 A co-dependent person works so hard to control and fix someone else that his/her own life is in turmoil as a result. Because we are powerless over other people, no one can really control anyone else, and others’ troubles are mostly due to patterns only they can change, a codependent person is in for one painful disappointment after another.
The term powerless does not mean helpless. Up until now you have been powerless over your thoughts, feelings and actions and have led you to believe that your needs should be sacrificed for others, regardless of the consequences. Co-dependency creates stress and leads to painful emotions. Shame and low self-esteem all blend together to create anxiety and fear about being judged, rejected or abandoned; making mistakes; being a failure; feeling trapped by being too close to another person or being alone. Very often the codependent’s self-esteem and self-worth comes from sacrificing themselves for their partner and their partner will gladly accept their sacrifice. Signs of codependency may include:
Below are twenty questions I have created for my clients to help provide them with an understanding of their codependent relationships and the impact of their on themselves and their partner. If you believe you struggle with codependence, thoughtfully answer the questions below and if you are currently working with a therapist, process your answers with your therapist. Codependence Questions
 Most depression drugs work by changing the balance of brain chemicals called neurotransmitters, which affect your mood. They include serotonin, noradrenaline, and norepinephrine. Your primary care doctor can prescribe antidepressants. But if your symptoms are severe, they’ll refer you to a psychiatrist. That’s a doctor who specializes in mental health. Medication can help with depression symptoms, but it doesn’t always treat the causes of your depression.
Different classes of antidepressants work on different brain chemicals. Tricyclics (TCAs) and serotonin norepinephrine reuptake inhibitors (SNRIs) raise serotonin and norepinephrine levels in your brain. Selective serotonin reuptake inhibitors (SSRIs) raise serotonin. Monoamine oxidase inhibitors (MAOIs) stop monoamine neurotransmitters from breaking down. Talk to your doctor if your symptoms haven’t improved after 3 months. You may need a stronger dose or a different antidepressant. Many people don’t get relief from the first antidepressant they try. Also, depression meds may stop working in a small number of people who’ve been taking them for a while. If this happens to you, your doctor can help. Work together to find the treatment that’s right for you. It may take time. The FDA says the generic drugs it approves are as effective as the brand-name versions. Both types have the same active ingredient. Ask your doctor if you can take the generic form of a drug. It may cost less than the brand-name version. You may be tempted to quit taking your medicine even though it’s working well. Or you might think about stopping because the dosing schedule is inconvenient, or because there are unpleasant side effects. Also, some people with depression don’t improve with antidepressants and must explore other treatment options. If newer antidepressants don’t work, your doctor may prescribe cyclic antidepressants. These were some of the first antidepressants made. They raise serotonin and norepinephrine levels in your brain. Keep taking your antidepressants for as long as your doctor says so (usually at least 6 months). Do this even if you feel better sooner, or your depression could return. Don’t be shy in telling your doctor about any side effects. There are often ways to manage them. For example, taking your antidepressant with food can help nausea. If you’re having sexual problems, your doctor may change your medicine or add another one. If you feel fatigued, try taking your medicine 1 to 2 hours before bedtime. If the antidepressant causes insomnia, take it in the morning. Many side effects go away on their own after a few weeks. The antidepressants used most often today have fewer side effects and drug interactions than older versions. Still, any antidepressant can interact with other medications. Let your doctor know about any new prescription drug, over-the-counter medicine, or dietary supplement you plan to take. These could affect how your depression medication works. It’s important to keep going to all your doctor appointments while you’re on antidepressants. It’s common for depression to come back. That’s called a relapse. Your doctor may change the dose -- or prescribe a new medication -- if your symptoms return. Be sure to tell your doctor about any major changes in your life, such as losing a job, developing another medical condition, or becoming pregnant. Your medication may make you feel jumpy or nervous. Exercise can help. Try a relaxing workout like yoga, or deep breathing exercises. Your doctor can switch you to a different antidepressant if that doesn’t help. Some people worry antidepressants will turn them into a “robot.” The fact is, antidepressants can ease feelings of sadness, but they don’t get rid of your emotions. Another