Nothing to fear but fear itself…Psychotherapy August 1, 2011 - 5:57 pm No Comment
Everyone gets anxious from time to time, for some reason when i stand in front of a large group of people and have to deliver a speech my mouth gets dry and my palms become clammy even though i feel quite calm inside. For about one in six of us, a low level of anxiety may cross over into what psychologists term a ‘disorder’ at some point in our lives. An ‘anxiety disorder’ is when people are almost continuously anxious and find it difficult to concentrate, have trouble sleeping and become irritable and restless. Women are roughly twice as likely as men to suffer from an anxiety disorder.
For the majority of us, anxiety will come and go as part of the normal human condition. Whether it’s a constant or occasional affliction, dealing with anxiety effectively is important.
People are often prescribed drugs for anxiety but these are less effective in the long-term, some are particularly addictive and many have side-effects. So what other types of treatment are available?
Relaxation training comes in a variety of flavours, but the five methods which have much in common and the most evidence to support them are (Manzoni et al., 2005):
1. Progressive relaxation
The most commonly studied type of relaxation therapy may be familiar to you. It involves mentally going around the muscle groups in your body, first tensing then relaxing each one. It’s as simple as that. And with practice it becomes easier to spot when you are becoming anxious and muscles are becoming tense as, oddly, people often don’t notice the first physical signs of anxiety.
This is based on the idea that the mind follows body. When you relax your body, the mind also clears.
2. Applied relaxation
Applied relaxation builds on progressive relaxation. First you learn to relax you muscle groups one after the other. The next stage is to cut out the tensing phase and move straight to relaxing each muscle. Next you learn to associate a certain cue or affirmation such as ‘ be here now’ with a relaxed state. You then learn to relax really quickly. Finally you practise your relaxation technique in real-world anxiety-provoking situations.
Once again, mostly this is about mind following the body.
3. Autogenic training
Goes back to the 1930s and is another technique for progressively relaxing the muscles. To help you do this it has a mantra which you repeat to yourself as you go around major muscle groups: “my right arm is very heavy” and so on. A second stage involves inducing a feeling of warmth in the muscles. Once they feel ‘heavy’ from the first stage, you follow another mantra about warmth: “my right arm is very warm” and so on.
Further stages involve calming the heart and the abdomen and cooling the brow in much the same way.
Once again, you’ll notice that this is all about the mind following a calm body. As before practitioners recommend daily practice so that you can relax more and more quickly. With practice the simple intention to start the training will be enough to cause the body to become relaxed and warm.
4. Mindfulness based strategies
There is statistically sound evidence (Kabat Zinn et al 2009) that mindfulness based stress reduction (MBSR) and mindfulness based cognitive therapy (MBCT) can work for people who experience anxiety. There are numerous books written by Kabat Zinn on MBSR which are readily available and some come with a CD which can be used to establish a daily practice which will sustainably regulate low-medium levels of anxiety.
Be aware that meditation is quite difficult and the drop-out rates are high from studies which investigate it (Krisanaprakornkit et al., 2006). This suggests some people don’t find it particularly acceptable. For people who can manage it, though, the results are often better than the other techniques (Manzoni et al., 2005).
Notice that this technique is much more actively related to the mind than the first three methods. It doesn’t just target the body and wait for the mind to follow, instead it’s about the way attention is focused. A fluttering attention (often referred to as the ‘mad monkey mind’) is the primary suspect in chronic anxiety, so learning to observe the mind as opposed to continually buying into its drama is a surefire way to creating a lasting calm, safe space within.
5. Cognitive behaviour therapy
Finally cognitive behaviour therapy, or CBT, targets both mind and body. As it’s primarily a talking therapy you normally have to go to a psychologist who will help you target unhelpful thinking patterns and behaviors. CBT and MBSR used together can be extremely powerful in anxiety management.
Integrative approaches work best
There’s no reason why you should stick to only one approach. When Manzoni et al. looked at studies which used multi-modal techniques, they found these were extremely effective.
If you need to relax—for whatever reason and at whatever time—then try one or more of these different methods. As you’ll have noticed the effective techniques share a lot in common. Regular practice is the key and, if you give it a chance, the mind really will follow the body.
Try this experiment…sit somewhere quietly where you won’t be disturbed for a short time (approx 10 mins). Set an alarm on your cellphone for 10 minutes time (so you don’t constantly worry about how long its taking). Then settle down and become aware that you are breathing…in and out through the nose…try and focus your attention on the in breath…and the out breath…the in breath… and the out breath…attempt to breath in for a count of 1…and out for a count of 1….in for a count of 2…and out for a count of 2…until you get to 10….while focussing your attention just on your breath. You’ll notice that it isn’t as easy as it appears, often you’ll lose count…thinking about a thousand different things, judging, planning, worrying…etc. That’s ok, it doesn’t mean you’re failing in any way, it just shows you how busy the mind is! when you notice that your attention is no longer on the breath, gently (important-don’t judge yourself or punish yourself) guide your attention back to the breath and start again at 1…until your attention can reman stable on the breath until you have got to 10. If you have had little or no experience of focussing your attention in this way, it should take you about 5-7 days to hold your attention in a stable way until a count of 10 at which time you can increase it to 15…20…etc.