How to Land Your Kid in Therapy

Aside

Stumbled across a great article on how “over-parenting” has lead to a generation of therapy-goers.  If you have the time (it’s a 4-pager), it’s a well-written and thought provoking piece – I very much recommend it.

Here’s an excerpt:

Here I was, seeing the flesh-and-blood results of the kind of parenting that my peers and I were trying to practice with our own kids, precisely so that they wouldn’t end up on a therapist’s couch one day. We were running ourselves ragged in a herculean effort to do right by our kids—yet what seemed like grown-up versions of them were sitting in our offices, saying they felt empty, confused, and anxious. Back in graduate school, the clinical focus had always been on how the lack of parental attunement affects the child. It never occurred to any of us to ask, what if the parents are too attuned? What happens to those kids?

via How to Land Your Kid in Therapy – Magazine – The Atlantic.

Curiosity, and why we need more of it in our lives

Therapy, when you think about it, is a rather unique relationship. In a short period of time therapists often will transition from being complete strangers to having clients sharing some very personal stories and feelings. When I began my training as a therapist one of the first ideas that was focused on was the importance of nurturing and maintaining an open curiosity within our sessions. In being curious we acknowledged how much was unknown to us about our clients’ lives and invited our clients to help us understand their perspective.

Since then I’ve found that the idea of curiosity has often been on my mind. Curiosity wasn’t something that I thought about much prior to that point however. When thinking of the qualities that an aspiring therapist needed to cultivate, it was qualities such as patience, understanding, or compassion that were talked about but curiosity…not so much. Especially when looking outside of the therapeutic context, curiosity isn’t often listed as at the top of people’s virtue lists.

In our society we praise people for being kind, or brave, or wise but not often for being curious. Curious George may be a loveable character for many people, myself included, but you don’t often hear people aspiring to be like him. Curiosity is sometimes highlighted as being one of the characteristics of the young but as much as we idealize youth, we are less likely to praise youthful traits later in life. Continue reading

What is a Therapist?

Aside

Over the years as I have continued my studies in psychotherapy, I have often been amazed at how varied and diverse the profession is. I started off with a general idea of what it meant to be a therapist and since then have found not only that my idea has grown in scope and complexity but that there are many different paths that people have taken towards the same goal. There are many different roads towards becoming a therapist and each bring their own perspectives and ideas on the profession. Often one is no more effective than the other even though they may differ greatly.

Since I have begun working as a therapist, this awareness has been reinforced by the diversity of perspectives and expectations that clients have of therapists and the therapeutic process. Depending on their background, their past experience with the mental health and their goals for coming to therapy, their concept of who I am, or what my role is as a therapist can look pretty different.

Rather than just talking about the different perspectives that people have of therapists, I thought it would be interesting to use this blog as an opportunity to hear from different people’s perspectives and highlight some of the similarities and differences that exist.

In the comments section below, write the first thing that comes to mind when you think of the question “What is a Therapist?”.

It could be a word, or an image, or a feeling or a more elaborate description depending on what feels right to you. In this there’s no right or wrong answers, only different perspectives.

The Secret Life of a Family Therapist

Therapists are the keepers of secrets.

Within the process of therapy, clients often share knowledge that is very private and personal. They share their fears and anxieties, topics that are sometimes very hard to share openly with other people in our lives. The therapy room can be a safe place where people can take off the masks that they wear or to share thoughts and memories long kept hidden. A place where secrets can be shared and processed while still being kept safe.

Even before I began seeing clients, the significance of the secrets that people share in therapy was something that I was made keenly aware of throughout my education and training. Confidentiality is often a central theme in any therapy course, reinforcing the importance of protecting the private information shared with us by our clients. In addition there’s the importance of acknowledging the trust that clients are placing in us in sharing their stories as well as their courage in telling it. Even with all the checks and balances, sharing a story that has long been kept hidden can still be a significant challenge and as a therapist it’s always important to be reminded of this.

