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Daniel L. Dealing with fear of symptoms

P

Porpoise

Peer Supporter
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Question
I’ve been diagnosed with fibromyalgia and the way it mainly manifests in me is pain, fatigue and a kind of malaise some time after activity, especially walking. I don’t mean walking on a treadmill or for the purpose of exercise; I mean just any ordinary walking around in the course of living. Over the past year it’s become worse and before I discovered the concept of TMS I was on a downward spiral: more and more afraid to walk anywhere. I could only manage about 30 seconds at a time. This led to my being semi-disabled, although I still work four days a week.

Although I do occasionally find doubts creeping in, I am increasingly feeling more certain in my gut of the TMS diagnosis. And over the past couple of weeks, there have been subtle changes. I’m finding that I’m limiting my walking slightly less. I’ve been increasingly able to ‘float through’ the pain spikes and fatigue that follow a slight increase in my walking. The claws of fear are ever so slightly letting go. It's a great feeling! I'm starting to unlearn the pain and illness I had learned.

However, I’m very aware that the fear is still there. I’ve conditioned myself to believe that the more I walk, the more pain I’ll get, and I’m finding it really hard to really let go of that belief. The thing is that only small amounts of extra everyday walking (an extra trip to the printing machine at work, for instance) can bring on symptoms, and at times I still feel very anxious at the prospect of 'walking more'. Sometimes that fear is quite palpable - I can feel it viscerally. The fear is ‘ if I get so much more extra pain/fatigue/illness from only a little bit more walking than usual, what will happen if I do a lot?' Hopefully as I continue to learn to 'float through' pain and other symptoms, I will become more confident about doing more and more. I do continually remind myself that I can’t hurt myself and I remember that the pain that follows later is a strategy to keep me scared and feeling helpless, but the issue of ’to walk or not to walk’ comes up dozens of times a day. It’s so hard to be indifferent about it!

So my question is: I've made some progress, but how can I overcome this fear of walking, given that it restricts my life so much that it's hard to attain a genuine attitude of indifference to it? Any suggestions or advice will be gratefully received. Thanks for listening!

Porpoise
 
Answer
Porpoise (great name),

Thanks for the question. There are a few of things I’d like to address:

(1) Congratulations on the progress you’ve made! That’s amazing – and important to celebrate. I tell all of my clients to celebrate the victories (both small and large) because with each celebration we’re re-training the brain as to what feels good to us. Instead of having our unconscious take pleasure from anxiety we can teach it to take pleasure from our successes, which will in turn reduce the anxiety. So again, congrats! You’re doing it!

(2) Don’t let those doubts creep in – you’re impeding your own progress. Every time you get a doubt, see if you can let go of it. It may or may not be “legitimate” in your mind, but it doesn’t matter. Let go of the doubt and then be proud of yourself for not indulging in it! This is a big step towards recovery. Doubts (fear) cause anxiety - anxiety solidifies the pain.

(3) I’ve got a new challenge for you: See what you feel when you ask yourself ‘to walk or not to walk’. I have a feeling it’s probably fear. And you said that that you can feel your fear as it arises in you, so really pay attention to see if that’s what you’re feeling when you ask yourself that question. If so, then you’re only feeding into the fear. Every time you feed into that fear, you solidify an addiction to anxiety. The fear is about what could happen in the future, and anxiety lives in the future.

The next time you go for a long walk, chances are pretty good that your pain will come up and it will suck. So let’s just accept that. Asking yourself the question of “to walk or not to walk” BEFORE you go on the long walk means that not only will you be feeling pain but you’ll also be feeling the residual effects of fear! Yikes – sounds exhausting. But if you’re able to let yourself walk and not start out from a place of fear, then congratulations – that’s what we call success! You’re allowing yourself to live in the moment without self-punishing yourself with fear. Keep practicing this – it’ll take a while before your unconscious gets the message that you’re not afraid anymore. None of this is easy; in fact it’s quite difficult. But I have faith that you can do it, and you should have faith too. We’re here to make ourselves better, and while the road can be rocky, let’s have confidence that it’s leading us to where we want to go.

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

 
Hi Daniel,

Thanks so very much for your reply.

