En Route

It's a while since I posted on here as I only do so if I think what I have to say is useful. Well, this morning during a period of reflection my mind went back to my teenage years. I've referred before to my experiences of mountain walking and this is another memory.

There was a group of us who used to go on a night hike once a year. Always the same walk; always the same time of year. Each June we used to hitchhike from Salford to Shap Village in the Lake District. Once everyone had arrived we would set out with only moonlight to show the way and follow a track past a farm and onto the fells. The sun would come up around four in the morning by which time we would be in the middle of nowhere, open moorland in all directions. Soon we would arrive at a beck with a footbridge. We stopped there for an early breakfast, then it was on again, climbing now before descending into the next valley, the next and a third. By now people were starting to get out of bed and get ready for the day; but not around us. We were still in the emptiness.

We knew where we were headed, of course. We knew we were making good progress. But also by now we were feeling the effort, tiring, but we still couldn't see our destination. It was hidden behind the twists and turns of the track, by more ridges ahead of us. We knew it was there but really, how much longer?

It struck me this morning that this analogy fits many of life's situations. Not least it describes the journey through mental ill health. As one of the Old Testament prophets put it, "How long, oh Lord? How long?" I don't know how long the journey will be for you. But I do know, from those night hikes, that you are on the right path and you will get there.

On Not Knowing What Will Happen

This is not a blog in the usual sense of being a sort of journal that simply unrolls across time. It is more by nature of an online handbook which has tips, hints, advice and how to’s about a very common problem, clinical anxiety. When I have said everything I feel that I can, it will stop. In the meantime, in the absence of specific questions long periods may occur between one post and the next. As has happened here. I don’t write it for the sake of writing it, but only post when something occurs to me which may be helpful. As is about to happen here. A very common source of anxiety is concern about what the future may hold. It’s an anxiety that may be vaguely concerning or it may be so severe that it overwhelms and paralyses the person. It is usually brought about by some major change in our lives which appropriately raises the question, “What happens now?”, and to which the answer is, “I don’t know.” But we want to know. Indeed we tell ourselves that we need to know, and the realisation that we don’t know fills us with fear and foreboding. Understandable but misguided. The truth is that there is nothing in the slightest way unusual about not knowing what the future holds. It’s just that normally we don’t notice. We have sufficient experience of past patterns to make predictions about future patterns, which generally speaking come to pass. I have a medical appointment tomorrow so I shall present myself at the health centre in good time and undergo the test that is scheduled. That’s my supposition. It’s well-founded because that’s what I do when I have medical appointments. But until it actually happens, it’s only a prediction; it’s not a reality until it happens. To give you an example. We are planning on moving back to England. Recently we were there for three weeks on holiday and decided that we would spend a few days on the Isle of Wight, the area we want to move to. I booked three nights in a B & B, we packed a case on the Sunday and had our rail tickets for Monday morning. But on Sunday night my wife was hit by severe stomach cramps which prevented her from sleeping much, and they were still with her on Monday morning. So we cancelled. We didn’t got to the Isle of Wight after all. It wasn’t a disaster, but it was a disappointment. The stomach cramps cleared up quickly and my wife returned to normal health. We ‘knew’ what we were going to do, but we didn’t do it; circumstances changed. So the first lesson to take hold of is that circumstances change all the time, but mainly we don’t react with fear or anxiety. Fear and anxiety are reserved for the big changes that come unforeseen - a spouse or partner dying or leaving us, a redundancy, an unwanted pregnancy, diagnosis with a serious illness. Things which basically we hadn’t planned upon happening. There is a second, equally important lesson to be learned; we will survive, Things will be fine. Different but fine; we will survive. It’s a strange characteristic of human beings that we always think that we are the finished product; that we are how we will always be and that life is settled and will stay like this. The only trouble is that we are wrong. Think back to the person you were at the age of twenty - what you were doing, your interests, job, where you were living, who your friends were. Now leap forward ten years to the age of thirty and look back from there. Can you believe that so many of those things could have changed so much in just ten years? Now come to the present day and see how much has changed since you were thirty. Most of the changes that occurred were things you would not, could not have predicted, and yet here you are today, different but still in one piece. Why then would you expect the future you to be the same as you today? It hasn’t happened in your past. Why should it happen in your future? Know this then; you don’t know what the future holds but it’s odds-on that it and you will be fine once you’ve made the transition from what is to what’s next. In the words of the cliché, life is a sentence; living is a process.