As therapists, not only are we responsible for honoring the secrets shared with us by our clients but in addition, we have the responsibility of guarding the secret of participating in therapy itself. The decision to attend therapy is often seen as very significant and often it’s a very private decision. In addition, there can be social stigma associated with attending therapy and sometimes the well meaning concern and curiosity of others in our lives can make it harder for clients to protect the content of their therapy work when their attendance is publicly known. This, I’ve discovered, is even more important in couple and family therapy work when different components of a family system can be involved in therapy at different times. Creating a safe and open space for dialogue is a central component of any therapy work and ensuring that clients are confident in the privacy of their work with you is of key importance to any therapist. Continue reading

Experiencing Hope and Resilience as a New Therapist

When I’ve talked to people about my decision to enter into the family therapy profession, I often get a comment that goes something like this:

“It’s got to be depressing sometimes listening to people’s problems all day.”

As I began my Master’s program last year, and anticipated the therapy work that I would begin as part of my practicum, this was one of the many sources of anxiety that I felt myself. Would I be able to protect myself and remain positive when working with people faced with all kinds of difficult challenges. People rarely come to see a therapist when they’re feeling happy and everything’s OK. Some days reading the news can be depressing enough, would I be able to handle spending hours each day talking with clients too?

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Depression: Inward Anger?

Emotions show

Image via Wikipedia

Emotions are a subject of considerable importance in most therapy settings.  It’s pretty hard to do any kind of useful therapy without bringing emotions into the picture in some way.  Traditionally, this equates to the old standby that therapy is just talking about your feelings.  Although this is partly true, it would be a great falsehood to claim that this is all that therapy is or can be.

Regardless, in my opinion, the core of all dysfunction stems from some kind of emotional ‘disturbance.’  This could take many forms, form as serious as a past traumatic event to the way that emotions were handled in the family you grew up in (arguably the only variable in life over which you truly have no choice).  For example, if you grew up in an environment in which emotions were regularly hidden or suppressed, you might be unlikely to be comfortable expressing outward emotions like anger or frustration most of the time.  Inward emotions, like sadness, might be more comfortable for you because they naturally lead to behaviours such as isolation and withdrawal from situations that may be overly stimulating.

In any emotion-focused therapy, one of the main goals can be to explore how problems manifest emotionally on different levels of awareness.  A lot of people are just not that familiar with their own emotions.  I have some theories on why that might be (like most things related to mental health, we’re not doing a very good job educating our children on emotions – despite the fact that they’ve been proven to be the same all over the world), but I’ll save that for another article.  Often times people will come to therapy with a problem, say depression, that seemingly comes out of nowhere, but often has to do with another emotion they’re uncomfortable with, for example anger.  Sometimes exploring how emotions are processed leads to insight about how the problem developed and how to move towards health.

Let’s consider the example of Rachel, a pretend case loosely based on an amalgamation of former clients.

Rachel grew up with a mother who worked at a demanding job, was often stressed out and irritable around the kids, and frequently had angry outbursts.  Rachel’s dad played the role of the even-keeled peacekeeper whenever a family conflict arose, and was pretty good at this seeing as Rachel can’t remember her dad ever really getting outwardly emotional.  Rachel quickly learned to navigate her interactions with her mom by taking after her dad and keeping as many of her emotions as she could on the inside.  It didn’t take her long to figure out that getting angry with her mom only made things worse for her, as mom would only get more upset in return.  Furthermore, she began to associate outward anger with her mom, and vowed (consciously or not) that she would not end up this way when she grew up.

Now in her twenties, Rachel (who no longer lives with her parents) starts to feel depressed.  This starts to affect her grades at school and her relationships with friends and roommates.  It’s not long before she’s dropped her classes, and as her depression gets steadily worse, she’s soon spending most days unable to even get out of bed.