You are right: of course the 'walk or not?' question springs from fear. Since I wrote, I've continued to make progress in all sorts of small ways - still small, but noticeable. Fear/anxiety is still coming up (the longer the walk - very short by anyone else's standards, but long by mine - the more anxiety), but every time I 'just do it' and then deal with the symptoms with less distress, it builds up confidence and produces less anxiety for the next time.

Your advice has been extremely helpful and I just wanted to let you know how much I appreciate it. Your faith in the process and in me really does mean a lot.
 
Hi, porpoise. Daniel Lyman really does give you good advice, and you're doing the right thing.
Don't anticipate pain before going for a walk, no matter how short or long it is.
Even a short walk means you're conquering your fear of walking, and each time you do it,
you get better. It could be great if you could get someone to walk with you. That too builds confidence.

To be sure you won't trip and fall, walk "heel to toe." That's what a physical therapist told me when
I was recovering from a fall on some ice. It was the last bit of ice on the street and it found me. haha!
 
Hi Walt and Daniel,

It isn't just going for a walk that's a problem for me - it's also all the tiny amounts of incidental walking I do during the course of a day that add up. I've made a lot of progress here - I'm doing more and more incidental walking comprised of tiny amounts around the house and at work. I'm doing more around the house - washing and tidying up, for example, which I used to avoid. I'm becoming more and more confident about this kind of walking.

The big issue for me is any sustained walking beyond about a minute at a time, and I think it's worth pointing out that for some people like myself the issue is not only pain but what could be called a 'whole mindbody' reaction. So, when I need to walk more than I'm used to (say 2 minutes - a long walk for me), I can feel fine at the time, but the next day I not only have more pain than usual; I can feel quite unwell and tired and sometimes distressed. These reactions can linger for a few days and I used to find them debilitating, especially when they occurred on a working day.

What I find increasingly helpful when these symptoms occur is to 'float through' them, just as with pain. I acknowledge the unpleasant emotions and the pain, but try to avoid getting bound up in stories or judgements about them, such as 'Here we go again!', 'I feel so awful!', or 'If I feel so bad after such a tiny bit of walking, how will I ever have a normal life again?' etc, etc. I try to remain in the present by getting involved in something more interesting and/or by listening to relaxation tapes if I'm not at work. If I have to go to work when this response has kicked in, rather than stay home I allow work interests to absorb me and try to be gentle and compassionate with myself about it. I used to feel so distressed and sorry for myself - I've made a great deal of progress in this area!

It may be that for people whose TMS symptoms are more complex (such as people with fibromyalgia or CFS) progress is sometimes just going to be fairly slow. I don't have CFS but I do get the delayed fatigue/malaise response as well as pain so the fear/despair factor has been considerable. I can sometimes feel quite discouraged when I know that some people heal in a matter of days or weeks when my own progress is so slow, but I'm so extraordinarily grateful that I'm gradually unlearning my TMS responses - that I'm very slowly but noticeably reclaiming my life.

Thanks again for your advice, Walt. Sometimes walking with someone else isn't possible, because any and all casual walking, e.g walking from room to room, adds up and can provoke symptoms and therefore anxiety, but I'll try to walk with someone else whenever possible, as you suggest.

Thanks also for the suggestion about walking 'heel to toe'. In December 2012 I stumbled over my own feet at work, fell, and fractured my hip, so I will take your advice to heart! At the same time, I find that the more I can simply allow myself to walk naturally without thinking about it, the better. So I guess I need to be mindful of how I'm walking while still allowing it be natural and unself-conscious.

Thanks again both Daniel and Walt for your advice and encouragement!
 
Happy Sunday, Porpoise. I'm glad you like my suggestion to walk heel to toe. It does make us think about our walking,
but if practiced enough it can become routine. Sidewalks are often uneven and it's easy to stub a toe and trip.

Walk for one minute or two or as long as you can. It all adds up. And yes, we do tend to walk a lot in the house.
That's all to the good, too.
 
Sounds like you're heading in the right direction - and with Walts great advice continuing to improve! The biggest trick at this point, however, is to have confidence in yourself and be persistent. Healing takes time and can be a trying process, but I know that it can be done.

Remind yourself every single day of how proud you are of yourself for doing this work!
 
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