I am often asked by new clients, "What is the best way to deal with anxiety?" My answer is always the same.  "If you study your thoughts and learn to change what you think about then you will solve your problems with anxiety".  I believe that is quite doable if the client is willing to learn to observe their thoughts for a time and become familiar with their own thinking patterns.  Only after becoming familiar with these patterns can they effectively begin to change them.  It comes down to this simple statement: Change your thoughts and that will change your emotions.

Certainly emotions are influenced by other things (ie. hormones and genetics), but most of the time emotions are responding to our thoughts. If we are pessimistic, cynical, and negative then we will view the world as threatening or unfriendly.  The result will be that we experience negative emotions such as anxiety, depression, anger, hate, even hopelessness and despair.  It is a clear response to our thoughts or perceptions and though the emotions that result may be powerful it doesn't mean that they can't be redirected if we first learn to redirect out thoughts.

There are two suggestions that I make to new clients. First is to do some reading on the subject of anxiety.  It was Sir Frances Bacon in 1597 who said, "Knowledge is indeed Power".  In other words, even a small amount of knowledge can be a huge advantage in solving the problem of controlling a client's anxiety.  So I ask clients to dedicate at least one hour a week to reading and practicing the exercises in the book that I heartily recommend on this topic.

It is entitled "The Anxiety and Phobia Workbook" by Edmund Bourne, Ph.D.  It has over 20 coping skills that it details and it goes into great detail explaining the importance of developing these skills to gain control over anxiety.  Not all of the skills he outlines work for everyone; but is important to try each one out to find the ones that do work for each client.  These become the topics for our discussions as I coach clients in how to best develop coping skills to reduce and then eliminate anxiety.

The second suggestion that I make to new clients is to learn the technique called Autogenics Relaxation Training.  It is a technique that elicits our naturally occurring Relaxation Response.  This is the exact opposite of the "Fight or Flight Response" (you can read about that in one of my other Blogs).  The Relaxation Response naturally calms clients down and sometimes even makes them feel comfortably drowsy.  It is a very slow response and requires some work to consistently get this response to activate in a predictable manner.  Like all good habits it takes at least 4-6 weeks to be ingrained as an effective coping skill.

Here's how it works.  First of all, it is necessary to become familiar with Abdominal Breathing.  Now, of course you have been breathing all your life (duh); however, this is a special type of breathing that requires you spend some time being mindful of how you breathe.  Mindful breathing simply means feeling your breathe go through your nose, sinuses, throat, chest and then deep into the vary bottom of your lungs.  It needs to be slow, gentle, and deep.  Try this for about a minute and you will begin to feel your body change ever so slightly to becoming more relaxed, or pleasantly warmer, or pleasantly feeling heavier or even pleasantly lighter.  Practice this several time a day so that you are more aware of your breathing and making the changes so that it becomes normal to do Abdominal Breathing.  This is something that you can work on long term, but for today just get the idea that this is the first thing to do in this little exercise.  The next thing I would like you to do is read the script below out loud to yourself when you are alone and won't be disturbed for 10 minutes or longer. By all means don't try this when you are driving or in a position when you have to be able to quickly respond to an event that requires your full attention (ie. babysitting, watching your TV or cell phone). You may eventually want to use this script to make a tape recording to play back to yourself so that you can do this exercise with your eyes closed for maximum effect. The use of this Augenic Script will seem silly at first and maybe even boring.  That's OK.  The purpose is to give you something to think about that is not going to cause you anxiety and may even feel nurturing and comforting to you.  The phrases are directed to your unconscious mind and may simply bore your conscious mind.  Here's the script.  When speaking the words imagine that you are talking to a child or someone who is very sensitive so that your words are soft and convey a sense of nurturing and encouragement.

My scalp is calm and relaxed.

My scalp is calm and relaxed.

My scalp is calm and relaxed.

My forehead is calm and relaxed.

My forehead is calm and relaxed.

My forehead is calm and relaxed.

