People seek counseling for any number of reasons, but something every person I have ever seen had in common is wanting to feel better quickly. I can hardly blame them. When I am not feeling well or things aren’t going right, I want things fixed in as little time as possible.
It is part of our human nature to seek solutions. When we are in pain of any kind, the brain immediately starts scanning to find a way out of the discomfort. The reality is that, for most of the people I work with in therapy, it takes time to work through and resolve the issues at the root of their pain. A longer-than-expected timeline for relief can be discouraging for the person seeking help. To give a person some degree of relief in the present moment, it is necessary to implement stabilization and coping skills so they can begin improving their quality of life and functioning.
There are so many options when we starting talking about coping and stabilization skills. Go to the self-help section of any bookstore and you will see several selections for coping with life. I have a bookshelf and a file drawer full of countless options, and it can be overwhelming to decide where to start. Each skill has its benefits and strengths, and it’s handy to have a variety of tools for handling life’s stressors. That said, I have a favorite: the simple, yet powerful, breath.
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This is where I start with most people: just breathing, paying attention to the breath, and noticing the depth and rate. It sounds so easy, right? As straightforward as it may seem, the breath has serious influence when it comes to calming the nervous system.
Let’s talk about science for a moment. Bessel van der Kolk (2012) does an excellent job of explaining how the nervous system operates in his book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. In the book, van der Kolk discusses Stephen Porges’ Polyvagal Theory, which is all about the role of the vagus nerve in arousal and social engagement.
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It comes down to this: We have two branches of the nervous system. The sympathetic nervous system, which can be considered “the accelerator in the nervous system†(van der Kolk, 2012), controls levels of arousal and the fight-or-flight response so we can effectively respond to threats. When this part of the nervous system is activated, the heart rate goes up, breathing becomes shallow and fast, and blood rushes to the extremities in preparation for fight or flight following the cues being sent from the sympathetic nervous system.
By connecting to the breath, you are able to be in the moment, becoming more mindful with what is happening now as opposed to engaging in the mental chaos that so often distracts us from what is actually happening around us.
Of course, this reaction is not activated only in response to actual threats to safety. It also happens in response to life’s stressors, including any core issues or traumas we haven’t yet worked through. Therefore, we end up experiencing all of the physical and mental consequences when are in a state of chronic sympathetic nervous system arousal (van der Kolk, 2012).
The other branch of the nervous system, the parasympathetic nervous system, is “the brake of the nervous system†(van der Kolk, 2012). The vagus nerve controls this part of the nervous system and can be broken down further to the dorsal vagal complex and the ventral vagal complex. The dorsal vagal complex is designed to drop your body into a freeze-and-flop response when the sympathetic nervous response is unsuccessful in achieving fight or flight. This is the state of shutdown or hypoarousal (van der Kolk, 2012).
Similarly, the ventral vagal complex also slows the body down, but it differs from the dorsal vagal complex in that its main function is not to respond in an extreme way to a threat or high levels of stress. Rather, it activates a relaxation response and helps the body to grow, heal, and digest. It also helps us to seek out and connect with others. When the ventral vagal complex is activated, we can feel a wide range of emotions but the nervous system is not overwhelmed and thus does not have to enter the shutdown response.
Here is where the breath comes in: When you breathe out slowly and mindfully, the ventral vagal complex is activated and your body is able to relax. More blood is directed to the parts of your brain that are involved in problem solving, and you are able to enter the state of social engagement. By connecting to the breath, you are able to be in the moment, becoming more mindful with what is happening now as opposed to engaging in the mental chaos that so often distracts us from what is actually happening around us. By specifically paying attention to exhaling, you are simultaneously calming the body and the mind (van der Kolk, 2012).
Harnessing the power of the breath is something we all can benefit from at any time. Regardless of whether a person is in therapy, we all need to calm the nervous system from time to time. Being mindful of the breath can help a person to deal with everyday stresses that we all inevitably encounter. Simply paying attention to breathing can help us to focus better and, therefore, make us more productive and effective in our lives.
