johnson Says...:

I have no experience or knowledge of Emotional Freedom Technique. My experience with any sort of quick fix is that it may work for minor symptoms or for reasons unrelated to the technique itself. Quick fixes like alcohol and Valium can lead to addiction and a worsening anxiety problem. Your lack of success with CBT is familiar. In my experience, CBT is effective with limited symptoms in otherwise healthy people. Most CBT practitioners are focused on "thoughts over behavior" interventions. Anyone who has tried to succeed at New Years resolutions knows that promises, positive thoughts, intent to break old habits is seldom successful. A recent survey found eighty percent New Years resolutions were unsuccessful.

There is no replacement for hard work. Emotional problems require emotional work. See a therapist who is skilled in interpersonal, emotion focused and/or psycho-dynamic therapy. Such therapists are more interested in better understanding you and helping you master your life and so are more flexible in their approach.

I'm very suspicious of a technique claims to remove negative emotions. We have negative emotions because they are important for survival. Without negative emotions you may be handicapped from protecting yourself and making good judgments.

EFT seems to be based on tapping parts of the body while receiving positive affirmations. Repetitive self-affirmations are likely just as effective. Humans have been impressed by magical cures for thousands of years by shamans and Witch Doctors. Part of what works about therapy is that the therapist and the client believes in what they are doing. If the treatment seems magical, beyond logic, or an intuitive fit,  I think that's a good reason to look somewhere else.