This is the point that Rachel seeks therapy, something she has never done before.  Her therapist soon notices that although Rachel describes terrible symptoms of depression, hopelessness, and despair, she often smiles and speaks with a bubbly voice.  The only evidence of her ordeal is an occasional bout of stifled tears.  Through talking with her therapist, she begins to explore how she experiences emotions, and states that she is often “the conflict mediator” or peacekeeper in her relations with others.  Even in her darkest hour, she nobly (or perhaps stubbornly) attempts to downplay the magnitude of her depression.  She’s so used to being “the helper,” that being in a position of needing help is completely foreign to her.

Eventually, her therapist makes the comment that given some of what Rachel has experienced, it would make good sense for her to feel angry.  This comes as somewhat of an epiphany to Rachel, who had never thought of it that way.  With the help of therapy she was able to see how she actually was really angry.  The rub is that she didn’t have any way to express that anger healthily, and so it festered and grew inside until it became unable to be ignored.  But still, Rachel’s discomfort with the emotion of anger was too deep-rooted for her to notice what was going on.  Something had to give, though.  If Rachel wasn’t going to let herself experience anger, that anger was going to get out in a different way.  So, instead of going outward, it was turned inward, which appeared outwardly as sadness, an emotion that Rachel was much more comfortable with because she could hide it.

After realizing this, Rachel began to work on better differentiating her emotional states and working on ways to healthily express her anger.  It wasn’t long before the worst of her depression lifted.

This is just one example of how emotions can get in our way when we don’t know our way around them well enough.  Doesn’t have to be sadness and anger, although some have theorized that depression can be thought of as a kind of inward anger, as described above.  We all have emotions we’re more comfortable with than others, and we’re the only ones that experience our own emotions, so it can be hard to know when they’re getting us into trouble.

In general, emotions do us a lot more good than harm.  I guess the bottom line in this article is that knowing our emotional selves better can be a great way to capitalize on the good and minimize the harm.

Feeling Pie: The Real Emotional Eating

feeling pie

One of the greatest therapy metaphors I ever heard was from a friend who was seeing a psychologist for a while.  She was trying to explain how she felt worried about how someone in her life would react emotionally if she were to do something, I forget what it was but that’s not really important.  To this, the therapist replied in the form of a metaphor (always a great choice).

Let’s all take a moment to just imagine a little something.  Imagine that everyone is walking around holding a pie.  But these are not normal pies.  No, these are feeling pies.  And everyone only has one.

These are very special pies.  They are all unique because they are all made of different kinds and amounts of ingredients, those being one’s feelings and emotional states.  Some are a bit more savoury – maybe a creamy, spice-laden pumpkin pie whose flavour slowly unfolds and subtly lingers.  Others might be bright, vivacious, tangy fruit pies that scream juicy tartness and explode in a sweet-sour citrus splash of delicious fury.

Regardless, everyone has their own unique pie made up of all of their feelings.  And no one is allowed to give or take pie to or from anyone else.

Now, say we’re sad.  We take a big old piece of pie, the sad part of our pie, and eat away.  Only we can eat the pie because only we can feel our emotions.  Correspondingly, only we can control our emotional response to any given event.  This is the key point in the feeling pie metaphor.

The corollary implication is that, because everyone has their own pie and everyone is in charge of their own pie, we can’t under normal circumstances make someone else eat a certain part of their pie.  Sure, we can create an event to which that person will react emotionally in a certain way, perhaps even predictably.  But that person is ultimately responsible for that feeling.

pumpkin pieSo, why would we worry about feeling guilty for possibly making someone else feel bad?  Their feeling bad is outside of your feeling pie jurisdiction.  That’s their pie and you don’t get any, them’s the rules.

You’re carrying around enough pie already and you don’t want any more anyway.  Besides, you know you have the best tasting pie around – it’s perfectly custom made for you and by you.  Why buy when you already have homemade?

If I feel guilty about how someone might react, I’m prospectively basing the emotion I think I’ll feel on an emotion that someone else might feel.  I’m eating guilt pie because I’m afraid that someone else is going to have to take a bite of anger pie, or sadness pie, or fear pie, etc.  So, I avoid doing that thing that I want to do, because I ultimately see myself as responsible for that other person’s emotions.