Weasel Words

Language is a wonderful gift. It allows us to communicate enormously complex information from one person to another. It provides us with song, poetry, literature as well as a vast range of technical information. It allows us to share experiences to the mutual benefit of all. Sadly, it also has a downside. I want to look at one aspect of that downside, as it affects people who are struggling to come to terms with some difficulty or another. Inside my head lights flash and alarm bells start to ring whenever I hear someone say to me, "If I were you.....". Unlike me, they don't have the full facts about my current situation, the one that they are about to help me with. They only have the picture as their imagination paints it for them and so what they say next will reflect that. It will be overly simple; it will almost certainly be something that I have already considered and rejected on at least one occasion. But most of all, they are lying - unconsciously admittedly, but still lying - because they are not going to tell me what they would do if they were me; they are about to tell me what I would do if I were them, which is very different. I am not them so no matter how good their solution is, it probably won't be appropriate for me. Their solution will lack an essential component, insight. So, for example, if I say that I am too frightened to fly to Australia, they might say "Why don't you just fly from Manchester to London as a start." Be suspicious of people who want to give you advice and solutions on a plate. No matter how authoritative their position, you should trust your own instincts (Yes, I know that's advice; I apologise; ignore me.) Actually that's a useful guide to a successful therapist, counsellor or life coach; they focus on listening not on telling. They use questions more than statements. In that example for instance, a good therapist will ask something along the lines of "What is it that you fear?", following up with more questions in an effort to understand the root of the problem. Next I would want to pursue another line of enquiry;"Have you thought about what you might do to tackle your fear?", "Why did that not seem a good idea?" Two weasel words of advice to really run away from are 'should' and 'ought'. Each describes a course of action - mental, emotional or physical - that the person offering presents wrapped up in an obligation to do something you're not doing, very likely for a reason. I enjoy painting in watercolour, not that well but I have sold a couple of pictures over the years. It was something I thought I couldn't do, but eventually tried and was pleased with my first attempt. I showed it to an artist friend who agreed that I had some ability. "I think I should sign up for some classes", I said. His advice was a categorical "No!". "A teacher will show you how to paint like he or she does. Paint the way you do. If you keep at it, you'll get there on your own." He was right. Ten years after that first painting I returned to the exact same subject and painted a new version. There was no comparison between the stumbling of the original and the competence of the second. Take all the help you can from people who see their role as being to assist you in finding your own way out of your present difficulties, and trust your instincts. And keep a keen look-out for those weasel words and phrases.

Don't Look Back?

I hear it said a lot to people who suffer with depression, that you shouldn't dwell on the past, but look to the future. Whilst I may agree with the first part of that advice, it shouldn't be seen as a total ban. As for the second part of the sentence, about the worst thing you can advise someone feeling that going on is too overwhelming, is that they should focus on that future they fear. But this blog is mainly about anxiety, not depression. I say mainlybecause what I want to write today actually applies to people undertaking any kind of therapy, but which is often overlooked or ignored. You want to get better. You are trying as hard as you can to keep moving forward towards some kind of 'normal' life, but at times it looks as if there is so far to go that you will never get there. How do you give yourself the courage and the incentive to keep at it? In my youth I used to spend a great deal of time walking in the Lake District; we called it hiking in those days; I don't know if that's still the case. The Lake District isn't just full of lakes. It is also a mountain region. so walking in the Lake District usually involves climbing up one side of a mountain in order to climb down the other side - and then do it all over again to the next mountain. Even if you are fit climbing a mountain is hard work. With every step you lift your whole body weight, plus whatever pack you are carrying, a few inches higher up the slope. Say your step is ten inches and the summit of the mountain is 1500 feet higher than the point where you sart, then you are going to have to lift your body weight another ten inches up the mountain 1800 times before you get to the top. Hard work. The way we dealt with this was to take a rest from time time to time to get our breath back. Not for two long though, or it took that much more determination to set off again. So short pauses punctuated the ascent and made it more easily achievable. But what was also important was what we did duringthose pauses. We turned round and we looked back in the direction we had come. And that was when we could see just how far we had already come - the tiny farmhouse at the foot of the fell: the ant-like people down by the side of the lake. That was a tremendous encouragement, and so off we went again with renewed vigour. It's just the same when you're struggling to make headway in therapy, every step so laborious and demanding. Stop. Pause. Have a rest and get your mental breath back. And take a good long look back at how far you"ve come. See how your progress is much greater than you had imagined or given yourself credit for - and give yourself that credit now. While I'm on this theme, just a word or two about the climb that still awaits you. I would look up and I could see the summit and the sky above and beyond it, and on I would go thinking "Not far now". Then I'd get near the summit only to see that it wasn't the summit at all. Simply, the gradient had changed so that although the next stretch was easier because it was less steep, before too long the mountain reared up again and mockingly looked down at me. The worst of these times was when you actually had to go steeply down into gully and then slog up the other side just to get back to the height you were at now. It's the same in therapy. So often it feels as if you are nearly there and then you get a different perspective and realise that the journey is longer than you think; and sometimes you have to lose height to stay on track and then climb it all over again. That's another reason why pause to get your breath and look back are important.

Delaying Tactics And Why They Help.

Anxiety comes upon you in different ways depending on what type it is. Separation anxiety never really quite goes away; it's somehow always there in the background. Existential anxiety suddenly deals you a hammer blow. Situational anxiety, on the other hand, sneaks up on you. It begins so small you may not even notice it. Then it grows. I'm reminded of something I once heard about cooking a live frog, assuming you would ever want to do such a thing. If you simply take a pan of boiling water and drop the frog in, the frog's reflexes will kick in and propel it straight back out again. No, what you have to do is put the frog in a pan of cold water and then slowly heat the water up. The frog doesn't notice the heat at first, later it may but it also starts to feel drowsy before passing out and you can now cook it just how you like it.

Take a less gruesome situation. When you get a puppy you need to teach it obedience. The earlier you start, the easier your life will be later. Even though it may be hard work to get the message across, it's nowhere near as difficult as if you start with an adult dog. Anxiety that starts small is much easier to overcome while it is still small. And if you keep it small, it stays easy to overcome. With some made up figures, here's what I mean:

If you make a dentist's appointment this Monday for next Monday, and you really don't like dental treatment then the blue line shows what happens to your anxiety level in the meantime. Anything over 80% and you'll probably cancel. If, on the other hand, you acknowledged from the outset that you were likely to become increasingly anxious over the week you would be able to decide to devote time to reducing the anxiety every time it gave a little flutter. You can usefully use two strategies side by side.

