Neurodiversity Ch 8

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Lois Prislovsky, Ph.D.

Emotional Regulation, SEL, & Performance Training

Chapter 8: Anxiety Do's - By Lois Prislovsky

“When you understand the interplay between the brain and the mind, you are in a perfect position to understand the secret to overcoming fear, anxiety, and worry.” Dr. Paul Jenkins

Anxiety is the most common and the most effectively treated psychological condition. I find practitioners like Dr. Paul Jenkins, Dr. Lissa Rankin, Dr. Mona Lisa Schulz, and Dr. Robert Leahy to be spot on with their shared sentiment that the cause and cure for anxiety are the brain and mind respectively. Once clients learn the role of the brain (an organ in their body) and their mind (thoughts which are in their control) they have the tools to manage anxiety.

The Brain automatically responds to threat. The limbic system can’t discern if danger is physically real. Despite orthodontic differences, a Sabre-toothed tiger and the cruelest popular girl in school heading your may way elicit the same physiological response. In The Fear Cure, Rankin classifies these as “True” and “False” fears. True fear is triggered when life and limb are threatened and False fear is in your “imagination.” Both types of fear are bad for your health if sustained, as our bodies are not designed to be frightened often. Chronic reaction to stress is toxic if unrelenting. The good news is both True and False fears can be beneficial if you learn how to filter the messages.

Below are five Do’s to better manage thoughts, emotions, and health. The Don’ts will be in my next chapter. I am not afraid to tell you I did not have the attention span to put all 10 tips in this one chapter. I tailored these as parenting tips for children. However, like juice boxes and popsicles they safe for self-care too.

To demonstrate each technique, I share how A.B. used each strategy to reduce his fears. A.B. was a twelve-year-old male client who literally presented with all six of the recognized anxiety disorders: 1. Specific Phobias 2. Panic Disorder 3. Obsessive-Compulsive Disorder (OCD) 4. Generalized Anxiety Disorder (GAD) 5. Social Anxiety Disorder (SAD) and 6. Post-Traumatic Stress Disorder (PTSD).

Do…

1. Facilitate optimism. Teach your children the importance of perspective. In Anxiety Free: Unravel your Fears Before They Unravel You, Robert Leahy reminds us to “alter your perspective so that you are no longer a victim of your own mind. There’s one great guiding principle: your fear level is determined not by the situation you find yourself in but by your interpretation of that situation. When the interpretation changes your whole sense of what is fearful and what is not changes with it.”

Adorable A.B. was open to learning and changing. And, yes, it helps to adore your clients. In fact, for me this draw is so crucial to being precisely who that client needs me to be every time, I honestly refer the potential client to another practitioner when that is missing. Before sending hate emails to my incompletely evolved self, please know in 20 years of practice, I referred away “hard to love” clients maybe 5 times. (Donald Sterling and Octomom types, I wish you all the best.)

A pessimist can learn to be an optimist. Carol Dweck in Mindset: The New Psychology of Success—How We Can Learn to Fulfill Our Potential writes that, while temperament plays a role, people can be taught “the growth mindset.”Those who learn to process as optimists are more likely to take action in response to stressors whereas pessimists may feel defeated, making them less likely to take constructive actions. Cognitive Behavior Therapy (CBT), a form of talk therapy emphasizes the role of thinking how we feel and what we do, is a robust approach to making the mindset change when you are ready reduce the pain of anxiety.

Rational Emotive Therapy (RET) is another empirically sound approach to examining one’s thoughts and challenging the message of fear by questioning its truth using logic and experience. Albert Ellis presents this application well in his book, How to Control Your Anxiety Before It Controls You.

A.B. was intellectually bright and had splinter gifts in vocabulary and analytical skills, so we started with both CBT and RET. I explained both theories to A.B. and we used the terms associated with each as we worked. I find transparency is empowering and effective. I should also note that our practice is set up as one stop shopping for psychoeducational needs so I rarely work with a client without the benefit of having a full psychoeducational report. This key information allows us to design strategies that build on each client’s individual strengths.

When A.B. first came to me, he struggled with anxiety so much that he was unable to go to school. His father changed his entire work schedule and began to homeschool him. Father and son were clearly close and affectionate. A.B.’s father was a strong positive force in his life. A.B. presented as socially less mature than his peers so I saw Dad and A.B. together every session. This collaboration proved productive as we all learned together and his father was quick to reinforce in other settings what was practiced in session.