myth is that you’ll need to take the drugs for life. A typical course of antidepressants lasts 6 to 12 months in people who’ve had only a single episode of major depression. But you may need treatment longer if you’ve had multiple episodes of depression in your life. Also, if you’ve heard antidepressants are physically addictive, that’s not true. Still, you could have unpleasant symptoms if you stop taking them suddenly. Studies show “talk” therapy and antidepressants are often the most effective way to treat depression. Types of therapy include cognitive behavioral therapy, which focuses on changing negative thoughts and behaviors, and interpersonal therapy, which focuses on your relationships with others. Exercise releases endorphins, chemicals linked to improved mood and lower rates of depression. Several studies suggest regular exercise is an effective treatment for mild to moderate depression. Group workouts or exercising with a partner may also be helpful. Your doctor will help you figure out the right time to stop your antidepressants. Quitting suddenly can cause unpleasant side effects or even a relapse. You could go into withdrawal for up to 2 weeks. You might be dizzy, nauseous, tired, or have headaches. Or you might get vertigo, which is when you feel like you or things around you are moving. Your depression symptoms may come back, too. Work with your doctor to slowly stop taking your medicine.  Rarely does a person emerge from childhood completely unscathed. Most of us learn to protect ourselves with defense mechanisms and personality traits that ensure our safety in the world. By adopting certain behavioral patterns, we unconsciously or consciously seek security and stability. We wear different kinds of masks to keep us from getting too hurt. However, in doing so, we close ourselves off from authentic relationships and stay stuck in the scabs of our childhood wounds.
By identifying our protective shields, we can begin to heal from past hurts and enjoy deeper intimacy with our loved ones. While our coping strategies are as varied as our personalities, here are ten of the most typical masks we wear. Ask yourself: Which mask do you wear? The Cool Guy By all outward appearances, this person seems to have mastered whatever it takes to stay calm in all situations. Unrattled by conflict or chaos, this person possesses the composure of a Zen Master. However, beneath the surface, one of two things happen. His bottled-up emotions either result in a nervous breakdown, or he periodically presses the release valve when no one is around, snapping at folks subordinate to him. He lambasts the waiter for forgetting his coffee or fires off a nasty email to his assistant for a small error. The Humorist Humor is a brilliant defense mechanism. I use it myself. If you’re laughing, you’re not crying, even though they can look the same. That said, it can and does prevent intimacy. Sarcasm, especially, tends to be rooted in pain and is not without consequences. The humorist tells a joke to skirt sincere discussions, to keep conversations from getting too real or deep. Uncomfortable with conflict, he will charm his way out of confrontation. His comedy serves as protective shield. As such, he doesn’t allow anyone in, and is lonely. The Overachiever Some people unconsciously pursue perfectionism as a defense against annihilation. If everything is done right, then their world can’t fall apart. While the accolades and praise associated with being a perfectionist may provide some temporary relief, the perfectionist is always at the mercy of something going wrong, and therefore lives in a constant state of anxiety. Her stubbornness, obsessiveness, and lack of trust build a barrier between her and her loved ones. The Martyr Most of us know a martyr, a person who boasts that she has single-handedly saved the world with her selfless actions. While martyrs can bring families together with compassion, their exaggeration of sacrifices drives loved ones away. The drama with which they do good serves as a protective shield from the very people who they are helping. The martyr secures her place in the world by believing her role is critical, all the while making everyone uncomfortable around her. The Bully Every environment in which we work and play is a 5th grade schoolyard with its shares of bullies. Their assertion of control can be subtle, a gentle manipulation to make you see it their way, or can be aggressive, even physical. While bullies appear to be confident in their forceful delivery of opinions and order, they are innately insecure. They want so badly to be respected that they will break the rules of appropriate conduct to get that esteem. Self-doubt drives their hostile behavior; an obsessive need to feel right that comes at the expense of others’ rights and feelings. The Control Freak The control freak uses order and power to achieve a sense of security. By making sure everything is in its proper place, he relieves his fear of the unknown, of ambiguity, of uncertainty. A mother hen, the control freak won’t let anyone out of her sight, and assumes responsibility for all those around her, even when they don’t want to