1. Visualising yourself arriving at the dentist's feeling calm and remaining calm, using the techniques I've described, practising feeling calm, in other words, and taking that practice into the waiting room and then on into the surgery when you actually go.

2. Not ignoring the part of your mind that says "I'm bound to worry. I hate the dentist's" and not arguing with it, because you'll lose. Instead, agree but put off the start of worrying; "Of course we'll worry about it but not today. It's a whole week away". And later, "Yes, I promise we'll worry, but let's leave it until the weekend. That's plenty soon enough." With a bit of luck there'll be something to distract you from worrying across the weekend, and then you've only got a bit of Monday to deal with. The green line illustrates how that can pan out.

One final thing here. Notice that nowhere is it actually suggested that you should relish the visit; simply that unpleasant as you may find it, you can do it.

It's For Your Own Protection

Right at the beginning of this blog I referred to anxiety as the bastard offspring of fear and imagination.I also  talked of fear giving us the means to deal with an actual, present danger, and thus the means to protect ourselves from harm. Anxiety performs the same function with regard to possible, imagined future threats, threats which don't exist but which anxiety treats as if they do.

I've also mentioned Freud's belief that emotions too powerful to express get buried in the subconscious part of the mind where they fester, perhaps for very many years. Freud also said something else which I have found helpful. He said that at a deep level people resist being cured of their neurosis, because, bad as it may be, what it is protecting them from is even worse (as they see it).

How does this relate to existential anxiety? Very simply, your mind will offer you all kinds of good reasons why you should shrink from tackling the problem *now*.

This is not the right time. Your protective mechanism will always tell you this; there is no absolute right time.

I can deal with it myself, slowly. Sorry, if that were true you would have dealt with it long ago - or even at the time these things happened.

I don't want people to think I'm making it all up or exaggerating. Mental health professionals won't think this at all. They have long experience of people imprisoned by distress like yours (though the causes may be different).

It would be better to walk away now so that someone more worthy may have the benefit of their expertise. No it wouldn't. You have been assessed by people who know what they are doing and have judged that you need and deserve the benefit of their intervention.

I don't want to have them lose patience with me and discharge me before I'm ready. They won't. They are in this for the long haul and they know it will be a lengthy and difficult process for you. They are prepared for it to take as long as it takes.

It's going to hurt too much. I would do better just to learn to live with it. Well at least there's some truth in that; it will hurt and that's why your mind shies away from dealing with it. But, it will not be more than you can endure, and you will be worse trying to live with it, not better. You survived the process that damaged you so badly; you will survive the painful process of healing.

An infected appendix requires surgery which leaves a painful incision wound. Rejecting surgery leads on to a ruptured appendix which results in peritonitis, shortly followed by death.

Have I missed any of your 'reasons' off my list? Tell me what they are and I'll explain why they too are excuses. 😄

Varieties Of Anxiety

The different types of anxiety that I wrote about also differ in the way that they manifest themselves. Separation anxiety is the consequence of deep distress at being separated from someone, which makes sense. This is why obstetric and paediatric practice these days is to ensure that mum and dad have the maximum possible access to their child when a hospital admission is necessary, so that feelings of abandonment are avoided as far as possible, and there is little or no long term effect in most cases. But separation anxiety is also common in everbody's life; it is a major component of that complex web of emotions which we call grief. A much loved partner, parent, grandparent, child or important other is snatched away by death and there is no hope (in this life) of reuniting. It may also come about as the result of a miscarriage or a marriage or relationship breakdown. The main way in which it is likely to manifest as a continuing problem in adolescent or adult life is in inappropriate behaviour to avoid a repetition of the experience. I'm thinking particularly here of people who have a pattern of breaking off relationships or friendships which to an outside observer seem to be developing well. They are, and therein lies the threat. So, get your retaliation in first; that way the pain is less. I am the eldest of three brothers. Six years ago, not yet sixty, my youngest brother fell ill and very shortly died. It came out of the blue. My other brother, once the funeral was over and we were all setting off for our various homes suddenly looked at me and only half-jokingly said " Right. i'm going to die next. I couldn't go through that again." I suppose I should be touched that my death would hit him that hard. Instead I thought, "typical of the selfish bastard!"

Existential anxiety is different. It hits you out of nowhere coming at you like a Formula 1 car going flat out. Why? Because in your past, probably in your early years something or things happened to you, or more likely, were done to you that were way too big to let go of, but way too big to handle. So your mind - the part Freud labeled the subconscious - stepped in to protect you. It buried them where you couldn't feel them, or only vaguely and tolerably, and you were able to survive. But at a price. That pain, anger, shame, guilt, despair festered and fermented, if you like, a build-up of emotional magma that one day would erupt. In the contemporary world events occur which trigger potentially dangerous memories and emotions; the eruption must be stopped at all costs. The result is blind panic, everything gets bottled up again and life, such as it is continues.

There's a problem here. I like analogies, so I'll turn to one here from my hiking days. You're out in wild country and you come across a river in full spate. It's not that deep but the power of that rushing water is tremendous. Your destination requires you to get to the other side. It's too wide to jump across and then is no bridge for miles in either direction. The hard fact: you can't go over it; you can't go under it; and you can't go round it. You have to go through it to reach your destination. The same is true of those buried traumas. There's no way over, under or round them. The only way to health is to go through them and it's going to be no easier and no more pleasant than wading that ragining torrent.

