Anxiety, Trauma, And Coping Parts 2 and 3

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th,: 2023

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We talk about coping and resilience, but this applies to things that are already done and dusted—coping after the fact. But if we are aware of these patterns, we can step in and stop them before they happen. Coping “ahead” is a way to break patterns. This is a technique that comes from the therapeutic modality of dialectical behavioral therapy, or DBT. Using this approach, you walk yourself through a mental rehearsal of a possible future situation. The idea is that if you are able to anticipate a challenging scenario, you give yourself the opportunity to practice what you will do in that event before it occurs. This way, you develop competence and agency. Beyond that, you are required to have considerable forethought and honesty when thinking about your strategy for dealing with emerging situations, rather than just passively waiting to see how you will react in the moment.

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When a crisis hits or a challenge rears its head, it may be incredibly difficult to respond there and then in a calm, rational, and level-headed way—even if you ordinarily are a very balanced and competent person! Don’t make life harder for yourself. If you notice a recurring pattern, the upside of this is that you are empowered to prepare in advance for how you want to cope with it. This is much, much easier than trying to strong-arm your way through difficult moments through willpower alone. So how do you cope ahead? First, you need to think about the kind of situations that typically prove difficult for you. Clara, who you already know is learning to deal with her anxiety and fear of abandonment, has identified a list of situations that tend to trigger her feelings of panic and catastrophic thinking: When saying goodbye to someone. When people are late or cancel at the last minute.

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When someone is doing the “silent treatment” or not paying attention. When somebody loses their temper and starts shouting. When two close friends or family members are fighting with one another. She also makes a list of people she most tends to feel anxious around (her mother-in-law, doctors, a particular person on social media) and times/periods that are most stressful and difficult (Mondays, the time before her birthday, evenings when she’s most tired). After a long and bitter experience, Clara knows that these situations and people tend to activate her core belief (“the world isn’t safe; I’m not safe”) and set off a range of unhelpful cognitive distortions. She knows that she then tends to behave in desperate and irrational ways. When things reach this point, she is often so fused with these feelings and thoughts that it’s difficult to pull back and gain perspective. But, if she knows this beforehand, she can plan ahead and help herself before the situation spirals out of control.

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The next step is to tune into your inner sage. If you’ve tried some of the exercises in this book, you’ve already been doing this. Your inner sage is the wisest part of you that always has your best interest at heart. This is your higher self, your intuition, your intelligence, and your real, best self, in whatever form makes most sense to you. This is the frame of mind that works to counterbalance the automatic, unconscious, often unhealthy emotional mind. When Clara’s husband came home a little late from work, she instantly blew up at him when he did arrive, causing a rift. She felt embarrassed by her extreme behavior and regretted it. For so many people, much damage can be done when the overly emotional mind has free reign and acts before the wiser mind can weigh in.

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Your inner sage is there to help you proactively plan how you want to behave in certain situations. Then when the situation arises, you may feel those strong emotions, but there is always that little voice of the sage who is standing off to the side, saying, “Remember what we said we were going to do? Let’s do that now." Merely being in conscious control of your own experience this way can be enough to break the spell of powerful and overwhelming negative emotions. In that small gap that is opened up, you give yourself the chance to make different choices. Four Steps to Letting Your Inner Sage Take Charge Step 1: Describe the situation First, gain clarity over the situation you are trying to prepare for. Label it. Gain as much psychological distance from it as you can and get very familiar with it.

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However, you are not seeing this situation from a fused point of view, but rather neutrally. Imagine you are describing the scenario to a disinterested third party, or as though you were writing a newspaper report. Just the facts. Try also to predict how you will be in that scenario. Name the expected emotions, thoughts, and actions. Clara, for example, finds going to the doctor extremely stressful, especially when that doctor withholds information or is generally dismissive or absent. She explores this situation and paints a picture in her mind of how it might play out: She gets panicky when kept in the dark, then imagines all kinds of nightmare scenarios that are really just mountains out of molehills. She keeps her eye on the facts, though: This feeling isn’t strictly warranted.