Reference:
van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Viking.
Corrective learning is a process that occurs when existing conceptions and beliefs are replaced by more adaptive ones. For individuals with anxiety, panic, and phobias, exposure therapy is a common form of treatment that aims to produce corrective learning.
During exposure therapy, individuals are exposed to things they fear or that threaten them. Because these situations or things are usually avoided as a result of anxiety, the theory behind exposure therapy posits that being confronted with the feared item or event in a controlled environment will allow the individual to realize that his or her fears surrounding that item or event will not be realized. It is also believed that the level of fear or anxiety that is experienced during the exposure directly predicts the level of reduction in anxiety at treatment outcome. In other words, the more fearful or anxious someone is during a session, the more he or she will be able to overcome that fear in the long run.
This theory has been tested at length. However, Alicia E. Meuret of the Department of Psychology at Southern Methodist University in Texas wanted to examine this further. In a recent study, Meuret assessed the physiological and emotional responses of 34 participants with agoraphobia and panic as they underwent either a cognitive behavioral or breathing-based exposure therapy. She found that the participants all experienced increases in panic and anxiety during the sessions, as evidenced by physiological markers and emotional responses, but that these increases did not lead to better outcomes. In fact, the more panicked and fearful the individuals were, the worse their treatment outcomes. Additionally, in contrast to existing research, Meuret found that symptom reduction during treatment did not predict treatment outcome. In other words, even if the individuals experienced spikes in treatment severity during exposure and then were able to reduce their anxiety as the session continued, this drop did not lead to better overall outcome.
It has been suggested that allowing a client to experience symptom reduction during exposure provides a sense of self-control and mastery for the client and accomplishment for the therapist. And although this may indeed be true, the reduction of symptoms after exposure does not seem necessary for treatment success. In fact, the treatment outcomes were similar for those who left sessions with symptoms that were elevated as well as with symptoms that were diminished. Meuret believes that these results contradict the theory that fear reactivity is an indicator of treatment outcome, although her study was limited by sample size and the fact most of the participants were well-educated white females. “More research is needed to examine the underlying mechanism of corrective learning during exposure across therapy types,†she said.
Reference:
- Meuret, Alicia E., Anke Seidel, Benjamin Rosenfield, Stefan G. Hofmann, and David Rosenfield. Does fear reactivity during exposure predict panic symptom reduction? Journal of Consulting and Clinical Psychology 80.5 (2012): 773-85. Print.
In counseling, many of the ways to address anger can also be used as tools to address anxiety. Deep breathing is one such tool. Getting that full, deep breath of oxygen will indeed help both our mind and body. Sadly, we may not stop to focus on our breathing or take in enough of that good oxygen. Furthermore, in times of distress, rapid breathing is more likely and will not help the thinking process or our ability to calmly make decisions.
When I sit in session and show clients that taking that breath is a bit more than a second or two process, they seem confused. Yet nearly everyone reports feeling remarkably calmer after trying it. Personally, I like to close my eyes so I am not focused on what is around me. Imagine as you take in that full breath through your nose that you are soaking in positive energy. Hold it a second or two, and then slowly breathe it out through your mouth. This is not a race. In fact, try to expel it slowly. Slowing down your breathing will mean you are slowing down your mind and body.
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Now, in the process of this deep breathing, let’s add some guided imagery. For this, think of a calm place. I would like this to be somewhere you feel relaxed and positive. For me, it is the beach. I want you to see yourself there without having to focus on where else you may need to be or other things you may need to be doing.
Experience as many of the senses as possible. For example, sitting on the sand, I can feel it between my toes. I can feel the warmth of the sun on my arms. I can smell the cool beach air and the scent of suntan lotion, and I can hear the gentle crashing of the waves and even children playing off in the background. I can also see the beauty of the area, as I watch the birds in the distance over the water. The beach is a calming place for me, so as I take in my deep breaths, I imagine soaking in the warmth and wonder of it, even as I am in my car, home, or wherever I am practicing.
