Rethinking Worry

My class at the VCS in December focused on worry and anxiety. Starting with a description and discussion of the differences between these, the focus was on strategies to be with emotions differently (working from a felt-sense, and building both grounding and emotion-regulation skills).

So what does worry, anxiety, fear, and panic have in common? Each state amps up our nervous system: awakening our senses and moving us into readiness for action – for our survival. Each state has a helpful side to it as well as a problematic side.worry_bird

Worry can encourage us to take action to change a situation. For example, a few years back I was worried that I wasn’t confident driving a car with standard transmission (which was all I had to drive at the time). I took a few extra driving lessons to gain experience and build confidence. The problematic side of worry however, shifts our thinking into a negative and catastrophic cycle. Focusing on themes that exacerbate a sense of helplessness, incongruence, and unpredictability can spiral us into anxiety. Worrying at this end of the continuum tends of focus on imagined future problems, which, by their very nature exceed our present-moment problem-solving abilities. In my example, had I focused on stalling the car while at an intersection, or rolling back down a hill, my worries would have shifted into anxiety and I might have found excuses to just not drive the car!

The trouble with worrying is that it appears as though it should be helpful. After all, we are in a sense working through a problem from many different angels! As practical as that sounds, worrying does not help us find solutions to our problems, mainly because the focus of worry tends to center on problems that can not be solved with present-moment resources.

“I’ve had a lot of worries in my life, most of which never happened”
– Mark Twain

The anxiety reaction serves us well if we are presented with real-life danger and need to respond rapidly and effectively to the situation. It activates our body and our mind, putting us on high alert and causing us to scan for possible danger. Anxiety is always an attempt to stay safe – our bodies built-in survival mechanism. Anxiety becomes problematic when there is no real danger and the anxiety response goes off anyway. It becomes a problem when the intense felt-sense of anxiety and the cognitions of anxiety get in the way of our daily activities. The thoughts associated with anxiety most often focus on the future, which can lead to too many unresolved “what ifs”. These are problematic by nature because we can not foresee the future, and they have a tendency to lead us towards the negative. As we move into anxiety, subtle changes start to take place in the body as the nervous system moves into activation. The anxiety response serves us well if we are faced with real danger (flight/fight/freeze response). It is less helpful when the danger is imagined and we are trying to evaluate a future course of action: forecasting the worst-case scenario just leaves us feeling apprehensive and fearful.

Practice 1: Grounding
Learning a new way to be with emotions can ben challenging. And just reading about it, or talking about it, doesn’t really help us learn how to do it. We have to actually learn to connect with the felt sense of emotion, and develop ways to settle the discomfort or fear that can arise when we do that. To do this, I used a guided mindfulness meditation for grounding that worked with deepening the breath.

Practice 2: Noticing the Felt-Sense of Emotion
Instead of running from worry, try focusing your attention on the way worry impacts you (for example, when you notice yourself worrying, what triggered it, how do your thoughts change, what sensations do you experience in your body, what is your typical response pattern for coping?). Once you have tuned in, use the grounding technique, and then prepare yourself to deal with the situation. Sometimes we need to pause and tune in so that we can respond to the situation with conscious intention. 

Practice 3: Linguistics Play a Role
The words we use play a strong role in how we perceive our self, others, and the world around us. Our words have the power to impact our quality of life – some words can be destructive, and other words can be empowering. Over the next few days, tune in to the words you use. Do you use a lot of “I can’t”, or should, could, always, never, or other words that focus on pain, scarcity, or blame? If you catch yourself using them, try swapping them out for statements that are more empowering. For example:

  • I can’t = I’m currently struggling with
  • It’s a problem = It’s an opportunity
  • I’m not getting it = I am learning and growing
  • What am I going to do? = I will be able to handle this
  • It’s terrible! = I can move on from this

References:
McLaren, K (2010). The Language of Emotions: What your feelings are trying to tell you.
Miller, K (2012). Mind-Body Attunement Therapy: Clinical Strategies

Creative Approaches for Children: ‘Live Calm Kids’ Group

“Do children’s groups really work? Do they actually engage in the process?”

Yesterday I was promoting a children’s group that I am co-facilitating (Live Calm Kids), and these are the questions someone asked me. They are great questions, and I really enjoyed our conversation. I thought it would be a helpful topic to write about – because many others might be wondering the same questions!

I believe that all therapy is designed to help us grow emotionally and move toward solutions to the difficulties we experience. There are so many benefits to group counselling, especially for children. The group therapy experience is unique because aside from the skilled facilitators, participants are within their peer group. The group itself becomes a powerful vehicle for change because so much of our learning comes from our social interactions.

“We human beings are social beings” (Dalai Lama)

When a group environment is positive and well facilitated, the universal needs for belonging, acceptance, and approval can be met, which foster resiliency in children. Experiencing a sense of “fitting in” can be difficult for those struggling with anxiety – a counselling group can be a powerful place for them to feel accepted and valued. A sense of belonging comes to replace their feelings of isolation and separateness.

children_waterfrontWhen children are struggling with anxiety, they often feel as though something is wrong with them. Because of this, bringing together a group of children with similar difficulties is powerful. Together they discuss emotions, learn about their reactions, and practice coping skills within a supportive group setting; with the subtle underpinning that they are not alone in their experience. Being around others with similar difficulties helps kids to feel understood, a powerful antidote to the sense of being different from others.