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Step 2: Identify the necessary skills Okay, so how could you possibly cope with such a situation if it should happen? Be as specific as possible and be creative. You might realize how comfortable it is to solve problems before they’re “real”! Would you need to take a timeout? Distract yourself? Call on someone for help? Find more information and support? Clara realizes that the thing that would most help her in her case is to speak up for herself and be assertive, asking for updates from the doctor and to be told what is happening and why.

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This cuts down on anxiety rumination. Step 3: Rehearse yourself coping So far so good. Next, try it out. Use the power of visualization to mentally rehearse not just the situation but how you will cope with it. Be vivid and detailed. See yourself inside the situation, not merely watching it from afar. Imagine it literally unfolding now, in the present, rather than hypothetically. And then conjure the details—who you’re with, what they’re saying, how you feel, what you’re doing, etc.

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Clara pictures in minute detail the consulting room of her local GP practice. She imagines herself feeling nervous and unsure, but rehearses the moment when she says, “Actually, can I please ask you to explain that more? I’m not sure I understand." She feels the strength of her assertive voice. She rehearses nodding her head, asking further questions. She pictures herself leaving the doctor’s office, feeling satisfied that she spoke up. Clara might do this a few times, and she even throws a few curveballs in. What happens if the doctor is a little rude?

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What happens if they shrug and tell her they don’t know? She rehearses all this too. The great thing about this technique is that you get to feel out the contours of a potentially stressful situation all on your own terms. Clara can speed things up, slow them down, or rewind them so she can try again. She can practice dealing with the things she is most afraid of—and she can ramp up that threat as and when she is ready. As someone with a tendency to catastrophize, Clara’s mind often jumps to the worst possible outcome. But she uses her visualization to safely address these ideas on her own terms. What’s the worst that could happen?

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Well, she mentally rehearses that, too. She pictures the scariest and most upsetting doctor’s appointment she can ... and fleshes out all the ways she would cope with that. By doing so, she prepares ahead, but she also reminds herself that she does actually possess valuable skills, resources, and coping mechanisms. In the heat of the moment, we can all forget our own strengths and forget that we are resilient and capable. Sometimes, we feel better able to cope with whatever comes our way simply because we have reminded ourselves that we can manage and have that confidence. Step 4: Relax As you’re doing this rehearsal, remember to practice a relaxed state of mind so that you pair up the difficult situation with a feeling of calm and collected control. Try to maintain a sense of calm while you rehearse, but afterward too. Stretch, take a deep breath, give yourself a pat on the back, and take a little break—rehearsing this way is hard work!

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But if you can practice this with your worst fears and your most disorienting triggers, you will give yourself the gift of facing it next time feeling fully prepared. You will instantly see the situation and be familiar with it. Sure, it will still be stressful or unpleasant. But you will not be swept away by this. Instead, your body and mind will already know what to do and slip into it automatically. If you need to, verbally remind yourself that you have done this before. “Inner sage, help me out—what do I do here?" Take a deep breath and pause.

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In that little space that you create, you will find that you can cope. In a way, coping ahead is not dissimilar from cognitive defusion—the only difference is that you are laying a plan for the future for how you will continue to maintain distance from overwhelming and stressing thoughts, and constantly keep in touch with your own power to choose how you will behave no matter what your feelings and thoughts and no matter how challenging the situation. Part 3: Systematic Desensitization Systematic desensitization therapy is a type of behavioral therapy used to treat things like anxiety, phobias, OCD, and PTSD. The idea is that people can be conditioned to avoid or be repelled by a certain stimulus, in just the same way that Pavlov’s dogs were conditioned to salivate whenever the bell rang and signaled that food was coming. But if these associations can be conditioned, the theory goes, that means they can also be deconditioned. So, for example, in the past, you might have had a very embarrassing and uncomfortable encounter where you met someone new. Your brain made the link: Meeting someone new equals painful feelings of embarrassment. The next time you were due to meet someone new, you instantly felt aversion and worry, as though in preparation for the stimulus (meeting someone new) to produce the same response (feelings of embarrassment).

