Using grounded mindfulness to cope with anxiety: Case example
Anxiety causes a great deal of distress and suffering. A common problem with anxiety is impaired attention. The sufferer not only pays excessive attention to distressful thoughts and feelings, but also the quality of attention is often associated with self-judgment and apprehensive expectations about things to come.
Techniques like deep/slow breathing and grounding can be highly effective in managing anxiety. Underlying these approaches is a quality of attention or mindfulness that helps one develop a more accepting and non-judgmental relationship to private thoughts and feelings. Mindfulness helps in gaining separation from worry, edginess and tension; the inner distance acquired allows for the development of adaptive ways of coping with anxiety, such as identifying the source of the anxiety, finding reassurance and discovering problems solving.
The excessive worry and thinking associated with anxiety may be experienced as an upward rise of energy, as if there were too much energy in the head (lots of thoughts) and in the chest (tension and fear); it is like loosing one’s footing (grounding) psychologically and emotionally. Deep/slow breathing and grounding (a sensing and imaging technique) provides one with a way to lower the psychological center of gravity into our body, thereby connecting us more securely to the ground; by regaining “our footing,” it stabilizes and relaxes us.
An integral part of breathing is mindfulness, a shifting of attention from worry and tension to sensing and imaging, toward finding adaptive and positive pathways of experiencing. In addition, the shift of attention increases the distance from the worry and tension; this allows us to manage and tolerate distressful feelings, to develop self-acceptance and to reduce self-judgment by identifying the sources of anxiety and developing adaptive ways of coping. An example may best illustrate this process. Lena’s name is fictitious, and her personal history has been disguised to keep her identity confidential
Lena is thirty-five years old. She is recently divorced and lives with her three children. Lena receives child support, and she also runs a part-time consulting business from her home. After the births of her last two children, Lena became weaker and depressed, and she developed several physical problems. More recently, after her divorce, she became anxious and experienced several panic attacks. Despite all of these stressors, Lena pushes herself constantly, always being busy. She is a wonderful and responsible mother, but she has a hard time taking care of herself. Her anxiety, panic and underlying depression compounded her life and work challenges. Realizing it was essential for her to take better care of her own health and to develop better ways to manage her depression, her anxiety and panic, she decided to go to therapy.
Grounded mindfulness gave her a way to calm herself. The deep breathing helped her learn to relax, the grounding calmed her. She learned to nurture herself in this way, but the deep breathing also gave her a way to learn to identify more with experiences of well-being and less with every day distresses – a shift of attention.
This shifting of attention gave her distance from her distress, and she began to have more and more insights about the sources of her distress. She has always been very hard on herself and highly self-critical; giving herself credit for her accomplishments was not acceptable. Further magnifying this negative attitude, both her mother and her ex-husband have been very critical and rejecting of her views. Throughout her life she has believed that she is unworthy or not good enough; these beliefs often made her feel helpless and hopeless. She coped with this pain by pushing herself to do and endure more, which in turn made her feel more tired and distressed. It became obvious that this manner of coping did not undo the stresses caused by the way she was seeing and treating herself.
Recently, she became keenly aware of this destructive cycle when her ex-husband came to pick up the kids. She witnessed herself getting tense, and when he left, she began to work furiously around the house. But this time, the time she had spent practicing grounded mindfulness began to pay off. At one point, she stopped herself and asked, “What’s going on?” She became conscious of her self-judgments (not good enough, worthless, and sick) and of her attempt to suppress those thoughts and feelings through her busyness. It was quite a revelation for her.
Next day, when she got to my office, she was nervous but excited about her discoveries. In previous sessions, we had worked with her self-judgments and with a technique for accepting and loving herself. In this session, after deep breathing and grounding we began to work in a deeper way with her judgmental side; she could now see this part of herself with more distance. Having more inner space, she could now dialogue with her inner judgment (her inner critic) more effectively, as if it were another person. She learned more about the nature of the critic in her – how it constantly pushed her to do more, to get better health right away, or to find fault with herself no matter how well she was doing.
More importantly, she discovered how this habitual old response would silence her personal expression. Lena had great difficulty in speaking up and setting boundaries. In the past, when she would stand up for herself with her husband, her words would often be turned around against her. Lena was usually blamed for all the problems, and she was often emotionally abused. It was not uncommon for her to suppress herself – “I can’t say anything….Maybe I am just a bad wife.”
Out of this confrontation with herself, she has grown more self-accepting and self-loving. Her ability to speak up on her own behalf has increased. Lena also began to feel less pressure “to get better.” She found that her inner critic was illusory. Lena described this as poking a balloon with a pin; its power deflates and diminishes. Furthermore, Lena's insights gave her a better understanding of her relationship with her mother, allowing her to see the similarities in her relationships with her ex-husband and her mother. These insights have allowed her to more grounded and secure in herself. Quieting her inner critic has reduced her anxiety, and her newly developed self-perspective has given her the freedom to be more healthy and able to better care for herself.
