Archive for year: 2020

Phobic anxiety is often like a low level panic disorder. If someone is forced into engaging with a phobic situation they may well develop a full blown panic attack, (see last weeks blog). Throughout this mini series on anxiety it is important to remember that anxiety is a good thing. It is our friend that has kept use safe throughout evolution. Being anxious about heights kept us safe when we lived in trees. Being anxious about predators kept us from being eaten. In our modern world being anxious about electricity keeps us from being electrocuted and being anxious about roads saves us from being run over. Anxiety is good. Anxiety disorder is a problem.

The Encyclopaedia Brittanica defines a phobia as…

…an extreme, irrational fear of a specific object or situation. A phobia is classified as a type of anxiety disorder, since anxiety is the chief symptom experienced by the sufferer. Phobias are thought to be learned emotional responses.

Many years ago I came across a man, in psychiatry, who was terrified of being turned into orange juice. Obviously this could not have any logical component. If he saw an orange his phobic response would make him distressed and if he could get away from the orange he would develop a full blown panic attack. It can be easy to look at other people’s phobias and fears a see them as silly or even stupid. The thing to realise is that the trigger to someone’s fear is very real to them. It is their reality.

Most phobic responses have a causal event. To be phobic about something infers that there is a negative connection to it. A difficult flight involving turbulence or a difficult landing in the wind can create a phobia to flying. Food poisoning from eating a particular food can create a phobic avoidance of that food or that restaurant forever.

Most of us are phobic about something. It could anything from a colour to a fairground ride. One the relationship has been made the mere mention of the trigger can cause the symptoms that are common to all anxieties.

• sweating
• trembling
• hot flushes or chills
• shortness of breath or difficulty breathing
• a choking sensation
• rapid heartbeat (tachycardia)
• pain or tightness in the chest
• a sensation of butterflies in the stomach
• nausea
• headaches and dizziness
• feeling faint
• numbness or pins and needles
• dry mouth
• a need to go to the toilet
• ringing in your ears
• confusion or disorientation

Complex phobias include agoraphobia and claustrophobia.

Treatment

Talking treatments, such as counselling, are often very effective at treating phobias. In particular, hypnotherapy, Cognitve Behavioural Therapy (CBT), Mindfulness and one to one counselling. Medication maybe prescribed for anxiety but is not usually very effective for phobias.

The important things is that phobias are learned and can be unlearned.

Take care and be happy

Sean x

In this blog I am looking at anxiety and it’s sibling panic attacks. I’d like to try in this blog and explain a bit about the brain and emotion along with the appropriateness of different forms of therapy. At a scientific level our understanding of neuropsychology and therefore our understanding of the neuropsychology of anxiety has come on leaps and bounds.

The human brain is different to all other mammals and primates in that we have the developed the higher cortex that gives rise to cognitive function, including speech, language, reasoning and self awareness. This we may term the “New Brain” and is the result of millions of years of evolution. If there is truly a difference between humans and other hominids this is it. The “Old Brain”, shared with many other species, that is also the result of millions of years of evolution, is dominated by the amygdala and the brain stem. The difference between these two parts of the brain is the difference between worry and fear.

Panic and fear based anxiety is emotional

Fear is an instinctual response, often a reflex, in the amygdala of the old brain that may lead to the physical, fight, flee and freeze responses that are activated in the brain stem. This tends to be highly emotional, often below awareness and may be triggered by thoughts, sounds, smells, colours and so on. When people have an old brain anxiety/panic attack it is a fear reaction and they will appear to be temporarily out of control. Once they have calmed down and the cognitive new brain is back on line they may be filled with remorse and be shocked and horrified by their instinctual behaviour.

The amygdala is a dual almond shaped organ, one in either hemisphere of the brain though usually termed in the singular. The difference between the two amygdalas, which  in Ayurvedic neuropsychology is recognised as a part of our intuitive function, that sense of knowing without knowing why we know. As such its function is both above and below our awareness. When it is functioning above our awareness we call it intuition. When it functions below our awareness we see it as the primal response of instinct. This is where we processes fear, yet we may never understand why we are afraid.