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Scientists and psychologists have been studying conditioning for a long time, but you don’t have to have an extreme phobia to be subject to its basic principles. If you have places and objects that remind you of a bad time in your past or a specific person you dislike, if you find yourself irrationally avoiding certain situations, or if your bad moods always seem to happen at particular times of day, then you may be experiencing the power of conditioning and association. Systematic desensitization is a way to use counterconditioning—i.e., to consciously decide which stimuli to expose ourselves to and how to manage and “train” our responses to them. Very broadly, the idea is simple: Expose yourself to the thing you fear in small quantities while you link the experience to feelings of relaxation. Then ramp up the stimulus and repeat until you have learned to tolerate the stimulus without going into anxious “fight or flight” mode. This process is usually done with a trained therapist, but you can do it yourself if you pay close attention to the two ingredients required: 1. Graded exposure, i.e., moving through a hierarchy of stimuli 2. Relaxation The key is to combine these effectively. If you are merely exposing yourself to things that freak you out, you will only reinforce those pathways and become more effective at freaking out! Similarly, if you only relax, you are not really challenging yourself to learn a different response. You need to pair the relaxation with the graded exposure for this technique to have any effect.

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Take a classic example: You’re afraid of spiders. 1. You construct a graded exposure “ladder” going from one to ten. 2. One is thinking about spiders, two is looking at a picture of a spider, ten is letting a spider walk on your hand, and so on. 3. You start with one and think about spiders. 4. As you think about spiders, you employ your relaxation techniques. 5. When you are able to remain relaxed while thinking about spiders, then you move on to level two. 6. You move up the ladder until you can let a spider walk on you happily, with no problem. As you can see, the theory is pretty simple.

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Let’s take a closer look at how you might use these principles in your own life to break bad habits, overcome fears and phobias, and tackle triggers from traumatic events in your past. We’ll return to Nick, who, having hunkered down at home with depression for months, has developed a mild form of agoraphobia—a fear of crowds, open spaces, and leaving the house. The problem set in gradually. Every time he went out to go shopping or meet friends, he found that he felt depressed and anxious. He hated people seeing how much weight he’d gained, he hated people’s nosy questions about how his job hunt was going, and he hated the noisy crowds that only seemed to drive home his feelings of isolation and annoyance with life in general. And so, without him realizing it, he began to associate the world outside his home with negative feelings, and the world inside as safe, comfortable, and happy. But he needs to break this association. He needs to get outside, exercise, volunteer, connect with friends, and more.

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But throwing himself into a busy social life all at once will likely only make him feel worse, and then the association will be strengthened. Instead, he uses systematic desensitization to consciously and proactively decide to break this conditioning in himself. Before we go on and see how he does this, bear in mind that this process is never meant to be painful, scary, or unpleasant—quite the opposite! Rather, we are trying to create a new association, i.e., the trigger equals good feelings. This means that we cannot embark on the process feeling like we are being forced to do something we don’t want to. Rather, remind yourself that you are in control, you go at the pace you want to, and that it’s not supposed to hurt! Pick a Relaxation Technique The desired goal is to feel completely calm, content, and at ease with the stimulus/trigger. It should feel utterly neutral to you.

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Hence, you need a relaxation technique to create this feeling in yourself. There is no set way to create relaxed feelings, but there are several popular techniques you can choose from, and you can mix and match them or create your own. Here is a simple relaxation technique based on what’s called progressive muscle relaxation. 1. Sit or lie down somewhere and begin with a few deep, slow belly breaths. 2. Start at your toes. Flex the toes upward as hard as you can, hold for a breath, and then relax. Flex them hard downward in the same way, hold, then release. As you release, do it slowly and with control, feeling the tension melt out of the muscles.

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You may like to repeat this a few times. 3. Move up your body and onto your calf muscles next. Flex them as tightly as you can, then slowly relax that tension as you breathe out. 4. Continue moving up your body, tensing and relaxing the muscles of the thighs, glutes, abdominal muscles, chest, shoulders, etc. It may be worth spending more time on the shoulders, jaw, neck, and hands—the places we often hold most tension. 5. When you reach your face, pay individual attention to your lips, brow muscles, and forehead. 6. Now, as though your conscious were an illuminating spotlight, run your awareness over your body and see if you can find any spots of tension. If you do, zoom in there and repeat the tension/release and breathe deeply and slowly and then relax.

