Anxiety and depression remission period

Don't force yourself to "catch up". A soft landing with residual symptoms is the key to reducing the risk of recurrence.

I received a visit from an Internet operator last year. When the attack first started, I couldn't even brush my teeth. I could only drink half a bowl of porridge every day for a week. I followed the doctor's instructions and took medicine and had a consultation once a week. After more than three months, I was able to go to work normally, and I could go camping with friends in the suburbs on weekends. At that time, he thought, "I'm completely cured." He stopped taking the medicine without consulting the doctor. He stayed up for two nights just in time for the big promotion of the project. A week later, he relapsed and couldn't even step out of the house. The symptoms were worse than the first attack.

Clinical statistics have clearly marked this pitfall: more than 60% of cases of recurrence of anxiety and depression occur in the first 6 months of first remission, and 80% of them are caused by privately cutting off medications or forcibly taking on stress that exceeds one's own load. According to the psychiatrist's judgment standard, the remission period must maintain the original treatment plan for at least 6-9 months, without recurrence of symptoms, and gradually reduce the medication based on the scale assessment and the doctor's judgment. It is definitely not a matter of "I feel better" and can stop the medication without authorization.

But if you just hold the mentality of "take the medicine as prescribed by the doctor and everything will be fine", you may also miss the most precious repair opportunity at this stage. In the view of a psychodynamic counselor, in the acute stage you are completely overwhelmed by your emotions. You can't even tell "am I sad or angry right now?" and you have no energy to dig out the underlying causes of your illness. ； On the contrary, it is the remission period, when the emotional wave subsides, and you can see clearly where the hidden reef that swept you away before is - for example, have you been accustomed to "only I am sensible enough to be loved" since you were a child, and have you never dared to say the three words "I don't want to"? The effect of long-term subconscious cultivation at this time is often much better than in the acute stage.

Practitioners of the cognitive behavioral school who pay more attention to current changes will give you another more practical idea: at this stage, there is no need to rush to solve such a heavy proposition as "childhood trauma". Just do small steps of behavioral experiments first. For example, you used to be able to work non-stop for 12 hours the day before you got sick. Now don’t force yourself to go back to this state immediately. First try to only arrange 3-4 hours of core work for yourself every day. The rest of the time can be spent on short videos. ； Every time there is a mood swing, jot it down, for example, "I received three 59-second messages from my boss today, and I was flustered for 20 minutes." Next time you encounter this situation, try to set a 15-minute buffer period for yourself, and then listen to it when your mood stabilizes. This will slowly raise the threshold for triggering stress reactions, which will make it less likely to cause problems.

I have met so many clients at this stage, and I found that the pitfalls they are most likely to fall into are actually not physical pitfalls, but mental pitfalls. A girl came to me a while ago and said that she was much better and could cook and go to the supermarket. Last week, her aunt asked her to help pick up her cousin after school. She had just finished working overtime that day and was actually exhausted. But she was too embarrassed to say, "I am still recovering and don't want to go." In fact, it is the "stigma rebound" during the remission period: when you are sick, you can still say "I am sick and I want to rest" with peace of mind. When you feel better, others will say "Aren't you all better?", and you panic first, thinking "Am I being too pretentious?" You insist on conforming to the standards of "normal people" in the eyes of others, but in the end you waste yourself.

To put it bluntly, the remission period is actually like the recovery period after removing the cast from a fracture: the broken end of the bone has grown back, but the surrounding muscles are still atrophied, and the ligaments have not yet regained their elasticity. You can't run a marathon right after removing the cast, right? You have to walk slowly with crutches first, and then try to walk a few steps without crutches. If your legs become weak, stop immediately and rest. No one will scold you, "Why can't you run after the cast is removed?" Why do you have to force yourself to return to a state where you are not sick immediately?

Of course, I have also heard many people say that "the remission period is about forcing yourself, otherwise you will always treat yourself as a patient and you will never get better for the rest of your life." This statement is not completely unreasonable. Many patients with mild to moderate symptoms have indeed regained a sense of control over their lives more quickly by returning to normal work and social interactions. But the premise is that you have to put a "brake button" on yourself: once you have insomnia for more than three days in a row, feel depressed for no reason, or have physical symptoms that disappeared before (such as headache, palpitation, gastrointestinal discomfort) reappear, you should immediately stop what you are doing and return to your comfort zone. You must not insist on saying "I will just stick to it", as the result of forcing it will most likely be relapse.

In fact, at this stage, there is really no unified "correct template". You don’t have to follow the “recovery strategies” on the Internet to exercise, read, and make new friends every day. If you can go downstairs and go to the supermarket for half an hour to buy an ice cream today, you have already exceeded the task. ； If you don’t want to go out tomorrow and stay at home watching cartoons all day, it’s definitely not a step back. You have been dealing with your emotions for so long, and you know your current carrying capacity better than anyone else. Don't rush to "recovery progress". Slower and steady is better than anything else.