Distressed and Non-distressed (satisfied) Marital Relationships in Couples Counseling
Part I
One of the most disturbing symptoms of a distressed relationship is the escalation of negative behaviors and emotions; these painful and harmful interactions can flare up rather quickly. For example, negative behaviors such as criticisms or withdrawal can be quickly reciprocated by the other partner resulting in a mutual escalation of negative interactions.
One of my roles in couple’s therapy is to protect the couple during couples counseling sessions from these adverse interactions. This protective role and the learning of effective relationship skills are important functions that need to be internalized by the couple.
Distressed couples are more reactive to their partner’s negative expressions than non-distressed couples. Distressed marriages are also characterized by inadequate relationship skills which manifest as dysfunctional expressions of emotions, emotionally invalidating behaviors, and behaviors which inhibit problem solving.Distressed marriages also exhibit a low rate of positive behavior, and a high rate of negative thoughts, emotions, and behaviors.
A common characteristic pattern in distressed relationships shows two predominant themes: (1) while attempting to maintain engagement in a discussion, wives over react emotionally and press to discussrelationships problems, a situation which then can lead to greater conflict; (2) husbands withdraw and disengage from disagreements and conflicts, thus escalating the wives’ attempt to maintain engagement.
Research by John Gottman (1993) suggests that men show a large autonomic nervous system (ANS) response to stress and recover more slowly than females. Males are much moreunpleasantly aroused in a fight than are wives; they are more inclined to avoid repeated situations associated with high ANS states of arousal.This ANS reactivity may have evolutionary survival value. Historically, men as the protectors had to be more responsive to external dangers (fight or flight).
In intimate relationships women seem more willing to engage in conflict and men are more inclined to avoid conflict and stone wall. Wives increase the intensity of expression (raise the volume) to get their husbands to talk, and the husband’s withdrawal may increase the chances of conflict. A cycle of demand /withdrawal, withdrawal/demand is created.
Non-distress wives, on the other hand, in a problem solving discussion, provide a high degree of non-negative replies (e.g., positive ways of looking at things). When they perceive their partner’s messages to be negative, distressed wives display more put-downs, commands and complaints than do non-distressed wives in problem-solving interactions. Distressed wives seem unwilling or unable to provide positive replies to their partner’s negative messages.
Thus, when wives show over-engagement and when husbands withdraw, these reactions represent barometers of distress in marital relationships. Marital success may be a function of the number of negative and positive interactions. Gottman’s (1993) research suggests that marital satisfaction may be measured by a ratio of 5 positive to 1 negative interaction.
Despite the differences and similarities that exist between partners, it is how the differences are handled that predicts future marital distress and divorce. It is the goal of successful marital therapy to help individuals learn how to manage differences. Negative escalation cycles of communication are problems in emotion regulation. Non-distressed couples break the cycles much quicker by responding to negative expression with neutral or positive behavior. Non-distressed wives play an important role in exiting out of these negative cycles, thereby regulating emotion. It appears that the expression of negative emotion in conflict at low or moderate levels is predictive of long-term increases in marital satisfaction. The expression of tolerable levels of negative emotion may facilitate problem solving and can have positive reinforcing consequences. Rather, it is high and chronic levels of conflict that are distressful. The level of conflict that couples can endure at any one time may be a function of their ability to withstand negative emotion. This tolerance may be influenced by historical factors, individual physiological differences in arousal mechanisms and learned responses.
In satisfied marriages, wives often take responsibility for solving and managing difficult conflicts. In egalitarian relationships, husbands seem to also play this role. In satisfying marriages, gender differences diminish with increased expression of emotional intimacy. In such marriages, men are just as likely as women to share hurts, aspirations and problems.
To reduce negative arousal and escalation, men must learn behaviors other than withdrawal. In the past women were given more responsibility for the climate of communication in marriage. Today, more is expected of men; men must also learn to carry more of the responsibility for the quality of communication and the maintenance and development of intimacy.
Beliefs (Exercise for self-exploration)
Make a list of the positive and negative beliefs in any or all of the following areas of your life: sexual behavior, ideas about right and wrong, beliefs about your role(s) in life, your self-worth, your work, friends and recreation, intellectual abilities, creativity, family, and home life, money, love and romance, spirituality, and aspirations, or any other beliefs that you can think of. Choose a number of beliefs that are related to emotionally intense charged events in your life, or you can think of emotionally intense events, and then see what beliefs you hold about the situation (your behavior, your expectations, other’s behavior and expectations, etc.). Then rank these beliefs according to intensity, number (1) being the most emotionally intense. Once that you become more adept you can work with more intense situations.
Our Emotional Intelligence: purpose and tasks of emotions
Our emotional life is the foundation of our interpersonal intelligence, our capacity to relate to others in creative and fulfilling ways. As a form of intuitive knowledge, our emotions play a vital role in communication, fulfillment of needs, intimacy and reasoning. They are a part of our sense of identity and coping strategies which are essential for our adaptation to life. Emotions carry energy and information with the power to heal and protect us.
