by Jill Weber
Sit quietly and comfortably. Close your eyes. Bring your breath to your conscious attention by noticing your chest rising and falling. Meet whatever emotion or feeling arises in your mind with your inner observer.
Your inner observer carries no judgment. Your inner observer places no pressure on you to act on your emotions. It merely notes what you are experiencing.
For example, your inner observer might verbally label: “chest tight,” “anxious,” “worried,” or “calm,” and “at ease.” If your inner observer becomes aware of your mind making judgments, simply label it “judging” or “thinking.” Notice how when you observe and label, the feeling state passes and then you observe and label the next feeling state.
Nothing you observe is right or wrong. Your emotional experience needs your calm, accepting awareness, nothing more and nothing less.
Turning Toward Difficult Emotions
Our culture floods us with the message that happiness and success depend on never experiencing suffering or painful emotions. Of course, we all feel negative emotions at times, and when we do, we’re left feeling defeated. Feeling that we must have made a terrible mistake somewhere along the way (why else would we be feeling so bad?), we spin our wheels doing whatever we believe necessary to avoid, push away, or somehow “fix” the upset.
We all experience negative emotions, including anxiety. No one is immune. Even people without full-on anxiety disorders go through anxious spikes; it’s just part of life. Bringing acceptance to your emotional world means giving up the fight against suffering and pain, so you may be free in spite of it. And, too, it means recognizing and believing that experiencing negative emotions is normal.
Accepting situations and experiences doesn’t mean you want them or that you’re resigning yourself to a lifetime of emotional pain. Acceptance doesn’t mean feeling you’re the victim of your pain and that your pain controls you. Acceptance doesn’t mean you necessarily like what you’re experiencing. Acceptance is the idea: “It is what it is.”
The metaphor of the Chinese finger trap used in acceptance and commitment therapy clearly shows how struggling against the experience of difficult emotions only increases negative emotion. The Chinese finger trap is a small woven cylinder that children often enjoy. You place a finger in each end of the cylinder, pull, and—wham—suddenly and unexpectedly your fingers are trapped. Trying to become unstuck, the inexperienced immediately attempt to pull their fingers out. The harder they pull, the tighter the tube becomes, evoking fear and even a little panic. The solution: Push the fingers toward the center of the tube. The tube becomes slightly bigger and then it is easy to wiggle the fingers out.
When we continually push away and avoid our experiences, we become increasingly afraid of the negative. Over time, we stop knowing our feelings altogether. Even pleasant experiences like joy become blocked. We are no longer present but instead live in a survival state, waiting for the next shoe to drop. This crisis-state existence leaves us with an emotional blind spot. After all, if you’re completely focused on bailing water out of a sinking boat, you might not notice the life preserver at your side. In my case, spending time processing and ultimately accepting my genetic cancer risk as a reality led to the decision to undergo an elective mastectomy with reconstruction—a literal life preserver that I was unable to see or even consider until I accepted my situation as it was.
Our emotions provide valuable information and guidance. They tell us what we want out of life, what we don’t want, how we feel about the people we are close to, and what we need to work on within ourselves. Acceptance allows us to play the game of life with the full deck of cards.
Go Deeper
Understanding What We Learned Early On
Most of us learn how to cope with our feelings while growing up. We model ourselves based on what our parents did, what they told us about how to handle negative feelings, or how they interacted with us when we were upset. These messages can play out over a lifetime and go unchallenged. For example, Juan, a client I worked with, came to see that whenever he was upset his parents told him he was fine and not to worry. Although well meant, this only increased his upset because he had no outlet to talk through what was bothering him so he could problem solve the situation and find true relief.
Take some time to think through what may be helpful or unhelpful in what you learned growing up about managing your emotions. In your notebook, write about any or all of these prompts that resonate with you.
•Did your caregivers express emotions? Did they cry or get angry? Or did they seem to have a tight lid on their emotions and rarely expressed frustration or sadness?
•Do you think you need to appear in control of emotions all of the time or do you feel completely out of control and so try to clamp down as much as possible?
•Can you recall any expressions from caregivers, coaches, or teachers telling you that you are “too sensitive,” “overly needy,” or “too emotional”?
•Did your family or caregivers describe you as being very independent/mature as a child? Did you hear a constant “good girl” or “good boy”? Did you feel as if you couldn’t be a kid with them? Did you feel there was limited space for you to be you emotionally?
•Consider your memories of joy and happiness in your household as you grew up. Do you recall your caregivers laughing among themselves? Did they notice and label your happiness? Or was joy squelched?
•When upsetting things happened to you as a child, did you feel as if you could talk to your parents openly? Or did you feel your caregivers would judge your upset or overly pressure you to “fix it” in some way? Did you not confide in them at all?
Identify the link between the type of emotional support you were given in childhood and how accepting you are now of your emotional experiences. Start changing the way you support yourself emotionally so you can be more unconditionally accepting of whatever you feel.
