Tag Archive for: counselling

Emma treats those with anxiety, using a variety of techniques including mindfulness and grounding.

How can I support someone with anxiety?

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Emma treats those with anxiety, using a variety of techniques including mindfulness and grounding.

Why is it difficult to support someone with anxiety ?

If you have not experienced the debilitating effect of anxiety, it can be very difficult to offer empathy or understanding to someone who has. I have written this blog to help you understand how to empathise and support a loved one with anxiety.

Some people struggle to understand anxiety and how it can be so crippling. A few individuals are dismissive of anxiety and minimalize it. This attitude is not helpful because it undermines the impact of poor mental health on society. This also implies someone suffering anxiety is somehow responsible or inadequate for not being able to manage the complexities of their experience.

An ‘anxiety attack’ is not something we can stop using rational discussion. Anxiety is a response triggered in the brain which interpretates information it receives externally and internally. Once our nervous system has been activated a cascade of physiological changes occur or are primed for action. Telling someone to stop this cascade is like asking someone to decrease their heart rate when they start to exercise. Offering support to someone with anxiety is more about being with them rather than talking at them.

The information that triggers the anxiety response comes from many sources. How individuals might interpret that information is based on genetics, up-bringing, social positioning, past experience, awareness, and education. If you have not been in that person’s shoes you are not in a position to judge their anxiety.

A simple guide to anxiety

  • Anxiety is a response to danger (real, perceived or imaginary)
  • An individual cannot stop being anxious because you tell them to
  • Anxiety may be irrational
  • Anxiety can start slowly or quickly
  • Anxiety is a physiological response, the further it has progressed the less easy it is to modify
  • Someone whose anxiety builds slowly can be helped to prevent it escalating.
  • Anxiety is often a result of a pattern of sustained thoughts and actions that have occurred over years
  • Long term treatment addresses the habitual process that has caused the anxiety
  • A panic attack is an extreme form of anxiety

If you want to read a little more about anxiety visit Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

How to support someone with anxiety

  • When they are very anxious or panicking-
    • Keep calm. Calmness is contagious, this is recognised when a baby is immediately calmed by the soothing voice of their mother. If you can get grounded and your breathing and heart rate is stable this confers calmness to others
    • Draw their attention, not necessarily just words but eye contact and if appropriate hand holding.
    • Encourage them to look at you
    • Consciously slow your breath and invite them to slow their breathe with yours.
    • Talk slowly and with purpose
    • Continue to encourage eye contact.
    • Suggest they place their feet firmly on the ground
    • To bring them back to the reality of the present moment encourage them to pay attention to things they can sense, ask them what colour clothing you have, or whether they can feel the ground, or air on their face.
    • You will begin to see their posture relax and them becoming calmer, this is when you can talk. Start with reassurance, ‘you are safe’, ‘I’m here’ ‘do you need anything?’
    • Only when they are back in a safe environment and recognise what happened can you ask them about what they were anxious about.
  • When they are generally anxious (and tearful)

Those suffering Generalised Anxiety Disorder (GAD) may have varying degrees of anxiety most of the time. Here are some ideas for you to try when they are at their low point.

    • If you know what makes your loved one happy and relaxed try to encourage them to do these things.
    • Gentle, regular and frequent encouragement is important.
    • It can be disheartening for your attempts to engage to be constantly turned down, but don’t give up.
    • Those with GAD can be anxious in large groups, or busy settings. Be prepared to invite yourself in for a coffee, or take them for a short walk.
    • Build on these activities. If you have a friendship group or close relatives you might want to set up a support hub where each takes a responsibility  for a daily connection with your loved one.
    • Someone with GAD gets safety and stability from knowing friends and family are consistent and reliable. Don’t over promise.
  • How does employment help someone with anxiety?
    •  Work can be a cause of stress but it can also provide a normal and familiar environment which is calming for the nervous system.
    • Generally some time off work after a long period of anxiety will help your loved one recover.
    • Mental exhaustion may not be very visible but your loved one may show symptoms of not being able to concentrate, or make decisions, feeling tired but not able to sleep, being edgy but not able to settle to do something.
    • Someone at work with mental exhaustion can feel very inadequate, unfulfilled, disillusioned and have steadily decreasing self belief. All these will make anxiety worse and potentially turn to depression.
    • If you suspect work is part of the problem discuss this with them.
    • Accepting the impact of GAD on life choices is hard, but small changes such as reduced working hours, change of locality, change in job role can be really beneficial. Try talking this through with them.
  • How to help your loved one manage their Generalized Anxiety Disorder

GAD as with most anxiety, can be well manged, I find people can return to a life with normal levels of anxiety with psychotherapy and/or appropriate medication, however in times of difficulty it can return.

Counselling and psychotherapy can help by providing a safe space to understand anxiety at a physiological level and an experiential level. A good therapist will enable a person with anxiety to understand when their thoughts and beliefs contribute to anxiety and help them to have a different relationship to thoughts. You might be able to do this too, but because there is an emotional attachment between you and your loved one it can be a lot harder and create frustration and animosity which is then counterproductive.