My eyes are calm and relaxed.

My eyes are calm and relaxed.

My eyes are calm and relaxed.

My jaws are calm and relaxed.

My jaws are calm and relaxed.

My jaws are calm and relaxed.

My throat is calm and relaxed.

My throat is calm and relaxed.

My throat is calm and relaxed.

My neck is calm and relaxed.

My neck is calm and relaxed.

My neck is calm and relaxed.

My shoulders are calm and relaxed.

My shoulders are calm and relaxed.

My shoulders are calm and relaxed.

My spine from my head to my tail bone is calm and relaxed.

My spine from my head to my tail bone is calm and relaxed.

My spine from my head to my tail bone is calm and relaxed.

My heartbeat is calm and relaxed.

My heartbeat is calm and relaxed.

My heartbeat is calm and relaxed.

My lungs breathe easily and deeply.

My lungs breathe easily and deeply.

My lungs breathe easily and deeply.

My abdomen is calm and relaxed.

My abdomen is calm and relaxed.

My abdomen is calm and relaxed.

My right arm from my shoulder to my fingers is calm and relaxed.

My right arm from my shoulder to my fingers is calm and relaxed.

My right arm from my shoulder to my fingers is calm and relaxed.

My left arm from my shoulder to my fingers is calm and relaxed.

My left arm from my shoulder to my fingers is calm and relaxed.

My left arm from my shoulder to my fingers is calm and relaxed.

My right leg from my hip to my toes is calm and relaxed.

My right leg from my hip to my toes is calm and relaxed.

My right leg from my hip to my toes is calm and relaxed.

My left leg from my hip to my toes is calm and relaxed.

My left leg from my hip to my toes is calm and relaxed.

My left leg from my hip to my toes is calm and relaxed.

In the center of my being I am calm and relaxed.

In the center of my being I am calm and relaxed.

In the center of my being I am calm and relaxed.

In my Heart and Soul I feel the warmth of God's Love for me.

In my Heart and Soul I feel the warmth of God's Love for me.

In my Heart and Soul I feel the warmth of God's Love for me.

I accept and love my Self just as I am right now.

I accept and love my Self just as I am right now.

I accept and love my Self just as I am right now.

And so it is becoming more and more true as I repeat these words.

And so it is becoming more and more true as I repeat these words.

And so it is becoming more and more true as I repeat these words.

This is the end of the exercise.  It will not initially feel as powerful as it does later after you have practiced it at least twice a day for a week.  Like anything else "Practice makes Perfect" and you will become infinitely more effective initiating the Relaxation Response the more you practice it.  Incidentally this exercise works well as a Night time Meditation to use before bedtime or in the middle of the night should you awaken.

Let me know what you think of this by writing me at [email protected]  Enjoy!

One of the first things that I found as a psychologist who specializes in working with anxiety clients was that they focused on the most negative moments in their lives and obsessed about them.  I don't in any way mean this in a judgmental fashion because I have been in outpatient therapy myself for anxiety on several occasions.  My point is that it seems that a significant portion of the client's lives were spent thinking negatively about themselves, other people, or the expectations of the future.  As I have written about before, I believe strongly that our thoughts control, for the most part, our emotions and negative thinking inevitably leads to negative emotions.  Part of my initial interview with a client is to give them a homework assignment to thoughtfully make a list of their 8 best moments and their 8 worst moments.  I ask them to write a paragraph about each moment with details of what happened to make it so memorable.  I ask that they include their thoughts, emotions, sensory experiences (ie. images, sounds, smells) and all the important details that come to mind. 

