From Stress-y to Sexy – The #1 Way to Bed Anxiety. Hint: It’s in your rhythm baby!

Sighing, panting, gasping...yawning.

Our breathing changes as our thoughts, feelings and behaviour change.  As we become worried, excited, elated, depressed or aroused, our breathing becomes shorter, jerkier, longer, deeper, shallower or smoother. What if the reverse were true? What if our breathing could change our thoughts, feelings and behaviour? What if breathing the right way meant more personal excellence and less anxiety and anger?  

Anxiety shows up in many ways from the more well-known symptoms like tight chest and throat, sweating, increased heart rate, nausea to the less obvious such as memory loss, insomnia and many others. It’s part of life, and yet for some of us it has too much of a hold.

The Kama Sutra of breathing…. backed by neuroscience!

I have taken this material from Dr Alan Watkins’ Ted Talk on You Tube called ‘How To Be Brilliant Every Day’. It's important to view part 1 and 2. I’ve used it with clients who have found it very helpful. Some are sceptical about breathing exercises to reduce anxiety. They say that in the middle of an anxiety attack the last thing they remember is breathing techniques. Others say that the usual breathing exercises prescribed make them more anxious because they worry about getting the technique right. Some others have tried breathing techniques and doubt they work as they have simply not found them effective. So why not give it a twirl? What have you go to lose?

My Lips Don’t lie

Firstly, Dr Watkins explains the neuroscience behind the technique which may help convince you. Secondly, the technique is easy to follow and you can download a free App in order to do so. Lastly, breathing exercises are most effective when done regularly, even if only 3 minutes three times per day. In this way, the baseline level of anxiety is kept lower which means an anxiety attack is less likely. The exercises thus act in a preventative way. So, it’s not really fair to write off breathing until you have tried doing it regularly.

Coherent breathing is useful not just to reduce anxiety but to increase any type of performance be it sports, business, academic performance, relationship, sexual. He explains that It’s not our thoughts that affect our feelings but our feelings that affect our thoughts. That’s why, when someone tells you not to worry when you are anxious, it’s like trying to use a garden hose to put out a raging forest fire.

Wild thing, you make my heart sing

Let’s imagine we have different layers. The bottom layer is our physiology. This is our heart beating, breathing, gut peristalsis etc. It is experienced as a stream of data.  Next level up are our emotions. E-motions are energy in motion, the energy of our physiology. Next layer up are our feelings. Feelings are the awareness in our minds of our emotions. Lastly come our thoughts.

When our physiology is out of whack we lobotomise ourselves. When our reptilian brain senses a threat, it goes into fight, flight or freeze. This is great when there is a real threat but the trouble is, our body gets it wrong. If we’ve suffered some kind of trauma in the past, our body can react as if we are in threat and go into a full-blown anxiety attack when we are tucked up in bed watching Netflix with a cup of cocoa.

In order to achieve brilliance every day we need to be able to tune in to the emotions and control them.

How do we do that?

Keep my heart rate coherent, baby.

The more the distance between each heart beat varies over time, the more incoherent our thinking and behaviour becomes.  We start to produce more cortisol which is associated with anxiety, anger and frustration.

Steady on…and breathe

 We need to aim for stable variance by taking rhythmic breaths. Within a minute our frontal lobes start working better and we become more perceptive, insightful and good at problem solving. This is where coherent differs from yoga or other breathing exercises which may focus on deep breathing or belly breathing. Here it doesn’t matter how deep or large the breathing. It doesn’t even matter what the ratio is. All that matters is that you breathe:

·      rhythmically

·      smoothly

·      focusing on your heart

It doesn’t matter how fast you are doing it, so long as you are doing it rhythmically. Dr Watkins says the reason to focus on the heart area is that not only does it get you out of your head but the heart is also the locus of passion, excitement and motivation so these get promoted.