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7. When you feel that your muscles are nice and relaxed, tell yourself “I am completely calm." These are not just words—really feel the sensation of calm in your body and what that’s like. Become familiar with this state—you will need to find your way back here later! Now, there are many, many variations on these breathing and relaxation techniques—it’s not worth getting too hung up on exactly how you reach a state of calm, only that you reach it. Some people like to combine their muscle relaxation and breathing with mental imagery and visualization. If you found it useful to visualize in some of the techniques from previous chapters, you might find that it helps to incorporate them here. For example, if you visualized your anxiety as the literal letters that spell out ANXIETY, made into a tall and foreboding brick wall, then you might like to imagine that this wall is being gently but steadily worn away by warm rain that makes the letters crumble and disappear. Or take some time to construct your “happy place” in as much vivid detail as you can.

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It can be what you want—a remote paradise island with cool blue waters, a peaceful and dimly lit chapel, or a pink cloud floating far above the earth. The more familiar you are with this place and the more you make the connection that this place means relaxation, peace, and happiness, the easier you will be able to summon up the state of mind that comes with it. Remember that it’s not the specific words, imagery, or technique that matters—what matters is that you are finding reliable paths into a calm state of mind. Construct Your Ladder You will need to set up a program/plan for yourself. Be deliberate. How you do it is up to you, but make sure that you are genuinely challenging yourself and that each step on the ladder is a fairly consistent increase from the step before it. If the ladder isn’t quite right, that’s okay, too, though—you can always make adjustments. Nick’s ladder looks like this: 1. Book a concert ticket 2. Mentally rehearse the steps needed to get to the concert and meet a friend there 3. Leave the house and walk to the subway station 4. Do the above but also get on the tube and travel to the right stop 5. Do the above but also walk around the busy streets in the city for around ten minutes 6. Repeat, but for thirty minutes 7. Stand in a busy crowd for ten minutes 8. Stand in a busy crowd for thirty minutes 9. Stand in a busy crowd for an hour or more 10.

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Talk to your friend and tell them about some of the difficulties you’re experiencing You may look at this ladder and think that step ten doesn’t seem so bad, or that walking around the city is more stressful than lingering in a crowd. But so long as your ladder makes sense to you, then that’s fine! To make your own ladder, you might find it helpful to first start by jotting down a whole bunch of different scenarios that cause you anxiety. Then, go through each one and sort them into piles: high, medium, and low. Then take each pile and try to rank them in order. You might need to break a few down into smaller tasks. Then, try to assign every task a number on a scale of one to ten. If it’s more appropriate, you may find a scale of one to one hundred is better.

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Nick starts his process by booking some concert tickets to a show he really wants to see, with a friend he has been neglecting somewhat. The show is in two months, giving him time to work through his ladder. On his own terms, he works through the ladder. He buys the tickets, then pauses and immediately runs through his relaxation technique. He started out feeling a little anxious, but after relaxing, he felt better. He took the time to mark the milestone and praised himself, even if it is only a small step. Next, he runs through the other steps, one after the other. So, when he has worked his way up to step five, he walks around the city.

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When he feels his anxiety levels rising and his mood dropping, he pauses, finds a quiet corner, and quickly runs through a shortened version of the relaxation technique. At step seven, he flounders a little and finds that he is overwhelmed, and comes home unhappy and defeated. That’s okay. He stays at that level for some time. Whenever he encounters fear, sadness, shame, or any other negative emotion, he stops and runs through his relaxation protocol. This is important—he never “pushes through." The only condition for his moving up the ladder is that he is completely comfortable with the previous step. Nick looks carefully at the task before him and his rough timeline and commits to taking a small step on the ladder every single day.

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Because he is deliberately trying to break old associations and create new ones, he takes the time after every session to go through affirmations, to recognize his progress, and to dwell on any good feelings he has managed to create. In two months’ time, Nick finds the concert a challenge, but he attends and enjoys it. When he comes home, he feels so good and so proud of the progress he’s made that he immediately creates a new ladder. Step one of this ladder is “go to another concert with my friend." Thank you for listening to The Science of Self, where you change your life from the inside out. If you enjoyed today's episode, please be sure to subscribe to our podcast or share it with your friends. Remember, you have the power to change your life. Start by learning how to cope with stress and adversity.

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hurchill, born on this day in: 1874