That's why you need skilled, experienced professionals; they are the walking poles that will allow you to keep your balance and get to the other side. That and a load of friends shouting support and encouragement.

There's more than enough to chew on there, so I'll pause now. Next time I'll say a little bit more about this, and then we'll turn to the easy one, situational anxiety.

Flat Is Good

Every person who suffers from a phobia of flying knows lots of people who really enjoy flying. So they see that as their ultimate goal; to get on a plane and recognise that it's fantastic. You can look out of the window and down below is a patchwork of green fields with cows and sheep, maybe caravans in some fields. And then as you leave England behind there's the beautiful blue of the sea, and the boats and the ships to look at.

You know what? At thirty eight thousand feet you can't see the animals or the boats. Which is no bad thing because probably what you're looking down on is the top of a blanket of cloud that most of the way down to Spain. And anyway, you might have an aisle seat. The welcome truth is that flying is like any other form of transport, tedious and time consuming. Oh there's the exhillaration of actually doing it for the first time, but pretty soon after that it's boring. That is your goal, to be bored by it instead of terrified.

There's another thing, too. My friend Jenasaurus of blog fame discovered that the way to overcome anxiety was to confront it; to say, "Go on then, do your worst!" And when she said that anxiety slunk off into a corner and refused to come out. But that challenging attitude is high maintenance. It burns up enormous amounts of energy and leaves you exhausted. What she hasn't noticed is that she has won - because I don't think she actually expected that. She thought that she had found a way to control anxiety, whereas in fact she had defeated it.

Jen, that battle is over. You've won. No need to go for walks to challenge anxiety any more. Go for exercise, for fun time with K, to get stuff from the shops, or keep appointments or drop in on friends for a cup of tea and a ciggy. There will be other, different things to overcome save uour energy for them.

Oh, and well done.

Distinguishing Between Different Types Of Anxiety

As often happens, it is reading or hearing about other people's experiences that clarifies my own thinking, so once again the credit for this post lies elsewhere. It's several years now since I retired from therapy and my memory needs jogging from time to time. I have been writing about anxiety here as if it is a single, unitary thing and it's not. Just as there are different types of arthritis, diabetes, dementia and autism for example, so there are different types of anxiety. When I was working with clients on a daily basis I was aware of this even if not consciously, and I adjusted my approach according to the apparent source of their anxiety; I had forgotten that, so it's good to be reminded. On reflection I would say that there are three main types of anxiety, which I shall refer to as situational anxiety, existential anxiety and separation anxiety. My posts here have been entirely concerned with situational anxiety and how to deal with it. In the early days of psychology the belief was commonly held that anxiety was the manifestation of a subconscious, unresolved conflict; Freud and his followers developed the psychoanalytic technique of using free association and stream of consciousness to encourage the patient to uncover the trauma that was at the root of their condition. In its own terms it was highly successful; it made an awful lot of psychoanalysts very rich, especially in America. Unfortunately, by the time the money ran out the patient was no better. Then in the 1960s when I was training, along came Behaviourism. In a nutshell this argued that deep seated trauma didn't exist. Anxiety was caused by faulty learning; something unpleasant happened and you associated your reaction with the situation in which it happened and subsequently felt anxious if confronted by a similar situation. What you had learned, you could unlearn. From developmental psychology we learned that a baby or young child will become anxious if separated even briefly from those it looks to for nurture. An example of this is my youngest granddaughter. From time to time her mother has to travel on business and may be away from home for as long as ten days. At nine years old, N finds this hard to cope with. The solution she has found to make life easier is to take an article of Mummy's clothing out of the laundry basket and have it in bed with her; it smells of Mummy and provides some comfort. What I concluded in my own work with clients was that these three types of anxiety were each quite different in origin and required a different approach in treatment. Situational anxiety arises out of wrongly attaching threat to a particular situation or activity and then having to avoid that situation or activity. Or your imagination paints a scary picture for you of a situation you haven't experienced - flying to Florida on holiday, for instance, and you develop a phobia about flying. This type of anxiety fits the Behaviourist model and is best dealt with by learning to react differently towards the focus of your anxiety. I've already written quite a lot about this, so I won't labour the point here. Separation anxiety, which usually has its origin in early experience, can persist in some cases up to and throughout adulthood. A lady in her sixties consulted me because she felt constantly vaguely anxious 'for no reason'. This free floating anxiety was something that went back as far as she could remember; she had somehow never felt quite comfortable in the world. This type of anxiety has a root cause, which is more than faulty learning. Something happened to cause an anxiousness that never went away. I saw her in the 1970s, so we are talking of someone born in the early part of the last century. We used hypnotherapy as an aid to finding the trigger. It went all the way back to birth. Jane was born prematurely and was taken straight from her mother to an incubator where she spent the next several weeks under nursing care which met her physical needs but left her floundering emotionally. There was no skin to skin contact with someone who smelled right, when she moved her limbs they never came into contact with anything, above her only emptiness to look at. We did make some progress, but really it should have been dealt with years before to be successfully resolved. And so that leaves existential anxiety. What is it? It is a terror that has no external object, and is probably the closest to what Freud had in mind. Past experiences generate emotions too dangerous to be expressed - or so it seems. For people with existential anxiety the threat is that something may burst the lock on the door behind which they had put the emotions of those experiences, and their escape threatens that person's continued existence, literally. The floodgates once opened will let everything out and overwhelm them. I'm becoming increasingly convinced that when I see a blog post with a TW flagged up, I am reading the story of someone in the grip of existential anxiety. This is not an area for amateurs; this needs the sustained support of a team of professionals, and it will need a great deal of time to find safe ways of dealing with what has been suppressed. In conclusion, it's probably the case that existential anxiety will be accompanied by situational anxiety where the upsurge of anxious feelings is wrongly associated with the external situation rather than the internal pressure, so whilst professional help, guidance and care are needed to deal with the existential anxiety, the sufferer can safely tackle any problems with situational anxiety, using the kind of things I've written about previously. I apologise for the length of this post, but I felt that it was better to treat the subject in some detail rather than cut corners to keep it brief.

