- Excessive worry and fear in completing everyday activities
- A sense that events are uncontrollable and unpredictable
- Uncomfortable physical feelings such as heart palpitations, sweating, rushed breathing, tension and pain
- Physiological response that facilitates escape or self-defense
- Negative thoughts about situation and events that cause you fear, worry and nervousness
Types of Anxiety
- Separation anxiety disorder
- Selective mutism
- Specific phobia-fear of specific place, person, object
- Generalized anxiety disorder-severe and uncontrollable fear
- Social anxiety disorder-out of proportion fear of social settings
- Panic disorder- often experienced as unexpected”panic attacks”
- Agoraphobia- avoidance of specific situation attributed to anxiety
- Substance/medication-induced anxiety disorder
Cognitive Behavioural Therapy (CBT) has been shown to be very effective at managing anxiety, it involves;
- Behavioral Exposure: gradually and repeatedly facing situations that one fears, until they no longer bring about fear.
- Cognitive Restructuring/Thought Record: Track and respond to thoughts in an organized way using various tools and worksheets.
- Psychoeducation: begin to understand relationship between thoughts emotions and behaviours.
- Relaxation Techniques: certain set of procedures taught to illicit physical and mental calmness (mindfulness meditation).
- Feeling low in energy
- Having difficulty with motivation
- Experiencing Sadness
- Feeling guilty and a sense of shame
- Ongoing irritability or anger
- Changes in weight
- Changes in sleep pattern
- Difficulty getting out of bed
- Social isolation or lack of interest in previously enjoyed hobbies
Mindfulness Based Cognitive Therapy (MBCT) by Segal, Williams, Teasdale (2002).
- This method was originally designed to be used for preventing relapse of clients with depression.
- Defined as the act of “paying attention in a particular way: on purpose, in the present moment and non-judgmentally” (Kabat-Zinn, 1994, p. 4)
- Puts the focus on the current moment rather than past or future events and encourages the use of visual, audio and sensory experiences.
- Encourages awareness of ongoing thoughts and to become an observer your relationship to your thoughts, rather than to engage in avoidance or rumination.
- Now also being used for patients with Bipolar Disorder or Generalized Anxiety Disorder with their mood and anxiety symptoms (Williams et al., 2008; Evans et al., 2008)
Emotion-Focused Therapy would involve
- Emotional Awareness Building- This includes looking at the relationship between your feelings, needs, wishes and values. Often our emotions prepare us for action in our environments. Our bodies are wired to pick up on emotions, that is why the limbic system responds to basic emotional responses. The Amygdala produces automatic emergency signals to the brain and produces gut reactions. Whereby in the neocortex pathway emotions are mediated by thoughts.
- Maladaptive Emotional Expression and how it relates to dysfunctions. This belief is that by helping you to understand your emotions, you can better manage the maladaptive patterns of behaviour that no longer fit your current situation.
- Emotional Regulation- Therapy would involve looking at fostering an environment that feels safe, calm, validating and empathic. Secondly, with the help of your therapist drawing on strategies to access emotions. This could involve attending to bodily emotions or remembering previous episodes. Third, strategies for containing emotions can be practiced such as: self-soothing, seeking support and understanding from others, using distancing imagery and naming and understanding emotions.
- Narrative Construction and Meaning Making- your experience with the therapist generates new emotions that are the basis for new meaning and understanding.
ANGER AND RAGE
- Angry outbursts that feel uncontrollable.
- Feel a lack of self control.
- Frequent negative reactions to emotional triggers.
- Low tolerance for people in your life.
- Often regret your comments and behaviours.
- On the anger thermometer do you go from zero to ten very quickly.
- Do you lack awareness of your physical and psychological symptoms when angry.
Conflict is an unavoidable area of life, yet needs to be managed in order to have meaningful human relationships. What becomes most important in your anger management training is
- Understanding your triggers.
- Taking time outs.
- Learning to build self-awareness of your physical.
- psychological symptoms of anger.
- Developing assertive communication skills.
- Putting your emotional needs into words.