The more senses you can envision, the easier it is to remain focused in the moment. Some people choose amusement parks or other loud venues. That’s okay as long you can focus and keep to your steady breathing pattern. The goal here is to consciously and intentionally slow our minds down while adding these positive and relaxing components. When asked if you should practice this when anxiety is creeping up, I say to try and practice these tools at least a few times a day. I don’t want you to have to wait until the anxiety is noticeable. Rather, if we are practicing relaxation, we will not only be in a better position to deal with it in those moments, but hopefully even fend some of it off in the first place via a calmer, more relaxed you.
Your mind is indeed a powerful tool. We hear about sharpening it with memory exercises and such to enhance our cognitive skills, but what about teaching it to relax? We live in a fast-paced society where expectations can be massive and relaxation is not taught in school. Rather, we learn how to be better students and thus more successful human beings. You need to teach your mind and body to calm down and be okay with relaxing once in awhile.
Mindfulness-based therapy is an approach in which the principles of mindfulness are applied for therapeutic purposes. What does this mean? My previous article discussed basic elements of mindfulness:
- Pause.
- Bring awareness to body, sensations, feelings, and thoughts.
- Connect with the breath.
- Be in the present moment.
- Adopt a nonjudgmental approach: apply compassion.
While working with clients, I developed recognition of two main components that emerge from these elements of mindfulness: I call them the two pillars of mindfulness-based therapy. These two pillars—observation, and the cultivation of compassion, acceptance, and virtues—bring about change in peoples’ perspective, and consequently in
their lives.
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Observation
Observation emerges from the first four elements of mindfulness. It calls us to place attention to the process, to bring awareness to the way that thoughts come and go, appear, develop, and disappear. One is asked to acknowledge patterns of thinking, as well as the expression of emotions in the body, the subtle changes in body sensation, and the movement of the breath in and out of the body.
Even though the content of thoughts is there and recognized, the intention is not to engage with it, cling to it, or feed it. This is similar to the way that, in therapy, the past, traumas, and personal stories are important to acknowledge, but they don’t become the center and focus of the therapy. The focus, rather, is on what is happening now, how feelings express themselves in the body, and what triggers reactivity.
This approach allows release of attachment to “my story,†“my depression,†or “my anxiety.†Observation empowers the client to choose between letting thoughts, emotions, and even real-life events control his or her life, actions, and reactions, or, alternatively, to be more active and present in his or her outer and inner life and choose how to respond to challenges that present themselves at any moment.
Observation calls to bring awareness not just to destructive patterns, but also to positive and pleasurable thoughts, emotions, and events. Here observation allows for the positive to be part of the experience of life. While observing, the emphasis is still on the process and not the content: how does a positive experience feel in the body, how does the feeling change when awareness is brought to it, how do positive thoughts appear and disappear?
The Cultivation of Compassion, Acceptance, and Virtues
The cultivation of compassion, acceptance, and virtues emerges from the last element of mindfulness. This second pillar does call for attention to content. In this case, there is an attempt to focus on and produce positive thoughts. Clients are encouraged to wish themselves well while practicing Loving-Kindness meditation and reciting phrases with positive wishes. They are invited to look at and further develop their virtues, and to focus on the good in their lives even when it is small or hidden.
The more I work with people, the more I realize how much this pillar is crucial for positive change and growth. In this practice, it is not just about observing inner activity, but rather cultivating and expanding that which is already present. Even when one is not aware of having any compassion for their self or of having any virtues, we work together to discover positive elements that do exist and develop ways to integrate compassion, acceptance, and virtues in everyday life. I have a few clients who cannot feel any compassion for themselves, but through their ability to feel compassion for others, like kids and pets, we can work on slowly shifting the flow of kindness from the heart and direct it toward themselves.
Working with these two pillars in mind, I use two opposite powers to help a client reach balance. Observation helps to reduce negativity and unhealthy patterns of reactivity and behaviors, and cultivation of compassion, acceptance, and virtues supplies the positive energy necessary to help one grow. It helps increase positive attitude, self-esteem, trust in self, and healthy activities.
