Sunday, October 26, 2008

Treating Anxiety Part 2: stress reduction techniques

Empowerment is the key to a stress reduced life. I say reduced as opposed to free because we all experience stress on some level. Deadlines from work, difficulties with significant relationships and financial dealings to name a few. It's more the way we react to these situations than the content or magnitude of the challenge that makes it debilitating. A former friend of mine's favorite saying was "it is only a big deal if you make a big deal out of it." And although I wanted to slap him upside the head when he evoked this after my pet died, there is some truth to it.

We need to control and quantify our reactions to challenges and setbacks as they occur. So developing a repertoire of stress reducing and controlling techniques is a valuable weapon in the battle against anxiety disorders. Being comfortable and well practiced with them is probably the most difficult facet in being successful with them. When we feel overwhelmed with problems our narrow focus becomes the problem itself, not our disposition as we take them on. So appreciate the importance of your mind-set in dealing with your anxiety related problems.

Listed below are a few SR techniques I have had success with clinically. It is important to experiment around and find the one or many that work for you. You must gain some mastery of the technique in a comfortable setting, and then be able to implement it when you first feel the anxiety coming on, anywhere, anytime anyplace.

Deep Breathing Technique: This is the most basic and widespread of SR techniques. It is frequently ridiculed in the media and movies as a desperate measure when someone is overwhelmed. I don't know how many movies or comedy sketches I have seen wherein someone is breathing into a paper bag in the most inappropriate of settings (you don't really need the paper bag).

The most important element of DBT is control. You chose a slow deliberate pace to breathe. When you inhale, you do not let your abdominal muscles expand, as if you are filling up with air. Instead, you tighten your abdominal and diaphragm muscles. When you exhale you can slowly relax the abdominal and diaphragm and control the stream of air. Performers, particularly singers, woodwind and brass players use this technique to enhance execution when reciting.

Although the easiest to master, DBT is highly effective. It is also the most feasible to combine with other techniques. The increase in oxygen to the brain and vital organs gives one a sense of well-being. One of the main symptoms of anxiety disorders is a feeling of loss of control, in particular body functions. An increased pulse, or sweating, for instance, makes us feel even more anxious. In taking complete control of our breathing, we resume command over our bodies. We gain a calmness that lets us address these uncomfortable sensations.

Positive Visualization: When overwhelmed with disturbing thoughts, simply imagine a time and place when you were completely relaxed. A vacation at the beach, the warm breeze and the sound of the surf. Even a romantic encounter, one you truly enjoyed and does not invoke other insecurities. We all have memories that when vividly recalled will elicit the same calming sensations when the experience occurred. They can serve as a distraction when we feel on the brink of an anxiety episode.

Meditation: This technique really utilizes the power of the mind. Mediation, in a transcendental sense, is the "art of think of nothing." You position yourself seated in a quiet, non-stimulating setting. You can start with a mantra, a 2 or 3 syllable nonsense phrase or word. Keep repeating it in your mind till all meaning is lost. Eventually you can drop the mantra and jump to thoughts of nothing. When you loose the internal dialogue associated with a conscious state, all of the physical symptoms associated with stress vanish. Muscle tension in the neck, a rapid pulse, acid stomach, will slowly melt away.

Thought Stopping: This is effective for anxiety related disorders related to repetitive disturbing thoughts. It is a procedure used to stop thoughts that are cues to thinking obsessively or acting compulsively. The key is to hear “stop” literally or figuratively whenever a negative or unhealthy thought arises. You can yell it to yourself when you are at home or alone, then replace it with the imagined audible in your head when in a more formal setting. Another method entails making a tape recording of your voice by repeating the unhealthy thought, i.e, "I think my hands are dirty," over and over again for 2 minutes, then yelling "stop" loudly and repeating the cycle over and over. Then lie down in a semi-conscious state and listen to the looped tape.

The idea is to "jar" the negative thoughts and feelings out. Once you are redirected you can shift your thinking and activities to more healthy ones. Hopefully, over time, the repetitive thoughts will vanish.

