DEAR DR. NERDLOVE: I have a few things I want to talk about, and I promise it all ties back to romantic relationships, so bear with me.

To give some context, my life hasn’t been easy. I experienced severe emotional abuse as a child, and that trauma shaped a lot of my relationships moving forward. For most of my life, I’ve found myself either attracting or being drawn to people who weren’t emotionally healthy, often in subtle ways. This pattern led to a lot of one-sided friendships or manipulative short-term relationships.

I’ve done a lot of work over the last few years with the help of a great therapist, and while I know it’s a long and difficult journey, I’m committed to healing. One of the coping mechanisms I developed early on was to cut people out of my life. Sometimes this has been necessary, but I know at other times it’s been an overreaction or even an inappropriate response to situations that didn’t warrant it.

Most recently, I’ve distanced myself from a friendship group that was, honestly, the healthiest I’ve had in a long time. While I wouldn’t say I was able to fully open up to them, they were good, caring people who genuinely made an effort to get to know me and spend time with me. But I’ve often felt overwhelmed by their attention, particularly when they would ask why I wasn’t dating anyone. On top of that, I’ve become very good at masking my emotions, so people often think I’m fine when I’m actually struggling. About a month ago, during a depressive episode, I ended up blocking all of them. They’ve tried reaching out, but I’ve ignored them, and now I find myself isolated.

This leads me to something else I struggle with: deep down, no matter how much I try to convince myself otherwise, I can’t seem to believe that any woman could be interested in me or fall in love with me. I’ve “put myself out there”, and my friendships with women have been good, but aside from very rarely meeting someone that was available, I just don’t understand the dynamics that lead to a romantic connection. If it weren’t for people suggesting otherwise, I’d almost believe that I am just that undesirable of a human.

In many ways, my life is going well. I’m doing well in almost every area, but emotionally, I still feel stuck. I often feel alienated, like I’m emotionally stunted compared to others. I have no real sense of what it feels like to love or be loved. I can’t picture what it would be like to have a close friend, someone I could confide in. I can’t imagine feeling that warmth in my chest when something good happens, or the excitement of taking the first steps in a romantic relationship.

I know I’m not an ugly man, nor am I useless or unkind. I know I’m not a bad person—quite the opposite, really. But when I look at others who seem to have fulfilling, loving relationships and close friendships, it’s hard not to feel like something’s missing in my own life. Therapy has been helpful, but it often feels like we only see the ‘highlight reel’ of progress, while the messy, painful side of healing is hidden behind the scenes. I’ve seen people recover quickly — like someone I once knew who, despite being suicidal, found a partner just a few months into therapy. But right now, I’m stuck in the messy part, unsure of how to move forward, and I’m left wondering if it’s even possible for me.

Ironically, I work with children now, and they seem to see something in me that I can’t see in myself. It’s clear that many of them find me to be the kindest, most understanding adult they know. Some of them have said I’ve been an inspiration to them, that I’ve made them feel safe, and that they’re grateful for everything I’ve done.

But despite the positive impact I’ve had on others, I still struggle to believe I have the capacity to be loved in return.

Emotionally Stunted

DEAR EMOTIONALLY STUNTED: OK I want to preface this by saying that I am not trying to diminish or otherwise minimize the trauma of the abuse you experienced growing up. That’s the sort of thing that leaves long-term, lasting scars, and I’m sorry you went through all of that.

But I would be remiss if I didn’t point out an obvious truth: it’s going to be hard to accept that you’re worthy of love if you don’t actually give people the chance to love you. This is the very definition of a self-reinforcing cycle; you don’t believe that you’re capable of being loved or worthy of being loved and so you shut out the people who are trying to show you that they love you and they care. That increases your loneliness and isolation and that, in turn, reinforces the feeling that you’re unworthy of being loved or so flawed in some way that you push people away.

And as simplistic as it may sound… have you considered not doing that?

Ok yes, that’s easily said and not so easily done. But even allowing for the fact that this is as much a trauma response and your brain trying to protect you from being hurt further, the fact remains that this is a conscious series of steps that you take. At each step of the way, you have had to decide that you were going to distance yourself from them, block them and then ignore them when they reach out to you. That means that there are multiple points in this process where you could have chosen to stop, to make a different choice and not give in to the fear.