And that’s precisely the viewpoint that feeling pie is all about deconstructing.  It’s not about doing whatever you want all the time.  What it is about is acknowledging that you aren’t responsible for other people’s feelings, and no one but you is responsible for yours.

I’ll see you around

this sad goodbye bear is going goodbye

“You must have the worst job in the world,” a client once told my supervisor.

I would be quite inclined to disagree, obviously.  However, the context in which these words were spoken lend them a strong element of truth.

There are probably lots, but I’m hard pressed at the moment to think of many jobs outside of the helping professions where you habitually build significant relationships with people, who are more often than not in a state of distress, see them change, grow, improve (or worsen),  hear some of their closest secrets, their worst fears, and at the end of the day, without fail, have to say goodbye.

And I’m quickly discovering that this is one element of being a helper that, for lack of a more descriptive word, sucks.  It’s balls.

It’s one of those things that you read in the intro to counselling textbooks and think that you’ve got a handle on, that you’ll know all the right things to say, that you’ll know how to take care of yourself when a client walks out of your office for the last time visibly trying to hold back tears after you’ve stumbled through saying goodbye.

I feel like there have been a lot of those lessons, the ones where all of a sudden what you read or learned about makes sense in a totally different way once you live it.  And you’re left thinking “ahhhhh… that’s what they were talking about!”  Except it’s just not possible to really know what they were talking about before you experience it.  You think you do.  But you don’t.  I’ll have a post of some of these lessons sometime in the future.

But one has to ask: why do we put ourselves through this painful process of saying goodbye, when it goes against every human impulse to remain connected, to just say, “I’m sure I’ll see you again, somewhere, sometime”?

Because there really is every impulse to say something to that effect.  Something about saying “goodbye” is so final, so definitive, such a reminder of our mortality, that to face it head on can be incredibly anxiety provoking.  Endings are uncomfortable, and experiencing one often brings up memories of endings from our past.

One of the most salient such memories for myself is having to say goodbye to my grandfather on his deathbed.  What could I possibly say that would communicate what I feel?  And how?  I’ll always remember how awkward that moment was, and how really, I couldn’t think of the ‘right’ thing to say.  How, more than anything, I felt embarrassed, and then guilty that this was the strongest thing that I felt.

In the situation I’m in now, at the end of an 8 month practicum, saying goodbye after goodbye after goodbye to the very people I had previously been trying to get to know better, to build a strong therapeutic relationship with, it’s hard not to be reminded of all the times I wish I had done a better job saying goodbye to other people in my life.

But I guess that’s just human nature.  It’s easier to avoid the hard feelings.  To ignore the discomfort.  To say, “I’ll see you around sometime” when we know that we damn sure won’t.

It’s time to reclaim goodbye.

Finally, a therapist in the family

This spring when I shared the news with friends and family about my acceptance into a master’s program their response usually comes in two parts. The first, as expected, is some form of congratulations, which is always greatly appreciated and nice to hear. Often following this is some version of, “So you’ll be able to help me” or “Free counselling for family members/friends right?”

In most cases these responses are so outlandish or humorously delivered that it’s easy to share a laugh about it and move on. Every so often I get a comment that has a hint of seriousness and in a few cases the people are genuinely asking to meet with me once my training in complete. These conversations are a little more awkward than when it’s all just a joke.

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1-800-DOCTORB. The B is for Bargain!

It just struck me as rather… juxtaposed… that I’m sitting here right now, doing some research for this post on none other than Dr. Drew of MTV fame while simultaneously listening to one of the best records ever recorded, Abbey Road by the Beatles.

I suppose that one could be doing a lot of silly things while listening to such an album, and the listening experience would still be quite pleasant, if not fantastic.  It was just a thought though.