That’s it, you've got it! ;)

Breathe

Rhythmically and

Evenly

Through the

Heart

Everyday

If you want an app to help with it then go to:

https://itunes.apple.com/us/app/coherent-breathing-assistant/id1121704122?mt=8

https://play.google.com/store/apps/details?id=com.rrr.macoherencecardiaque&hl=en_GB

What if I’m going crazy? What if it's contaminated? What if I lose her? - How to Be Free of OCD

OCD refers to obsessive compulsive thoughts and behaviour. These can include obsessive thoughts around four types of vulnerabilities which are: 1) health and illness, 2) danger, 3) poverty and 4) losing control.  Specifically, we can think obsessively about sex, death, relationships and contamination, amongst others. We may behave compulsively by cleaning, checking and double-checking or repeatedly asking our partner the same question. We also tend to avoid certain situations which make us feel particularly anxious. On a physical level, it is common to experience a tightness in our chests, shallow breathing, sweaty palms, palpitations, dizziness or brain fog when in the grips of obsessive and compulsive thoughts and behaviours. We may also generally feel low in mood, lonely, empty and tired because of our condition. 

What If?

Underlying the specific nature of the thoughts and behavour is the ‘what if’ question. For example, ‘what if I didn’t lock the door on my way out?’ Or, ‘what if the food I am eating is contaminated?’ Or, ‘what if I picked up the knife and tried to stab someone else (or myself) and what if this means that I am going crazy? In his highly acclaimed book, ‘Freedom from Obsessive-Compulsive Disorder: A Personalised Recovery Program for Living with Uncertainty, Dr Jonathan Grayson explains that regardless of what the specific nature of the OCD is, the bottom line is the difficulty living with uncertainty. He goes on to say that whilst we all struggle with uncertainty to an extent, particularly around the existential uncertainties in life such as birth, death, life changes etc., those with OCD find uncertainty and the resulting anxiety, particularly difficult to manage. This is at the core of the disorder, regardless of the specific thoughts and behaviours. Indeed, it is common for the nature of the OCD to change over a lifetime. One might start with obsessive thoughts about killing oneself or another and then move on to obsessive thoughts about whether we really love our partner. It is common for OCD symptoms to disappear for months to years or to at least subside and feel more manageable and then to reappear or worsen at life transitions such as graduation, changing profession, getting married, having children or retiring. We can imagine the present subject or subjects of our OCD as the current actors on the stage whilst the difficulty with uncertainty, the backdrop to the scene, remains the same. The scenes and the actors come and go but it is the backdrop, the difficultly with uncertainty which does not change. I use this metaphor because in terms of treatment it can feel tempting to want to ‘talk out’ the OCD. Often this might lead to feeling better temporarily, however since the underlying issue is around uncertainty and no therapist can give us 100% assurance on a ‘what if’ question, it is far more fruitful initially to focus on the difficulty with uncertainty.

Why do some individuals find uncertainty so difficult?

Clinical research shows that there can be neurological differences in some OCD sufferers. To simplify greatly, this means that there are some neural pathways going from the orbital frontal cortex to the cingulate gyrus, to the thalamus and back to the orbital frontal cortexwhich act as a negative feedback loop. See this explanation from the BBC http://www.bbc.co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml

These parts of the brain are responsible for OCD like behaviour. When one of these parts is not working properly then we can have OCD symptoms. Other research suggests that OCD is linked to a  low level of serotonin. For this reason it is worthwhile considering the option of taking an SSRI or anti-anxiety medication, particularly if therapy alone does not help or if there is also low mood, dysthymia or depression. In my experience, clients are often wary of becoming reliant or medication or think that they should be able to ’sort their problems out on their own’. I suggest that taking medication should be discussed with a psychiatrist but can been viewed as an additional support. Sometimes we feel too overwhelmed with our OCD symptoms to be able to engage in therapy. In these cases, medication can help take the edge off, particularly since starting therapy can sometimes temporarily increase our anxiety and worsen our symptoms. However in my clinical experience, whilst medication can improve symptoms, it is not enough to stop them and this is why therapy is also necessary.

What is the treatment for OCD? 

Exploration of Adverse Childhood Experiences

Whilst some argue that OCD is purely a biological matter, I have found that all OCD clients have experienced significant circumstances in their childhood where there was a backdrop of uncertainty and a feeling of not being in control. Sometimes it takes bit of exploration to identify this. Many of us feel very protective of our parents. We might feel guilty exploring childhood difficulties with a therapist, as if we are betraying our parents. It is also fairly common not to remember too much about our childhood or to emphasise how we were so lucky and had such a good childhood. The fact is that however good our childhood was, we all experienced some hurts, upsets, minor traumas or full-blown trauma along the way. This is simply because our parents are human and no human is perfect. Even the most well -meaning parents may have unintentionally negatively impacted their child or children. Whether it is because they parented in the same way as they were parented so thought that their behaviour was normal. Or because they were not fully available to their child due to overworking, depression, alcoholism or OCD, amongst others. In fact it is common for an OCD sufferer to have a parent who also struggles. Sometimes the parental wounding can simply be because you have different temperaments. For example, an outgoing mother with a shy introverted child might unintentionally wound the child when she insists that they sing in front of the whole family at every family gathering. 