A.B. used CBT and RET to help identify and deconstruct each of his troubling thoughts and behaviors. A.B.’s analytical strengths and hyper-verbal presentation allowed him to navigate these quickly. He also had a well-deserved ADHD label and rarely sat still long enough for such introspection and discussion but we made it easier by encouraging A.B. to be physically active when contemplating. Like many individuals with ADHD Combined type he thinks best when moving. (I resemble that remark. In fact, I’m typing this while peddling a bike – don’t worry it’s a stationary bike – I learned that lesson.) In my office, A.B. frequented a large pilates ball, mini-trampoline, a couch and a spinning office chair. I often playfully reinforced his breakthrough ideas with a “nitrous boost” spin of his chair. Sometimes you don’t need a child psychologist, just a child-like psychologist. (In developmental biology, neoteny refers to retaining childlike qualities into later development.) A.B. needed encouragement to lighten up and use his childhood powers of curiosity, playfulness, creativity, and flexibility to help him break through fears.

With shaping, fun and respectful peer-like dialogue A.B., was able to stay on task and generate his own solutions. In weekly sessions with homework, A.B. cognitively worked through almost one anxiety roadblock per week.

2. Practice Mindfulness. Mindfulness is an excellent way to process anxiety. It changes emotional reactions, which are often unconscious in to a chosen, controlled, fully conscious response. With mindfulness, one can choose to only get angry on purpose and other fun tricks. Suppressing emotions is proven to decrease well-being. Specifically, holding anger and fear is counterproductive to health. Mindfulness allows one to feel and validate emotions and then move on. Sylvia Boorstein in her book, It’s Easier Than You Think, makes a case that pain is inevitable but suffering is optional. The key is to own the emotion, and then do with it as you will. Rankin’s The Fear Cure recommends examining “false” fears long enough to let them teach you “wake up” messages: “Fear points a bony finger at everything that needs to be healed in our lives, and if we’re brave enough to heal it, courage blossoms and peace is the prize.”

Phobias are reactions that get stuck in a feedback loop. These conditioned fears can be extinguished by increasing awareness and restoring control to the user of the brain. I often use hypnosis as a fast way to help clients increase mindfulness. This may sound paradoxical, as hypnotherapy focuses on unconscious knowing. I find it most effective when used in combination with self-awareness learning. I start by explaining the approach and the logic behind it even down to the specific words I may be using as we Ericksonian hypnotherapists are trained to use connotations that have more value to that particular client.

A.B. enjoyed learning about hypnosis and being hypnotized. I am confident about this because after each hypnosis exercise, I ask the client to fill out a brief feedback form with a satisfaction rating. (A.B. was not one to tell me what he thinks I want to hear. His Prefrontal Cortex was not there yet.) He answered questions like, “The most difficult part of this exercise was preparing for it.” “The most helpful part of this session was I don’t feel as scared of bees”. “I am not yet ready to hang out in a bee hive”. And “I am just now starting to realize bees are nothing to me.” As I do with all clients, we recorded the actual hypnosis so he could take home the CD and practice it 4 to 5 more times before our next visit. This is advantageous for many reasons. For one, the subject can hear the content is positive and can safely take full ownership of his/her transformation. Second, hypnosis is in essence a state of extreme focus, and practicing sustained attention is beneficial especially to those with ADHD. Third, all hypnosis is self-hypnosis; as A.B. practiced the CD at home, he became better at self-regulation.

To keep A.B. interested in continuing specific neural growth and integration, we talked about people who, like him, practiced purposeful thinking and were able to enter higher phases of functioning. For instance, in Super Brain: Unleashing the Explosive Power of Your Mind to Maximize Health, Happiness, and Spiritual Well-Being, Deepak Chopra and Rudolph Tanzi share accounts of Tibetan Buddhist monks who use this same feedback loop combined with meditation techniques to warm their entire bodies by focusing on getting warmer. When they maintain focus on this intention, they can sit in ice caves meditating over night while wearing nothing more than thin, silk saffron robes.

Saffron was not A.B.’s color, yet he was able to achieve similar brain/body connection in his own hyper-focused relaxed state of hypnosis. For example, in addition to considering practical problem-solving suggestions during hypnosis, A.B. was able to: 1. numb his hand to near 100%; 2. hold and feel an imaginary tennis racket; 3. auditorily follow a non-existent fly and 4; describe a flower he was able to “see” on the floor in front of him.