Biofeedback: Biofeedback is not a SRT per se. It is a method of measuring physical responses associated with stress. A SRT is implemented and then the effectiveness of that technique is measured by the biofeedback instrument, as it looks for a decrease in a stress related physical response. It gives the client the ability to confirm the effectiveness of the technique. The client no longer will have to say "I think I am relaxing," because there is measurable confirmation to the relaxation. Once the sensation is confirmed and quantified, the client has learned to relax.

There are several biofeedback instruments available to measure stress. Some are quite inexpensive. I have found a Galvanic Skin Response instrument quite effective in practice. I paid $25 for it on ebay. Here are some definitions:

Pulse and Variable Heart Rate: When stressed, the heartbeat not only increases, but becomes more arrhythmic or uneven. Breathing does too. The "Stress Eraser, " measures both of these and keeps a diary to monitor improvement. It will even tell you when to breathe in a healthy cadence. It is portable and made of i pod style polished metal. It measures from your index fingertip. Might be an overkill on price but very stylish and effective.

Galvanic Skin Response: As mentioned above, very effective and inexpensive. Measures moisture at your fingertips, the minute "perspiration response." It emits a theramin-like tone that lowers as you relax. PC software is also cheap and attainable. These will create graphs to illustrate response over time and offer games that encourage you to relax. Time proven and effective biofeedback instrument.

Muscle Tension Instruments: Not highly commercialized, these measure tightening muscles, particularly in the neck. Highly effective in treating migraines and muscle tension-related headaches. Not very practical in terms of comfort (hard to cope with electric diodes placed on the neck).

Brain-Wave Machines: These are also used mostly in clinical settings, but are gaining popularity via the portability of the microchip. These directly measure the beta waves that are associated with a relaxed, conscious state. They are potentially the most effective way of measuring anxiety, but are also the most expensive, with the alpha-beta-wave machines of any real value topping $1k.

External Skin Temp- As we become stressed, blood rushes out of our extremities to our vital organs. These instruments measure body temp at your finger tips and scrutinize temps slightly below the normal 98.6. These are the most inexpensive in the biofeedback realm, but as you might have guessed, the least effective because there is a delay between the anxious response and the change in skin temperature, analogous to the delay in change in room temperature after you turn the thermostat down. It is therefore hard to get a feel for the cause and effect relationship of anxiety and this physical response. A mood ring is a simple example of an external skin temperature biofeedback instrument.

Stress reduction techniques do work. This is supported by research. It is difficult to find the time to implement them and find the right one that works for you. Biofeedback gives you an opportunity to confirm your progress and accomplishments and makes the dedication to anxiety reduction that much easier.

This blog has covered valuable information regarding controlling anxiety. In part one, we gained an understanding of how anxiety manifests itself and relates to our daily living and cycles. Part two has given us background on tools and techniques we can use to combat this illness. In part three, we will examine how to use stress reduction in the most practical settings, when and where it occurs in our work, travels and at home.

Monday, October 20, 2008

Treating Anxiety Part 1: cycles and patterns

Anxiety is by far the most addressed issue in clinical therapy. It is the big kahuna of psychiatric treatment. The 3 largest selling prescription drugs in the U.S. for all ailments of body and mind are approved to treat anxiety. These drugs usually produce moderate to excellent initial success, but are known for profound side-effects and increased tolerance. That's why learning to manage it on your own is so important.

Although anxiety manifests itself in many ways, there are some common elements we can identify that help us gain an understand of the cause-effect relationship and behavior chains that make it an obstacle to enjoy and function in our daily lives. Here are a few commonalities:

The Tension Mounts: Anxiety accumulates through stress. Most people report anxiety heightening by the end of the day. Panic attacks occur far more often in the PM then AM. It is therefore very important for sufferers to take stress breaks during the day. If you have an anxiety problem and you are spending your lunch or coffee break surfing the net, calling family or friends or some other activity that requires significant attention and concentration, then you are making poor use of your time. Take a few minutes periodically during the day implement a stress reduction technique (much more on them later). This will at least slow the accumulation of stress during the day and make it more manageable as it peaks.

