One of the most frequent questions I hear from people considering CBT is: “Can you help me get rid of my anxiety?”
I wish I could answer with an unqualified “Yes!” But I’m a psychologist, not a purveyor of snake oil, and professional ethics require me to set reasonable expectations for treatment.
Wiping out anxiety completely isn’t a realistic therapeutic goal. It’s also not in anyone’s best interest to aim for total mental control. Like it or not, anxiety—whether a hard-wired physical response to an objective threat or the product of an over-active imagination—plays an important role in everyone’s emotional repertoire. So we all need to negotiate a peaceful coexistence with it.
A few weeks ago I had the chance to test out my own advice about meeting fears head on. I was at the highest point in LA’s Runyon Canyon enjoying the vista of the city spread out beneath me and the Hollywood sign in the distance on a perfect Southern California day. I sat on a rock soaking up the warmth of the sun and giving the experience my full, mindful attention. Then I started on the descent.
That’s when the panic gripped me.
Heights have always made me nervous, and I’ve never liked hiking downhill. But this time I wasn’t just cautiously inching my way down the slope in my typical fashion. I froze completely. My heart pounded. My mouth dried up. I felt dizzy. I couldn’t figure out how to put one foot in front of the other.
The steep dirt path littered with jagged rocks made my anxious brain conjure up images of slipping and plunging forward and cracking open my head and lying in a pool of blood. Not likely. But it could happen.
Oh, wait! It had happened —just a few months earlier, on a perfectly flat walk only two blocks from my house when I tripped on an uneven patch of sidewalk and landed in the emergency room.
OK, so my fears weren’t entirely irrational (an argument I hear frequently from people with anxiety reluctant to approach triggering situations). But, still, I had to make my way down the mountain.
So I decided to recruit the mindfulness skills I’d just been practicing. I didn’t try to relax. I didn’t tell myself I had nothing to worry about (because, really, how could I possibly reassure myself given the evidence to the contrary?). I didn’t try to push away the gory images. I didn’t attempt to slide down on my butt crab-style, a technique I’ve employed in the past to navigate precipices. I didn’t try to take a calming breath or grab onto my husband’s arm for support (not a viable option anyway because he was focused on his own worries about slipping and dropping his camera).
What did I do? I gave myself permission to be scared. I decided not to care about how slowly I was going and made room for the faster hikers to pass me. I looked down at the path in front of me. I concentrated on finding a place to plant my foot and took a step. Then another. And another. Until I finally reached the bottom.
And the next day, I went back and climbed to the top again. The view was breathtaking
I’ve been extremely fortunate with my health. No major illnesses or injuries. I even walked away unscathed from a head-on collision with a drunk driver who plowed through a traffic light at the intersection where I was stopped, totaling my car.
So my accident a few days ago, which landed me in the emergency room and required extensive oral surgery, was a new experience for me.
I went out for my usual walk with my dog. Wearing headphones and listening to a podcast, I was “distracted walking.” My foot caught on a bump in the sidewalk. I fell forward, tried to brace my fall with my hands, and landed hard on my chin.
Let’s just say the damage, in the medical-speak of the ER, was “impressive,” the sort usually only seen in major automobile accidents, or among young men who’ve been in bar fights or crashed into trees while snowboarding.
My jaw is now wired shut to heal the fractures. I’ve heard from friends who are envious of the enforced opportunity to shed a few pounds on a liquid diet, or who’ve known of people who voluntary opted for jaw-wiring as part of a weight-loss plan. I am not amused.
Nevertheless, I’m trying to make the best of a bad situation. While waiting for hours in the ER, I researched expensive Vitamix blenders,which I’d been eyeing for awhile but felt were too extravagent, and treated myself to one (with a single click on amazon). I’m using up my CSA produce in kale smoothies and creamed vegetable soups. I’ve been catching up on emails and on the latest novel I’ve been trying to get through for weeks. I’m writing a long-overdue blog post.
And, to my surprise, I’m even feeling a little grateful. While I was undergoing a CT scan of my skull, a worried thought of the kind health-anxious folks are frequently plagued with popped into my head: “What if this is one of those situations you hear about, where someone goes into the hospital for one thing and finds out they have something else much more serious? What if I have a brain tumor?”