be cared for. He becomes unraveled when anyone deviates from the plan. The Self-Basher Suffering from a chronic case of unworthiness and insecurity, the self-basher projects a negative view of herself to others. Perhaps unconsciously, she believes that she can insulate herself from hurt by hurting herself first. She, then, berates herself and insults herself as a protective measure against any potential zingers coming her way. Self-deprecation becomes a defense mechanism with which she avoids any risk of intimacy. The People-Pleaser The people-pleaser will go to desperate lengths to win the approval of those around her, because her sense of identity is largely based on the assessment of others. Her values often vacillate depending on the input of the day because she looks to outside sources to validate who she is. This mask-type solicits the advice of friends, doctors, experts, co-workers, and mentors because she lacks a strong foundation. Easily influenced by others, decisions are especially difficult for her. The Introvert The timid person or introvert is deathly afraid of failure and rejection. He would much rather feel the pangs of loneliness than risk not being liked. Like the perfectionist, he is so afraid of making a mistake that he refuses to challenge himself. He blushes easily, is embarrassed easily, and doesn’t say much for fear of saying the wrong thing. The Social Butterfly Although the life of the party, the social butterfly is innately lonely. They compensates for feelings of insecurity with their gift of gab and small talk. They have many acquaintances but few, if any, real friends. Although their calendar is packed full of social events, but their life lacks meaning. They keep their conversations superficial because deeper dialogues may expose their anxiety or shed their confident persona.  Although it may feel like you’re the only one with this problem, social anxiety is actually quite common. Many people struggle with these fears. But the situations that trigger the symptoms of social anxiety disorder can be different.
Some people experience anxiety in most social situations. For others, anxiety is connected to specific social situations, such as speaking to strangers, mingling at parties, or performing in front of an audience. Common social anxiety triggers include:
Signs and symptoms of social anxiety disorder Just because you occasionally get nervous in social situations doesn’t mean you have social anxiety disorder or social phobia. Many people feel shy or self-conscious on occasion, yet it doesn’t get in the way of their everyday functioning. Social anxiety disorder, on the other hand, does interfere with your normal routine and causes tremendous distress. For example, it’s perfectly normal to get the jitters before giving a speech. But if you have social anxiety, you might worry for weeks ahead of time, call in sick to get out of it, or start shaking so bad during the speech that you can hardly speak. Emotional signs and symptoms of social anxiety disorder:
Physical signs and symptoms:
Behavioral signs and symptoms:
Social anxiety disorder in children: There’s nothing abnormal about a child being shy, but children with social anxiety disorder experience extreme distress over everyday situations such as playing with other kids, reading in class, speaking to adults, or taking tests. Often, children with social phobia don’t even want to go to school. How to overcome social anxiety disorder tip 1: Challenge negative thoughts While it may seem like there’s nothing you can do about the symptoms of social anxiety disorder or social phobia, in reality, there are many things that can help. The first step is challenging your mentality. Social anxiety sufferers have negative thoughts and beliefs that contribute to their fears and anxiety. These can include thoughts such as:
Tip 1: Identify the automatic negative thoughts that underlie your fear of social situations. For example, if you’re worried about an upcoming work presentation, the underlying negative thought might be: “I’m going to blow it. Everyone will think I’m completely incompetent.” Analyze and challenge these thoughts. It helps to ask yourself questions about the negative thoughts: “Do I know for sure that I’m going to blow the presentation?” or “Even if I’m nervous, will people necessarily think I’m incompetent?” Through this logical evaluation of your negative thoughts, you can gradually replace them with more realistic and positive ways of looking at social situations that trigger your anxiety. It can be incredibly scary to think about why you feel and think the way you do, but understanding the reasons for your anxieties will help lessen their negative impact on your life. Unhelpful thinking styles that fuel social anxiety. Ask yourself if you’re engaging in any of the following unhelpful thinking styles:
