Sick leave due to anxiety, been back at work 5 weeks and struggling again :(

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I had around 2 months off of work due to anxiety and depression. I posted on AIBU at the time and received a lot of helpful advice so I hoped I could return and ask for some more support/advice as sadly things aren't going well again.

I returned to work as I felt ready to and I was given such a slow, gradual return that it felt really feasible. I'm 5 weeks into my back to work plan and working 4 and a half days and I'm starting to really struggle again and I don't know what to do or say.

I have weekly calls with an occupational health advisor person my company referred me to, and it's helpful but most of the time the advice is to try breathing exercises and mindfulness, which did help me in my first few weeks but I feel like I'm struggling again and that's not enough.

I have weekly meetings with my manager and HR and they are keen to support me, and I have mentioned I have had some bad days in the last couple of weeks. They ask me how can they help support me and to be honest I don't have any idea what to ask for. My work has been really stripped back and simplified, a lot of things removed from my calendar and I'm still struggling. The anxiety hits me at weird times, and I don't really understand it. Today I was in the office and was able to chat to colleagues and go for lunch and from the outside I looked ok/normal. But I had to keep going to the loos as I kept feeling like I was going to cry, I just had this awful homesick feeling of wanting to go home and I started crying on the train home. I just feel awful again and I don't know why. I handed in my notice when I was off sick as I didn't think I could return, and now I feel like I need to hand in my notice again and tell my manager that the return to work isn't working out.

I feel so completely hopeless and can't stop crying. I don't know what happened today to trigger all of this

Is wfh an option?

Yeah, I work from home 4 days a week and go into the office 1 day a week.

My first day back in the office I was there for 4 hours and it went well, I'm now up to 7 hours and I found it exhausting, I was ok up until lunch time but after that I was clock watching and just wanting to go home.

Are you taking medication for anxiety?

Yes, sertraline although I recently had to decrease my dose due to side effects

What is it about being back in the office that is making you panic, even if it sounds silly saying it, tell us and we may be able to come up with solutions.

Maybe 'pause' your phased return so you only do a half day in the office for another few weeks?
Therapy?
Medication?
It's not unusual to have ups and downs and sounds like you have been doing ok until the last couple of weeks so just be honest, sounds like they are wanting to support you to stay in work. You had a relatively short period off so it's not the end of the world if you need to slow down the phased return for a while.

How old are you?

Do you have any idea of what is causing the anxiety? I think it needs to be addressed rather than simply masked. Have you had talking therapies?

I would go back to your GP. Maybe you could increase the dose again or maybe you could switch to a different medication?

I also think see your GP lovely. There will be a different medication you can try.

Escitalopram is good for anxiety and has a better side effect profile. I am sorry you are going through this. I have been there. CBT is helpful, along with acceptance and commitment therapy (ACT) and bear in mind that mindfulness and meditation take a while to start helping and at first actually feel very difficult. Always remember it is temporary, you will get through this. It comes in waves. Try to accept it and don’t fight with it, knowing it will fade again.

Stoic philosophy, Seneca’s letters and Marcus Aurelius Meditations. 2000 years old but reading this has given me relief from my anxiety for for first time in a long time.

ACT therapy has really helped me (try the audio books by Russell Harris), it helps you to sit with the emotion and contain it rather than trying to struggle with it. For example with unhelpful anxious thoughts it advises to acknowledge it, 'thank you brain for that story that I can't cope in the office/I'm not good enough/ I need to hand my notice in, now I'm going to carry on doing what I need to do.'
As weird as it sounds more days in the office might help... anxiety commonly sells us a lie that avoidance will make us feel safe and settled. There might be initial relief if you headed home but then the anxious feelings would return and maybe be amplified when you tried to head out again. Avoidance doesn't keep us safe from anxiety, it feeds anxiety. Gentle exposure to stressors is important.

Genuinely cant recommend The Happiness Trap enough whilst you are waiting for real therapy, a self compassion work book may also he a good shout. Many areas also offer CBT or other coping skills online whilst you are on the waiting list. You might also want to see if Mind have an offering in your area, they often have services you can access to learn about coping skills and distress tolerance tools which help when anxiety is high.

Sensory grounding is one tool you could use at work, trying a really strong taste (sour sweets often work well) to give you a moment to interrupt your anxiety loop before you start breathing exercises/ muscle tensing and releasing etc.

One of the most effective tools for anxiety is exercise, is this something that you could give a go at all?

Are you on the waiting list for therapy?

A different medication might be worth a try as it may be that you are not in the therapeutic range for you for sertraline now.

There is hope for recovery ❤️ all the best on your journey.

I only decreased my sertraline dose a few days ago so not due if I need to try and ride it out first before seeing my GP?