I get that this is doesn’t feel like a step-by-step process to you. I get that it’s something that happens in a moment of panic. Some aspect of your connection with people hits the tripwire in your brain, your endocrine system dumps a metric f--kton of adrenaline and you’re in fight-or-flight mode and you slam your fist on the block button. But here’s the thing: while this may have started as a way to protect yourself, this behavior is no longer serving you. It’s evolved past its utility in a way that’s all too common: avoidance has made the feeling worse.

Like a solider who’s still trying to fight a war that’s long over, this self-defense mechanism no longer has an enemy to fight, but it can’t bring itself to accept this. So the mission has changed. Now you’re not protecting yourself from people who have hurt you; you’re trying to protect yourself from the discomfort of that fear. You’ve, quite literally, become afraid of fear itself, the feeling of that discomfort that the fear brings. Icing people out and blocking them isn’t about protecting yourself so much as just trying to make that feeling go away. 

I think, to some degree, you understand this. But I wonder if you’ve ever stopped and tried to break the cycle. Part of why you’re in this circumstance is because this cycle has gone on for so long that it’s basically just serving to perpetuate its own existence. And the only way to break this cycle is, quite honestly, to choose to break it. 

Now I’m not saying that this is as easy as deciding to do something and magically you’ll have the will to do it. You’re dealing with the most primal instinct humans have: self-preservation. Fear is the manifestation of a desire for safety and security; it’s our brain trying to keep us alive, no matter the cost. Happiness isn’t even a secondary consideration; it’s barely a consideration at all. So that drive is very powerful and very compelling in the literal sense.

But the fact that it’s powerful doesn’t mean that it’s unstoppable. It relies on the immediate response to that fear. But that’s the thing: you don’t need to do anything to push through. In fact, the thing you should be doing is… nothing. You don’t react immediately; you, instead, choose to pause. To wait. To grit your teeth and breathe through the fear. As the litany says: fear is the mind-killer, the little death. You want to face your fear and let it through you and past you. When you do, then you often see that the immediacy of the panic subsides and you recognize that you were about to react to a threat that is, quite literally, only in your mind. Taking that moment to just restrain yourself from making an impulsive decision can be all it takes to realize that this isn’t the dire threat you thought it was.

Now some of this is the something you should be working with your therapist on. But one thing that I think you should start doing is getting in the habit of focusing on your breath. When you feel those moments – whether you’re in a depressive mood or simply feeling the panic starting to rise – you want to do what’s called 4-4-4 breathing. You exhale all the air out of your lungs, then breathe in a slow and controlled pace for a count of four seconds. Then you hold your breath in your lungs for four seconds, then breath out to a count of four. Then you repeat the process: four seconds in, four seconds holding your breath and four seconds out again.

This does two things. The first is that it slows your heart rate down; because you aren’t breathing rapidly, you are disrupting the panic cycle and forcing your central nervous system and cardiovascular system to slow their roll. Just as importantly, however, you are taking your mind off the thing that’s causing you to panic and giving it something else to focus on instead. By distracting yourself and turning your thoughts away from what you’re experiencing in that moment, you give everything a chance to calm down and for the moment to pass. When it does, I think you’ll experience a greater feeling of relief than you would expect. Then, as the rest of your systems come down from red alert, you’ll be in a better position to make choices that will actually benefit you instead of lashing out.

The other thing I would point out is that breaking the cycle doesn’t mean just preventing yourself from shutting people out in a panic. The fact that you closed that particular door doesn’t mean that you can’t reopen it again. You actually have an opportunity to do just that, even as you read this. Those friends you cut off have been reaching out to you. You can choose to reach back, to unblock them and to let them back in. You can say “I’m sorry, I let my fear get in the way”. It’s clear that they care for you and that they’re worried. They’re going to understand, especially if they know your history.

I know coming back to them can be scary. Worse, it’s embarrassing, and we do so many stupid things because we don’t like feeling embarrassed. But much like the fear, if you can recognize the embarrassment for what it is – another form of misaligned attempt to protect yourself – you can push through that too. The momentary sting of coming back to your friends and saying “I didn’t mean to push you away” is far less than the relief that comes from ending your self-imposed isolation.

The last thing I would suggest is that you need to work on learning to love and accept yourself. When we quote Ru Paul’s famous saying of “If you don’t love yourself how the hell are you going to love anyone else,” we’re not saying that loving others is contingent on loving yourself first. We’re saying that if you can’t love yourself, you have a much harder time accepting love from others. You may have love to give, but it’s harder to give when you can’t receive.  