STRATEGY: PRACTICING ACCEPTANCE
Although it can be hard to accept painful emotions—to not avoid or push them away—the consequences that come from not doing so far outweigh the pain of facing whatever it is you’re really feeling. Come up with several examples in your life where your lack of acceptance of your feelings has only caused you more negative emotion or wheel spinning.
As you reflect on these examples, be honest with yourself and acknowledge the #1 feeling you tend to avoid that brings the most consequences to you—sadness, anger, anxiety, guilt, shame, frustration, joy.
Consider the results of avoiding this emotion. Has it increased your anxiety? Caused you to siphon off large amounts of emotional energy in vain? Or has avoiding this emotion blocked joy and contentment?
STRATEGY: SITTING WITH DIFFICULT EMOTIONS
It is likely you have avoided negative emotions because you’re afraid of feeling them or you don’t know how to feel them. Here is a way to do just that, and it takes only 10 minutes:
1.Set a timer for 10 minutes. Bring to your conscious awareness an emotion you tend to avoid or suppress. Try to conjure it up so you can feel it right now.
2.Observe where in your body you experience the upset or discomfort. Recognize how it feels. See if you can literally visualize the feeling as you experience it in your body. Instead of fighting the feeling, welcome it in.
3.Whisper out loud, “Welcome, I’m glad you’re here.” See if you can observe the feeling, almost as if you are looking down on a physical thing separate from yourself.
4.Internally note: “I notice a feeling of -------- coming over me.” Tell yourself, “I am making room for you,” or “I can feel this feeling and also be okay.”
5.Notice the anxiety that drifts over you as you allow yourself to face a feeling you always avoid. It’s okay to feel this anxiety. It makes sense because you’re afraid of this emotion and I’m asking you to feel it. You can be afraid and still invite the emotion in. Show yourself you can enter into the feeling and still be okay.
When your time is up, move
forward and let go of this experience.
WRAP-UP
•All emotions are a normal (and helpful) part of human experience.
•Pushing away negative feelings increases anxious thinking.
•Regularly identifying your feelings will decrease anxiety.
•Expressing your feelings will decrease anxiety.
•Accepting your emotional world will decrease anxiety.
•You can experience negative feelings and still be okay.
CHAPTER THREE
Your Body & Physical Sensations
Anxiety and the Body
Cole struggled with debilitating physical symptoms including lack of appetite, racing heart, an inability to concentrate, feeling internally keyed up, and insomnia with racing thoughts. These distressing symptoms were all he could talk about because they were so unnerving. Cole understandably felt as if his body was betraying him and that no amount of anxiety-reduction work would solve this.
Anxiety regularly shows itself with physical symptoms. At some point, sometimes after years of experiencing such symptoms, the dam breaks and the body will no longer be ignored. For Cole this meant such intense heart palpitations that he would become dizzy and pass out. Other people might react in a different way, like succumbing to acute exhaustion, or no longer being able to drive because of severe back spasms, or being unable to concentrate because of persistent headaches. For symptoms like this, anxiety treatment begins once medical causes are ruled out.
When I see clients like Cole in my psychology practice, they are usually surprised that “all” they have is anxiety. For example, for a long time Cole believed that eventually a specific physical ailment would be identified as the root of his very real suffering.
Anxiety impacts the brain and the brain impacts anxiety. In other words, emotions influence our physical functioning and our physical functioning influences our emotional states. Improving our overall physical functioning and body awareness can make all the difference. Cole eventually became more at ease by learning to observe his physical sensations and taking better physical care of himself.
STRATEGY: BODY SCAN
Anxiety inhabits your body. The trick is to start tuning in so you can more quickly recognize the physical signals. The goal of this exercise is to develop awareness for where you carry your anxiety.
1.Pick a position or posture that is most comfortable for you—lying down or sitting up, eyes open or closed. As you do this, let go of judgment. You are simply observing yourself in the here and now.
2.Each time you breathe out, feel your body relax as it releases tension. Recognize when your attention shifts and gently direct it back to your body awareness.
3.One by one, focus on each segment of your body, opening up to whatever is present in that moment. Name the body part and imagine you are breathing into it. Observe areas of tension, strain, pain, or ease: Head . . . Neck . . . Shoulders . . . Arms . . . Hands . . . Chest . . . Back . . . Stomach . . . Thighs . . . Calves . . . Feet . . .
As you come out of this exercise, make a mental note of where anxiety tends to rest in your body so you can tune in to that spot more quickly.
STRATEGY: PROGRESSIVE MUSCLE RELAXATION
When you notice a spike in anxiety and your body feels tense, take 5 to 10 minutes for a progressive muscle relaxation. This strategy also helps when you can’t sleep at night or to downshift into relaxation before bed.
Lie down or sit comfortably. In turn, tense each muscle in your body (face, shoulders, hands, arms, stomach, buttocks, legs, feet) while breathing in for a count of 5, and then release the muscle while breathing out for a count of 5. While doing so, pay close attention to the contrast between your experience of muscle tension and muscle relaxation.
Repeat this exercise a few times. Notice your body loosen and gradually become more at ease.