- Building your emotional vocabulary.
- Feeling wound up
- Feel tight like a drum
- Feel like you are “always behind on your activities”
- feeling phsysiological symptoms of hearth palpitations, tightness in the chest, sweating.
- Craving more foods high in fat lately
- Finding it difficult to fall asleep at night
- Wake up feeling nervous in the mornings
Effective Stress Management Practice
Mindfulness Based Stress Reduction (MBSR) by Kabat-Zinn (1990). This practice helps individuals with stress, chronic pain and illness (Majid, Seghatoleslam, Homan, Akhvast and Habil, 2012). The principal behind the practice is to teach you to use your breathing as a mechanism to sooth yourself and reduce your stress hormones. Studies show that mindfulness has long-term effects on the brain. It can protects against cortical thinning, so that you are cognitively more alert and robust. Becoming a witness of yourself challenges you to change your relationship with your thoughts and emotions. Mindfulness increases ability to experience negative events with less physical reactivity.
- Are you finding yourself fighting with your partner over the same issues
- Does every small matter blow up into an argument
- Do you feel hopeless and scared for the future of your relationship
- Do you feel like you can’t communicate with your partner
- Are you repeatedly feeling shut out or attacked by your partner
What do the Experts Have to Say
John and Julie Gottman has spent the last 30 years looking at what makes couples happy and what prevents couples from having lasting relationships. What they have found is that happy couples argue at a ration of 20:1, meaning twenty good exchanges for one argument. Whereas couples in unhappy relationships will argue at a ratio of 5:1 and couples on the verge of separation argue at a ratio of 1:1.
Not only is it important to continually engage in encounters and experiences to strengthen your bond, but it is equally important to learn effective ways of communication and resolving conflict.
Gottman notes that couples that draw on the “Four Horseman” during arguments are more likely to have their relationship end within 5 years of marriage. Also did you know that the first three minutes of your argument will predict it’s outcome.
John Gottman’s Four Horseman
- Contempt-attacking with an intention to insult
- Defensiveness- seeing yourself as the victim, blaming partner
- Criticism- attacking your partner’s personality or character
- Stonewalling-shutting down all together, going silent, this is the most dangerous of the stances, since couples usually disengage and stop trying to “remedy” their relationship.
How Can a Marriage Therapist Help
Having specialized training in the Gottman method of couples’ counselling, I can support you to tackle the negative patterns of conflict resolution in your relationship. I can help you to engage in more effective communication strategies with your partner. If you naturally hold your partner in contempt, I can support you to learn to appreciate them in moments of tension. If you find yourself getting heated quickly in arguments and reverting to criticisms, it might be important to learn strategies to have softer start-ups. If you find that you naturally become defensive and are looking to blame your partner for their faults, it will be important to work on taking responsibility for your actions. If you find that you often feel overwhelmed when in arguments and tend to shut down, it will be important to begin to develop physiological soothing techniques.
CHILDHOOD OF INVALIDATION
- Are you experiencing tension with your family
- Did you grow up in an environment of ongoing tension, fighting and hostility
- Do you find it very difficult to manage your emotions because of their sudden and extreme nature often feeling like you are in crisis
- Do you find it difficult to have stable and healthy relationships
- Do you engage in behaviours of self harm, suicidal ideation or substance abuse
- Do you often question your self-worth or feel unworthy of love
- Do you desperately long for security but find that you often feel lonely
How is family related to our sense of self
Developmental psychologists will often use the term “attachment” to refer to the way in which we connect to our primary caregiver. Typically referring to the mother, but in her absence, this could sometimes be a father or grandparent. It is from this early relationship that children learn their place in the world, by the quality of love and care that they receive from their caregiver.Children that grow up in unstable and conflictual environments often get confusing messages about safety, stability, and connection. Due to their environment being chaotic and conflictual, they can often become young adults that lack parental validation and find themselves suddenly getting intense surges of emotions. Some will go on to cultivate equally volatile friendships and romantic relationships, mirroring their upbringing. While, others will prefer to avoid connection and closeness due to the associated fears of instability and turbulence.Effective Treatments:
Dialectical Behavioral Therapy (DBT)
- Support-focused: It encourages you to draw on your strengths to look at yourself and your situation in life.