Tip 2: Focus on others, not yourself When we’re in a social situation that makes us nervous, many of us tend to get caught up in our anxious thoughts and feelings. You may be convinced that everyone is looking at you and judging you. Your focus is on your bodily sensations, hoping that by paying extra close attention you can better control them. But this excessive self-focus just makes you more aware of how nervous you’re feeling, triggering even more anxiety! It also prevents you from fully concentrating on the conversations around you or the performance you’re giving. Switching from an internal to an external focus can go a long way toward reducing social anxiety. This is easier said than done, but you can’t pay attention to two things at once. The more you concentrate on what’s happening around you, the less you’ll be affected by anxiety. Focus your attention on other people—but not on what they’re thinking of you! Instead, do your best to engage them and make a genuine connection. Remember that anxiety isn’t as visible as you think. And even if someone notices that you’re nervous, that doesn’t mean they’ll think badly of you. Chances are other people are feeling just as nervous as you—or have done in the past. Really listen to what is being said—not to your own negative thoughts. Focus on the present moment, rather than worrying about what you’re going to say or beating yourself up for a flub that’s already passed. Release the pressure to be perfect. Instead, focus on being genuine and attentive—qualities that other people will appreciate. Tip 3: Learn to control your breathing Many changes happen in your body when you become anxious. One of the first changes is that you begin to breathe quickly. Overbreathing (hyperventilation) throws off the balance of oxygen and carbon dioxide in your body—leading to more physical symptoms of anxiety, such as dizziness, a feeling of suffocation, increased heart rate, and muscle tension. Learning to slow your breathing down can help bring your physical symptoms of anxiety back under control. Practicing the following breathing exercise will help you stay calm:
Tip 4: Face your fears One of the most helpful things you can do to overcome social anxiety is to face the social situations you fear rather than avoid them. Avoidance keeps social anxiety disorder going. While avoiding nerve-wracking situations may help you feel better in the short term, it prevents you from becoming more comfortable in social situations and learning how to cope in the long term. In fact, the more you avoid a feared social situation, the more frightening it becomes. Avoidance can also prevent you from doing things you’d like to do or reaching certain goals. For example, a fear of speaking up may prevent you from sharing your ideas at work, standing out in the classroom, or making new friends. While it may seem impossible to overcome a feared social situation, you can do it by taking it one small step at a time. The key is to start with a situation that you can handle and gradually work your way up to more challenging situations, building your confidence and coping skills as you move up the “anxiety ladder.” For example, if socializing with strangers makes you anxious, you might start by accompanying an outgoing friend to a party. Once you’re comfortable with that step, you might try introducing yourself to one new person, and so on. To work your way up a social anxiety ladder: Don’t try to face your biggest fear right away. It’s never a good idea to move too fast, take on too much, or force things. This may backfire and reinforce your anxiety. Be patient. Overcoming social anxiety takes time and practice. It’s a gradual step-by-step progress. Use the skills you’ve learned to stay calm, such as focusing on your breathing and challenging negative assumptions. Socially interacting with co-workers: A sample anxiety ladder: Step 1: Say “hi” to students and other students. Step 2: Ask students questions about how to complete tasks at work. Step 3: Ask a students what they did on the weekend. Step 4: Sit in the staff room during coffee break. Step 5: Eat lunch in the staff room. Step 6: Eat lunch in the staff room and make small talk with coworkers (e.g., talk about the weather, sports, current events, etc.) Step 7: Ask a co-worker to go for coffee after work. Step 8: Go out for lunch with a group of co-workers. Step 9: Share personal information about yourself with co-workers. Step 10: Attend a staff party. Tip 5: Make an effort to be more social: Actively seeking out supportive social environments is another effective way of challenging your fears and overcoming social anxiety. The following suggestions are good ways to start interacting with others in positive ways: Take a social skills class or an assertiveness training class: These classes are often offered at local adult education centers or community colleges. Volunteer doing something you enjoy: Perhaps walking a dog in a shelter, or working at your local food bank—anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people. Work on your communication skills: Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help. You can make friends even if you’re shy or socially awkward. No matter how awkward or nervous you feel in the company of others, you can learn to silence self-critical thoughts, boost your self-esteem, and become more confident and secure in your interactions with others. You don’t have to change your personality. By simply learning new