Credit Where It's Due

This blog owes its existence and a great deal of its content - the good parts - to a good friend of mine on Facebook who has to contend with serious mental health problems but does so with amazing fortitude and good humour. She also blogs regularly at jenauruswake.wordpress.com. Whether you have mental health problems of your own or not, this is a blog well worth following.

I mention this because recently she has had to battle her way through a particularly bad patch which, thank goodness, she now seems to have largely overcome. The way she did so taught me something new, and I think it's worth sharing.

I have said already that anxiety's sole power rests in its ability to make you fear fear itself. On the Jenausaurus blog, you can read what happens when you pluck up the courage to call its bluff. I'm not going to paraphrase it here. Go to her blog and read all her recent posts which track the changes she has brought about.

Angela's Story

Very shortly after I shared the previous post on Facebook I received a comment which in essence told me that whilst the bottom rung might be attainable, the next rung was the one at the top of the ladder. There were no in between rungs. The lady who told me this knew from experience; she has drawn up too many two rung ladders in the past to see this as a solution for her. So let me tell you about Angela. I’m going back over thirty years but her experience in therapy taught me a lot. Angela was a single woman in her late forties living at home with her elderly, widowed father. She had always lived with her parents and had long suffered with ‘nerves’. Over time what had started out as vague unfocused anxiety had become stronger, more firmly established and more debilitating, until the point came where she was the victim of severe agoraphobia. Before her mother died, the three of them used to drive out regularly into the surrounding countryside where from the safety of the car Angela could enjoy the views across the fields. After her mother died there was a trusted neighbour who took her mother’s place in the car and the trips continued. Apart from that she never left the house; she couldn’t. I was asked to see her and judge whether I could help. She couldn’t come to me, so it would be necessary for me to go to her. Fortunately this was in the early days of my practice and so I could schedule the time needed to visit her at home. Home was a terraced house in a northern industrial town, and the front door opened directly onto the pavement. Angela could not approach that door if it were open. A ladder was not going to be easy to construct in reality. So we constructed a ladder in the imagination. I used hypnosis quite extensively and so explained what was involved and dispelled the popular myths as best I could. It proved to be a state that she could enter either under my direction or by using a self-hypnosis technique which I taught her. Next we brought into play imagination and visualisation and combined that with another of my tools - practice! I’ve said before, and I repeat, do not try to do something because trying implies the possibility of failing and that provokes anxiety, and anxiety is precisely what we don’t want. Instead, practise doing something without feeling anxious. And so Angela would settle down in her armchair, relax into a hypnotic state and then call up a visual image. She started with the image of her standing, relaxed in the open doorway. The moment her relaxed feeling began to slip she wiped the screen clean and returned to simply relaxing until she felt ready to call up the image and practice a little more. To begin with these practise periods were simply a few seconds. No matter. All practice is practice and all of it is valuable. Soon she found that she was able to watch herself calmly until it got boring. The next step was that instead of watching herself from the outside as it were, she now imagined herself standing in the open doorway looking calmly out into the street. She moved from being an observer to being the person in the doorway, and that too became boring before very long. So then she went in person to the front door, opened it and stood there. At no time did she tolerate even a little anxiety. This was not about coping with anxiety; it was about dispensing with it. Neither did she fall into the temptation of setting a goal of how long she would practise for. That way opens another door, the door to anxiety. Let’s be clear. This was no overnight, miracle cure. This was long repeated practice with tiny improvements to begin with which eventually gathered pace. From standing in the doorway she progressed to standing on the pavement. From standing on the pavement she moved on imagining herself walking along the street and then to actually walking along the street a little way and then returning home, still calm and relaxed. Then she was able to walk to the end of the street and back. Then round the corner and into the passage at the back of the houses (what I knew as an entry, growing up in Salford) towards her own back door. Now another thought had to be adopted. We fondly imagine that as human beings we are logical creatures, but if that were true no one would ever have these problems in the first place. We are ruled primarily by our emotions. If our instinct is that we need to retrace our footsteps to the front door, when logic tells us that the back door is closer, listen to instinct. Go back the way you came. Language can be unwittingly misleading. I’ve used the expression ‘we’ a couple of times. I did not go on these practice walks with Angela; she did them on her own. My interventions were always in her front room on my visits. Some time after she had regained the freedom to go out and about in her own town Angela did two things. She got a part time job serving in the local greengrocers, and then a few months later, knowing that she needed to replace her underwear, but not able to ask that her father do it for her, she spent a fortnight practising walking from the car park in a neighbouring town to Marks & Spencers, walking into the store, selecting what she needed, paying for it and walking back to the car. Then she went and did it. Not only that, but she coped with the fact that they had moved the lingerie department since she was last in the store. I tell you this not to impress you with my skill - all the work was done by Angela - but to demonstrate that there is always a way back from even the most overwhelming anxiety, by practising in your imagination what you cannot yet do in reality, by filling that huge gap between the bottom and top rungs with imaginary rungs and using them to bridge the gap.