- Cognitive-based: DBT helps you to identify thoughts, notions, and assumptions that make your life more difficult.
- Collaborative: There is an ongoing engagement between the therapist and yourself to problem solve and engage in various role-plays, homework assignments and self-soothing (mindfulness) exercises. The practice is encouraged on a weekly basis in order for you to learn, apply and master the DBT skills.
Historically, the majority of research in this area was based on the experiences of war veterans. Later, parallels were seen in the experiences of others who had experienced distressing, upsetting, or scarring events. Types of Trauma
- Child Abuse
- Mass Interpersonal Violence
- Natural disasters
- Large-Scale Transportation Accidents
- Fire and Burns
- Motor Vehicle Accident
- Rape and Sexual Assault
- Stranger Physical Assault
- Intimate Partner Violence
- Sex trafficking
- Witnessing or Being Confronted with Homicide or Suicide of Another Person
- Life-threatening Medical Conditions
- Emergency Worker Exposure to Trauma
What are the long-term effects of trauma?
- Reduced capacity to regulate affective states-often feeling hyperarousal, dysphoria, becoming “triggered”, all or nothing approach, compulsive/inhibited sexuality and suicidal ideation/self injury behaviours
- Distorts a person’s ability to remember and make sense of the world. Often this is experienced as amnesia/hyperamnesia, dissociative experiences and reliving experiences (often multisensory).
- Alters an individual’s sense of who they are, often feeling a loss of self, shame, guilt, and self-blame. In addition, to a a sense of defilement or stigma and a sense of complete difference from others.
- Changes a person’s perception of the perpetrator, causing a preoccupation with the relationship and with the perpetrator (including revenge), unrealistic attribution of total power to perpetrator, sense of special relationship, acceptance of belief system of rationalizations of perpetrator.
- Impacts an individual’s relationships with others and their ability to relate to others (interpersonal trauma), which often leads to confusion around the nature of interpersonal relationships in general. The trauma can cause general isolation and withdrawal, reduced capacity for empathy, disruption in intimate relationships, repeated search for “rescuer”, persistent distrust and diminished ability to assess interpersonal danger.
- Affects an individual’s biologically, when the central nervous system gets overloaded and physiological consequences include: an exaggerated startle response, startled habituation, chronic hyperarousal, physical symptoms (headaches, nausea, stomach pain, GI problems, etc.) and alexithymia.
- Alterations in an person’s system of meaning that include a loss of sustaining faith or spirituality, a sense of hopelessness or despair, reduced capacity to imagine a future and difficulty finding meaning in life.
Trauma Recovery In Therapy Stage Approach (Judith Herman, 1992, Trauma and Recovery)
- Safety and Stabilization
- Coming to Terms with Traumatic Memories Integration,
- Reconnection and Moving On
Eight Keys To Safe Trauma Recovery (Babette Rothschild, 2010)
1. Plot Your Course With Mindfulness.
2. Begin With Your Epilogue…
3. You Made It.
4. Remembering Is Not RequireStop Flashback.
5. Reconcile Forgiveness and Shame, first, share your shame and second, forgive your limitations
6. Take Smaller Steps for Bigger Leaps- Most traumatized client cycle between too much (hyper) and too little (hyper) arousal. Beginning to work on the optimal zone of arousal and effective functioning is very important in therapy.
7. Develop Grounding Techniques- A set of strategies used to detach from emotional pain by bringing the focus to the outside external world and away from the self. Mental techniques can include describing objects, counting items and using humour. Physical Grounding can include running cold water over hands/face, touching objects around you, carry a grounding object in your pocket and noticing changes in your body. Lastly, soothing strategies can include saying something kind to yourself, remembering words in an inspiring song, poem etc.
8. Get Moving
Hannah Esmaili-Counselling2Wellness Inc. 2896 Bloor Street West, Etobicoke, ON 416-999-8618