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Basically, what I was helping Camille do was to step away from the content of her thoughts, get some distance, and learn to regard it as a kind of game. She looked at her compulsive analyzing and problem-solving and said, "Here I am again, labeling something as dangerous and trying to avoid it." Then she embraced what she'd just been rejecting, "I'm going to act as though this is exactly what needs to be happening."

Ideally, if anxious clients can respond by saying "yes" to the encounter--to accept exactly what they're experiencing in that moment--then they'll be back in control. They can learn to do this if they can endure discomfort. But for many, anxiety has become so dominant that they can't make such a shift directly. To stay on course, they need some sense of safety and a strong faith. In the past, I'd have asked them to be anchored by the skills I taught them. But now, their relationship to me is playing a larger role. I have always felt compassion for their suffering. Now I'm better able to appeal to their courage, knowing the direct benefits that accrue from opening their arms to what they most fear.

In the early stages, when their courage and confidence is still at low ebb, I don't suggest they have to commit to actually trying to change--I only propose that they may want to try experimenting a little. As I suggest homework, I use expressions like, "How about playing with this move?" and "Perhaps you can fool around with these responses." I imply that these strategies are malleable and temporary: "What do you think about trying this move a few times just to see what happens? We can talk about it next time." It's easier for clients to set aside defenses and endure distress if they think the "trial" will only be for a few moments.

The key is helping them alter their frame of reference, which is the entrenched belief that they can't tolerate discomfort and insecurity, even for a moment. To gently challenge them, I turn their struggle with anxiety into a mental game. Anxiety pitches you uncomfortable physical symptoms and uncertainty about the future; it wins if it can get you to avoid threatening activities, fight the symptoms, and hope they go away. But somehow, if you can purposely encourage symptoms, act as if you want them rather than dread them, you trick anxiety and hoist it by its own petard, so to speak. This new frame of reference--treating anxiety as a kind of game--seems to refocus clients' attention away from a pointless fight with their symptoms. Just trying to rev up symptoms makes symptoms seem weaker, more under your control. Clients soon find, in fact, that as they stop resisting symptoms, the symptoms begin to fade and then disappear.

How does this work in practice? Social anxiety disorder gives us shaky hands, a quaking voice, and worry about the critical judgments of others. The anxiety "expects" us to try to avoid it--perhaps by never going to parties or giving a talk in public. So, in this new game, we flip things around. Imagine when feeling anxious before a performance that you ask anxiety to make your hands shake, your voice quake, and the fear worsen. Do your best to get those feelings to last as long as possible. Plead with anxiety to make your hands even shakier, your heart pound even more, your voice become even tighter! That is, refuse to play the game that the anxiety disorder expects. Take charge.

I encourage my clients to push the old game board away and pull up their own game board of seeking out doubt and distress when anxiety wants them to defend against it or run. They then see that the symptom isn't nearly as powerful when they're in charge of it.

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