Schema Therapy

A common theme in childhood experience of OCD sufferers is having felt ‘not good enough’ or insignificant. Perhaps there was conflict in the marital home and the child was not given the attention they needed. Perhaps one had to compete with other siblings who demanded more of our parents’ attention due to special needs. Maybe we were bullied at school and didn’t tell anyone so didn’t get the support we needed. Perhaps we had a parent with a volatile temper and felt as if we were constantly living on egg shells. We might at times have felt alone, insignificant and lacking the reassurance and empathy we needed from one of our key care givers. Dr Jeffrey Young created Schema Therapy which is an effective tool for uncovering childhood situations which have left an unhealthy mark on our psyche. Schema Therapy also provides a treatment model for how to heal these schema. Schema is the name coined to refer tothe particular type of difficult childhood circumstances we experienced that still impact us in an unhelpful way today. These do not need to be ‘ Big T’ traumas. Often ongoing and seemly low-grade traumas such as a parent being preoccupied with depression can have just as damaging an effect.  There are around 18 different schema and the one which relates to OCD is the Vulnerability to Harm and Illness schema.

Gestalt Therapy 

Gestalt therapy posits that anxiety is the feeling of excitement when we are not allowing ourselves to fully breathe. The Gestalt definition of excitement refers to the whole range of outward going and forceful e-motions including not only excitement but all types of anger from feeling irked, irritated, annoyed, frustrated, angry, enraged, hateful, spiteful, malicious, vindictive and murderous, to name but a few. In my experience, clients with OCD often have a difficult relationship with anger. They believe that anger is a ‘bad’ emotion and that it is unhealthy. They may try to bypass their anger. Either we don't feel anger at all or we bottle it up or get angry with ‘the world’, current affairs or  public transport services, for example. We find it difficult to own and express anger assertively and directly to another, usually a significant other. We might be passive-aggressive or deflect our anger by getting irate with the shopkeeper who short-changed us rather than our partner who pissed us off. We fear that expressing anger directly is risky and that we may end up losing the person we love if we do so. We have normally learned early in our childhood that getting angry is risky. We may instead internalise our angry feelings and become angry with ourselves. A common denominator in all OCD clients I have worked with is the very critical inner voice. Often clients are accompanied by a constant narrative about just how terrible, incompetent or ridiculous they are for having OCD symptoms. They blame and get frustrated with themselves. This then causes us to feel even worse about ourselves and never resolves our OCD. Therefore an important part of therapy is exploring how we learned that expressing anger was risky, how we can learn to express it appropriately, and how we can develop a more compassionate voice to ourselves.  Often this  includes experiential work where we look at where the misplaced anger really belongs and where we fight back against the original person who made us feel bad as a child.

CBT

This is clinically proven to be effective in the treatment of OCD. It is premised on the idea that our thoughts affect our feelings which then affect our behaviours. For example a thought such as ‘what if I were to pick up that knife and cut my wrists?’ leads to a feeling of anxiety and a behaviour of eliminating all knives from the house. If we can challenge our thought and replace it with something more helpful then we don’t feel anxious and we are ok with knives in the house. Challenging the thoughts and beliefs entails firstly logging them to see what kind of unhelpful inner talk we have, and then analysing them for cognitive distortions such as catastrophic thinking, ‘black and white thinking’, fortune telling, amongst others. See this link for a full list and explanation of thinking errors. We also look for the evidence to suggest our thought has significance. For example is there any evidence which supports the idea I might cut my wrists? Have I ever done that before? Probably not. The second part of CBT is the behavioural part where we start to expose ourselves to situations and thoughts that are difficult for us until they no longer affect us. For example we tolerate eating with a fork that might be contaminated and when we do it enough times, we realise we can handle the uncertainty and the anxiety that accompanies it and it is no longer a big deal for us.