Hints-

 

 

    • Encourage your loved one to seek outside support Counselling for anxiety.
    •  Have your own support network away from your loved one. It can be hard to continually be supportive and patient.
    • Learn to recognise what is a thought and what is reality. This is important to enable you to stop engaging with their anxious thoughts.
    • Do some research to help understand more about anxiety.
    • Healing from anxiety involves changing neuropathways in the brain, it therefore can take time. The longer the anxiety has been going on the longer the healing.
    • To repeat myself, being calm during a crisis is one of the most helpful things you can be. Calmness is contagious.

In summary

Anxiety can happen to anyone, some people, possibly due to their experiences, genetics and their childhood are more likely than others to suffer.

Anxiety is the body’s way of saying ‘I sense danger and I need to be ultra-vigilant’.

Feelings of anxiety may not be justified, as there is no danger, but an anxious person cannot always hear that truth, so it is not helpful to repeat ‘Don’t worry everything is fine’.

If you can be calm, patient, consistent, reliable and show empathy you are giving them safety to experience their environment as safe too.

Resources

Book Review: A Mindfulness Guide for the Frazzled by Ruby Wax

Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

Counselling can be for anyone.

Emma Dunn Counselling and psychotherapy

Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

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Thoughts and Anxiety

Anxiety often manifests itself as poor eating, irritability due to poor sleep, and an inability to concentrate. First line treatment addresses these manifestations. Anxious people are encouraged to exercise to become physically tired; eat regular meals and to make lists  to feel less over- whelmed. These are useful for symptom alleviation but without identifying the cause there is potential for anxiety to continue. The link between thoughts and anxiety is not being addressed in these treatment. It is understanding the cause that will ultimately decrease the symptoms of anxiety.

Anxiety might be interpreted as a reaction to a real situation. Do you believe anxiety is a reaction to a real situation?

Have you ever considered your thoughts and anxiety as one problem?

The Neuroscience of Anxiety

Emma Dunn Counselling and Psychotherapy

Summary of the brains response to a threat

The stress response is the same whether there is a real threat to our physical safety or a perceived one. An area in our brain called the amygdala is the warning bell that makes us physically alert through a cascade of hormone and nervous reactions. One of the hormones released is cortisol, which further alarms the amygdala so it becomes even more alert to negative stimuli. Meanwhile, another area of the brain, the hippocampus, becomes less responsive. The hippocampus normally provides a control over the amygdala such that positive experiences are noticed as well as the negative ones and we can weigh up rationally what is the best action to take. The more often we are stimulated by anxious reactive thoughts the more readily we get to a state of alertness and vigilance, and less able to keep calm and rational. We attune into (implicit) memories that are not quite clear ‘the sense of something bad going to happen’; thoughts and reality become inseparable, we become less able to access reality, which might appropriately be remembered as as ‘when such and such happened, I was concerned but it all worked out in the end’.

Thoughts

Thoughts and Mindfulness

In the context of Mindfulness there are 3 types of thinking

  • Active-Useful, essential for planning, doing, reaching our goals
  • Flow-thoughts occur but are not judged, they pass by.
  • Fixed-unhelpful patterns of thinking, not usually based on reality.

Mindfulness aims to help us move away from fixed thinking to flow thinking and active thinking.

It is useful to remember that

  1. Thoughts are not facts
  2. We are not our thoughts

We are then in a better position not to let thoughts and anxiety dominate our thinking and behaviour.

A useful way to notice whether a thought is an unhelpful one is whether it creates an emotion, or whether it is helping or not, that is enabling you to do a task or stopping you from doing a task by relating to the past or the future, rather than the present.

Psychotherapy and Thought

Psychotherapy is about understand the workings of the mind, and bringing it into awareness. It is about recognising behaviours that are based on past experiences, and understanding that we do not need to repeat behaviours and thoughts, especially those that cause unhappiness.

The implicit memories that were mentioned earlier, it is these that psychotherapy can help unravel and challenge.
An example
As we grow up we often maintain the beliefs, behaviours and thinking patterns that were familiar to us as children, when they are out of awareness, as adults they can prove to be unhelpful. An innocuous example might be that as a child ‘greediness’ was discouraged. So little Billy, to please his mum would take the smallest bun when offered a plate of cakes. As an adult Billy’s wife offers him a plate of buns, obligingly he takes the smallest, not wanting to be disliked for being greedy, Billy’s wife is upset thinking Billy does not like her cooking. There is something in Billy’s wife’s belief, behaviours and thinking that feels rejected if someone doesn’t accept what she offers.

These actions can be so ingrained that we believe them. Billy believes he is greedy if he takes a big bun and his wife believes she is rejected because he didn’t take the biggest one. These are fixed thoughts. The reality of the situation has not been made explicit, spoken about. In a state of anxiety further implicit memories may be stored (remember these are not based on reality). Billy’s implicit memory might be is that he upsets his wife by eating buns, his wife’s that Billy doesn’t like her cooking. A tiny event reaffirming a whole set of thinking and anxiety based on past experiences not relevant in the present.

