Anxiety, awareness, looking, and seeing

When our anxiety controls our attention, our attention becomes narrowed and constricted. We hone in on what is threatening- and often become pre-occupied with getting rid of our anxiety. We simply don’t want to feel as anxious as we actually feel!

When our anxiety controls our attention, our brains often shut down certain aspects of experience.  We have difficulty seeing what else is there.

As long as we can prevent ourselves from looking, we can avoid things that make us anxious. Often when we avoid what makes us anxious, we don’t have to come to terms with sadness, loss, or pain.

We actively avoid talking about certain subjects. We avoid conflict, emotions, and people. We fill silence with awkward chatter and exit the room if the intensity becomes intolerable. We avoid eye contact. We make up platitudes that aren’t true to what we are thinking or feeling at all.

Mindful practice enables us to pay attention to aspects of our experience that we simply don’t want to pay attention to. When we pay attention- with openness and curiosity- we can start to get our minds around the places that our anxiety tries to control.

It is the acknowledgement that sets us free. When we are open to this anxiety, this pain, this discomfort, this awkward moment, this silence- we can bear with it. We can receive, acknowledge, and understand. We can accept it and know it for what it is. “It” loses its power over our frenetic actions.

When we willingly re-direct our attention to that which evokes anxiety- we start to see what is in front of us. We no longer have to avoid people, places, subjects, or topics of conversation- because we acknowledge them. We recognize when others change- and when they don’t change- and the impact it has on us.

When we are vulnerable and receptive, we are moved and touched and influenced by the world around us. We might get hurt. We may need to get up and brush ourselves off. But we participate in life and we take risks.

We live as if we are alive.

 

The value of revisiting trauma

The value of revisiting traumatic experiences is that it gives a person an opportunity to organize, make sense of, and gain clarity on past events. Many people who suffer from post-traumatic stress experience memories and associated events in ways that are intrusive and beyond personal control. This makes the memory itself something to avoid at all costs.

However, the benefit of revisiting memories and recalling traumatic events is to decrease fear that is associated with the remembering of the memory. When a person can remember the memory without shutting down, avoiding, or dissociating, the person can then begin the journey of grieving and meaning-making. The past becomes clearer- what actually happened, happened.  A person can begin to get their mind around it and talk about in a way that integrates self-experience in the context of space and time.

One way of getting through painful times includes valuing, spending time with, and paying attention to the people you care about. Sadness lets us know who matters and what matters. If we did not have sadness, we would not know what is important. Reality as it is cannot always be avoided, but the sustaining relationships we do have are worth investing in, paying attention to, and fostering.

 

When not to use DBT skills: Conference highlights on treating anxiety disorders (with Melanie Harned, Ph.D. and Katheryn Korslund, Ph.D.).

This last week I was able to attend a wonderful conference on exposure-based treatments. Exposure therapy is basically this: If you are confronted with objects, sensations, or memories that you are afraid of over and over again eventually your fear of them goes down. Exposure is used to treat anxiety disorders such as panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. According to the conference presenters, 60-85% of anxiety-disordered clients who receive exposure therapy show clinically significant improvement.

One example of exposure treatment is for people who have panic attacks. Panic attacks generally include a range of symptoms such as a racing heart, shortness of breath, fear about going crazy or dying, numbness and tingling, feeling flushed, and intense physical sensations. In essence, when people have panic attacks they are often afraid of having more panic attacks. For instance, when a person runs a short distance, they may get out of breath (naturally!). Not so naturally, however, they may become flooded with anxiety that this is yet another panic attack coming on. Therefore they go out of their way to avoid anything that includes a racing heart, shortness of breath, or physical sensations associated with exercise. Perhaps this includes feeling their heart beat or feeling their breath. Therefore they may avoid any activity (or any emotion!) that involves physical sensations.

Exposure treatment for panic disorder involves facing and experiencing physical sensations. This is known as interoceptive exposure. For instance, clients are asked to participate in activities that create the feeling of not getting enough air in the lungs. Classic examples may include running up a staircase, breathing through one nostril through a straw, spinning around in a chair, or hyperventilating on purpose. (Hey, when I was in graduate school, we had to do all the above with our classmates!).

The important thing that makes exposure treatment work is that the person has to be alive, awake, attentive- and not under the influence of drugs, medications, or alcohol- to make it work. NO CHEATING!!! This is actually a time NOT to use DBT distracting skills. The point is that a person’s brain has to experience the situation differently when the person is exposed to the feared stimulus. Anxiety will go up- initially- and then it will go down. Otherwise the brain never learns! The new learning is experienced, and this makes all the difference in the world. No amount of rational cognitive problem solving is going to convince your brain otherwise.

This conference gave me new food for thought, allowed me to visit old material that I haven’t seen in a while, and was an excellent and thorough overview of exposure treatment for trauma (including when not to use it!). I will keep chewing on this food for thought- and definitely keep you posted.