Best Friend, Worst Enemy

Imagination is both of these things. It can trap you in overwhelming anxiety, can paralyse you with fear, or it can release you to lead the life that you could and should be leading. And the good news is that you have the power to choose which it shall be. If right now you are prone to acute anxiety - and if you’re not, why on earth would you be reading this? - it feels as if choice is one thing that you don’t have. Anxiety is in control and you just have to submit to it or make the best of a bad job. This is an illusion and one that we must tackle, so let’s look at what imagination is and how it works. Imagination is the capacity to picture something which is not present or not happening right now. And your imagination is a very powerful one.It paints two pictures side by side. It paints a picture of what might happen, and it also paints a picture of how you would react. The trouble comes when you accept the pictures it provides as certain to happen. Let’s take an example. It’s time you went to the dentist for a check-up, but you don’t enjoy trips to the dentist. So what happens? The thought of going to the dentist immediately conjures up for you the dentist’s chair, the masked face of the dentist staring down at you, the feel of fingers, mirrors and other gadgets being inserted into your mouth, …. you get the picture. But as if that wasn’t enough, you get a picture as well of you, sweating, trembling, bursting into tears, panicking, fighting to get out of the chair and escape. What a lethal combination of images! Is it any wonder that you put off the idea of ringing up for an appointment until next week, like you did last week and the week before. And yet none of this is actually real. All of it is simply a figment of your fertile imagination. But it has the power, if allowed to go unchallenged, of bringing about a self-fulfilling prophecy. You begin to feel anxious at the mere thought of making an appointment, and once the appointment is made the anxiety persists and increases until indeed you arrive at the dentist’ surgery a gibbering wreck, and now with the added complication of fearing that you are going to make a fool of yourself; and we all know that, in the words of the saying, “I’d rather die than make a fool of myself.” Where did these powerful images come from? From you. You created them with the help of your imagination. So immediately we have all the proof that we need, that you have a powerful imagination. The problem is that you are using it destructively, when you could be using it constructively. If you can imagine a negative outcome and be convinced by it, then you can equally imagine a positive outcome and be convinced by that. It’s simply a matter of practice. Where people had phobic anxiety it was very popular among therapists a few years ago to use a scaled approach to desensitisation. I don’t know whether it’s still popular, but it can certainly be helpful for many people. It involved drawing up a hierarchy of anxiety, usually consisting of about ten steps. An example would be a fear of spiders. You take a sheet of paper. At the top, you write down the most terrifying thing involving spiders that you can imagine. Then at the bottom of the sheet, you write down the very smallest situation that would involve a spider but cause you little or no anxiety. For instance, it might reading the word ‘spider’ in a book or newspaper. Next, half way up the sheet you write down something that falls roughly half way between these two extremes. Finally you slot in another four in the bottom half and three in the top half, so that you have a list going from one end to the other in order of severity. You begin the desensitisation process down at the bottom, repeatedly reading the word ’spider’ until it causes no anxiety at all. Or put another way, until it gets boring because it’s so easy. Boredom is a great healer! Now, you go up one level and work on that in the same way until you have switched off its capacity to trigger anxiety, and so on and so on until you can confront your worst fear related to spiders and not react to it. At that point, you are no longer arachnophobic. I was going to describe this process as climbing a ladder, but I don’t think that’s helpful because it suggests that the hierarchy is still there, but you have learned to overcome it. The vandal in me prefers to imagine a different scenario. When reading the word ’spider’ no longer has any power, you saw that bit of ladder off and throw it away; the second rung is now at the level previously occupied by the first. You then progressively saw chunks off the ladder until the top has come down to you. No climbing involved. Now you make a bonfire out of all those redundant chunks of ladder and toast a marshmallow or two by way of celebration. There’s only one fly in this particular ointment; sometimes the bottom rung itself generates too much anxiety to get started. That’s where imagination comes in as a helpful friend. That’s what we look at next.

