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.

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