Tag Archive for: stress

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.

Christmas Stress-How to change your mindset using Mindfulness

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Christmas Stress – How to change your mindset at Christmas

Christmas and Mindfulness
Anyone hosting Christmas will be aware of all the jobs that need to be done, the presents and party clothes to buy, food to be ordered, the list can go on. For those having Christmas alone, or if this year is the first without a loved one, the festivities provide a complex set of emotions which can be difficult to bare.

It may be that you have a silent dread of Christmas. However, Christmas is going to happen.

What follows are a few ideas about how changing your mindset may help.

Many of the reasons why stress builds up prior to Christmas is to do with thoughts and behaviours, habits and expectations.

For example;

  1. The emphasis placed on family traditions
  2. You may be concerned about how much work needs to be done to make the day successful
  3. Present buying; how much to spend, what to buy
  4. The day being a reminder of those we have lost

You may be able to relate to these. Mindfulness encourages a different approach and awareness to the meanings we give to things such as traditions and expectations.

Mindfulness allows us to treat the current moment as all there is.  It helps us see how much meaning we attach to the past at the expense of the present.

  1. The emphasis placed on family traditions

It can be difficult to change habits, certainly if we frame them as ‘family traditions’. I wonder if when your ‘family tradition’ happened for the first time the intention was for it to go on past its sell by date?

Interestingly we are aware in other circumstances, such as holidays, that when we try to repeat the experience it causes greater disappointment. Can this be applied to Christmas?

Traditions may include when to put the decorations up, real tree or artificial, Christmas day menu, the family members invited, the timing of present opening, television and what film to watch.

Before planning gets well under way why not ask yourself and your family, whether  these traditions important and why. Do they create a good experience?

You may find you can drop one or two and everyone has a sense of relief.

  1. The concern about how much work needs to be done for the day to be successful

There is as much work as you want. Is it true that the more work you put in, the happier everyone is? Or is this about you, and how others might perceive you?

Thoughts can creep into our head and be believed. At Christmas there might be a little bit more organising and planning but it happens every year and we do it every year. It is often worth noticing the thoughts we have, and reminding ourselves they are thoughts. There might be the thought, ‘I won’t get it done in time’ or ‘what if the turkey is under cooked ?’ Notice what happens to your stress levels when you have these thoughts. Are they appropriate, what is the worst that can happen? Thoughts are not facts, mindfulness enables us to notice a thought and not react to it.

Take a mindful moment. Take a deep in-breath and a slower out breath, counting to five. Repeat once or twice more.

  1. Present buying; how much to spend, what to buy

Why are you buying presents, who for and at what cost?

Present buying is a reflection of who you are and your relationship with the recipient, as well as your personal beliefs about Christmas.

There are many ways in which we get distracted from this, especially adverts and consumerism and ‘family traditions’. The shops become full of ‘gift ideas’. Spend a little time reflecting on why you want to give as a gift. There is some truth in the statement ‘it is the thought that counts’. A mindful approach focuses your mind on the reality of Christmas, encourages you to stick to intentions meaning it is less likely you buy things spontaneously.

You may also reflect on what does receiving a gift mean to you, and is this truth based on reality. A common belief is that a person close to you will instinctively know what you want. Unfortunately, life isn’t this simple, either tell them or be prepared for anything. People are not mind readers.

  1. The day is a reminder of those we have lost

Anniversaries are reminders. Allowing a time in the day to acknowledge absent friends and family can be useful. You and other friends and family also represent a little of that missing person, a shared joke, or shared gene, this too can be honoured. They have not gone completely.

Mindfulness encourages us to stay in the here and now, it is this moment that is important, comparisons often bring dissatisfaction. Each Christmas will be different, enjoying it for what it is can be more rewarding than not liking it for what it isn’t.

Mindfulness at Christmas

Mindfulness involves a regular commitment to paying attention to the present moment. Christmas often draws us into the past, the past has gone, enjoy the ‘now’ as this too will soon be gone.

You might be interested in

Thoughts and Anxiety-Using psychotherapy to alleviate stress

Mindfulness meditation for novices-Part 3

If Christmas does provide a challenge getting some counselling support may just help build up resilience.

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

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A Mindfulness Guide for the Frazzled

Book Review

Ruby Wax- A Mindfulness Guide for the Frazzled

Ruby Wax is known to me firstly as a comedian and more recently a Master of Mindfulness based cognitive therapy. It is because of the latter and her potential to reach the masses that I wanted to review her book, to help others decide whether it is a worthwhile read and me whether to stock it in my client library.

She writes with an easy style and you are soon drawn into the ideas of mindfulness. She is keen to teach the physiology of the brain (neuroscience) to help us understand that our behaviours and emotions are natural animal responses to the need to stay alive. The evolution of the brain is described very simply. She switches from humour to personal experience to science and back again. This might be engaging for some and keeps those not interested in the science bits motivated to continue reading. I found the science stilted and her style more forced, she acknowledges help with these passages from the experts which I can see is reflected in the prose. The humour is nice, although I am not sure whether it is a distraction some times.