Thankfully, I don’t. I’m just facing a somewhat arduous process of recovery. But I will heal over time.
I think I’m practicing acceptance. It’s not a situation I like. I’m not a good patient. I want to be in control.
But it is what it is. So rather than wallowing, I’m trying to treat myself kindly (when I’m not berating myself for my carelessness), connect with friends over email, arrange milkshake dates for when I can be seen in public, allow my husband to run around doing errands for me, and experiment with new soup recipes.
Mindfulness practitioners tell us you can accept something without being happy about it. If there’s a secret to getting through life’s ups and downs in the best way possible, I think cultivating an attitude of acceptance (which isn’t the same as resignation) is key.
We’ll see. I’m working on it.
Learning to disentangle ourselves from distressing thoughts and observe our internal reactions before responding are skills worth cultivating. They can help us cope better with a wide variety of emotions—anxiety, depression, and anger, to name a few—without resorting to avoidance, withdrawal, distraction, or lashing out to deal with them.
Mindfulness, defined by Mindfulness-Based Stress Reduction (MBSR) founder Jon Kabat-Zinn as “paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment,” is a way to change the way we respond to our thoughts. A growing body of evidence from brain-imaging studies suggests that regular meditation practice—one important means of cultivating mindfulness—actually alters the brain structures involved in attention, concentration, and willpower, as well as the areas central to emotional reactions.
These findings have been compelling enough to convince me to develop a personal meditation practice (I’ve described my own experience with MBSR in previous posts) and also to add meditation to my cognitive-behavioral therapy repertoire.
It’s been a hard sell, and I understand why. I was a mindfulness skeptic myself. I’m not a fan of approaches smacking of New Age pop psychology, and the currently voguish “mindful revolution“, which has spawned to date 462 iPhone apps along with the titular Time cover story, carries with it that woo-woo whiff. But, as I said, the science backing it has sold me.
Not so for many of the people I think might benefit from practicing meditation. I can’t count the number of times I’ve heard, “Meditation doesn’t work for me.” I’m always curious to understand what that means. If meditation were “working,” what would be happening?
The most common answers I get to my question are: “I can’t empty my mind,” or, “I’m always thinking,” or “I just can’t relax.”
I suspect the impossible goal of mind-emptying comes from all the yoga teachers who end their classes with Shavasana, inviting practitioners to let go of their thoughts and relax. While relaxation is indeed a major benefit of yoga, it’s not the goal of mindfulness meditation (although it sometimes can be a pleasant by-product). Perhaps, fittingly, Shavasana is also known as “corpse pose,” reminding us that as long as we’re living, breathing, sentient beings, our minds will always be busy thinking.
So if achieving a relaxed feeling and a blank mind aren’t the point of mindfulness meditation, why do it?
The major benefit of practicing mindfulness for emotional health is to learn to let experiences unfold without filtering them through the layers of thoughts, comparisons, judgments, interpretations, and memories often taking us away from the present and into a morass of negative mental activity. It’s not about stopping thoughts but about redirecting them, taking a more objective perspective, and focusing on what’s important in any given moment.
In short, meditation is weight-training for the brain. It strengthens the mental muscles for attention and concentration. And, as with lifting weights, results don’t happen overnight. You can’t expect to become a power lifter after one or two sessions in the gym. Yet many would-be meditators get discouraged and give up when they don’t see immediate changes.
And what if your mind keeps going a mile-a-minute and it wanders and you get lost in thought and your attention can’t stay on your breath (the most common focal point used in mindfulness meditation) for more than a second at a time before you start thinking again about that conversation you had with your boss or what you’re going to make for dinner tonight or how you’ll find the time to finish the project that’s due tomorrow or where you’re going to get the money for your daughter’s orthodontia or whether that weird mole on your arm is cancer or what a loser you are because you can’t even concentrate on your breath and meditate right?
Then I’d say you’ll get lots of practice refocusing, again and again and again, which will help build those mental muscles.
And I’d also say,”Congratulations!” Because you’re alive.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.