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Nancy Henningsen, Ed.D, LCSW, 301.661.4433

Changing Lives Blog

Monday, November 30, 2009

Can Mindfulness Help My Anxiety?

Being mindful is about being aware of what's happening around us and inside us in any given moment. We all have thoughts about the future, the past, perhaps 17,000 thoughts in any given day. But those of us who live with anxiety can get stuck in a particular thought. We end up looping around, fixating on a particular thought such as "What if my train crashes on my way to work?" or "Will I lose my job today?" We focus on this thought until our mind convinces us something serious WILL happen. This is called catastrophizing. It can become a habit.

Mindfulness is about noticing automatic behaviors, simply noting them, not judging or analyzing them, just learning to be aware of them. Mindfulness is about experiencing the anxiety and then moving past it. It is about befriending it although this may sound counterintuitive.

The biological pathways of anxiety are becoming increasingly understood by researchers. Therapists like myself are using this knowledge in developing treatment protocols. These are based on the patient's particular life circumstances and state of discomfort. From a mindfulness perspective, avoidance and maladaptive habits are what our brains have learned to do and programmed into our bodies. It's about the brain, not a personal defect. A mindfulness approach is about what is happening in the present moment so it is positive and accepting. It can include meditation but it does not require it. It is awareness OF, rather than thinking ABOUT.

Those thousands of thoughts are like clouds passing above us. They come and go. They are temporary like our feelings and sometimes our body sensations. But they do repeat because our experiences have conditioned our reactions. Our hippocampus near the base of the brain stores emotional memory so that scary or traumatic memories can trigger alarm even when we merely think about possible danger. The evolutionary process has also shaped our neuralphysiological reactions. But the quick action we needed on the savanna to escape a predator can easily lead to road rage or anger at ourselves or others if we're always on automatic pilot.

Mindfulness is about acceptance. It is about noticing and separating the facts of experience from the conclusions our mind makes afterwards. Jerry, one of my patients, experiences frequent paranoic thoughts. He noticed when they popped up, learned to talk back to them for a brief moment, and then took deep breaths letting the thoughts go off in a white cloud. He would get up, and observe what the person next to him was doing. A reality check. Usually they would be absorbed in the words on the screen, not looking at him at all. All of us have triggers which stir up our emotions. Jerry grew up in a household with very anxious parents who carefully observed his actions trying to keep him safe.

We do not always identify our triggers, or schemas. During the first few therapy sessions we examine and identify these schemas, enmeshed strands of intense emotions, body sensations, thoughts, and/or feelings usually formed in childhood. Three of the most common I see at work are negativity, being hypercritical, and "there's something wrong with me". Mindfulness can help us see them, feel them, and then LET THEM GO. Therapy is yes, about change, but we probably want to change our behaviors and reactions, not our basic natures. Understanding and deconstructing our schemas is a part of the process. Mindfulness may sound easy but it requires practice and noticing and learning to let go.

Practicing self-compassion is another form of mindfulness. The early research in this area show that practicing it can reduce the impact of a negative event. It can also help us regulate our emotions. Self-compassion also relates positively to life satisfaction and emotional intelligence. We can also learn and practice this in therapy sessions if appropriate.

For more information, consult Christopher Germer, The Mindful Path to Self-compassion.

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Sunday, November 01, 2009

What Can You Expect from Couples Counseling?

When two individuals make a marriage or "live-together" commitment, they bring with it their individual expectations, values, past wounds, and life memories. Sometimes they have children and financial debts to add to the complex mix. Couples often have different communication and conflict resolutions styles. Love grows and flourishes in the initial romance period but it can die on the vine if not watered by attention and positive affection.

When angry talk, emotional coldness, and continual carping and negativity start to dominate the relationship, it's time to find a couples counselor.

Couples counseling is about getting in touch with past wounds, talking honestly about unmet expectations, discovering individual triggers for angry outburst and observing the intimacy dance that happens with all couples. It is also about revisiting the joys felt during the initial stages of falling in love.

Couples fall in love for a reason. But then life intervenes. All too often a small fault grows larger and sets the stage for frustration. Human beings are usually optimistic in thinking they can change the annoying habits in their partner. But change happens from within and cannot be forced.

I begin the work with an initial couples session where each person sets forth the issues which are causing the friction as each perceives it. We agree about some initial goals and set up individual sessions, either one or two, with each of the partners. The purpose is to learn about past history and experiences. What did each partner learn about love and conflict resolution growing up? About expectations? About gender roles? Sex?

Then we all meet again to discuss individual strengths, vulnerabilities, share ideas on communication style and learned habits. For example, do the individuals differ in terms of conflict resolution? Hang on to grudges? Avoid sexual intimacy? Have unmet expectations? Has there been an affair? If there are kids, how do the adults find their own time?

The last step is deciding whether to go ahead with therapy. I ask for a 8-12 session good faith effort! These can be every week or every other week. And yes, there's usually a takeaway activity to be tried. The time frame varies with each couple depending on how entrenched they are in behaviors, how aware they are of their triggers, how present and mindful they are about their actions. Change happens with small steps.

We know what habits and patterns make marriages work. These are readily available in popular self-help literature. But we can't understand the emotional underpinnings without bringing them into the light. We can live on the surface on automatic drive. Gaining awareness of unconscious emotional underpinnings is crucial to a happy tension-free relationship.

In a recent case, Monica and Harry (names changed) were able to forge a successful, loving relationship once each of them came to see how their individual relationships with an emotionally abusive father (Harry) and a cold, standoffish mother (Monica) were still at play in their couples relationship.

Successfully and joyfully living with another person can't happen when individuals live on automatic pilot.

For more information, see The Mindful Couple: How Acceptance and Mindfulness Can Lead You to the Love You Want, by Robyn Walser and Darrah Westrup.

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