Practice Makes Possible

Whenever someone tells me that they are trying hard to overcome their anxiety, my response is always the same; please don’t. What kind of crazy advice is that to someone fighting a constant battle against crippling anxiety! Actually, not as stupid as it sounds. If you try to do something there are two possible outcomes. You may succeed or you may fail. Whilst we love to succeed, the prospect of failing is not a good feeling. It arouses a degree of anxiety in us as we approach the task, whatever it may be. But isn’t anxiety just what we want to avoid? Look at it another way; if you want to confront your anxiety and overcome it, then you have to use the only mechanism that your body/mind has for the task - the fight or flight mechanism, which is where the physiological sensations of anxiety come from in the first place. Let’s spend a bit more time with the plank. It can teach us a lot. The plank is not a threat in itself, although we may create a threat around it. If you can easily walk along it when it’s on the floor, you could in theory walk along it just as easily when it’s thirty feet off the ground. Except that most people can’t. What stops them is their imagination. They picture themselves falling off and breaking a leg, or worse. That picture in their mind’s eye is what stops them from simply strolling along it. In the same way, what confronts you in particular situations is a self-generated image of you not being able to do it without feeling awful and having to run away from it. So when I say, please don’t try to overcome your anxiety or cope with your anxiety it’s because I want to suggest a better way. Why should you have to live your life with an undercurrent of anxiety that you somehow manage to control? There was a book written a few years ago entitled “Feel The Fear And Do It Anyway”. Wrong!!! Far better to get rid of the anxiety in the first place; you don’t need it. It’s a product of your imagination. Unwittingly, you created it. You can discard it. How? By practice. So you take a walk along a plank on the ground. You are probably a little careful because you’re not sure that you will place your feet absolutely correctly. So walk along it again… and again… and again, until you’re doing it without thinking. Now we’ll put it on two bricks. You show a little caution the first time; you could lose your footing. So do it again, over and over until it’s boring, and it’s time to put it between two chairs and start practising walking along it properly off the ground. Then, if you wish, prop it on two stepladders like painters and decorators often do and practise walking along with confidence. You too could be a steel erector, trotting along girders a hundred feet off the ground. There’s another advantage to practising. It doesn’t involve success and failure - as long as you don’t do something silly like turning it into a challenge. “I’m going to walk this plank fifty times and then I’ll reward myself with a cup of tea and a biscuit.” Do you see that you’ve just reintroduced the possibility of failure - and the fear that that arouses? No, you practice, that’s all. How long you practice is entirely up to you. Because the benefits are cumulative, 30 seconds of practice is just as valuable as half an hour. Take your time and stay comfortable. The object is to erase the anxiety, not put up with it, and that takes as long as it takes, but it’s worth the wait. I mentioned imagination. That’s what I want to come back to next time.

The Bull And The Plank

A bull is a potentially dangerous animal: a plank is a plank. I saw a photo recently that had been shared on Facebook. It showed a sign on a field gate which read, “Do not enter this field unless you can cross it in eight seconds. The bull can cross it in nine!” A bull which feels that its territory is being invaded can be a very aggressive animal indeed. Given the chance, it will seriously injure you, possibly even kill you. So the sensible walker, faced with a field with a bull in it, looks for an alternative route to crossing the field. The Spanish matador (or to give him his correct title, the torero) on the other hand, deliberately goes into the ring, confronts the bull and in the end, kills it. Sometimes it doesn’t quite work like that; the torero isn’t as careful as he needs to be and is gored by the bull, ending up in hospital or occasionally, in the cemetery. A bull, whether you avoid it or confront it, is a dangerous animal, and you must deal with that fact or risk perishing. A plank, however, is simply a plank, an inanimate object. Planks used to be made of wood. Now increasingly they are made from metal. Apart from that, a plank is a plank is a plank. If I place a standard metal plank, the kind used in scaffolding, on the floor of my office and invite you to walk along it, you can do so easily and without undue concern. If I now place it on two bricks so that it stands a few inches off the floor you can still walk along it easily though you may be a tad more careful. Now, instead, I place it on two chairs; you begin to feel nervous. I take you and the plank outside and have it placed at roof height from the corner of the building to the corner of the next building. Neither you nor I would now risk walking along the plank. Why not? It’s still the same plank that presented no problems on the floor of my office. It is not the plank which changes but our response to the invitation to walk along it. So long as we think that everything will be fine, it is. Once we begin to have doubts, it’s not. And yet we’ve all seen photos from the 1920s showing steel erectors nonchalantly sitting on a metal girder several hundred feet in the air, eating their lunch. They know and have fully assimilated the knowledge that it is the same girder that it was when it was still on the ground. The bull is the one who determines what your experience will be; you are the one who determines what your experience with the plank will be. Where is the relevance of all this? If you suffer anxiety and phobia, the objects of your response are planks, not bulls. Change your attitude to the plank, and your behaviour towards it inevitably changes too. Whereas, no matter how well you convince yourself that a bull is a lovely, gentle, much misunderstood creature who just needs to be shown a little affection, the bull will still kill you if you trespass on its territory.

What If.......?

