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.

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.