In our next meeting I may ask them to go over the worst moments in some detail.  I should add that going over the worst moments may be too painful for some clients with severe anxiety disorders and so I sometimes delay this topic with them until a few sessions later.  Doing this exercise allows the client to quickly communicate to me the nature of the events that have shaped their manner of thinking and often it is immediately evident that they have a negative thinking pattern because of the traumatic or painful events of their past.  This is particularly evident for those clients who have abusive childhoods and early on in life begin to believe that they are in some way flawed, inadequate, unlovable or undeserving of success.  As we discuss the worst moments list I can observe their emotional experience and tell pretty quickly if they have "worked through" the emotional material or if they are still "stuck" in thinking about it.  If they are tearfully talking about it then I know we need to address it sometime in the therapy process.

During the second meeting I make a point to discuss their best moments list and spend a greater amount of time focusing on their positive experiences in their lives.  It is amazing how a person with anxiety seems to forget that they have been a success at anything in life.  Severely anxious clients seem to have dismissed any moments in their past which involved personal success in goals that they accomplished (and often only fleetingly enjoyed) or in the moments of their past when they felt a deep peace or sense of well-being.

Before I end the second session I will ask them if they would like to learn a simple technique that will give them immediate relief from anxiety.  Stupid question right?  They came for exactly that purpose, but it is important to give the client a sense of control so I never try something new in therapy without asking permission.  So we begin Strategic Self-Hypnosis training by having them place one hand on their stomach and the other on their chest.  I ask them to breathe deeply moving the hand on their stomach so they begin to do yogic or abdominal breathing for 12 breaths. While they are deeply breathing I ask them to just notice the movement of air into their nose, sinuses, chest and lungs.  As they focus on the movement of air I ask them to notice whether they are beginning to feel warmer, lighter, heavier, or just sleepy.  My suggesting that they will feel one of these four sensations is the hypnotic suggestion that they will then do outside of the therapy sessions on their own.

Clients will almost always smile during this exercise and note that they are feeling more comfortable in just a few breaths.  I then ask them to use their imagination to visualize a door of any size, shape, design, or texture that they like and to see on the door the words "Best Moments".  As they are becoming accustomed to visualizing the door I then ask them to imagine opening the door on one of their best moments and feeling themselves back in that situation that they are remembering.  I ask them to continue to deep breathe and to stay with the image deepening and making it more vivid with each breathe.  After perhaps five minutes I ask them to open their eyes and to right down what they experienced.  In the majority of cases, the clients reported a substantial reduction in anxiety and muscle tension in the very first trail of Strategic Self-Hypnosis.  This simple experience has been the first step for many of my clients in developing their own custom set of coping skills that they employ on a daily basis to overcome anxiety by simply changing the way they are breathing and the content of what they are thinking about.  You may want to try this at home, not while driving of course, and see what kind of results you have in changing your emotions and the sensations of your body.

For quite some time I have been aware that many of my clients all had something in common that lay well outside of what was a conventional diagnosis of anxiety or depression.  Many of them were deeply emotional people who had an exquisitely high level of sensitivity not just to stressful situations but also to other people's sufferings, to music, art, and literature. In fact, a number of them were in fact artists, writers, and musicians who used their extraordinary sensitivity to not just appreciate the beauties of the world around them but to add their own contribution to the milieu they so much enjoyed.  Several of my clients have written books of poetry, fiction, and one worked as a videojournalist who traveled the world making documentaries.  The problems these clients all encountered was that they were basically introverts trying to adapt to an extraverted world.  The terms introvert and extravert were originated by Dr. Carl Jung, a famous Swiss psychologist who wrote extensively about these differences in personality in the early part of the 20th Century.  In 1921 he wrote the book, Psychological Types, in which he developed his ideas about the basic types of personality that he found to be common to populations all over the world. Those of you who have taken the modern psychological test known as the Myers-Briggs Inventor are familiar with his thinking and perhaps are acquainted with your own inherent personality tendencies along the introvert-extravert continuum.  Dr Jung believed that one third to one half of all peoples were introverts.  By this he meant that they were somewhat reserved, often thought long and hard before speaking, and tended to need a significant amount of "alone time" in order to recharge their psychological batteries.  This did not mean that they were anti-social but rather they needed more time away from people (crowds were particularly draining for them) and time spent doing things they enjoyed alone or with a very small group of friends.  Many famous people have been known to be introverts: Albert Einstein, Eleanor Roosevelt, Bill Gates, and Jung himself.  What makes this an issue in therapy is that in American society we do not, as a culture, value introversion.  On the contrary we much more prefer to value extraverts and their aggressive drive to dominate, interact, get things done, and their fun loving "can do" attitude which is in the heart of every T.V. commercial and magazine ad.  Our cultural icons in business, sports, and celebrities in general tend to be extraverts.  On the other hand, the people who often make the greatest contributions to the long term good to our society are the introverts.