Mindfulness

To oversimplify, this is holding the knowing that all our experiences are temporary and often momentary. By reframing how we view our symptoms, we give them less power. For example, think about how different it feels to say to yourself, ‘In this moment I am feeling anxious’ or ‘right now i am having a thought that the spoon may be contaminated’ rather than simply focussing on how anxious you feel or how dirty the spoon might be. Mindfulness Based Cognitive Therapy (MBCT) has also been clinically proven to be effective for working with mental health disorders including depression and OCD. A great resource to learn more about mindfulness is Tara Brach's website.

Sensorimotor Therapy

Dr Pat Ogden, co-author of Sensorimotor Therapy offers an alternative to the CBT approach. The idea is that we can alter the faulty neural pathways that lead to OCD and anxiety by introducing somatic interventions. Dr Ogden describes the building blocks of experience which include 1)our thoughts, 2)emotions, 3)body sensations, 4) movements and 5) remembered images, smells or sounds that may come to mind as we focus on these. If we can change one of the building blocks in our well-trodden neural path then we can break the path and behave differently.  This might mean having the ‘what if’ thought but not allowing it to take hold. One of the ways we can break the old pattern is by working directly with our bodies. For example making the opposite movement that our body wants to make when we are feeling anxious such as lowering our shoulders and standing straight rather than raising our shoulders and hunching over. Somatic interventions are also offered for the client to try which help to reduce anxiety. Learning techniques to master anxiety gives us a sense of mastery and can give us the confidence to engage in the next steps of therapy.

I believe that having expertise of all these approaches means that the client and I have a highly equipped tool box for tackling OCD. Some clients are ready to get started with CBT straight away and others find this more difficult in which case we may start with exploring key schema, mindfulness and anxiety management techniques until they feel ready to start CBT. Others respond well to the benefits of a containing and nurturing therapeutic relationship and a Gestalt Therapy approach.

The key to contentment - self approval

A common thread that runs through a lot of the issues my clients bring is validation. By validation I mean the process of being confirmed as ‘ok’, ‘acceptable’ or ‘good enough’.  For many individuals this sense of being ‘ok’ is derived from others or how we imagine others think of us. We need others to consider us interesting in order for us to feel interesting. We need others to think that we are beautiful in order to feel beautiful. We need others to think that we are intelligent in order to feel intelligent. We need others to give us permission to feel ok before we give ourselves permission to feel ok.

And what’s wrong with that you might ask? On the one hand we are social animals so of course what other people think of us is important. If we were not influenced by others’ perceptions, what that would make us? Psychopaths?

There is nothing wrong with being influenced by others. However if you imagine there is a continuum going from one extreme of needing others to validate our experience to the other extreme of not needing anyone to validate our experience, I suggest that being closer to the centre of the continuum would feel better. Firstly, if we are dependent on others’ validation in order to feel ok then we can never feel ok within ourselves. Instead we feel anxious and uncertain each time we think we have upset them.

Secondly it takes up a lot of energy to be constantly evaluating oneself on whether we are worthy of approval. It’s tiring! Not to mention how frustrating and irritating it is to strain so hard for others’ confirmation. Although often we hide these angry feelings from ourselves, they show up when our attempts to get approval from another are rejected. Then we might think, ‘how dare they not like me when I was trying so hard’. We might react to the rejection in a way that is disproportionate to the situation for example feeling furious or devastated.

Lastly, it is often a futile task. Think about the people that you find most interesting or attractive.  They often have an easy-ness about them, the ease of being ok with themselves, the ease of not having to try too hard to please. This enables them to be spontaneous and to feel excited in the moment about their encounter with you. This is what makes them attractive to others. Indeed it is precisely this element of openness and spontaneity that we lose when we are trying so hard to be validated. We may succeed in portraying a polished image however in exerting such control over ourselves we also manage to polish away qualities such as openness, vulnerability, ability to be with uncertainty and sensitivity to the environment and to others. These are qualities which we find endearing in others We’ve probably all been in the presence of people who seem to have mastered the social game and yet they do it by not allowing anyone else a word in edgeways, or by asking lots of questions without giving anything away themselves. Somehow we find ourselves glazing over or getting bored.