The first in a series of articles dedicated to understanding, appreciating, and coping with our anger.
“Sticks and Stones.” I am sure most of you have heard this saying and think you know the ending. It is said to go “sticks and stones may break my bones but words will never hurt me.” I think our parents taught us this, thinking it would help us ward off teasing by others. Unfortunately, this misguided saying is far from true. You see, in reality, sticks and stones may break my bones but WORDS CAN DO SERIOUS DAMAGE. Broken bones heal and yet harmful words may stick with and haunt us.
Many clients come to me struggling with their anger and just want to “fix it.” They hope a few tools will do the trick. Sometimes, this is all it takes. More often though, it is not that simple. As we delve into a quick history, it becomes clear that their anger has been around for a long time. In fact, it has grown over time. Realistically, we cannot expect life-long patterns to be broken overnight. I firmly believe it is valuable for me to help clients understand where their anger comes from. For most of us, anger is directly related to deep-seeded pain from growing up, and I want to help look at sources of pain throughout our lives.
When clients bring up how:
1) their parents weren’t there for them
2) their parents handled their own anger inappropriately
3) they were never taught or encouraged to communicate their feelings
4) they don’t show sadness and believe tears are a sign of weakness
I know how that translates into unresolved sadness and pain which, if not expressed, tends to come out as to anger.
I tend to hear people say “if I don’t think about it, the thoughts/feelings will go away.” This is not the case. In fact, stuffing our feelings will only last so long. Like a volcano, when we stuff our feelings and hold them down, they will eventually erupt or leak out. Exploding over someone spilling something or cutting in front of you, and then not understanding why you are getting that upset, is a problem. When I hear how angry someone gets over “nothing,” I want to look at where the anger is really coming from.
Our anger does not just appear out of thin air. More often than not, when we focus on how the anger has come to be, I can help clients grasp at least a few deeper issues within their past that may be tied to current anger. Of course, I am always wanting to explore with them how their denial of sadness and pain (to generalize, something that, especially we guys, don’t like to show) may have found a way into anger (a feeling we guys may be more expected and comfortable showing).
Too often, clients believe others are “making” them angry. Thinking about your anger (feelings, thoughts, actions, etc.), this in indeed yours. Own it! No one makes us do anything unless we decide to do it. No one makes me sad, happy, angry or anything. The other person can do something, that I may not like, and then I get to choose how I want to respond. Yes, at times, someone’s behavior will lead me to feeling upset but, again, I decide if this will happen. I am indeed in control. Why give up yours? Own your feelings. This will help you understand how many choices you have and how to next respond (or not).
It is important for me to normalize client’s anger. Typically, when I ask people if anger is bad, the answer I hear is “YES.” No, I say. Anger is a normal feeling. It is just what we do with anger that can be positive or problematic. Be clear on this; we all get angry. We all get happy, sad, anxious, etc. sometimes. Feelings are a normal part of our existence and we need to express them.
Upcoming articles here, will focus on not only how to face our pain and best express it, but also on tools to best cope with painful feelings and the anger we may have inside. To start, though, I want to highlight how imperative it is to learn how to calm both the mind and body. One of the best ways to do this is via a commonly used tool known as deep-breathing. Sounds simple but you would not believe how we may fail to take the necessary full breaths, especially under stress.
Taking a slow, deep breath through your nose, holding it a second or two, and then slowly expelling the air through your mouth should not be just a few second process. When we focus on this and take the time needed, it will be difficult to be angry as it helps stop the racing thoughts that tend to go hand-in-hand with anger. Again, this is not a race. Just the opposite. Calmly breathing helps the body and trains our minds to slow down. Furthermore, we don’t want to wait until we are upset to do this. The more we are calming ourselves during the day, the less likely we are to get hyped up in the first place. Try practicing this a few times daily and get ready for more next month.