The second section of the book is about applying mindfulness and how to use mindfulness with your children. There are some simple ideas to encourage an open and non-critical relationship with our family members. She clearly speaks from experience as a mother and a daughter and highlights how things are often easier said than done. This may be interpreted as don’t bother if you think it will fail which possible undermines some of the messages she wants to put across. However the message is simpler, you cannot fail just try, but try regularly-daily.

Frazzled fron coverIn the middle of the book is a stand-alone 6-week Mindfulness programme. It introduces the reader to familiar practices of meditations, for example the Body scan and the 3-minute breath. I was introduced to a lovely one focusing on listening. The practices show how to access our body, thoughts, senses and emotions in the present, through simple exercises set out week by week. There are questions after each practice to help you notice what might have changed or been different from your usual experience.

Part way through the book Ruby puts  ‘mindfulness’ on hold and shares a  moving journey about her own sufferings that happened during the writing of ‘Frazzled’. This makes the book all the more personal, and perhaps shows in that the latter section of the book seems to me a bit less dynamic or humorous than the first.

Finally she describes a retreat she went on. Retreats I guess are a bit like having children, you really cannot know what it’s like until you have done it. Her experience is heart-warming, real, and genuine.

I would recommend this book to the curious,  to those who love Ruby, and to those with anxiety looking for help through mindfulness. It is for a secular audience not the expert, although she does list her references and resources for those interested.

It does not touch on the spiritual or loving aspects of mindfulness these are more associated with Buddhism, and neither to does it claim to. To conclude  this is an easy read for those looking for an introduction to Mindfulness.

A Mindfulness Guide for the Frazzled by Ruby Wax

The Johari Window and Improving our Understanding of our Patients

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Joseph Luft and Harrington Ingham in 1955 created this ‘Window’ concept to understand how individuals work  within teams and to improve productivity, communication and collaborative working. It is frequently used within counselling to explore self awareness.

It is a metaphor for displaying ourselves, drawing on ideas of visibility and transparency as well as curtaining off areas to keep them protected from on lookers who may mean harm.

I wonder if this tool can also be used to understand the complexity of the patient presenting to their doctor or Health Care Professional (HCP)?

The Open Quadrant

The transparent two way picture.

This is what the patient is willing and able to show to their doctor. But what is it that the doctor believes they are being shown? And what are they willing to see? The picture is quite a simple discrete one, I believe that too often the view for the doctor and HCP is the illness and  treatment for which their patient has been diagnosed. This is not necessarily so for the patient, their presenting picture; what they make visible, may be quite different, not even on the radar of the doctor or HCP. For example they may be showing as an anxious parent unsure of their ability to provide for their children, a highly paid business man who is in denial  ‘not very ill at all’. So  despite this quadrant being ‘open’, and that our patient willing to disclose some of them self, is the same picture being seen by the doctor? Is the doctor, only looking to see a patient with an illness, not a person?

The Blind Quadrant

This area is designed to represent what the other person can see but the patient themselves cannot see. I have  interpreted this slightly differently to emphasise the knowledge the HCP or doctor has about the patient because of their illness.

This area is saturated by the doctor’s knowledge about the patient’s diagnosis, prognosis, and expected complications. So they see, or focus on their own intelligence and ‘dump’ it on the patient. Whether they are able to tune into other aspects of the patient ( not their illness) such as their bravado, courage, or fear,  would provide potential for an improved empathic relationship. Do the blind and open quadrants merge, the patient becoming the illness, detached from the person?

Perhaps the doctor too is being blind?

The Secret Quadrant

This is describing the things the patient is keeping well guarded and hidden from the HCP or doctor who will be completely unaware of them.

An acknowledgement by HCP’s that they in fact are not being presented with the whole of their patient and the patient is concealing aspects of themselves may be useful. It may be relevant to reflect: what is my patient hiding from me?Is this related to their illness?  The situation, environment? Am I being presented with the whole person? How can I facilitate openness? What impact will this have on concordance? Self management?

The Hidden Quadrant

Neither the HCP nor the patient knows what is hidden. But by providing space to explore the potential for understanding how the patient’s illness is impacting on relationships, behaviours and emotions will only serve to increase the potential for our patient to modify their behaviour  to help them reach the potential they hope for themselves. So facilitating the exploration of anxiety, poor sleep patterns, bad dreams and other negative characteristics may prove beneficial for physical health and the relationship between patient and HCP/ doctor,  and patient and their illness.

Johari-Window-Medical-Model

I would just like to conclude that there are missed opportunities within the NHS care settings that deny the patient the opportunity to be truly known by health care professionals such as doctors, who claim to wish to do patients no harm and yet understand very little about the patient they wish to avoid harming.