I tried to find an embarrassingly bad picture of Dr. Drew, but he has proven so striking that not even 3 pages of google images yielded any such results. So I leave you with this "I'm listening thoughtfully and still looking cool" image.

Something about Dr. Drew very much rubs me the wrong way.  I was convinced for so long that there was no way he was an actual doctor.  Sadly, wikipedia proved me wrong.  Anyway, I’ve become quite interested in how therapy is represented in the media (in fact, I realized after it was too late that it would be an interesting thesis topic… oh well).  Dr. Drew seems to be the exact opposite of what used to be therapy’s most popular television icon…

Alternatively, this was THE FIRST result on google images for Dr. Phil. Don't look too closely at the bald spot. It'll burn into your retinas.

Despite the obvious visual improvements and lack of funny accent with Dr. Drew, I can’t help but think that we’ve gone from one extreme of terribleness to the other.  Dr. Phil, as we all know, began his TV career with the help of Oprah, meaning that his target audience was probably middle class females between the ages of… I dunno… 30 to 50.

Dr. Drew, on the other hand, seems the epitome of cool.  Dr. Phil was on Oprah, Dr. Drew is on MTV.  Dr. Phil got a daytime talk show, Dr. Drew got shows on everything from Discovery Health to radio to shows like “Celebrity Rehab with Dr. Drew,” “Sex Rehab with Dr. Drew,” and “Sober House.”  His target audience is clearly young, attractive, upper class yuppies.  I’m pretty sure Dr. Phil had some kind of terrible divorce or something.  Dr. Drew has three kids (triplets), probably a hot younger wife, and apparently he’s some kind of opera singer.  That’s one fail at life for Dr. Phil to at least three wins at life for Dr. Drew.

Irrevocably cooler, yes.  But an improvement?  I’m not so sure.  I mean, I’ve never watched a full episode of any one of Dr. Drew’s shows (I either get too angry or too saddened to watch), but his carefully groomed, perfectly plucked, and youthful image just somehow seems wrong to me.  Does this man look 51 years old?  Does he?  Dammit man, does he!?  It’s not right!

Am I jealous?  Is this some kind of twisted man-crush?  Why… the cruelty!

I started this post with the full intention of making him out to sound like a quack, and look at what’s happened.

Okay – all I ask is that we stop naming these TV “doctors” by their first names.  It’s not right.  Dr. Phil.  Dr. Drew.  We have to stop this pattern before it gets out of hand.

Dr. Dave.  Hmm…

Changing menus: Getting your drink on

As a psychologist in training, I have the unique pleasure of trying to figure out, on a regular basis, exactly what I do for a living.  When I stopped to really think about it, I think it isn’t quite entirely my fault that I still don’t know.

No, seriously. Stop laughing.

The best reason I have for blaming someone else for my sustained confusion is that the questions that psychology asks are so profound, so broad, that it would be like identifying as a ‘democrat’ or a ’republican’. Everyone understand it’s just a bit more complicated than that, but uses those terms out of convenience.

A more developed reason is that, rapidly approaching, if not already in effect, is an era in which the question “what kind of psychologist are you”, is pretty much as natural as “what type of medical doctor are you?” I’m sure that back in the day, a doctor was the man that took care of your illness, whatever it was, and really did the best he could with the leeches and the damp towel cloth, or whatever level of understanding and technology he had. But, as time progressed, and the wealth and technology available increased, we got to a point where we have pediatricians, anesthesiologists, neurologists and dermatologists.

And when I thought more about why I didn’t know exactly what the hell I did for a living, something else occurred to me.

‘Psychology’ is dead. Now before you get upset or accuse me of being sensationalist, just gimme  a minute to ‘splain.

Originally conceived as a branch within philosophy, as the study of the mind, ‘psychology’ come so far, and gone in so many directions, that any attempt to define it is doomed to failure. Anyone that’s suffered through an introductory psychology course knows this well. It’s like the blind men who try to describe the elephant as they use their hands to feel the part closest to them. To one, it’s a like wall, to another, like a pillar, and to another still, like a rope.

