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The things we do in life that get us into trouble are usually done when our nervous systems are highly charged or activated. Outbursts of anger, compulsive behaviors, sudden decisions—these reflect an overactivated and temporarily deregulated nervous system. In mindfulness-based therapy, we teach clients to track their level of activation as a first step toward self-regulation.

“I can see that even as you talk about this, you seem agitated. How would you rate your level of agitation, on a scale of 1 to 10, with 1 the calmest you’ve ever felt and 10 the most agitated?”

“I’m about a 6 right now—not nearly as bad as I get when I’m at my worst, waiting for the phone call. Then I’m about an 8 or 9.”

“OK, so it’s not as bad as sometimes. . . . Do you feel OK about exploring this?”

“Yes,” she said, “I’m good to stay with this.”

“OK, can you identify where in your body you feel the agitation?

“It’s in my belly—that awful grinding feeling. Also in my jaws—I’m clenching them. And my breath is shallow and tight; it feels crappy.”

“Yeah, not such a good feeling! Is it OK to stay with this?” I waited for a nod. “So, let yourself bring a gentle awareness to the grinding feeling in your belly, the clenching in your jaws, and the tightness in your breath. Stay with all that and notice what happens next.” I waited in silence as Suzanne went inward.

“I notice things start to ease up,” she said. “My breath returns. It’s like another part of me is saying it’s just going to be OK.”

These are powerful moments. We often find that by simply staying with an uncomfortable experience and bringing a gentle awareness to it, the experience shifts on its own. We start to realize we don’t have to fight against what’s been scaring us.

For several more months, Suzanne practiced this kind of mindfulness. I assigned homework: for example, to track her level of activation after the next date with a man. She used the 1-to-10 scale to track the sensations in her body. When she noticed herself getting more than a 5, she practiced resourcing herself. First, she tried just bringing awareness to a part of her body that wasn’t agitated. If that wasn’t enough, she called up an image that had been powerful for her in the therapy session; for example, her grandmother, who’d always been there for her. In the most difficult situations, she engaged in an activity, like going for a walk, which actively disrupted the increasing agitation.

All good therapies use the therapeutic alliance as an opportunity for the client to internalize positive relational experience and learn self-soothing from the support that comes from the relationship. In mindfulness-based therapy, we also develop the client’s capacity to attend directly to disruptive internal experience and bring to bear their own self-regulatory capacities.

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