So how do we feel more ok with ourselves? Well I can’t offer a ‘magic wand’ cure. However the journey starts with learning to validate oneself more. In order to do this we need to get to know ourselves so that we can connect with our own signs and signals that we are doing ok.  The route to this is through our bodies. Our body sensations and emotions provide important messages about ourselves. From time to time throughout the day try asking yourself the simple question, ‘am I doing ok in this moment here and now?’ Then close your eyes and go inside to feel the answer.  Wait for the voice that may be weak that tells you that you are doing ok. Be patient and let it tell you exactly how you are doing ok in this minute. Notice the body sensations and emotions that go with it. For example a client in therapy looks at me as if seeking my approval on what she is saying. I ask her to see if she can approve of herself. She takes a moment to reflect, notices a warm steady glow in her chest, a quietness and absence of anxiety. She connects these sensations and emotions with something positive. She realises and tells herself that actually she is doing ok right now with me. She even manages to elaborate on why this is. She is self-reflecting, courageously exploring herself and taking the risk of sharing difficult material with me. Indeed therapy is hard so dammit she is doing more than just ok!

So go on, try it and let me know how you get on?

Getting Grounded

I mentioned in my previous article on social anxiety that it was important to get as grounded as possible. When we feel anxious we tend to breathe more quickly and less fully. As a result we can become heady and have physical symptoms such as feeling dizzy, spaced out or numb. Consequently we no longer feel balanced and find it difficult to get in touch with other more supportive states that counter the anxious thoughts for example excitement, curiosity or confidence. Grounding involves being more in our bodies and less in our heads.

I’m not saying that it’s as easy as getting grounded to beat anxiety. Many of my clients have, out of their awareness, chosen precisely not to feel grounded. Feeling one’s body can bring up uncomfortable emotions. Emotions originate in the body and are linked to physical sensations for example a sinking heart and disappointment, a tight chest and anxiety, a fluttering in the stomach and excitement. An individual who has experienced trauma may have ‘escaped’ to their mind or disassociated in order to avoid the harrowing experience and accompanying anxiety. This then becomes a habitual pattern.

However even those of us with no trauma that live in cities are often ungrounded due to our environment. Many of us work in offices surrounded by electronic equipment and the latest technology, spending large amounts of time interacting digitally, being constantly bombarded with news feeds, text messages, television, You Tube, emails, Twitter etc.

So getting grounded is important for all and yet it can be unfamiliar and challenging. For this reason approaching getting grounded with compassion and curiosity rather than with an, ‘I must get grounded’ attitude works best. Here is one exercise to try.

Belly breathing

In a private space, place your hand so it is gently covering your belly. Start by taking a normal breath in and then breathing out normally (not trying to do anything to the breath like extend it or deepen it). When you come to the end of the out-breath and are ready to breath in again, pause for five seconds without breathing. As you pause, push your lower belly out as far as it can go as if you had just eaten a meal that had made you feel bloated (this in itself can be difficult for those who are not comfortable with their body image). After five seconds relax your belly and breathe in. You will notice that you breathe in more deeply as you want to get more oxygen in after holding the breath. Continue doing this for three minutes and building up to ten minutes. Ideally you would do this twice a day. Clients sometimes report having tried breathing when they are feeling anxious and finding that it does nothing at all to help them in that moment. However the best way to benefit from these types of breathing exercises is to do them regularly as a way to keep general anxiety levels down. In that way we are less likely to get into a highly anxious state.

And the science shows that breathing exercises really do work. The reason being that anxiety has a direct effect on our physiology. As I am sure you are all familiar, when we are anxious our flight or flight system kicks in., our sympathetic nervous system. Our adrenal glands, located above our kidneys, start to produce more adrenaline and noradrenaline. Our heart rate increases and we experience physical symptoms of anxiety such as sweating or dizziness, amongst others. By belly breathing we activate the hypothalamus that transmits neurohormones, which cause the body to relax. Deep breathing also directly affects the kidney and adrenal area, also promoting relaxations. Deep breathing therefore activates the mechanisms that cause the body to slow down and relax, the parasympathetic nervous system. So why not give it a try? Set yourself a 30-day challenge of just three minutes a day and notice how much grounded you feel. It is also a useful exercise to do before a big moment such as a job interview or first date as it helps to counter the nervousness that can get in the way of performing your best. I’d be interested to hear what your experience with it is so drop me a line and let me know.