Back in the day, when there was just one giant land mass, things were simpler. But as we all know, over time, things broke off,
separated and developed their own unique climates, plants and animals. Hawaii lucked out, and Greenland just had to deal with it.

The tricksy (yes, it is a word because I want to use it as one, like psychology) part of it is, time, in a rate of movement sense of the word, is speeding up. One of the key reasons for this is rapidly enhanced communication methods like the internet. Another is the fact that we can use tools which help us make better tools, which speeds up the movement of those giant moving plates that we give different names and borders to as time passes and wars are won and lost. We do to knowledge what we do to land. We fight over it, but in different ways.

With knowledge, as with tectonic plates, there’s a lot of pressure that’s been building, in different places, in different issues, as a result of this speeding up of time. And as always when plates and worlds collide, there’s a lot of damage, but in the end, what emerges is a new vista, a place of elevated height where we can see further than we’ve ever before. If we’re lucky, maybe, just maybe, we can catch that it’s not flat, but it curves, ever so slightly. Instead of on the shoulders of giants, we find ourselves on the edges of plates, and by extension, paradigms.

So, if all this take of the ground moving gives you motion sickness, don’t stress. This is good news. I promise, and everything.

In a concrete way, this means that we can carve out a critical role in preventative care as people that teach others how to take care of their bodies, and the behavior that’s so intimately connected with them. It means that we can more deeply understand and explain to others how thoughts are wrapped in language, and fired through cannons of genetics set off by environmental fuses.  It means that with positive psychology we can measure the upper limits of human mind and spirit, and train people how to reach them before we send them out to face the challenges on behalf of others.

I live in Florida at the moment, and I see the flux, I sense the sublimated chaos oozing from everywhere around me.  Even people in my own building are foreclosing on a regular basis. Chaos is a part of growth, and true change means destruction before reconstruction, and dissolution before recrystalization.

It’s been said that the best way to predict the future is to write it. As a field of thought in flux, fledgling, the synthesis of so many other things synthesized before it, a great many things are now possible. Millennia old thoughts like mindfulness are being recast as therapies that help those previously thought to be forever on the cusp of self-harm. Enigmas are giving way to sharper ways of expressing truths that were always known, but never fully articulated.

Old wine in new bottles? Maybe.
Old wine in red bull? Intense! (see health psychologist)
Open bar? Sweet.

I’m not saying it will be easy, but it is being done, and will continue to be done, with or without your two cents.

Terrifying? Possibly. Exciting? Most definitely. Your choice? Always.


One thing I always say about anxiety

For quite some time, and likely still, the “common cold” of mental health seemed to be depression.  Statistics are hovering around the 1 in 10 mark for experiencing a depressive episode in one’s lifetime, with men being the more likely gender to suffer it.  Keeping in mind, of course, that these are only reported cases in which a diagnosis was given.  If we acknowledge that in a lot of cases a depressive episode will go unreported and undiagnosed, that number goes up a significant amount.  I would guess that it doubles at least.

But this is not a post about depression.

I recently decided to go through the list of people that I’ve seen in the last 8 months and tally up the “presenting concerns.”  The issue at the top of the list, unsurprisingly, was our common cold – depression (incidentally, only a small fraction of these people had a diagnosed ‘disorder’ such major depressive disorder – though many met the criteria).  But coming up at a close second was another issue that has been, in my view, becoming more and more prevalent: anxiety.

It’s not always easy to separate the two.  In fact, in the DSM-V, they are flirting with creating a new diagnostic category called mixed anxiety depression because the two so often play together.

In any case, if I were to count the number of issues of my clients without limiting it to one issue per client, I’m confident that anxiety would be at the top of the list.  It’s just something that accompanies other problems.  And there’s good reason for that, which I’ll get into shortly.