Panic

A dictionary definition is a sudden uncontrollable fear or anxiety, often causing wildly unthinking behaviour.

The Mayo clinic defines panic as…

“ …a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying”.

Symptoms 

Panic attacks typically begin suddenly, without warning. They can strike at any time — when you’re driving a car, at the shops, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.

Panic attacks typically include some of these signs or symptoms:

• Sense of impending doom or danger
• Fear of loss of control or death
• Rapid, pounding heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or tightness in your throat
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness, lightheadedness or faintness
• Numbness or tingling sensation
• Feeling of unreality or detachment

Worry Based Anxiety is cognitive

Worry based anxiety is completely different to emotional based panic anxiety. The anxiety that is experienced in the new cognitive brain is completely different to primal amygdala responses, in that it is experienced as a reasoned response based in logic.

The reasoning and the logic may, in reality, be faulty but it is experienced by the person as factual. People will say “it is a known fact that…” when it is nothing of the sort. Worry based anxiety comes from the person not living in the present moment. They have projected themselves forward into ideas and experiences that may never happen but they are living them in the present as though they have. The tools of worry based anxiety are obsessing, which may lead to obsessive compulsive disorder or OCD, rumination, dog with a bone syndrome where we cannot let it go and tend to go over and over the same issue again and again.

Ayurveda

In Ayurveda, worry based anxiety, in the cognitive cortex, is seen as part of the process of the imagination. People with a poor imagination do not get worry anxiety because they have difficulty imagining negative futures to become anxious about. Cognitive anxiety is dealt with by Tantric therapy, which is not all about sex it is about dealing with and controlling the imagination. Worry in the amygdala is dealt with in the Raja therapy.

Tantric therapy is based in using visualisation to create future images that are positive and do not have the worry attached to them. The habit if attaching worry anxiety to a particular thought or image is replaced with new positive images that are the new worry free habit. Raja based therapy is mindful relaxation and meditative practice that reduces the levels of stress hormone in the body system reducing the instinctual feelings of fear.

Cognitive behavioural therapy

Over the years I, and many other therapist, have a stream of people presenting with emotional anxiety who will state how they have had CBT for their anxiety and how it worked really well, although it is not for everyone.

What happens is someone presents for therapy with amygdala based emotional anxiety. Because the world of therapy is awash with CBT practitioners the patient will almost certainly see a CBT therapist who uses their learned tools for dealing with cognitive anxiety. What happens is that the therapist uses a set of cognitive exercises that suppress the patients fear based emotions. it is as though they force in a cork to trap the emotions in a bottle of fizzy emotions. Because the emotions have not been processed or resolved over time the emotions gradually push the cork out of the bottle and the patient ends up just where they began with the same emotional anxiety.

Don’t get me wrong I am not against CBT, just the way that it can be limited or misused. The bottom line is cognitive therapy works best for cortex based worry anxiety. Emotional therapy works best for amygdala based fear anxiety and panic. The trick is that you need to know the difference.

If your anxiety if based in logical reasoning seek out a cognitive therapist they will be great for you.

If your anxiety is fear based find a therapist skilled in emotional work they maybe psychodynamic, cognitive analytical (CAT), Mindfulness based therapies or sit an 8 week Mindfulness based stress reduction (MBSR) course and you should get what you need.

Most importantly none of us need to suffer anxiety, If you do then please do something about it.

Take care and be happy

Sean X

This week Ed and I were looking at anxiety from four points of view, as described in the book The Four Thoughts That F*ck You Up… and How To Fix Them, by Daniel Fryer. Each follows different issues related to Mindfulness.

1: Dogmatic demands: holding onto rigid beliefs

These maybe religious, political, social and so on.

2: Doing a drama: catastrophising and blowing a situation out of proportion.

3: The ‘I can’t copes: telling ourselves we can’t cope or deal with something – Thoughts become things.

4: Pejorative put-downs: putting ourselves or the world down – if you say it often enough you get to believe it.

Whichever way you look at it, it follows that anyone who lives in states of anxiety can not be living with happiness, the two do not really go together. The chances are that anyone who is experiencing levels of anxiety is not living in their own present. To be truly happy you need to be living in your now. Holding onto past happiness is nostalgia and hoping for future happiness is anticipation.