Through psychotherapy Billy will gain an understanding that perceptions of greediness are individual. He will identify with his own physiological experience about what it is for him to be greedy, or even whether greediness is an unhelpful experience that represents for him an interpretation of poor self-worth (i.e. he doesn’t deserve a big cake because his mother will not love him, and as an adult, his wife will not love him if he has it) He will become aware through dialogue that explaining why he makes certain choices can avoid future misunderstandings, and stop the perpetuation of irrational decision making. He will learn that other people, including his wife, experience his behaviours in their own way, not necessarily how they were intended.

Psychotherapy and Mindfulness

Thoughts and anxiety can be inseparable. Through Mindfulness practice there can be an awareness of our thinking, noticing spiralling sequential thinking sometimes pulls us away from reality into a repetitive story of stress, and worry; Mindful practice enables us to begin to slow down fixed thinking, replacing it with flowing thoughts.

Psychotherapy acts as an adjunct helping us to notice actions and behaviours that are based on habit, or implicit memories, and previously out of our awareness. It therefore helps us to modify our behaviour and take greater control, strengthening explicit memory formation and the role of the hippocampus, enabling rationality informed by experience.

Thoughts and anxiety lose their grip on each other. Thoughts become focused based on reality, and our physical arousal is appropriate based on actual threat or excitement.

We learn to make our thoughts explicit to help identify reality from ‘make believe’. Relationships improve and anxiety decreases.

Further information about mindfulness can be found below.

If you think counselling can help you please look at my website Insightfulness or visit Counselling Directory or British Association for Counselling and Psychotherapy where you might find some helpful resources.

Resources

Books

The practical neuroscience of Buddha’s Brain. By Rick Hanson, with Richard Mendius

Mindfulness; a practical guide to finding peace in a frantic world. By Mark Williams and Danny Penman

Web Sites

The Mindfulness Project

Oxford Mindfulness Centre

Counselling Directory

British Association for Counselling and Psychotherapy

A Brief Demonstration of how Neuroscience Substantiates Counselling Practice

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Emma Dunn Counselling and psychotherapy

Eye contact in counselling;  An example of  when it might be one sided.

Eye contact is often highlighted as an important part of engagement with an other. When I am counselling others my gaze is focused on the eyes of the person sitting in the other chair; ‘my client’. This is regardless of whether they are looking at me. It is as if I am saying to them I am here, ready, attentive and available for you.

However it is more usual for them, in times of deep reflection to have their eyes averted, almost glazed over.

I noticed myself doing the same, glazing over, when trying to describe to a friend, how I might feel if I could sail. I was trying to describe the sensation of being at one with the boat optimising the energy of the wind. I was disengaged from eye contact but became aware of this only after I had formed the words and understood what it was that I was wanting to express. It was then that I was reminded of the work of John Kounios and Mark Beeman, on the neuroscience of insight and why I believe so passionately about listening to our own experiences, and facilitating insightful moments. Picture Blog 2

Neuroscience is tending to indicate that insightful solutions to problems occur when the right hemisphere of the brain, notable the anterior superior temporal gyrus, is active, working creativity, and the left brain becomes less active- not working at interpreting external, in particular visual stimuli. This is seen clearly when my clients look away and appear ‘vacant’. This is why holding silence can be so powerful, it allows the right hemisphere priority to act on stimuli from the prefrontal cortex and the limbic system where emotion, non-verbal activity is shown to occur. Getting in touch with our feelings and experiences. Then, once some sense has been made, the left hemisphere, logic and language come into play and the state of introspection returns to engagement and ideas are articulated and a clarity follows. Client’s and counsellor’s eyes then meet, as if to provide assurance that the experiences are valid.

It is during the silence, when I as a counsellor have been fully available, I too have been using the right side of my brain. Activity of mirror neurones in the here and now, combined with personal experiences based on my attachment history will inform me in a way that enables me to show empathy. When my client articulates her reflections I too am in tune with the implications and emotions that these generated and our counselling relationship deepens and work progresses.

photo Blog (1)

 

I believe, psychotherapists who practice reverie and/or use  the impact of clients on their sense of self, either as countertransference or somatic experiences, even in dreams or in the supervision process are demonstrating how powerful it can be to allow our right-sided creative, emotional brain to speak to us. The antithesis of active problem solving, where we consciously piece the clues together, reverie allows the insights to suddenly arise within the process of being in relationship.

 

It continues to surprise me when counsellors are fearful of the work of neuroscience which is helping us to understand the work we know can happen in counselling. This brief exploration of insight, demonstrates how concepts from other models for example reverie, relational depth, empathy, dream work and Gestalt ideas can all be substantiated at least in part by science, this is a wonderful truth that endorses psychotherapy and counselling as an effective means of helping people to understand themselves, come to terms with this and make use of experience to reach whatever goals they are aiming for.