In a counselling group, children have the ability to watch others learn coping behaviours and hear their stories of success. This instills hope and inspiration as they become encouraged by their peers’ positive experiences.

We are social beings, and as such much of our self-esteem is development via feedback and reflection from others. Group counselling provides children with opportunities to improve their ability to relate to others through discussions, art, movement, and playful techniques.

And we can’t forget the power of modeling when it comes to learning! The group facilitators have an important role in modeling active listening, providing non-judgmental feedback, and offering support. Over the course of the group, children start to pick up on these behaviours and incorporate them. And by doing so, they being to receive increasingly positive feedback from others, which serves to enhance their self-esteem and emotional growth.

The course of therapy and healing will be unique for everyone; group therapy can establish the foundations necessary to reduce stress-related symptoms and lead to positive changes. Please contact me if you would like to learn more about the group Live Calm Kids.

LiveCalmKids


Resources:

Paul Kymissis & David Halperin (ed), Group Therapy with Children and Adolescents
Cathy Malchiodi, Creative Interventions with Traumatized Children
Irvin Yalom, The Theory and Practice of Group Therapy

Help for Insomnia: Creating a Bedtime Routine

sleepA good nights sleep (and more importantly, consecutive nights of getting good sleep!) is incredibly important, yet it is something as adults we rarely give much attention to. Our brains need sleep in order to function properly and regulate emotion effectively. Learning is easier when we sleep well, and so is decision making. Even coping with change becomes more manageable when our brains have been rested! Jim White (2000) writes,

“Poor sleeping fails to recharge the individual’s batteries. Thus, during the next day, the individual is less able to fight the effects of stress. Stress then feeds the sleep problems the following night and a vicious cycle has developed. Over a period of weeks or months, the individual’s ability to cope slowly declines. Learning how to improve the quality and quantity of sleep will leave the individual in a better state to fight daytime stress. Fighting daytime stress will help the individual overcome sleep problems. A positive cycle has replaced the vicious cycle.”

Read on to learn ideas on creating and implementing a bedtime routine that soothes. Every person is unique, so please do add/edit/modify as necessary to fit your own life better.

It is important to create a bedtime routine that you can be consistent with each night, regardless of the time you go to bed. Anytime we try out a new routine, I always suggest to try following it consistently for 21 days – simply because evidence does suggest that the more frequently we do something, the more likely it is to become instinctual. So in other words, the more a behaviour is repeated, the more likely it will become a part of your routine.

The following is a list of ideas for creating a soothing bedtime routine. No need to incorporate all of them – select the ones that fit for you and your life, and then create your own routine!

  1. Start the bedtime routine about 30 minutes prior to the time you want to be in bed
  2. Take a shower, or even just wash your face/hands – doing so is symbolic of washing the remnants of the day away
  3. Make a cup of decaf tea for yourself, or have a glass of water
  4. Sit down (but not in bed), and take a few minutes to write out any left-over thoughts that are troubling you. Troubling thoughts could go in to a ‘dumping journal’ – which is never kept but instead each entry destroyed in order to create closure, a sense of letting go, and to ensure your privacy. The thoughts that go into the dumping journal are often the angry, sad, or fearful thoughts that you wouldn’t want to look back on.
  5. End with a positive note: use another journal (one that you want to keep and look back on) to finish on a positive note. You could write anything in this one – something you hope for the next day, what you did well this day, what you have learned that you want to remember, something someone did for you that was kind, etc. You could also fill it with beautiful pictures, sayings that are important to you, and so forth. This is the journal that lifts you up and leaves you smiling.
  6. Put the journal away – you have given attention to those troubling thoughts and devised a plan for the next day, so you can be finished looking at those troubling thoughts for the night now
  7. Read.  Not a murder mystery, and not a book that will take a lot of analytical thinking. Try a frivolous read – doing so can help you start to settle.
  8. Still not feeling settled? Lay down in bed and try listening to a meditation for relaxing. Jon Kabat-Zinn (mindfulness meditation) and Paul McKenna (guided hypnosis) have excellent recorded meditations – but there are many other options.

If you find your mind wandering towards troublesome thoughts while you are listening to the meditation, try to bring your awareness back to the meditation, with gentle kindness towards yourself. You are learning something new, after all – and that can take time. If you find that troublesome thoughts are overpowering, you can no longer focus, or if fear is mounting rapidly, get out of bed. Once you are out of bed, return to your sitting place and write or scribble those thoughts into the dumping journal. If you live with someone caring, try talking with them. Afterwards, remind yourself that although looking at these troublesome thoughts is helpful, it is not helpful to ruminate on them at bedtime. You have given some attention to them and you will attend more to them tomorrow!

