This is a post I’ve been meaning to write for a while (I started a draft on World Mental Health Day, October of last year!), but in either looking back at 2023 or looking forward to 2024, now seems like the right time to finally sit down and finish it.

What was up with 2023?

Let’s go back one year further: In 2022 I started feeling anxiety more often and to a greater extent. I should be clear, this didn’t start in 2022. My anxiety has ebbed and flowed since I was a teenager, and I’ve dealt with it successfully (or unsuccessfully) since then. Late in 2022 I had a few panic attacks. In 2023 these didn’t magically get better, instead I started having more intense panic attacks with greater frequency.

… define a “panic attack’

A panic attack, for me, is like my brain doing this:

And once I’m in panic mode, I generally feel like I’ve lost control of my body, which could mean feeling like I’m going to die, or pass out, or throw up, or all three. It is a real hoot, let me tell you. It usually starts quickly but then it can last for minutes or… sometimes hours. And unsurprisingly once I’ve had one, my body goes into full

mode. Which means one panic attack is usually followed by another, and another, and… you get the idea.

Well that sounds awful

It is! But 2023 saw both sides of anxiety: having it, but also dealing with it.

How do you deal with anxiety?

Before I go further, let me say this: I’m not a doctor, psychologist, or therapist. I’m also not a dog, nor is this generated by AI, which is to say this is my experience and hopefully someone else finds it and benefits from it in some way. I’m writing this in part because it’s helpful for me, but also because there’s surprisingly few things out there written by men about dealing with anxiety that don’t fall into the bucket of:

• I threw away everything in my life and hiked across the country to live on an alpaca farm and find my inner peace.
• or: every day I think about the stoics of the Roman Empire and how they would deal with stress.

If that works for you, great! Who doesn’t love alpacas and togas. Or togas made of alpaca wool, if that’s where you end up. But these are some more practical things that work for me, with notes on the pros and cons, presented as they were presented to me.

Exercise! Get on your feet, get up and make it happen.

In general I’m very pro-exercise, I do some sort of workout almost every day. It certainly helps me with anxiety by two mechanisms:

• It makes me much more aware of my body and how it responds to real physical stress.
• It gives me the sensation of an elevated heart rate in a controlled environment. If I need to back off, I can.

So when doesn’t it help? While it can keep my overall anxiety levels down, mixing physical stress with anxiety I haven’t dealt with can sometimes be a terrible combo. I’ve had some miserable panic attacks while mountain biking. I simply wasn’t present with the activity I was doing (which I usually enjoy!) and instead trapped in the anxiety loop illustrated above. And when your brain starts firing off all the ”oh shit oh no” chemicals just to find your body is halfway there already, well, it’s not a great mix.

Have you tried [insert app name here] for meditation?

There is a very real physical thing that happens during a panic attack where your breathing goes out of control. The whole “breathe into a bag” trope is… somewhat true, in that it’s asking you to focus your breathing on one specific action, and to take deep breaths. Which is all good for dealing with a panic attack, but part of my change in thinking in 2023 was that ideally we’d not have panic attacks at all, right?

As far as meditation goes, imagine the same “anxiety loop” gif above but every once in a while one of the anxious thoughts dissolves to nothingness. I think I’d have to run off to the alpaca farm to have few enough thoughts for that to work reliably.

Just relax! Just do it! Do it now! RELAX!!!

Personally there are times where I have to acknowledge there’s too much bandwidth in the brain pipeline, and cut some things out. If I can. Sometimes it’s hard when those things are anxious thoughts along with like, a job, a family, operating heavy machinery, etc.

Also, it is never a helpful thing to say “take a vacation!” or “take a break!” or “just relax!” to someone dealing with anxiety, because the anxiety is not going to magically stay at home while you’re laying on the beach.

Talk to somebody.

There’s value in talking about anxiety beyond just therapy. It’s part of why I’m writing this blog post. Talking about anxiety to everyone or anyone can be hard, though. If someone at work asks how you’re doing and you reply:

once, ok sure, we all have bad days. If you do it often (or, uh, constantly), let’s be honest, this probably isn’t in Bob’s personal or professional capacity to be able to deal with. Even a good friend or family member might get to a point of asking “ok, but allllllways?” Whereas with a good therapist you’re paying them (or if you’re lucky, insurance is paying them) to always have the patience to say, in this order:

• “I hear you”
• “your feelings are valid”
• “why do you feel that way?”

Over and over until a 💡 turns on in your brain.

New for 2023! The 💡 for me this year was understanding anxiety as not just a thing to get over, but a thing I live with that isn’t my fault, and if I had times where I responded or acted a way because I was anxious, that’s just who I am.

In the past I thought of anxiety more like a broken arm, something that could be fixed, when in reality it’s more like a missing arm. If you kept trying to do things with your missing arm instead of adapting to use the arm you did have, people would think you silly. But when your silly responses are in your head, no one else knows where they’re coming from! And also your brain is really great at convincing you to keep trying to use the missing arm, because with mental health it’s like your brain tricking itself? Hopefully this analogy was helpful. My brain wrote it, so it could be another trick.

We have drugs for this.

I’d had many, many panic attacks before a doctor finally recognized them and said “hey that’s probably terrible, at the very least take Ativan if one happens”. And that stuff works, for me, with relatively few side effects, but it’s a “break glass in case of emergency” solution, not an every day one. Which I thought was fine, until this year, when I finally put it together that anxiety was affecting me all the damn time.

New for 2023! I started taking an SSRI. This was suggested last time I started therapy, but I’d read so many bad things about them that I was hesitant. This time around I was much more in the “well what’s the worst that could happen” camp, so I started one, and it works. If I had to describe how my brain feels with them, take the gif of my brain from above and remove the anxiety loop. I might still have anxious thoughts, but they process and go away, giving me a lot more space to think about actually important things. As far as negative things for SSRIs go, I only have two notes:

• I put on some weight. This is less an effect of the drug itself, and more that since I no longer go through long periods of mentally and physically feeling like shit, I eat more regularly. I wouldn’t say it’s a bad thing, on the whole.
• For the first few weeks I still needed Ativan handy, because it’s quite common until the SSRI has fully taken effect to have “breakthrough” panic attacks. If a normal panic attack is anxiety building over time until it becomes unbearable, a breakthrough one is like you feeling pretty much fine then HELLO immediate panic attack. I’ll be honest — these were much worse than normal ones. I’ll use another terrible analogy: imagine being hit by a bus. I was used to seeing the bus coming, this was more like I had headphones in and the bus came from behind. But after a few weeks I stopped having panic attacks entirely, which is great!

Let me conclude by saying: 2023 wasn’t only anxiety. Lots of good things happened. Some bad things happened. Anxiety is always there, but in 2024 I’m hopeful that’s a thing I can acknowledge but never really think about, instead of the other way around.