The thing is, part of what makes this insidious and hard to shake is that this really is down to these old systems that had a purpose once, but have long outlasted them. These coping mechanisms were predicated on the hurt that others were inflicting on you, and part of why they linger is… well, because of the ways it’s trying to protect you. One of the ways it tries to protect you is by misunderstanding why you need to be protected in the first place. There are few things more painful than being hurt by people who you love or who are supposed to care for you. It feels wrong. It’s much easier to believe that there’s a reason for their abuse, that someone who supposedly loves you wouldn’t hurt you like this unless they had to or unless you deserved it. Rather than accept that the people who abused you were wrong and mistreated you, intentionally or otherwise, it’s easier to assume the fault is in you. You are protecting yourself from one pain – the pain of someone you love treating you in such ugly ways – by taking the blame on yourself. It’s not their fault. People who love you shouldn’t hurt you or treat you like that. So, the fault must clearly be in you instead.

This is part of why you feel less worthy and more broken than others. It’s why you feel like other people – people who seem to “recover” more quickly than you – are succeeding where you’re failing. It’s not just the highlight reel issue, it’s the continuing acceptance of the framing that you brought this on yourself because you’re flawed, damaged or broken. It’s one more thing that you take as proof that the people who treated you badly saw something in you, something that made their mistreatment understandable, even inevitable.   

And that’s bulls--t. 100%, complete, total bulls--t being expelled from choleric bovines. 

It’s logical in its twisted way, but it’s the logic of a scared and hurt child who doesn’t understand what’s going on. But you’re no longer that child. The pain is still there, the scars are still there… but you’re not the child you were. You can understand now what you couldn’t before: that this wasn’t your fault, that you didn’t deserve this and that the people who hurt you are wrong.

Understanding and accepting this on so thoroughly that it becomes part of you, accepting that mistreatment isn’t part of love, is part of how you break those cycles of falling for toxic or one-sided relationships. You stop accepting that behavior as good or necessary, and you stop believing that you deserve that treatment for sins that you have never committed and that were never yours in the first place.

You shouldn’t feel ashamed for this pain, or for how you’ve tried to manage it all this time. I think you would do better to acknowledge that these coping mechanisms have been doing their best to keep you safe, to thank them for what they intended, and to acknowledge that their job is over and has been for quite some time. It’s time to decommission those defenses, lower your shields, and accept that it’s time for a change. There will still be people who you need to guard against, people who you need to cut out of your life. But that’s not the same as letting your fears control you and isolate you.

You have people in your life who are good for you, who express love and affection for you and who – in your own words – are probably the healthiest social connection you’ve had in years. Start there. Welcome them back in. Accept that they love you and that you’re worthy of being loved. Let that acceptance be part of how you find the strength to simply hold still and breathe when you feel that fear, until the fear has passed through you and you turn your inner eye to see that is has gone and only you remain.

It’s a seemingly small thing, but it’s the first step to ending your isolation and learning to allow others to love you the way you wish you were loved.

All will be well.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com

DEAR DR. NERDLOVE: I know you’re not a real doctor, but I’m hoping if you can’t answer my question, maybe you can help me figuring out how to get recommendations from someone who can.

It’s this: I have been dealing with (and trying to treat) chronic tachycardia for a bit over a year now. Recently (past six months or so) it seems like orgasm or even nearing orgasm triggers a cardiac event (usually acute rapid heartbeat and I pass out). I’m not sure exactly, because honestly after it happened twice, I just stopped nearing orgasm during sex/masturbation. I tried last night, though, and I triggered the tachycardia. Fortunately, didn’t pass out, but I felt physically awful afterward.

So: is there a way to orgasm slower?

Or, maybe reduce the risk of rapid heartbeat, maybe ramp up more slowly?

Or maybe, I don’t know, is there a mildly calming drug or supplement that can temporarily slow down heartbeat but keep sex drive going?

Yes, I know, I will not take anything without talking to my cardiologist. But I’m looking for any direction or options.

For context, the chronic tachycardia is likely either a complication of a condition I’ve had since birth, or a side effect of the medication I’ve taken for it for decades. In cardio rehab, physical therapist determined a walking speed of 3.0 mph, for 4 minutes, creates a sustained tachycardia that causes me to pass out and my blood O2 to drop. So… that’s annoying. I have to pace myself at, like, 2.5 mph or slower to walk for half an hour.

Also, I am a cisgender woman, married to a very sexy cisgender man, we’re both mid-30s, and our sex life is solid other than this issue. My husband is honestly more cautious and in general is more into sensual-erotic intimacy that doesn’t necessarily lead to orgasm anyway. Which I also enjoy!