Anxiety’s Physical Symptoms
The body’s stress system combined with heredity and environmental experiences over time can set the stage for a variety of chronic medical conditions. Persistent exposure to stress through psychological trauma, grief and loss, life transitions, habitual worry, and chronic perfectionism can cripple the adrenal system. The adrenal glands overwork to manage the ongoing stress, and then eventually give way and underwork. The result creates a roller coaster of anxiety spikes followed by exhaustion. Exhaustion can lead to a variety of medical diagnoses.
Anxiety is also linked with the release of stress hormones and chemicals that, over time, can worsen medical conditions. For example, research is showing that stress and chronic pain are likely linked to the same neuronal pathway. Nerve pain increases the expression of the neurotransmitter PACAP, which is the same neurotransmitter the brain releases in reaction to stress. In other words, stress can bring on and/or worsen physical pain symptoms.
The body’s biological response to stress can also significantly impact our cardiovascular, digestive, respiratory, and endocrine systems. In a large meta-analysis examining over 20 studies and about 250,000 individuals, researchers found that anxiety was associated with a 26 percent increased risk of coronary heart disease and a 48 percent increased risk of death due to a cardiac-related incident.
The stomach and bowel are directly impacted by the body’s fight-or-flight response. Over time, nerves that manage digestion can become reactive, causing unpredictable abdominal discomfort, such as irritable bowel and upset stomach. Although the symptoms are not life threatening, they significantly impact quality of life and can be quite difficult to manage. In addition, people are more vulnerable to stomach ulcers when the stress hormone cortisol is released on a chronic basis.
Anxiety is often present in people with respiratory disease, particularly asthma and Chronic Obstructive Pulmonary Disease (COPD). Fear and worry impact breathing, making these illnesses all the more distressing. The stress reaction due to anxiety is also linked with migraines, rheumatoid arthritis, hyperthyroidism, diabetes, and autoimmune illnesses.
Unfortunately, anxiety is often not considered a significant factor when treating these complicated and often debilitating symptoms. If anxiety is overlooked, medical symptoms may become worse. Knowing which of your symptoms are anxiety related and managing them will improve your overall physical functioning and psychological well-being.
STRATEGY: WHAT STORIES ARE YOU TELLING?
There is a back-and-forth interplay between anxiety and medical illness. The story you tell yourself about your medical symptom(s) and how it impacts you physically is the variable we’re going to focus on here. Let’s begin with an example:
My client Sierra endured uncomfortable bouts of gastroesophageal reflux disease (GERD). The symptoms were so painful that she was frequently distracted from work and family responsibilities, slept upright at night and so slept poorly, and despite medication had a perpetual burning sensation in her chest. By the time Sierra entered therapy, she had seen a number of gastroenterologists without gaining relief. When I talked to her about the relationship between stress, anxiety, and medical conditions, she was exasperated and felt that I was minimizing her genuine physical illness. After some conversation, Sierra softened her view, although she was unable to believe that her GERD symptoms could be helped by anything other than a medical fix.
We persevered. She started practicing mindfulness, changed her diet, and studied the relationship between stress and physical health. Eventually she became aware that her GERD, although very real and painful, often flared after she experienced a stressful event. Armed with this knowledge, she developed stress-reducing strategies to use each time her anxiety was triggered. She still experienced GERD but reported that the intensity of her symptoms halved. As a result, her symptoms had less of an impact on her life.
Your perception of your ability to manage and control your medical condition makes a difference. Managing anxiety and stress better will not take away your medical condition, but it will enhance your quality of life. Reflect on the following statements and say them out loud a
number of times. The more you say them, the less you will feel at the mercy of your physical symptoms.
•I believe I have some control over my physical symptoms.
•I believe if my physical symptoms were to improve it would be due in part to anxiety-reduction strategies.
•The way I think about my physical state impacts my symptoms.
•Exercise will likely improve my physical symptoms.
•My current quality of life could improve.
•My medical diagnosis (or physical symptom) is not entirely out of my hands; I must persevere in living a less-anxious life.
•Stress-relieving strategies and taking good care of my physical self will help me feel better physically.
Working to believe these statements will motivate you toward healthy self-care.
Go Deeper
What Else Could You Think About?
Obsessive thinking is a way to avoid facing deeper emotions. Perhaps we worry we can’t manage the painful emotions, or perhaps we fear they will overwhelm us.
One client, Jack, told me if he did not think about his medical condition so regularly, he would begin to feel a tremendous sense of helplessness and vulnerability. He felt ineffective and powerless if he was not preoccupied with his health. Hyperfocusing on his body and medical care was a way to not feel like a victim; a way to take charge. With his obsessive thinking, Jack felt like he was doing something. This was difficult to experience and express, but once Jack understood his real fear, we could productively work on helping him feel less vulnerable. One way we did this was by looking at what he could control about his medical diagnosis, and then using acceptance strategies to deal with the rest.
Jack became more self-aware, noticing when his anxiety was triggered. He did more to quickly identify the sources of his anxious thoughts. He practiced mindfulness daily, exercised regularly, ate a healthy diet, and worked on breathing and positive self-talk. The rest he turned over to his medical team and the universe.
