Divya in Crisis
Divya, a 30-year-old first-generation immigrant from India came to the US in 2015 on a student visa. She studied software engineering and now works with a multinational company in San Jose on an H1-B visa. During the COVID-19 pandemic, she started working remotely from home and has continued to work from home since then. Divya is unmarried.
Since last year, Divya has feared the loss of her job and the inability to find a partner. She is often tired, feels her heart pounding, has a dry mouth, as well as difficulty concentrating and sleeping. Divya asked Dr. Sharma to help her understand what was going on and how she could overcome this state of mind.
Divya: Why is this happening to me?
Dr. Sharma: Divya, most likely there is nothing to be alarmed about your symptoms but you may want to consult your primary care provider as well. What you describe seems to be the early stages of anxiety.
Anxiety is an inevitable part of life. Inherent in anxiety are two aspects – inefficiency and fear. Inefficiency is due to loss of mental alertness and being able to problem solve. While fear is imagining that the outcomes of one’s actions are going to be negative, it can be easily managed right now. There may be several factors triggering your state of mind, such as living alone, fear of not getting permanent residency, fear of loss of job, and being away from the support of family, among other things.
Divya: What do I do if I cannot manage how I feel?
Dr. Sharma: You must maintain a positive outlook. You will be able to manage your present symptoms but if you are not able to overcome them then it can lead to generalized anxiety disorder which is unrealistic or excessive worry about life situations. It can also lead to panic disorder which is short bouts of uncontrolled anxiety. If you feel you are not able to manage it, then you must consult your primary care provider.
Divya : How do I overcome this state of anxiety?
Dr. Sharma: Divya, one of the methods popular in the US is Rational Emotive Therapy (RET) described by Albert Ellis. You can see a professional counselor referred by your primary care provider or apply a self-help approach on your own. According to RET, most of our thoughts are irrational and must be refuted. For example, we may think that we must be loved by everyone, that we have to be a perfectionist, that certain people are bad and must be punished, that if things do not go our way it is catastrophic, and so on.
Remember, no situation is 100% bad and it helps to be moderate in our judgments. This can be simply practiced by applying the ABCDE technique where A = Activating system identification; B = Belief system identification; C = Consequences of indulging in irrational beliefs; D = Disputing irrational beliefs; E = enjoying the effects of changed thinking.
Divya: Will Indian Philosophy offer some answers and help?
Dr. Sharma: One contemporary Indian philosopher, G. V. Vethathiri, has suggested classifying worries into four categories – worries to be faced (being away from family in your case); worries to be solved immediately (continuation of work); worries to be postponed (marriage, permanent residency etc.) and worries to be ignored (societal and family pressures to get married). In this way, you can lighten the burden on your mind at any given time by focusing on only worries to be faced and solved immediately. Try practicing this analytical technique every day or every week.
Divya: What else can I do?
Dr. Sharma: Yes, Divya. There is another way that we use to reduce unrealistic and excessive fear. This is called systematic desensitization. This involves breaking down the anxiety-producing scenes into small steps. Then imagine each step beforehand and couple it with a relaxation response. Relaxation can be done by deep breathing, or relaxing your muscles from the head to the toes (progressive muscle relaxation), or feeling warmth and heaviness in the body parts (autogenic training), or imagining a pleasurable event (visual imagery).
Divya: I have heard about cognitive behavioral therapy (CBT). Can it help?
Dr. Sharma: Yes, Divya, you are right. CBT is another approach that a professional counselor referred to by your primary care provider can help you with or you can apply it as a self-help measure. The word cognitive means it works on thoughts and behavioral means it is action oriented. Its primary objective is to change our negative automatic thoughts and substitute those with positive ones.
Divya: Can you refer me to some resources?
Dr. Sharma: There are several resources that you can refer to. Anxiety and Depression Association of America provides information about dealing with anxiety disorders. It provides links to self-help books, important treatment providers, and helpful information about dealing with stress.
Another resource is WebMD which provides information on anxiety disorders and their medical treatments. You can consult with your primary care provider to check if you need to professional treatment.
Another resource from WebMD describes Rational Emotive Therapy which may help you understand the various nuances of this approach from this website.
If you have questions, reach out to Dr. Sharma at firstname.lastname@example.org