It's not just the office that has been causing anxiety, if I write everything down that's upset me today and yesterday maybe that will help:

Yesterday, working from home:

• Felt quite lonely as a few colleagues, including my secondary line manager, haven't acknowledged me at all since I have returned. I don't know why my second line manager hasn't reached out at all


• Had a meeting with around 10 people I had to speak up in briefly, I was anxious all morning and couldn't concentrate on my work until I had done it. I was excused from going the last few weeks so this was my first time attending since being back at work


• Spending ages on work that used to take me an hour, knocked my confidence and feel like I'm so behind


• My manager reviewed my first piece of work since I have been back and had a lot of feedback, quite a lot of basic things. I feel like I've lost everything I've learnt and all of my progress, and think my manager maybe wishes they had accepted my resignation and gotten rid of me


• Sitting around colleagues who only started a few months ago and hearing them confidently talk about their work and projects and be confident in their meetings and just realise how behind them I now feel


• I was due to head home an hour earlier than everyone else as part of my reduced hours, but a colleague I needed to speak to before I could leave was busy and I had to wait around for 45 minutes when all I wanted to do was go home


• Just wanted to go home, simple as that. I felt so homesick. I kept going to the loo to try and talk myself out of it and give myself space away from everyone but it didn't help

I'm in my mid 20s.

I feel like work is going to lose their patience with me and just ask me to leave if I ask for any more time. I just don't know what is reasonable and unreasonable to ask of work. I feel like they have bent over backwards to help me already

If it’s within your resources, perhaps try visiting a HCPC-Reg clinical psychologist. Sadly occ health is only able to offer surface-level CBT type interventions. Whilst these work for some, they do not work for all. You may need some deeper work to understand and address what is actually underlying your anxiety, as well as simply strategies to simply deal with it ‘in the moment’. Best of luck.

Are you using hormonal birth control?

I'll try and look into finding a clinical psychologist to go to. I'm a very private person, but I think childhood things are rearing their ugly head and if it's affecting my ability to work I obviously need to address them

I'll also contact my employee assistance programme, even if they aren't very helpful at least I've tried it

I'm not on hormonal birth control

Hi OP I’m an nhs CBT therapist and, depending on where you are, you could access support either face to face or over the phone/video call. I treat anxiety often and this sounds potentially like social anxiety, but could equally be low self esteem due to your depression. A full IAPT assessment might be helpful to narrow down an intervention and some tools that might be helpful.

Can you think back to a point during the phased return when you were less anxious, at least to a point of being able to cope. Could you request a return to that level while you ask gp to review meds. Try not to compare yourself to new colleagues, they are not coping with what you are and have enthusiasm of a new job on their side.

Your work sounds like they have been very accommodating of your illness, which is good to hear.
Are you able to give up work and not earn? It sounds like you need a good break and perhaps find a different career path? You’re lovely and young with the world ahead of you. I do hope you get all the help and support you need. There have been lots of helpful suggestions here. All the very best.

IAPT is free through the GP, so worth exploring, they often offer a range of different therapy and will tailor one to meet your needs which is fab.

All of the things you've mentioned make sense that you feel anxious about, that anticipation about the meeting is really tough, well done for attending and speaking up, that's a real achievement. The worries around feedback and responses from other people make sense, too could try activities like thought challenging around those especially when you have help from a psychologist.

Could you perhaps take going home off the table? So set an intention in the morning, today is going to be hard, but getting through it is another step forward on my journey, I can get through it without going home. Then when that thought arises you can remind yourself, Im not going home, I can help myself get through this by... And see how that goes? It's drawing a line under that go home thought. With the homesick feeling that is such a hard way to feel, are there things that could help comfort and soothe you? Some people find things like a nice smelling hand cream helpful, it sounds trivial but anything that soothes you can help get you out of that fight or flight mode and Into the calmer part of you. There's a great app called Calm Harm that has loads of ideas for riding the wave of distress, .
might be worth a look.

There are so many tools around you can try , and it can feel really hard and frustrating because it likely will be a bit trial and error until you find the combination of things that will help you the most, but you will.

Are there supportive colleagues you can chat with as you're going through this?
You are doing a fab thing by reaching out for help, that isn't easy.

Thank you all, I'm listening to all of your advice and trying to take it all on board.

Unfortunately, I can't give up work. I've had 2 months on statutory sick pay which has drained my savings already.

I will contact my GP about medication and IAPT.

I have a meeting with my manager and HR today to talk through how things have been going so far this week and I'm not really sure what to say, or how much detail to give. I could ask for a temporary decrease in hours again. I feel completely drained

Be honest with work, if you don't open up they can't support you. Also be honest with your GP for the same reason.

I say this kindly but you also need to advocate for yourself and be proactive ie contact the employee assistance programme & go back to GP to push for help