But I also enjoy and desire overtly sexual experiences, including orgasm, pretty frequently. I don’t want orgasm to be completely off the table (even when masturbating?) just because my heart gets too into it!

I have not brought this up to my cardiologist or physical therapist, because it’s extremely awkward. What do I even say?

Also, I feel like it sounds whiny or entitled. Like we’re focusing on preventing a heart attack, or keeping my condition stable so I won’t need a transplant in a few years, but I’m upset because I can’t have a specific sexual experience?

Maybe my question should be, “how do I set aside this desire and be happy with what I have?”

I don’t know. Any advice is welcome.

Heart Is Actually Broken

DEAR HEART IS ACTUALLY BROKEN: I know you said this at the start of your letter, HAB, but I want to repeat this for emphasis: Dr. NerdLove is NOT a real doctor and this is very much something that you need to talk to your doctor about. I’ve got friends with similar issues, and they’ve provided some insight into options, but you absolutely need to be talking to your doctor about this.

Here’s the thing: tachycardia is no joke, and it can present serious issues for people’s day to day lives. Managing it and keeping it under control requires a lot of care and attention. But it also means that you have to be willing to speak up when these issues are causing problems in your life. One of the issues a lot of women in particular have when dealing with doctors and people in the medical field is feeling like they can’t speak up and advocate for themselves… and with good reason. A lot of women find it difficult to get medical professionals to take them seriously, especially if they’re addressing concerns they have with a particular treatment or medication and the effects it may be having on their lives. It’s very easy to get discouraged when a person in a position of authority tells you that it’s not a big deal, all in your head, or something that you should be able to just deal with.

The thing is: you’re the expert on you, and you’re the best authority on what you’re experiencing and how it’s affecting you. So, as scary and as hard as it can be, you want to get in the habit of being your own first line of defense and most zealous advocate, especially with things that are affecting your overall quality of life.

And sex, sexual pleasure and intimacy with your partner are all very much a part of your overall quality of life, not things that should be dismissed or hand waved away. So while it can feel awkward to bring this up, it is something you should be willing to advocate for. Now, maybe you would need to bring your husband as both your moral support and advocate, especially if your doctor isn’t willing to listen or take things seriously. It may be, for example, that the doctor would be more willing to listen if your husband repeats what you said. As absurd as it is and as screamingly sexist as it is, “what she said, but with a penis” is often the only way to break through the systematic sexism that infects so much of life. But also having him with you and knowing that he’s going to back and reinforce your play can give you the additional boost to say what you need to say.

I would recommend memorizing the following phrases and using them as needed: “this affects my relationships, my productivity at work and my overall quality of life”, “what would you recommend for a male patient experiencing these symptoms” and “will you please make a note in my records that I requested this, and you refused?” 

I would also suggest that your husband be ready with “don’t ask/tell me, ask/tell her, she’s the patient.”

Now that having been said, there’re a few things that you can try. The first is: hydrate. Seriously. Treat sex like any other form of physical activity and stay hydrated. The next is realize that certain positions may not be good for you. On your back or on your side can work. On top, with the level of effort and motion needed is likely to be how you end up meeting the local first responders while naked – something you probably want to avoid. Rear-entry positions where you’re bent over or on your knees are less likely to be as risky, but still not great.

You mention that your husband is more into sensuality; that’s good, because it’ll be easier to keep things at a more measured pace. Hard and fast is almost certainly going to be off the table, so a long, slow build-up is going to be the way to go.

As cheesy as it may sound, you may actually want to look into some tantric practices. Focusing on sexual activity where breath control and gradual arousal are prioritized can be good for getting you where you want to be without hitting the danger zone for your heart. The same goes with masturbation; a longer, slower and more gradual build up will likely be better for you than going to town with a high-speed, high-intensity vibrator. If you’re someone who needs direct clitoral stimulation, then something that can give a low buzz and let things build without getting your circulatory system worked up may be helpful.

But again: you really need to be in the care of a cardiologist and discussing options with them – including what side effects you’re not willing to tolerate. A lot of heart medications will tank the libido, which may keep your tachycardia under control but works against your goal of a fulfilling sex life with your husband.