Holding onto past unhappiness is depression and expecting a future with fear is anxiety.

Anxiety is a state of being when your conscious mind travels forward to an imagined and often fearful future event that, may never, and probably, will never take place. In anxiety the experiences, those images, they are in the present, as though they are happening right now. Those who do not, or have not experienced anxiety will often have problems understanding this. Platitudes such as ‘pull yourself together”, “stop being stupid” and “look at how good your life is” don’t really help.

Learning to stop looking negatively into the future is part of the solution to anxiety. After all in most situations there is really little or nothing for any of us to worry about. It may seem completely obvious to tell the sufferer to live in the present, to  “be here now!” Yet this can be experienced as the impossible task because the sufferer is’ living ‘their’ present. It is just that their present happens to be dislocated into an imagined future.

When I look at my case load, whether they are individuals, couples or referrals through an occupational health department, at least 60% of what I deal with would be termed anxiety or involving the symptoms of anxiety. Anxiety is the product of the emotional mind and no amount of cognitive talking therapy will resolve feelings. We need to look elsewhere for a lasting solution.

Anxiety itself is not a bad thing. It is an emotional response that has kept us all safe throughout evolution. To have an awareness of, and raised alertness to, dangers around us is a good thing. However, to have continual anxiety about the future that we live in the present is termed Generalise Anxiety Disorder (GAD), the key is in the word ‘disorder’. It is this disorder that people mean when they say they have anxiety.

Anxiety comes in several forms…

Ordinary anxiety is normal and useful, even helpful and keeps us safe.

Reactive anxiety is responsive an event such as an accident, assault, bereavement.

Generalised Anxiety Disorder (GAD) is when anxiety can seem to be all around us.

Ordinary anxiety is completely normal, transitory and keeps us safe. Reactive anxiety will normally require some therapeutic intervention and may take a while to resolve, though it will resolve eventually. GAD is completely different issues and will normally require medication and some therapy, though often with GAD talking therapies such as CBT (cognitive behavioural therapy) will have a limited effect. The trick with anxiety is not what you think it is what you feel and more importantly what you see in your imagination.

Anxiety disorder is of itself completely irrational though it is completely visual. To be fearful of a future involves being able to visualise it. It is the imagination that is the problem. People with anxiety disorder have good imaginations. Those with poor imagination can not visualise a future to be fearful of. The key to resolving anxiety is in positive visualisation.

For example if you fear flying when you think about your coming holiday what you are really doing is visualising getting to the airport, getting on the plane, imagining the take off, the turbulence and the landing. Most of all you may imagine the plane crashing. You can feel the fact that you will be several miles up in the air and that there is nothing beneath you, As you rehearse these images your limbic system releases chemistry that creates the physical symptoms of anxiety in your body. It is important to realise that no cognitive process has taken place. Non of this is about thinking it is all about feeling and feelings related to the images in your mind. It follows that if the perpetrator of the anxiety are the visions in your mind then the solution is to change those images to those that have a good feeling and serve you well.

When the anxious person learns to use their imagination to visualise a future that serves them well, one that they might actually look forward to, they reduce their symptoms of anxiety eventually eliminating anxiety all together.

I say this to as a person who has suffered anxiety disorder. Who attended talking therapies and failed to overcome anxiety disorder. Who eventually discovered visualising therapies, overcame anxiety disorder and has subsequently helped thousands of people to do the same.

When you realise that to have anxiety disorder requires that you have a good imagination to be able visualise those things that trigger your symptoms it follows that the solution to your problems is to change the images. Visualisation works well because it is playing to their strengths. What was the problem now has become the solution.

Visualisation therapy can be found through a therapist who understands the emotional mind and the part that the imagination plays in anxiety. You may find the solution through psychotherapy, hypnotherapy, deep guided relaxation, meditation, and mindfulness. Visual therapies are a positive and effective alternative to straight talking therapy and medication.

Take care, be happy and live in the present!