 

It is not that either the introvert or the extravert is all good or all bad; it is just that the  introvert in our society is not particularly valued.  This is particularly a problem in the public school system in which introverts, however smart they may be, are often the target of bullies and much more aggressive children.  Unfortunately this difference among school children can leave scars on the introvert because they are viewed as unathlectic, unpopular, and nerds. Interestingly introverts are often drawn to extraverts for marriage because, just as Ying and Yang, each offers the other person some different perspectives and strengths. This makes for many fascinating conversations but can also lead toproblems in the relationship.  Family and relationship counseling is often needed to help build a bridge of understanding betwee the introvert and extravert when they form an intimate partnership.  For more information about my work with highly sensitive people, who make up most of my practice, I recommend a couple of excellent books.  The first is "The Highly Sensitive Person: How to Thrive When the World Overwhelms You" by Elaine N. Aron, Ph. D.   The second book is "Quiet" written by Susan Cain, J.D.   In "Quiet" the author, on page 13 offers some interesting questions that allow the reader to make a judgment as to how frequently they think as an introvert.  Some of the questions have to do with issues like: how much do you try to avoid conflict, how often do you spend with a very close cirlce of friends,  do you tend to favor listening or talking, do you like to do work that allows you to dive in so there are few outside interruptions or distraction, do you often feel drained by interactions with other people, and do you often let the phone calls go through to voicemail?  Both of these books are written to those people like myself who are basically introverts but must live in a society that doesn't necessarily value or understand quiet, sensitive people. Much of my work centers around helping my client determine what is their personality type, what specific issues they want to work on, and then providing training in the appropriate coping skills.  Many times it is simply a matter of teaching someone who is an introvert to take time out for themselves without feeling guilty and to stop trying to be something they are not genetically wired to be.  Self-acceptance and self-esteem development go hand in hand in providing a solid platform to do mindfulness training, relaxation training, biofeedback, and E.M.D.R. therapy.  All of these approaches teach the introvert to value their rich inner world and to create a boundary with the outer world that tey often find rude, loud, and insensitive.  Our clinic offers coaching via phone and e-mail for those individuals who are not geographically able to access our services in person.

Much has been written about counseling, coaching, and psychotherapy.  For someone seeking help from a professional the quest to find the right person who is a good fit can be confusing and frustrating.  Most clients have health insurance and they may search a long list of psychologists in vain because they all seem to be offering essentially the same service.  So what makes the difference? What makes counseling with psychologist A a better experience that psychologist B?  The answer based on many research studies may be surprising.  It is not technique, nor it is price, nor is it the degrees that the psychologist holds. Simply stated it is the trust that is established between the psychologist and their client and the strong hope that their problem can therefore be solved.

 

Let me also qualify the above statement by quickly adding that there are many coping skills (ie. journaling, progressive relaxation, EMDR, cognitive behavioral therapy, support groups) that add to the quality of the counseling experience and hasten recovery, or perhaps discovery, of the empowered true self.  Many of these coping skills are found in self-help books.  However, many of my clients have read many self-help books but never been able to accomplish lasting change until they started working with a psychologist who would help them hold themselves accountable for maintaining their new habits of thinking and feeling.

