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.