A.B. gained confidence. His brain was beginning to follow orders from his mind reliably.

With continued CBT, RET and hypnotherapy, A.B. was able to conquer about one phobia per week: crowds/loud noises, bees, tests, and “brick and mortar” schools. With those fears better managed, he was able to participate in neurofeedback training for more gains.

3. Consider Neurofeedback (NFB). Research and technology have advanced to allow neurotherapists to target specific areas of the brain responsible for an individual’s anxiety. Plus, it’s crazy fun to play video games with your mind. Look, Ma, no hands! Seriously, that is what neurofeedback treatment for ADHD and anxiety involves at Psychoeducational Network. I did it myself. It helped. (But it is not all fun and games – neurofeedback clients are required to refrain from alcohol on the evenings prior to training. A.B. seemed ok with it, but I tried to get another opinion. Finally, the third guy I asked, who was ringing up my Heineken at the gas station said it was fine with him.) It is a non-invasive technique proven to be safe and effective. Using an electroencephalograph to monitor brain waves and a system of positive reinforcement, clients learn how to train their brains to regulate anxiety. For more information about neurofeedback please check out Dr. Rex Cannon’s videos at www.psychoeducationalnetwork.com.

A.B.’s success with NFB was featured in a HealthlineNews article by Penny Williams, “Can Neurofeedback help kids with ADHD press the restart button?” Below is an excerpt from that article. Please note it is primarily about A.B.’s ADHD but his co-morbid anxiety also improved.

A.B.’s Mom, “After the second or third week, my son noted his thoughts were ‘quieter than normal,’ which he really liked. Overall, after a month of neurofeedback, we noticed reduced anxiety and better responses to our requests to do things he didn’t like, such as homework and chores. We were happy with the differences we saw in his behavior.”

4. Encourage Generosity. To help others break the cycle of anxiety ruminations, share–When in doubt, think out.

The Dalai Lama states, “Helping others does not mean we do this at our own expense. Wise people want happiness. How to do this? By cultivating compassion, by cultivating altruism. When they care for others, they themselves are the first to benefit—they are the first to get maximum happiness. That’s real wisdom.”

In conjunction with CBT, RET, hypnosis, and NFB we encouraged A.B. to begin giving to others. At this point, A.B. had transitioned back to a “brick and mortar” school. He had many opportunities to give. I asked A.B., “What could you do, say, or give to help your Dad, Mom, sister or someone at school?” This outward thinking, eased A.B. into becoming less egocentric, immature and more likeable, all of which reduced his social anxiety and his OCD thought loops. He often chose to give compliments to a girl in his class whom he perceived as struggling with low self-esteem. By opening his heart and mind to others, A.B. began to break his self-absorption patterns and feelings of being frightened and alone.

5. Listen. It is both comforting and cathartic to be heard. In The Whole-Brain Child: Revolutionary Strategies to Nurture Your Child’s Developing Mind, renowned neuropsychiatrist Dr. Daniel Siegel shares compelling information about brain anatomy and how to foster secure attachment by listening to your child with these 4 S’s in mind: Seen, Safe, Soothed, and Secure. Parents are encouraged to see the inner life needs of the child, provide safety with comfort and compassion, and soothe by reaching out to connect when children are distressed. Secure children are then resilient and able to deal with life’s challenges with flexibility and strength. A.B. was able to process his PTSD with this type of support.

Let your child talk freely and honestly about his/her feelings when he/she is ready. At this time, do not try to fix; just listen with openness and understanding. In Living Buddha, Living Christ, Thich Nhat Hanh explains the Buddhist term vipasyana (looking deeply) as observing something or someone with so much concentration that the distinction between observer and observed disappears. When we are able to let go of barriers between ourselves and others, understanding is possible. Once isolation is gone, fear is diminished, and growth is imminent.

A.B. also had a bad habit of interrupting and talking over others. By mirroring our active listening and role-playing, A.B. improved his listening skills and decreased his panic attacks.

Remember anxiety is not always a bad state of being. It means you are thinking about risks and opportunities; however, when fear immobilizes goal progression, its time to do something different. In Brainstorm: The Power and Purpose of the Teenage Brain” Siegel reminds us, “our brains are programmable and we are the programmers.”