Now, I’m not too big a fan of the manualization of therapy.  I like to think that each individual person that I sit with has a unique life situation and that there are many equally valid ways of resolving whatever distress they are going through, and that we have to work to find out which way is going to be the most productive.  I have a problem with pretending to know exactly what is required to do to ‘fix’ a person before I even know anything about them.

However, when it comes to anxiety (and perhaps more specifically, panic), there’s come to be one thing that I ALWAYS do, and it couldn’t be simpler.  It takes 5 minutes.  It’s so simple that I’m going to do it with you, right now, because I know that you’ve experienced anxiety before and that this might be new information for you.  But that’s all it is: information.  So, without further ado, I present to you…

A Brief Discussion on the Physiological/Evolutionary Nature of Anxiety
with illustration!

At some point in our evolutionary history, the fact that some folks had something that we now call the ‘autonomic nervous system’ became somewhat of a survival advantage.  You see, this nifty gifty had  two sub-systems: one called the sympathetic and one called the parasympathetic nervous system.  The former had this neat function where it got us really pumped up in response to some kind of threat in our environment.  Maybe a poisonous snake crossed your path, maybe some pre-historic douche-canoe was making moves on a certain female member of the species that you wouldn’t mind impregnating.  In any case, a threat is detected.  This is where the sympathetic nervous system decides to step in and do its thing.  Suddenly, more blood starts pumping out to your arm and leg muscles, your heart rate doubles, breathing becomes fast and shallow, and your pupils dilate, and all sorts of chemical changes start happening.  In a split second, you are literally stronger, faster, and more alert.  Now, you have much more capacity with which to either flee the threat or engage it physically.  This is what is more popularly known as the fight/flight response.

This is all well and good.  Obviously this all developed over generations and the process of evolution refined it to be what it is today.  But as with so many traits that allowed us to survive in an ancestral environment, it doesn’t always function with the same level of effectiveness in our lives today.  The simple fact of the matter is that, for the more fortunate of us, we don’t live life surrounded by the possibility of constant threats to our survival.

So, for those of us who don’t have problems with anxiety or panic, this system tends to be well-regulated most of the time.  Every now and then a legitimate threat is perceived and you’ll get that response happening, but most of the time, when faced with normal everyday stimuli, nothing happens.

When we start talking about anxiety, and particularly with panic attacks, what effectively has happened is that the sympathetic nervous system’s threshold has been lowered way down.  It’s been over-sensitized for some reason (which obviously varies depending on one’s history – in the case of trauma there is very good reason for this).  But the point is that there is a natural, physiological process that is happening – one that was well-developed back when our ancestors didn’t have the cognitive abilities that we now possess in order to make logical sense of the the world around us.

So, when someone with social anxiety begins to have a panic attack when forced to interact in a group, we (and they) can easily come to the conclusion that it just doesn’t make any sense for that to happen – nothing bad is going to come out of it and there is no logical reason to become anxious.  But on a deeper level, this system that’s basically been told to go into red alert status starts going off the rails.

So what about this other subsystem of the autonomic nervous system – the parasympathetic one?  This one is actually responsible for the exact opposite function of its sister – it calms us down when a threat is no longer present.  Our blood begins to flow back to our core, heart rate slows, pupils return to normal size, breathing slows, and all sorts of chemical changes happen.  It’s no longer adaptive to be hyper-vigilant and ready to spring at the drop of a pin.  And this is also the system that has to start kicking in when maladaptive anxiety is starting to cause panic.

It’s just not possible for both of these systems to be fired up at the same time.  You can’t be anxious and relaxed simultaneously.  And this is the bottom line of what I say to anxious people.  The beauty of it is that there is an incredibly simple way to kick-start the parasympathetic nervous system’s calming effects – it’s as simple as taking control of your breath.  Slow down your breathing, you slow down your heart rate, and just maybe, that gets some of the other processes going.

I find it to be a hopeful message.  It’s just a starting point, and it’s by no means the ideal, ultimate  solution to anxiety, but it is simple enough that it’s worth saying every time.