Domino Effect: When we are under stress, we often make hasty and impulsive decisions. The consequences of these decisions are often cause for more stress and anxiety. Like a bad lie made from a politician, things start to unravel and we experience chaos and a loss of control. The saying or song "one thing leads to another," probably alludes to this phenomena. This dynamic once again points to the need to keep stress at a minimum and reset periodically during the day.

The Mind-Body Relationship: There are several measurable physical response directly associated with anxiety: increased and variable heart rate, adrenalin being dumped in the blood stream, increased muscle tension to name a few. These will be further addressed in the discussion of biofeedback in part 2. When we experience uncomfortable physical sensations the result is generally, you guessed it, more anxiety. Someone's heartbeat increases and palpitates and they wonder if they need to go to ER. Or someone begins to perspire in a social setting and they become more self-conscious and less confident.

The common theme between these 3 elements of anxiety disorders is one of mounting and accumulating stress. We see a chain of events and behaviors that help feed the anxiety. The preventive or proactive element of treating this disorder is vital. The onus is on you to identify these maladaptive trends as they happen and try to subvert them. Then the therapist or other resource can give you a repertoire of techniques to help you tame this debilitating beast.

up next: Treating Anxiety Part 2: relaxation techniques

Friday, October 17, 2008

My 1st Letter!

After patiently waiting for 3 weeks now I finally got a request for advice from an anonymous source. As I clicked the link to view the correspondence I was anxiously anticipating the content, The snail mail equivalent would be having trembling hands as I opened the unsealed envelope.

This inquiry is excellent because of it's focus on equity, respect and control in significant relationships, an issue so many of us can identify with:

Hi Jeff, How are you doing? I clicked on your blog page. I also bookmarked it. I need all the advice I can get in I still have an insecure feeling inside when it comes to men. Is this normal? Like one thing about Trent that irritates me is that like he said he would call me last night and he didn't. This is about the 3rd time he has done this. Should I not be so petty or realize now he is not always a man of his word? I honestly would just like to learn to be happy without a man. lol Have a good day. Anonymous

Ty for the wonderful thoughts and your letter. I guess we all wish we could be content by ourselves. But having a romantic relationship that meets our needs is an important part of anyone's life. And having someone you can rely on and is consistent is very important too. So I can see why you are disappointed in Trent's recent behavior.

As adults seeking relationships we all fight this constant battle of 2 mutually strong desires: between being alone an accountable to no one and having our romantic and companionship needs met by someone significant in our lives. Both seem like strong and persuasive needs. Unfortunately it is difficult to satisfy both: in sharing your time and space with someone else, we are forced to surrender some of the freedom and autonomy we can enjoy when we focus on our own interests and self-care.

Developmental psychologist and psychoanalyst Erik Erikson makes reference to this quandary in his eight stages of human development:

Intimacy vs. isolation (young adult stage) refers to the 6th stage of Erik Erikson's theory of Psychosocial development where the social task of the young adult is to create strong, long-lasting bonds of friendship and love. Those that fail in this task risk remaining isolated for the rest of their lives.

He identifies this as a conflict that begins at young adulthood. I would contend that in this era of transient and more temporary romantic bonds this conflict carries on into middle adulthood, given the slowing of the aging process and our youthful and neotenous values and outlook in modern society.

I would also argue that the "risk of remaining isolated for the rest of their lives," is a gloomy exaggeration of the isolation outcome, as some people are quite content with a solitary existence.

Ok, I need to get some advice in here at some point and get away from the academic digression.

So how can we try to live our lives in a way where both needs are satisfied? What are some of the common misconceptions or cognitive errors that we bring into the relationship? Here are a few "bullets" that contend with my writer's difficulty with her boyfriend.

