Putting out the fire
Cognitive behavioral therapy was the key to quelling the flames of Jonathan Friedman’s anxiety
Listen to Jonathan’s Story
It was the dead of winter in eastern Canada, where temperatures can often fall to double digits below zero, and Jonathan Friedman, a student studying at Ryerson University in Toronto, was regularly attending class in shorts and a t-shirt – and sweating through the shirt well before class concluded.
“Not to be too graphic, but I used to feel like there was fire underneath my skin, kind of like I was melting,” says Friedman, now 27 and still living in Toronto, where he was born and raised. “It wasn’t that I probably wasn’t cold, but that’s what my body thought was happening. I was going to school to learn and my brain was saying, ‘Jonathan, you’re going to fight a bear today.’”
Often Friedman was forced to leave the room or skip classes entirely. Moreover, the internal heat wave was manifesting in other places and situations as well, especially on the Toronto subway.
“It’s crowded, there are a lot of people and you don’t really know what they’re thinking about you because everyone’s wearing headphones and hasn’t had their second cup of coffee yet,” he says. “They’re probably taking a nap or thinking about what they’re going to do at work that day or maybe they had a fight with their spouse. But my head was saying, ‘Hey Jonathan, all these people are staring at you because you look funny, or you’re fat, or you smiled and now somebody thinks you’re creepy.”
Friedman wasn’t sure what the root cause of the panic attacks might be. True, his younger years had not been without some strife. He describes himself as a “metal head kind of kid and sort of an outcast” all the way through high school and he grew up in a household where his paternal grandparents, both Holocaust survivors, served as secondary parents. His mother lived with bipolar disorder, which led to his parents divorcing when he was 8.
After that he and his two younger brothers lived primarily with their father, though they continued to see their mother nearly every weekend. Between the long hours he spent at a Jewish school – 8 a.m. to 4:30 p.m. daily and 13 courses a term – and driving his younger siblings to spend weekends with their mother, there wasn’t much time for extracurriculars. But whether any of that was the source of his problem seemed unlikely.
When the panic attacks persisted for nearly a year and began to impact his social life as well, Friedman took advantage of Canada’s universal healthcare system s to seek a diagnosis and a solution. One of the many specialists he consulted wryly joked that perhaps he was going through menopause. The “19-year-old dude” did not find this particularly amusing.
Meanwhile, Friedman’s self-destructive behaviors began to magnify. One of the areas that had always been extremely important to Friedman was having a healthy romantic relationship. (His family used to tease him about never being without a girlfriend.) Since the age of 15, he’d had a series of unhealthy romances that lasted as long as two years, but usually ended abruptly and unpleasantly.
“What would happen was that I would go to these partners I was supposed to be really intimate with and I’d try to seek validation by telling them what I was feeling and quite often I’d be met with, ‘What the heck? You’re so weird,’” he recalls. “I kept going to the wall and saying, ‘Wall, give me water.’ And the wall would say, ‘I can’t give you water, I’m just a wall.”
At the end of one particularly toxic relationship, Friedman — feeling that “the bottle knows me better” than anyone else — went on a two month alcoholic bender that culminated at a tequila bar where he stole two giant sombreros off the wall and was kicked out of a dance club.
“That turned into one of the darkest nights I’d ever had, where all the anxiety surfaced — my parents’ divorce, all those relationships and all my unresolved issues — and kind of culminated all at once,” he said. “I started asking a lot of the really big questions like, ‘Is life worth it? Am I loveable? Am I allowed to have the things I want?’”
Eventually he ended up in the office of an endocrinologist, a doctor who treats hormonal and metabolic dysfunction, who narrowed the temperature dis-regulation problem down to two possibilities.
“Either you have this very rare male disorder that happens in point zero zero one percent of men,” the doctor said. “Or you have an anxiety disorder and you should go to a therapist.”
Friedman decided to try his chances with a counselor. He chose one who specialized in cognitive behavioral therapy (CBT), a psycho-social intervention that focuses on challenging and changing distorted thinking and behaviors by increasing mindfulness, improving emotional regulation and developing personal coping strategies and skills for targeted situations.
Before therapy he had just “taken life’s punches,” allowing them to permeate his thinking, leading to “some pretty dark thoughts, some heavy drinking, some scary relationships and just a pretty negative perspective on the whole world.” With the help of the counselor, Friedman began identifying the triggers for his anxiety attacks and looking at the behaviors that ensued and the consequences those behaviors created.