skills and adopting a different outlook you can overcome your fears and anxiety and build rewarding friendships. Tip 6: Adopt an anti-anxiety lifestyle The mind and the body are intrinsically linked—and more and more evidence suggests that how you treat your body can have a significant effect on your anxiety levels, your ability to manage anxiety symptoms, and your overall self-confidence. While lifestyle changes alone aren’t enough to overcome social phobia or social anxiety disorder, they can support your overall treatment progress. The following lifestyle tips will help you reduce your overall anxiety levels and set the stage for successful treatment. Avoid or limit caffeine – Coffee, tea, soda, and energy drinks act as stimulants that increase anxiety symptoms. Consider cutting out caffeine entirely, or keeping your intake low and limited to the morning. Get active – Make physical activity a priority—30 minutes per day if possible. If you hate to exercise, try pairing it with something you do enjoy, such as window shopping while walking laps around the mall or dancing to your favorite music. Add more omega-3 fats to your diet – Omega-3 fatty acids support brain health and can improve your mood, outlook, and ability to handle anxiety. The best sources are fatty fish (salmon, herring, mackerel, anchovies, sardines), seaweed, flaxseed, and walnuts. Drink only in moderation – You may be tempted to drink before a social situation to calm your nerves, but alcohol increases your risk of having an anxiety attack. Quit smoking – Nicotine is a powerful stimulant. Contrary to popular belief, smoking leads to higher, not lower, levels of anxiety. If you need help kicking the habit, see: How to Quit Smoking. Get enough quality sleep – When you’re sleep deprived, you’re more vulnerable to anxiety. Being well rested will help you stay calm in social situations. Social anxiety disorder treatment If you’ve tried the self-help techniques above and you’re still struggling with disabling social anxiety, you may need professional help as well. Therapy for social anxiety Of all the professional treatments available, cognitive-behavioral therapy (CBT) has been shown to work best for treating social anxiety disorder. CBT is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better. CBT for social phobia may involve: Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises. Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views. Facing the social situations you fear in a gradual, systematic way, rather than avoiding them. While you can learn and practice these exercises on your own, if you’ve had trouble with self-help, you may benefit from the extra support and guidance a therapist brings. Role-playing, social skills training, and other CBT techniques, often as part of a therapy group. Group therapy uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you’re afraid of, you will become more and more comfortable, and your anxiety will lessen. Medication for social anxiety disorder Medication is sometimes used to relieve the symptoms of social anxiety, but it’s not a cure. Medication is considered most helpful when used in addition to therapy and self-help techniques that address the root cause of your social anxiety disorder. Three types of medication are used in the treatment of social anxiety: Beta blockers are used for relieving performance anxiety. While they don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat. Antidepressants: Zoloft may be helpful when social anxiety disorder is severe and debilitating. Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so are typically prescribed only when other medications have not worked.  If you find you’re drinking more alcohol during the COVID-19 pandemic or starting to drink alone, you’re—well, not alone. Maybe you used to drink only occasionally, but now it feels like there’s permission to make drinking a daily ritual.
Working from home makes it even easier to turn to alcohol in the evening (or earlier). Why not have a drink (or three) every night when you don’t have to get up early to make yourself presentable and get to work on time? Pouring a drink can be especially appealing after a stressful day, which is pretty much every day now. But what if you’re not entirely comfortable with your recent pattern of alcohol use, and part of you worries it might become a real issue? Even if you’ve never had a problem with drinking, you might be concerned about the long-term effects, and whether you’ll be able to step away from this higher level of consumption once the pandemic is behind us. If you suspect your relationship with alcohol is moving in an unhealthy direction, don’t be hard on yourself. Turning to familiar ways of coping is a common and understandable response to this bewildering situation. As you’re assessing your relationship with alcohol, look for the following warning signs that your drinking may be going too far:
So how to avoid developing a serious problem with alcohol? The only surefire approach is to avoid drinking altogether, but the following recommendations can lower the risk. In general, these preventive measures are the flip side of the risk factors.
