Ask The Therapist: “I am addicted to smoking… I have been having muscle relaxants just to keep myself calm and sleep…”

In 2016, the number of people estimated to be suffering from mental health issues like depression and anxiety amounted to roughly 1.1 billion. Since then, numbers have likely continued to rise. Moreover, studies have also shown women especially on average are a) more likely to suffer from mental health issues, and b) less likely to talk about them. The taboo in Pakistan surrounding depression and anxiety disorders only serve to aggravate the individuals suffering even more. For the women who cannot seek out full time therapy, we’ve enlisted the help of a trained therapist. You sent us in your questions – here are the answers!

“I am a 21-year-old girl and I am addicted to smoking. I started smoking in university (November, 2019) because I was stressed. It was my choice because I saw people around me smoking. I had panic attacks on meethi Eid (2020). I have been through trauma. I loved a guy truly and was ditched by him.

My education is paused by my parents and I am not in contact with any of my friends. My mobile has been under my parent’s custody since December 2019. Since then I have been facing panic attacks. And now I am scared of the outer world. For the past few months, I have been having muscle relaxants just to keep myself calm and sleep as much as I can. Now it’s been a week and I can’t sleep. I just look at the ceiling all night. I crave to smoke and I want to feel nothing but just the numb feeling I get after having the muscle relaxant. Tell me what I should do.”

Shahrukh’s Response:

Dear Anon,

You really sound like you’ve been through a great deal in the last year, and I imagine that a lot of what you’re experiencing is beginning to take its toll. Let’s explore some of the issues that you mentioned, and try to find ways to help you manage some of the difficult emotions that you might be feeling. 

Coping Mechanisms: Resourceful vs. Unresourceful

As humans, we instinctively try to find ways to escape from emotions or experiences that are considered difficult. Some ways are resourceful and mindful, meaning that you are able to connect with your feelings and allow space for them to exist. Alternatively, another way of dealing with grief is through a method of distractions and outward projection. This could be done through various avenues: drinking, binge eating, binge watching shows, sleeping, taking out your frustrations on others etc. Smoking would fall into the latter category. The activities/actions listed above are considered to be “unhealthy or unresourceful”, and while that may be true, they could also be seen as things that are fulfilling a certain purpose: to give us relief. Which begs the question: what are you seeking relief from?

Panic Attacks: What Are They Telling You?

Panic attacks can often be one of the most terrifying things a person can experience. Before delving deeper into this, let’s talk about ways that could help you during these attacks.

  • Remember that this is only temporary, and that this is just your body’s way of communicating something to you.
  • Seek out support: perhaps you might know someone who is able to support you when you’re experiencing these symptoms, so reaching out to a support system could be helpful.
  • Slow, deep breaths: stay aware of your breath, taking slow and deep breaths. Inhale through the nose, hold for five seconds and exhale through the mouth for 5 seconds. Repeat. 
  • Use the 5-4-3-2-1 Technique: this is a great way of shifting your attention elsewhere. In this exercise, you would name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and one thing you can taste. 
  • Counting backwards from 100 in 7s: This is another way for you to shift your attention from any anxious thoughts.

Root of the Panic

Panic attacks are usually a manifestation of anxiety that has built up. From what I’ve read, it seems that there are some changes that took place in your life, specifically when your education was paused by your parents. Routines were shifted, your ability to connect with your friends and the outside world became extremely limited, and now with the pandemic, there has been a lot of change in terms of how we interact with the world. Given all that has happened, some questions to be mindful of are:

  • What is it that I need right now?
  • What is causing this anxiety?
  • Are there any thoughts that bother me? If so, what are they?
  • What can I offer myself at this time in terms of comfort and support?

Further Steps To Take

There are several steps you can take in order to manage the anxiety that leads up to the panic attacks, which could help with the sleep routine:

  • Exercise: physical exercise is a great way to release some of that built up energy and anxiety, as well as tiring out your body enough to fall asleep at night. Try to schedule this in at least 4-5 hours before you can.
  • Meditation: this is a way for you to connect with yourself, your body and to the here and now. Sometimes anxiety can take you into your head, into a world of hypothetical situations and worst-case scenarios. Meditation is a way for you to bring yourself back into the present. 
  • Minimizing caffeine and sugar intake: caffeine and sugar can activate your nervous system and can contribute to the physical manifestations of anxiety. Be mindful of your intake and try to keep it to a minimal level.
  • Eating well: each regularly and well is something that will keep your body regulated. Try to incorporate foods such as fruits, vegetables and proteins into your diet. 
  • Therapy: if this is an option you can avail, therapy is an excellent avenue for you to talk about and explore your anxiety in a safe space, as well as learn different ways of managing that anxiety. 

Anon, sometimes our inability to sleep at night can be a sign of something bigger. I would invite you to be mindful of what you’re feeling, and making space for it. I really hope that this was helpful, and that you find the peace and grounding that you are looking for. Best of luck and stay in your power!

The above article is written by Shahrukh Shahbaz Malik who is trained in humanistic integrative counselling at CPDD in the UK and currently has her own private practice in Karachi. The views expressed in this article are those of one expert. They do not necessarily represent the views of Mashion, nor do they represent the complete picture of the topic at hand. This article is for informational purposes only and is not a substitute for medical diagnosis or treatment.

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