“Looking at things in that A-B-C way and seeing the connections between the behaviors and the consequences really allowed me to have a deeper insight into what was happening with the anxiety,” he said. “We started with the broad level of daily tasks, like taking the subway, but then also looking at how I could communicate better in my relationships to form healthier patterns.”
Putting in place a “preventative routine” was critically helpful, Friedman says. For example, one of the things that always eased his anxiety was “lifting things.” So going to the gym regularly and lifting weights “as heavy as I possibly can,” became a proactive part of his self-care schedule. When he experienced acute panic attacks at unpredictable times — at work or in the middle of a meeting or conversation – he also kept “fidget toys” nearby to occupy his hands, redirect his focus and “help keep me cool.” He also began to keep a daily journal to become more cognizant of his train of thought.
In an unexpectedly reflective way, Jonathan saw much of what he’d talked about with his therapist play out during his job as a youth counselor for children with “autism and anxiety, which are kind of weird best friends.” Many of the children he taught were nonverbal; his work involved helping them to express themselves with an IPad or other assisted technology. Because they couldn’t speak directly, they tended to express their anxiety through negative physical behaviors. Ultimately Friedman realized their coping mechanisms were not so different from his own (even if the resulting destructive behaviors were quite different).
CBT also gave Friedman the tools to communicate more accurately and openly with his girlfriend of the past three years, Cassandra. Both he and Cassandra, who lives with depression, revealed their mental health challenges to each other early on in the relationship and have developed healthy communication habits that allow them to support each other both in crisis moments and over relationship hurdles. They’ve even developed “cheat codes” to signal distress when they’re having a bad moment in public.
“Let’s say I’m having an anxiety attack and at the time I’m just unable to be helped because I’m past of the point of no return,” Friedman said. “I’ll just look at her and say, ‘Papaya!’ It’s funny and it kind of takes the edge off. But it also lets her know I’m struggling in that moment and maybe she’ll hook me up with a glass of water, or give me some space, or suggest I go to the gym. Having that openness about what we’re going through at any given time has been really helpful for our relationship.”
Interestingly enough, Friedman says, after returning to CBT for more reinforcement of its concepts, the skills and tools he began to practice started having a “ripple effect” on others within his social circle. Soon “everyone around me was starting to take a look at their own mental health.”
“In the end, we all became much better friends because we have these very open and vulnerable conversations,” he says. “I was always scared before that if I was anxious and unable to do things, people wouldn’t like me. Being able to really come to terms with that and being able to verbalize it to the people around me has really been a game changer.”
After 8 years of working as many as 80-90 hours a week as a youth counselor, Friedman suffered burnout. As the Covid pandemic began, he started a coffee company (“I learned how to really bootstrap something”), ran a half marathon (“which was a big deal because I have asthma”) and began doing digital marketing for his stepmother’s online coaching company. One day last fall they had a conversation about how many young people his age were struggling and in need of coaching, but found it inaccessible for a variety of reasons — from cost to the methods in which it was offered.
That planted a seed that Friedman is now developing into a new venture that will launch in October, a website called “The journal that talks back.” (www.thejournalthattalksback.com) Friedman describes it as “kind of like the coaching version of text therapy.”
“It allows people to be anonymous, to connect any time in a private online space and access coaching on the go,” he says of the privacy protected site that allows interactions between young professional or college students and a coach specifically matched to their needs.
“Even with the free healthcare we have in Canada that I’m so grateful for, you’re often on a waiting list for as much as a year for therapy or coaching,” he says. “And with crisis text lines, they’re often for people in an emergency. We wanted to create a kind of holistic service that allows people who experience something on a Saturday and don’t have a therapy appointment until Thursday to talk about it right there and then.”
As isolating as the pandemic has been for many, Friedman believes it has brought the importance of caring for our mental health into unprecedented focus. He sees it as “a really unique opportunity” to turn the rote “How are you?” everyone encounters multiple times a day into more than just an automated response.
“There seem to be more open communications and more of an acceptance that if you need to take a day because you’re struggling or just to take care of your mental health, that’s something we all should do,” he says. “And I think that’s a bit of a silver lining in all this chaos.
“We are at a turning point and I think more people are coming to that sort of meta-cognition, that thinking about their thinking. If we can all share a bit more about ourselves, or ask that extra question, we can do a lot of really fantastic work to support people’s mental health.”