If you’re wondering whether to change your drinking behavior, take care to ask yourself the right question. Most commonly we’ll ask ourselves if we’re “addicted” or if we’re “an alcoholic,” but those questions are usually too black-or-white to offer meaningful answers. The better question is, "Is the way I’m drinking a net positive in my life?" If not, talk with a qualified substance abuse psychotherapist or someone you love and trust about the concerns you have. Explore with them whether it’s time to change your relationship with alcohol, and how they might support you along the way.  Fight-or-flight is the instinctive physiological response to an external threat. It is a reaction that no doubt has early evolutionary roots. When fight or flight kicks in, the brain does not take time to weigh the circumstances, because a very quick response can mean survival. Of course, this lack of reflection means that in many cases, the body is overreacting. With experience, most of us learn to quickly recover from the first flush of fight or flight and find an appropriate response. It is a balance.
Fight or flight, or something akin to it, can also come about when a person experiences sharp, chronic romantic trauma. Those who have had relationships in which they were emotionally abused, physically or sexually threatened, or assaulted understandably may have developed an acute sensitivity to the cues that preceded these events. Even if they have managed to extricate themselves from a bad relationship, they may retain the learned impulse to react without reflection to any hint of a repeat. As a result, the distress they experienced in bad relationships now gets triggered, inappropriately, in new situations with other people. If this describes you, you may in the moment feel a dreadful sense of deja vu and react negatively. While it may feel like the exact same situation, as you reflect later, you recognize that it was not the same situation at all. This often makes people feel ashamed or guilty for mistreating a current, healthier partner. Here are some ways to assess if your past romantic trauma is being triggered in your current relationship — and how to start processing the original trauma: If you suffered a betrayal through cheating in your past romantic relationship you may find yourself thinking that your current boyfriend is fooling around behind your back, whether it is flirting or cheating. Do not allow yourself to engage in making assumptions. Ask yourself how well do you know this person and is this something he or she would do? Take a step back and work through the hurt you suffered in your last relationship. Consider talking to your new partner about how you were betrayed and what you need to feel safe in your current relationship. Talk with him/her about how you are working on not letting this old experience taint your new one. If your past partner was controlling or domineering, you'll likely become triggered when a partner tells you what to do, how to feel, or how to act. Your new partner may not actually be trying to control you, but merely expressing an opinion. Nonetheless, the triggering may send you into flight or fight. You may tune out while they are talking, ignore them, or appear paralyzed. Instead, try to communicate with your partner about what you're noticing about yourself and how loaded the idea of control is for you. Instead of blaming, see if you can understand where your partner is coming from and if they will consider ways to communicate opinions and desires that feel less threatening to you and are less likely to trigger an overreaction. If you suffered emotional abuse in past relationships, it would not be unusual for conflict in a new relationship to trigger an overreaction. Your current partner may just be expressing normal feelings that need to get out, but for you, it feels as if the walls are caving in. You may panic or live in a state of fear about upsetting your partner. The possibility of an argument paralyzes you. Instead, work on noticing how your partner is communicating upset to you; instead of assuming it’s the same old thing, look for differences: Is he or she more sensitive to you, or are they still able to see the good in you even when upset with you? Remind yourself that all couples have conflict, and even if someone is upset, you can work things through without it becoming a crisis. If you suffered physical or sexual abuse in past relationships, you may be susceptible to having negative emotions triggered by physical closeness or touch. If your past partner hurt you physically or made you feel as if you were physically disgusting or had no worth, then sexual interactions may become emotionally painful. Many in this situation leave an encounter by disconnecting and tuning out. Before entering a new romantic relationship, consider that your body and brain need time to heal to feel safe again. It is unrealistic to go from physical mistreatment to feeling safe while being physically vulnerable with a new partner. Take a break, talk to a therapist to help you work through the trauma. Do not force yourself to engage physically: If you are not fully on board, each new sexual experience will only add to that original trauma. |
Thom KesslerMarriage & Family Therapist and Registered Addiction Specialist Archives
October 2022
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