Sean x

So here we are in the New Year. The world is all new and starting afresh. We even have a post Brexit Britain to look forward to – or so some people think – we will see. Anyway, I have heard a few people telling me that this year they just can’t seem to get going. These sentiments come with a mix of guilt and the admitting procrastination. I don’t really see the issue. In a world when we seem to be obsessed with doing things and have generally lost the art of simply just being anyone who dares to sit and relax, reflect or even meditate can be accused of procrastination. But, what about if the art of being was what we were really meant to be doing and not physically and practically moving things about to create the illusion that we have value? In the current climate it is so easy to assume that the person who does not need to do and move things about is a waster and of little use. However, procrastination might even be a celebration that might reduce stress, anxiety and even create more happiness?

You see that even when we are doing nothing we are really doing something. To the person who always needs to be busy someone who meditates or simply stops long enough to enjoy the view may be seen as a procrastinator. Yet, perhaps it’s the person who is being still and apparently doing nothing who is seeing the real world and making the breakthroughs in science art or literature, human consciousness and compassion that might just save the world. 

If you break down the word procrastination you get Pro = forward, future… Crastinus = tomorrow. For many procrastination simply means to delay not that the person will not complete the task. To procrastinate does not make the person lazy they may simply be the type who considers before they act. This may give their action more meaning and values than if they simply acted in a quick but meaningless response.

However, laziness does exist. There are people who are really lazy and do as little as possible. In our busyness to keep doing we may no longer be able to tell the differences. Sometimes, if you are feeling like procrastinating and putting things off it maybe an emotional barometer that tells you whether what you are doing is what you really should be doing. It may help you discover what is it that you really want from your life. It is time to reflect.

Imagine that when you wake you are about to go and do something that makes you feel good. Do you have problems getting out of bed?, Well no. Now, imagine that you are waking to a day full of things that you don’t want to do. Do you have problems getting out of bed?, Well yes. Procrastination may not be a bad thing but it might just be that our need to procrastinate is our system trying to tell us something?

The sooner I fall behind, the more time I have to catch up. 

Author Unknown

In the west we tend to be driven by what is termed ‘the Protestant work ethic’. Most people work long hours to the exclusion of family, friends and their own life and fulfilment. Yet very few people really actually like their work life. I work with thousands of people who wake on a Monday with the dread of another week in their workplace. They would rather  be doing anything else. Procrastination does not always mean to do nothing, doing something else instead is often termed displacement.

Anyone can do any amount of work, provided it isn’t the work

the are supposed to be doing at that moment. 

Robert Benchley

Displacement activity is something that you do to avoid doing what you don’t want to do, or a way of dealing with a difficult situation. For example a rabbit that is cornered and is about to be eaten by a fox and knowing there is now escape will displace this energy of fear into the activity of washing itself.

In psychology, procrastination refers to the act of replacing more urgent actions with tasks less urgent, or doing something from which one derives enjoyment, and thus putting off impending tasks to a later time.’

Wikipedia

The  clue in this definition is ‘enjoyment’. The protestant work ethic goes alongside with ideas like ‘life is hard’, ‘life is earnest’ and ‘everyone has their cross to bear’. Well I don’t buy any of that, I am in the school of life should be fun and life should be fulfilling. It seems that we have no problem finding the energy to do things that we do want to do, things that make us feel good. While, those things that we don’t want to do sap our energy and take away our motivation.

My approach to life is that when I feel the need to procrastinate or displace, I look at, and enjoy the process, and at the same time I look at what I need to do with my life so that I feel engaged and connected and restore the balance between what I need to do and what I want to do. This is often described as ‘work life balance’. In the end if you are living the life that you really want the issues of procrastination and displacement do not exist because you are enjoying and fulfilling yourself in the present moment so that getting out off bed on any day, even Monday is never a problem.

The best way to get something done is to begin. 

Author Unknown

That comes back to the live in the present question ‘what do you really, really, really want to do with your life?’ Until you answer this question you will be forever procrastinating and displacing. Becoming aware of when and why you procrastinate will help you answer the question of what do you really want. So there may be times when procrastination is really something we should celebrate, focus on and use effectively.

I’d like to procrastinate but I just can’t seem to be bothered

Take care and live in the present and enjoy your procrastination.

Sean x