  • Never Again: it is unreasonable to expect the same intense feelings and bonds in a later adult relationship as you had as a young adult. Both parties are more protective of their hearts and set in their ways and you will never get that feeling of "oneness,' that you did with earlier love interests. It is a sad fact, but a realistic expectation. Even young couples that do stay together for years and beyond to a golden anniversary drift apart in terms of insatiable attachment and time spent together. But their appreciation for each other and love grows in many other ways; their shared time together, the mutual pride of raising a family. That mutual love can also be gleaned in a relationship that starts in later adulthood. It is a matter of duplicating that appreciation by finding mutual pride in shared and productive activities (including the combining of two families) and sharing time in activities that are spontaneous, fun and unique enough to be chronicled as an enduring and sustained memory.
  • Be Confrontational: If your partner does something that you believe falls short of your mutual agreement, don't just sit back and keep taking it in a patterned way. Take a stand, but frame it in a way that is constructive and encourages further growth and so he/she does not feel put on the spot. "I want to ask you about something because I really care about our mutual satisfaction in this relationship," for example. Keep your emotions in check, moderately positive and upbeat. You will in most cases get some honest dialogue and know where you stand in the relationship. Maybe you won't like the answer, but it beats the uncertainty and painful lingering effect of feeling like you are being taken advantage of and not knowing where your partner stands.
  • Keep Yourself Centered: Aware of what you have control over and do not. Remember your self-worth and that it is reasonable, desirable and you are deserving of having a healthy relationship. When you start to say you must have this relationship and you must have it right now, that's when you cross over to irrational thoughts that lead to unrealistic expectations and a deteriorating mood.
We all have to find a balance between our own personal content and the satisfaction of having someone special in our lives. Once we have found our place in that continuum and find a person that shares our dreams and values, the conflict between autonomy and belonging will be resolved.

Saturday, October 11, 2008

Small Craft Warning: Politics and Emotion in 2008

Still waiting for that 1st advice letter/inquiry. Having a friend, former client (one sent an amusing prank email) or even myself send me one would be easy, but I want the letters to be real and genuine. I know quite a few of you are giving me my share of impressions, so please help me get this thing rolling.

Ah, but there is plenty of treatment fodder out there anyways. I was thinking about the current economic "crisis" and the upcoming election and how this cultural climate might impact treatment. What are some attitudes and feelings I am picking up on in these turbulent times? I may see this exaggerated in my practice because I live in a Detroit suburb and this area is being impacted by the economic downturn more than any other area in the US. I have a few listed below and the how and why as it relates to a mounting tension in American culture. As the third wave feminists would say "the person is political" and I have been observing how the political seas of change are effecting my clientele, many who are finding how these hard times are compounding the stress associated with their already unsettled lives.

wait and see

people's dreams and aspirations are being put on hold. Fearful of making large purchases. Reluctant to take on new challenges, such as school or a new business venture. Hopeless thinking about their future endeavors panning out. A pessimistic paralysis as they tread water and wait for the cultural environment to change in a way that makes personal growth more feasible.

bargaining with themselves

A lost job, a foreclosed home, will lead to self-reflection. Having explored all reasonable options, they endeavor in magical thinking: perusing luck, ritual behaviors and excessive use of faith.

slash and burn

A sense of abandonment. People feel they may as well run up the credit cards and enjoy life because "I am loosing my home and going bankrupt anyways." Hedonistic tendencies follow.

sour grapes

As the election nears, and the outcome becomes more evident, those who see that their ideas for change are not going to take place. They begin to express anger and hatred towards those that do not see things their way.

these are all irrational responses to an albeit overwhelming challenge. We need to contain and moderate these feeling as a starting point to our own personal adaptation to these changes in our political and economic environment. We need to have a grip on how much influence these socio-economic factors have on our lives and how much control we can exert over this phenomena and how much support we can glean from those around us. And lastly, in terms of exerting our own control, DON'T FORGET TO VOTE.

Jeff aka “Dr. Memory.”