Some words this morning on health anxiety, aka, the great "what if!" disorder. This is one of the most common withdrawal symptoms and one of the most stubborn. As I often say, fear is like a river. It needs somewhere to flow. Coming off benzos is like breaking the dam. The water rushes down, usually forging new pathways to flow.
This is further complicated by the nervous system's desire to make sense of everything. It tries to identify the danger the fear should and normally would be signaling. However, coming off benzos imitates real danger but doesn't put us in actual danger. Not in the sense of a real bear attack. But it hacks the brain and sends a powerful message of imminent danger. The limbic system responds accordingly. Massive fear is produced, and the amygdala searches for signs of danger.
Now, this is where it can get tricky. There are no bears outside of our horrid withdrawal symptoms. So, what does the brain do? That's right, it latches onto the symptoms. It says, "Pay extra special attention to that symptom (bear) and anything around it."
Remember, the limbic system doesn't just look for some single source of danger. It searches for any trace of it. Hence, if you get stuck on a bridge in a near-death experience, not only can the bridge become associated with danger, but so can the car, the color shirt you’re wearing, and even what's on the radio at the time of the distress. Perhaps it's a song you were listening to. After the experience, that song may give you anxiety. This is how it often works.
So, there you are with withdrawal symptoms, bizarre and concerning. The limbic system becomes wildly vulnerable and primed to search for danger (and respond to danger), and I mean profoundly so like nothing you've likely ever experienced before. It hooks into a particular symptom, and then all your senses and nerves become incredibly sensitive, trying to read this condition and gather more and more information on it, which could help save your life.
As this process continues, the fear grows, the sensitivities grow, and the symptoms increase, producing more fear and creating more sensitivities, further developing the symptom. Round and round we go.
You rush to the hospital (safety), and your limbic system notices. It says, "Ah, great work! You see, I thought you were in serious danger, so I've been hitting you full of life-saving chemicals (fear response), and you were able to run to safety and survive the danger! Great. I'll be keeping an even more watchful eye on this moving forward!"
It's as if your amygdala says, "You're welcome!"
Of course, this only makes us feel more fear and more symptoms, and we are tempted by instinct to have more of a protective or defensive evasive response. Again, this only further strengthens the process here. I hope this is becoming clear to you by this point. So, what happens next? The cycle strengthens, like a hurricane gathering more and more wind. It spins harder, faster, and with more strength.
This is how health anxiety pulls us into its vortex, and the entire time, it isn't just "fear" messing with our minds. It's what fear communicates. Fear doesn't just communicate "danger.” No, that's too simple. Fear communicates, "approaching danger!" In other words, something terrible is about to happen or is in the process of happening. It's always the feeling that something seriously wrong is happening, and everyone trying to calm our nerves has missed it! They don't get it! They can't see or smell the bear the way we can! The doctors have missed it! The tests have missed it!
Well, that is precisely true. However, it's a false alarm.
Say it with me, "It's a false alarm."
Indeed, they cannot hear the alarm the way you can, but that doesn't make your alarm accurate. At some point, it's a false alarm, a self-perpetuated false alarm. Sure, it was triggered by withdrawal, but our own fear responses are perpetuating it. Each time we check our pulse, blood pressure, and O2 levels, it strengthens. Each time we ask for reassurance, ruminate, or engage in symptom talk, it strengthens. Each time we avoid something we want to do, feel, taste, etc., it strengthens. Each time we run to the hospital, call the doctor, or get tests, we feed the bears, and things strengthen. Any attention we give it, especially in response to fear, can feed the bear and keep health anxiety alive.
One of the toughest challenges I have as a therapist and benzo coach who specializes in health anxiety is first convincing my clients that they even have health anxiety. I’ve had people become angry with me and even shout at me. They’ve stopped working with me and have even left my school because they didn’t think I understood them. Usually, after some months, they return and apologize, finally realizing the truth. But by then, they’ve usually wasted a lot of money on needless tests, doctor visits, and ER trips, and now their health anxiety is even stronger and more stubborn than before.
Further, health anxiety can fester over a specific symptom or set of symptoms. Things can progress into full-blown somatic symptoms, psychogenic (nocebo effect). At this point, treating the health anxiety is incredibly tough because the fear response and feeling that “something horrible is wrong” is so strong and now so woven into the fabric of their symptoms that it’s just too tough for them to separate themselves from it.
In other words, the lies that health anxiety tells us have become too loud and too convincing to hear any other rational voice. This is the nature of the beast, but it can be undone. We can reverse-engineer things and retrain the limbic system to understand that it is safe again. In my next blog, I will expand on this and how we can start right now to correct this problem and get rid of our health anxiety and the related persisting symptomology.
Commentaires