What If…….? The value of fear and imagination working harmoniously together is that we are able to learn from situations and respond appropriately if they occur again in the future. This goes all the way back to our primitive origins as a species. We learned that certain animals, places and people were dangerous and had to be approached cautiously and in the right way; some were simply best avoided completely. If experience has shown us that a hostile tribe lives in the valley over the ridge, then that valley is best avoided. This brings us to what psychologists have identified as two particular types of learning; approach and avoidance. The two are very different and for very good reason. Think of living in a hostile world. Think, too, of the saying that fools rush in where angels fear to tread. If you rush into a new situation, you may not survive it. Better to approach slowly and cautiously. If you are in any doubt, back off and review the situation before venturing further. Little by little you reassure yourself that it is safe to go into the situation. Is there a bear sleeping in the cave? Just in case, do nothing that might awaken it. Evident danger on the other hand demands a rapid response. Get out quickly - and stay out. Looking at that the other way round. If you have encountered something scary the instant response is to avoid it in future. No second or third tries. It’s dangerous; stay away. It takes a long time to learn that in fact your experience was a one off and it is actually OK to return to that place or activity. They say that if you fall off a horse the best thing is to get back on as quickly as possible to recover your confidence. Easier said than done. We have been talking so far of actual situations which arise and how the responses that we have learned have survival value. That is what our brains have evolved to deal with, real, actual, imminent threats to our survival. Unfortunately, it is the only mechanism that we have. If the threat is only hypothetical, we still react as if it were real. This is where the combination of fear and imagination becomes toxic. Our mind and body come to a state of arousal in order to deal with something which is not happening - but which might. The result is anxiety which can be very mild, will the bus be late, for instance, or can be extreme; if I try to fly to somewhere the plane might crash. Or the lift might get stuck between floors and I’ll be trapped. Combine that strong anxiety with avoidance learning and thus are born panics and phobias. An example may be helpful. A person is standing at the bus stop one morning on the way to work when suddenly they feel dizzy and light headed, they are shaky and breathless. Somehow they manage to get onto the bus, go to work and do whatever they have to; the feeling has passed. But that is not the end of it. The following morning as they prepare to leave the house, the thought hits them, “I hope I don’t get that feeling again today.” Immediately they feel a little pang of anxiety, which prompts them to think, “Actually I don’t feel too good now.” On the way to the bus stop the anxiety builds, and by the time the bus arrives they struggle to get on it. The day after is worse, as is the day after that. They have taken the first steps to becoming agoraphobic. What caused the original experience? They ate out with friends the previous evening and unknowingly ate a dodgy prawn which showed itself the following morning at the bus stop. They didn’t eat any more dodgy prawns, but since they hadn’t made that connection, it didn’t matter. The seed was sown, and the rest followed. When there is a real, identifiable threat we focus on that. We either fight and overcome it or we run from it, and that is an end to it. One way or another we deal with it and then our system returns to normal. If we get the feelings, but can’t identify the cause there is nothing to deal with and so the state persists and itself frightens us. Unconsciously, we cast around for a cause and that leads us inevitably into asking a fateful question, “What if……..?” Acute anxiety may be described as having a sense of deep foreboding in certain situations. We fear that in such a situation something awful and overpowering will happen to us. And we build a self-fulfilling prophecy. Fear serves a useful purpose; anxiety never does. Well, I hope I have showed how anxiety develops; it is a learned response. Fortunately, if we can learn to react in a particular way, we can also learn how not to react that way.

The Bastard Offspring Of Fear And Imagination

That is what anxiety is; the child of two important human capacities, the ability to recognise and respond to a dangerous situation, and the ability to create pictures in our mind that allow us to to preview situations and plan accordingly. So if I am crossing a busy road and suddenly hear the sound of squealing tyres as a car comes straight towards me, fear impels me at speed out of its path and to safety. Alternatively, if I am attacked by a mugger, I fight back to overcome him. A mechanism as old as humanity itself, often referred to as the ‘fight or flight’ mechanism. Psychologists refer to all animals being at any moment in one of two states; the state of rest, or the state of arousal. ‘Rest’ doesn’t mean sitting or lying down doing nothing. It means that everything around us is fine, so we can simply get on with the business of living. ‘Arousal” on the other hand, means that we have detected a potential threat or problem and have switched to an alertness which allows us to take whatever action may be necessary. To make that switch the bloodstream is flooded with the hormone adrenalin which increases the heart rate, prompts the lungs to pull in air in greater quantities, andtexses the appropriate muscles. At the same time blood is redirected from the brain and the digestive organs to the major muscles which can then be supplied with a rich supply of the oxygen they need for action. The threat is reacted to, the danger passes, and now another hormone, acetylcholine, flows into the bloodstream to mop up all the adrenalin which is no longer needed, and the organism returns to a state of rest. All of this happens incredibly rapidly (the adrenalin is already on its way before we have even had a chance to make any conscious decisions) because an imminent threat may be the end of us if we don’t respond quickly enough. Imagination allows us to conjure up images which save us having to directly experience whatever it is that we want to review. If I want to decided what to do with the approaching weekend, and the choice is between a long walk in the countryside or a day at the beach, I picture each with my imagination and can imagine how each would feel and which would better suit my mood. I don’t have to go into the countryside to rule it out, nor do I have to go and see how the beach feels in order to choose it. But that is what most animals would have to do. Almost certainly many animals have a limited ability to do something like this - chimpanzees and ravens, for instance can look at a stick or a twig and see that it can be used to reach something otherwise beyond their grasp - but it is very highly developed in humans. It is one of the things that has allowed us to develop to the intellectual level we enjoy. Each of these two characteristics is a valuable and necessary part of our armoury for successfully living in the world. Trouble starts when the two come together and produce a third, anxiety.

Why Another New Blog.

I belong to a group on Facebook which has a core membership of frequent contributors. What has become clear over the months has been how many people are plagued by anxiety across the whole spectrum from mild to out and out panic attacks. Clearly, too, many are coping or attempting to cope by avoidance behaviour, if lifts are a problem they will find a reason to use the stairs instead; if it's flying, go by ferry or holiday in the UK; being sick, avoiding certain foods. All of these strategies work up to a point, but it would be so much better if sufferers could learn to put the anxiety behind them.

I'm retired now, but I trained as a psychologist and worked for many years in the field of therapy, where the two main reasons people consulted me were related to anxiety and depression. Over the years I built up a valuable understanding of what anxiety is, how it operates, and what people can do themselves to take back control.

So the answer to the question is that through this blog I hope to share what I have learned so that it may benefit people now and in the future.

I welcome comment and feedback, so I hope we can develop a virtual community here.