It can be hard to speak up about something so personal, I know. But if it’s important to you – and it certainly sounds like it is – then you should make that clear. Even if your voice quavers and your knees shake while you’re doing it. To paraphrase a particular general: be afraid… but do it anyway.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com

DEAR DR. NERDLOVE: I was hoping a fresh perspective from someone who isn’t my therapist could help me. I’m 28, have had one girlfriend in college, and have otherwise never talked to a single girl in my life (she approached me). Granted, I wasn’t particularly attracted to her physically or emotionally, but I wasn’t about to squander my chance to lose the V card, so we had our fling for about 6 months and then amicably/mutually split.

Whether it’s making a dating profile, or approaching a woman with romantic intent, I have a full-fledged panic attack/meltdown. Trying to get me to date is like that scene in Rain Man at the airport when Tom Cruise tries to get Dustin Hoffman on the airplane; he protests, he’s unsure, he is anxious, and when Tom Cruise tries to force Hoffman onto the plane, he has a full-fledged meltdown at the gate. I have a similar response with expressing any modicum of romantic intent. I lose all sensibilities and will claw, kick, and punch to get me the F--K OUT OF THERE! I know nothing worse than a bruised ego will happen if I approach a woman, I know I won’t be cast out from society if I make a dating profile, I know that women desire men, and I’m not an unlovable monster nor a creep for making advancements. I have no logic to attach to these overwhelming feelings.

I am currently (and have been for about 3 years) medicated on an NDRI and an anti-psychotic for major depression/anxiety with NSSI tendencies that I’ve exhibited since I was a kid. My therapist and I have explored many angles to no avail such as exposure therapy to just outright taking the plunge and have all resulted in the same thing: a meltdown. I can talk to girls I am not attracted to and/or when there’s zero chance of any non-platonic engagement. But the expression of romantic intent on my end sends shockwaves of panic through me. I do want to find love and build an amazing life with a woman and stem the tides of loneliness, but I’ve yet to vault this lifelong wall of a hurdle. I’m hoping you’ve seen this before or you could provide some unique perspective.

From,

Man of Many Meltdowns

DEAR MAN OF MANY MELTDOWNS: There are a lot of times when people use hyperbolic language to describe the level of fear or anxiety they experience when dealing with an intimidating or scary experience. This can actually make things harder, because a lot of terms in casual use have actual medical meanings and definitions. As a relevant example, people will use the term “panic attack” to describe the mundane feeling of “this makes me very upset and anxious, makes me nauseous and gives me knots in my stomach”. The problem is… that’s not a panic attack. In medical terms, people who are experiencing panic attacks often mistake the symptoms – chest pains, numbness in the extremities, hyperventilating or an inability to breathe and an honest, intense sense that they are literally about to die – for heart attacks.

This is one of the reasons why it can be important to really think about your word choice and how you describe what you experience. There’s a world of difference between an anxiety attack and a full-bore panic attack and conflating the two makes it much harder to tell someone what to do about it.

So MOMM, I’m going to assume that when you say you have a full-blown panic attack, you mean you have a literal, physical fight-or-flight response that feels like you are going to die. Because otherwise… well, this is one of those times when exaggerating for effect or overstating what you’re actually experiencing can get in the way of actual help.

The first thing I would ask is whether you’ve talked to your prescribing physician about the medications you’re taking. You want to first make sure that there aren’t any side-effects that may be affecting you. A number of NDRIs, for example, can increase anxiety. It’s not common, but it can happen. I’d be more worried about whether it’s having an adverse interaction with your anti-psychotics.

The second thing I would suggest is that, after having double checked that your meds aren’t the cause, to think carefully about how these attacks come on. There is a significant difference if, for example, it’s something you feel ramping up or if it’s an abrupt, binary state. Is it that you can talk to someone but if there’s any romantic or sexual interest, you feel the panic come on? Or is it the equivalent of someone saying the words “Niagra Falls” and suddenly a switch in your brain flips. That might tell you a bit more about precisely where the issue is and how to deal with it.

If it’s more of a ramping up, then what you’re going to want to do to start is focus on the symptoms. One of the keys to managing anxiety and panic is to remember that the body rules the brain, not vice-versa. Our brains respond to the input our bodies give; when we feel the symptoms of a feeling, such as an elevated heart rate, a dry mouth and sweaty palms, we don’t immediately assume we’re afraid; we feel the physical sensations and then ascribe a reason to them based on what’s happening around us.