References:

Jim White (2000). Treating Anxiety and Stress

Jon Kabat-Zinn, Guided Mindfulness
Meditation http://www.mindfulnesscds.com/collections/all-1/products/series-4

Paul McKenna
http://www.paulmckenna.com/sleep

 

Deepening the Breath

Anxiety and stress can affect the way you breathe. Holding your breath, as well as breathing rapidly or shallowly may be related to chronic anxiety, which can be a symptom of post-traumatic stress. Awareness and regulation of the quality of your breathing can have several positive effects:

  • Slowing and deepening your breathing allows for adequate intake of oxygen and output of carbon dioxide which is needed for physical well-being
  • Conscious breathing during times of distress allow you to release muscular and emotional tension, thus reducing levels of distress
  • Focusing awareness on breathing can shift thoughts away from flashbacks and non-productive or obsessive thinking, and bring your awareness back to the present moment

Get to know what your breathing patterns are like throughout the day. Take a quiet moment to tune in, and notice the following qualities of your breathing:

  • the depth of your breathing: is it shallow, deep, moderate
  • the rate of your breathing: is it fast, slow, moderate
  • the pause between the inhalation and exhalation of your breath
  • the expansion and contraction of your rib and abdominal areas
  • changes in the overall pattern of your breathing

Here is a simple breathing technique you can do anywhere:

  1. In a moment of calmness, inhale completely, and then count starting at 1 as you exhale
  2. When your exhale was complete (oxygen was completely out of your lungs) what number did you have?– This number now becomes your baseline. When you find yourself feeling anxious, stressed out, angry, etc. focus on slowing your breathing:
  3. Add 2 more numbers to your baseline

** This means slowing the rate of your exhale, not counting faster!

So, if during a moment of calm, your exhale takes you to the court of 6, during a moment of emotional upset, you will want to stretch that exhale to the count of 8.

Want to make that deep breathing more powerful? Add a Visualization to dandelionIncrease your Calm:

For some people, it is helpful to pair deep breathing with a calming vision. As you are learning this technique, it may be helpful to visualize a ship floating on the sea. As you breathe in, waves wash up onto the shore and the ship bobs closer. It bobs close enough to the shore that you can clearly see its details: lettering on the bow, the colour of the sails, people on the deck, etc. As you exhale, the waves pull away from the shore and the ship bobs farther out of view. Or you may want to visualize a feather floating in the air, a balloon, and so forth. Because deep breathing involves the pulling of oxygen into the lower lungs first, for some people it is helpful to visualize a jar being filled with water. As the water is poured in, it splashes into the bottom of the jar, then rises to the top, overflowing over the rim and out onto your hands. The jar symbolizes your torso, and the water the oxygen you breathe.

Resources:

Exhale-plus-2 Idea adapted from Carolyn Costin, MA, M.ED, MFT (2011)

Cohen, B. M., Barns, M. M., & Rankin, A. B.  (1995). Managing Traumatic Stress Through Art: Drawing from the Centre

Haskell, L. (2003). First Stage Trauma Treatment

Mate, G. (2003). When the Body Says No: The Cost of Hidden Stress

Sgt. Charles E. Humes (2003). Lowering Pursuit-Induced Adrenaline Overloads
http://www.pusuitwatchorg/stories/adrenaline.html

What is Affect Regulation?

Affect regulation strategies include developing the tools and resources necessary to recognize, observe, modulate, and cope with affects you may be experiencing (affect is another word for emotion). In developing these tools and skills, you will be better able to cope with disturbing emotions as they arise (such as grief, anxiety, anger, fear, frustration, etc.).

Developing the ability to regulate affect begins with learning to identify emotional sensations within your body.

Containment strategies are useful techniques to regulate affect because they can be effectively used to control intrusive trauma memories and images (flashbacks), and disturbing physiological sensations. These overwhelming memories, images, sensations, feelings, or thoughts can sometimes lead to harmful behaviour, making it extremely difficult for you to focus on healing. Learning effective containment skills can empower you and reassure you during difficult times. The term containment is not used here to refer to “stuffing” or ignoring your experiencing. Just the opposite, in fact. It’s about acknowledging the incredible power the distressing memories have, and creating the safe internal place from which to work through them. In her book “Healing from Trauma”, Jasmine Lee Cori describes it as “to contain something is to hold it, to create a place for it, in some ways to protect it”.

“With containment… we learn to discriminate how much (emotion) we an handle at  any given moment without overload. We understand that the point is to keep the feelings from getting so intense that they burn us. We learn to contain a feeling so that it doesn’t run roughshod over us but instead is given a place and listened to” — Jasmine Lee Cori

Because every person is unique, there may be some affect regulation strategies that work well for you and others that do not. Try the strategies that sound interesting to you, approaching them with an open mind and a curious attitude. Try each strategy you select over a couple of days, and write in your journal what the strategy was like for you.

Resources:

Cori, J. L. (2008). Healing from Trauma, A Survivor’s Guide to Understanding your Symptoms and Reclaiming your Life.

Haskell, L. (2003). First Stage Trauma Treatment: A guide for mental health professionals working with women.