 

For many clients seeking treatment they come because something or someone in their lives has caused them to lose trust.  It may be that they no longer trust other people in general.  It may be they no longer understand or trust themselves.  It may be that they don't trust anyone or anything and are hopeless that anyone can help them..  In the later case, these clients are often in a more desperate psychological condition and may become very withdrawn from others.  The later group is more likely to become an addict and suffer from hopelessness that could lead to suicide.

 

I often tell clients when they enter counseling that I may not be a good "fit" for them and that I am more than willing to refer them to another professional that they would be more comfortable with than myself.  The two most important elements for the client is that they first of all feel as comfortable as possible sitting and talking with their potential psychologist.  Secondly at the end of the first meeting they must also have come to the belief that what they are suffering with is "treatable" and can be cured.  If these two things do not happen after the first session or two then it's time to go shopping again and interview another psychologist.

 

Why is trust so important? Why has it be demonstrated over and over again in clinical studies as the most important element in healing and recovery from a mental disorder?  It is because the client must have developed the confidence in their psychologist that they can tell them anything at all, no matter how embarrassing, and that they will not be judged harshly but rather they will be understood and accepted as a fellow human being quite capable of error (aren't well all?).  This confidence that  the client is totally and completely accepted is absolutely essential for a full recovery from anxiety, depression, trauma, or relationship issues.  It really doesn't matter what the diagnosis, it is still the trust level between the psychologist and client, and the client's ability to hold onto hope, that significantly determines the success or failure of the course of treatment.

 

For many clients, having established this trust may take a great deal of time and some testing of the psychologist to check to see if they in fact can be trusted with the most intimate details of their lives.  In point of fact, much of what is discussed in the later conversations between psychologist and client will be personal information that the client has never dared discuss with anyone else!  They have generally not confided their deepest secrets, doubts, and misgivings with anyone because of their fear of being judged and rejected.  It is for this reason that it is impossible to judge how quickly counseling can resolve certain deep seated personal problems.  This past week, I had a new client ask me, "How long with it take for EMDR to fix my trauma so I can be my old self?" I smiled and said kindly, "That is entirely dependent on you and your ability to eventually trust me."   She laughed and admitted, "I don't trust anybody so it may take awhile."  Then we both laughed and that led to a good discussion of the topic that we are discussing in this blog.

 

Trust is not easily given to another person; this is particularly true if those people close to the client have proved to be unreliable or even abusive.  For the psychologist, I can tell you that it is a great honor to be sitting with someone and have them trust you with their deepest secrets and most embarrassing moments and to see them look over at you and find that you are giving them support and not condemnation.  My profession is deeply satisfying, not just because I am able to help people overcome their fears and develop a truly satisfying life; but it is doubly satisfying because I am trusted by others who feel safe enough to discuss and resolve problems that may have plagued them for years.  In some cases, one client who is in her 80s, for literally six decades of her life had never discussed how miserable her childhood was with an overbearing mother and an alcoholic father.  She had been in three miserable marriages because, in part, she had held that same view of herself as her abusive mother had repeated told her, "You don't deserve to be happy!"   It was only when she was able to discuss this long held belief adopted at a very impressionable age that she could recognize how her unconscious perception of herself had kept her in unsatisfactory relationships for all of her life.  It took a great deal of courage on her part, and patience on my part, for her to disclose and then change her deeply held self-perception.  When she realized that she could now, as an adult, quite simply change that negative self-definition (she had plenty of accomplishments to refute that false view of herself) then she broke down crying (actually a shed a few tears with her) because after six decades she was at last free.  She was free to define herself realistically as  worthy and empowered woman who could now make choices to fill her remaining years with joy.  She is choosing activities and interests that keep her challenged and gratified in ways she had never experienced before.  Why?  In part, because she found the courage to trust and hope for her own recovery.  I can tell you that it is very gratifying to see someone make these changes and to rejoice with them when they come to find their own power to create a life that they choose and reject a life based on the mistaken beliefs about themselves that they unwittingly incorporate from the negative figures who influenced their thinking in childhood.  Do I love my job?  Absolutely.