Part of why this can be important is because it means that controlling the symptoms means controlling the feeling. The racing heartbeat and rapid shallow breathing is your body flooding your blood with oxygen and adrenaline, getting you ready to fight or flee. But if you control your heartbeat, you change how you feel. Without that racing heartbeat, you aren’t going to be as afraid. You may feel a more intellectual anxiety – something more abstract – but you aren’t feeling like you’re in immediate danger of death or injury.

So if these attacks start by ramping up, even if they ramp up very quickly, then part of what you want to do is focus on your breathing. If you control your breath and force yourself to breathe in a measured, controlled way, you force your heart to slow down. Slowing your heartrate down decreases your level of fear and anxiety. Controlling your breathing like this also forces you to be present – you’re having to divert your bandwidth to being aware and mindful of your body. This helps pull your attention away from the hypotheticals that are causing you to have this sudden surge of fear.

You want to do four-count breathing; breathe in for the count of four, hold it for the count of four, then breathe out for a count of four. Keep doing this – in slowly, hold it, out slowly – until you feel the panic start to subside. It can take some time to get used to doing this with a measure of control; after all, when you’re in full freak-out mode, you’re not thinking rationally if you’re thinking at all. Practicing this technique, especially when you’re feeling the early stages of this panic, can help you turn that into muscle memory, something you do on autopilot, rather than something you have to remember to do.

The next thing I would do is talk to your doctor about the possibility of beta-blockers. These prevent adrenaline from coming in contact with the beta-receptors in your heart, keeping the adrenaline from making your heart pump faster and spread the adrenaline through your system. Beta-blockers are usually prescribed for managing heart disease, but they’ve long been used off-label for managing anxiety and keeping people calm in stressful or dangerous situations. This can help keep you from melting down just because you think someone’s cute and want to ask her for her number.

However, this is emphatically needs to be discussed with your physician first, because you want to make double and triple sure that this isn’t going to have any interactions with the meds you’re taking.

The last thing I would suggest is that you need to address the actual triggers. After all, controlling the symptoms is just that: controlling the symptoms, not the source. They’re a bandage, not a cure. The issue at the heart of this is why you freak out. Maybe it’s something residual from the woman you dated – the one you said you were only with because you wanted to lose your virginity. There may be lingering issues there; feelings of guilt because you feel like you were using her, feeling like you did something wrong by being with her when you didn’t like her, even the possibility of trauma from trying to force yourself to be attracted and to want to be with her.

Or there could be something else entirely. That’s for you and your therapist to dig into, not a loudmouth with an advice column.

Now there’s one thing that I think you may want to consider and that’s that you may need a different therapist or a different form of therapy. One of the things folks often don’t realize is that not every therapist is going to be able to help with their particular issues, nor is their form of treatment helpful or appropriate for the condition they’re dealing with.  

Sometimes it’s a matter of needing a different therapist; therapy is, in some ways, a lot like dating, and you need someone you actually click with and work well with. But other times, it’s a matter of needing a different tool for the job. Some mental health issues respond to medicine, some to talk therapy and others to things like cognitive-behavioral therapy or other techniques.

Think of it like trying to accomplish a particular task. You could, for example, use a knife to cut a tree branch… but you’d accomplish it a lot faster and more efficiently with a saw. So it is with therapy. Some treatments can work, but not as well; others are functionally useless for the issue you’re dealing with.

You’ve mentioned that talk therapy and exposure therapy haven’t helped. It may well be that you need to try something a little further afield. If this is akin to something like PTSD, then maybe what you need is to look into treatment like EMDR. This form of therapy was created specifically to alleviate the fear and pain from traumatic memories and experiences; it’s been used to great effect with first-responders, combat veterans and other people who’ve dealt with the sorts of situations that f--k people up for life.

This isn’t necessarily for everyone, and you may well not be a good candidate for it. But talking about this with your therapist and looking into other therapy options may be helpful if what you’ve been doing thus far hasn’t worked.

Now I know a lot of folks have a hard time telling their therapist that what they’re doing isn’t working, much as people have a hard time telling their doctor that the treatment they’ve been prescribed isn’t helping. There’s an understandable feeling of “well, maybe I’m not doing the work/ not doing it hard enough/ not doing it for long enough”. But the only person who knows what’s going on in your head is you. If you know that things aren’t helping or are causing other issues, then you have to be your own first and best advocate for your own needs.

But first, start with talking to your prescribing physician to rule out drug interactions and work on controlling your breath. If you can manage to get things under control this way, then you’ll have a lot more available bandwidth to start digging into the root of the problem and addressing things from there.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com