Learning the role our emotions play in our health, our growth and the healing of unresolved emotional events, enhances our ability to protect ourselves in healthy ways, to be open and confident.
We often view emotions in terms of good and bad emotions: joy and forgiveness are good, fear or anger is not, etc. Yet all our emotions contain information, each with its own character, energy and purpose. Emotions can be seen as energies that protect and strengthen our body. If we honor our emotions, we can use them as an avenue to our growth. Each one of our emotions can be seen as embodying a purpose and fulfilling a task. Problem arise from “clinging” to our emotions, from lacking natural adaptive emotional movement, and from projecting the source of our emotions onto others, for example, not acknowledging our anger and projecting it onto others, or seeing the source of joy and love as existing in others rather than in ourselves; all of these patterns cause problems which bring people into counseling or couples counseling.
Let’s look at a few key emotions. Healthy anger or assentation promotes action in being ourselves and discernment; it removes obstacles to growth and protects us by alerting us to violations of our boundaries. Anger helps restore our boundaries once a violation has occurred and affirms our needs and views. Derivatives of anger such as jealousy, disgust, fury, rage and hatred emanate from the lack of healthy (non-clinging) movement of the natural energy carried by anger/assertion.
The task or purpose of joy is communion or connection, and celebration of life, self and others. In lack of joy, the fire of joy is diminished; and in sadness, there is a longing for joy, communion/connection with self, others and life.
Grief expresses affliction, loss, death. It is a response to what must be mourned, or allowed to move. It is about letting go of what is no longer there or useful in order to make room for something new. Grief can also be an experience of loss of something missing that is needed and without which we cannot be whole, for example, self-worth or connection to our deeper nature. The loss can also be experienced as a sense of shame or unworthiness.
Fear alerts us; it acts as a protector and preserver of life by noticing danger. It answers the question, what must be done or what action needs to be taken for preservation. Terror and panic can act as anesthetics against excessive pain or trauma; for example, in such instances we may dissociate from the experience in order to survive. Anxiety can alert us to the presence of underlying fear; although if not allowed to resolve, it recycles in ways that impairs our balance.
Sympathy promotes understanding, acceptance, caring, nurturing and alleviation of suffering. In guilt, sympathy moves us towards reparation. Sympathy also plays a vital role in forgiveness, the ability to show mercy through strength in not hurting others or continuing to hurt ourselves. Excessive worry emanates from an imbalance in the free motion of sympathy and reflective thought.
We can usually see the free flow of emotions in young children; one minute they may be angry, shortly after happy or scared. Early on in life, children do not seem to hold to any particular emotion for a very long time. As they grow, children start to hold on to particular emotions; they begin to develop a preferred style of emotional coping. Their preferred style carries benefits as well as limitations.
In counseling or couples counseling, it is beneficial to explore these strengths and limitations. For example with anger/assentation as a preferred style, the “anger-out” style can inappropriately manifest as hostility and explosiveness, and it can be fed and colored by beliefs about fairness and being wronged. This style can create difficulties in relationships by displaying a tendency to perceive mistreatment, injustice, or interference in the achievement of one’s personal or relationship goals.
Exploring Personal Beliefs in Counseling
Our experience of reality is determined by the beliefs that we hold about ourselves and the world. Believes are like spectacles through which we see, or like boundaries around us which represent the limits of our experience. Our emotions and behavior are deeply influences by the ideas and beliefs that we hold to be true.
Many of our beliefs represent our acceptance of positions that do not result from personal experience but are the product of suggestions made by our parents and/or society. In our learning process we may accept many ideas and rules that may not be in harmony with our inner nature, these beliefs may not be the result of our choice. These beliefs may be unconscious and continue to affect the way we think and feel. They then control our lives without us knowing it; we may just be barely aware of some internal conflict, pain, health problem, etc. Even though they may be false or limiting, we still continue to indoctrinate ourselves into believing them. The responsibility to change them is ours. We often see these beliefs as a fact of life, and not as beliefs about life.
Some beliefs are interconnected, forming complex structures. These are core beliefs or strong ideas about our experience. This complex structure or belief system forms our self-concept and our world view. Many of our beliefs can generate negative emotions. These same beliefs can cause illness as well. These beliefs may include overgeneralizations, denial of self-worth, faulty values, and impossible goals, etc. Here are a few examples of limiting beliefs : I am sick and always will be, people dislike me, you can’t trust people, I can never do what I want to do, human nature is evil, I am not good, what I do is meaningless, it’s a dog eat dog world, etc. By becoming conscious of our beliefs we can then choose to retain a belief, change it or totally discard it. This gives us a greater sense of control, responsibility and freedom for our life.It may also provide us with the necessary impetus to heal an illness or even redirect the course of our lives.
So many of the difficulties that people come to see me for in counseling are rooted in beliefs that are limiting on dysfunctional. I recently started seeing a woman (let’s call her Leah) who was having difficulties in her intimate relationship. She is smart, capable, warm and caring, but she was lacking confidence in her intimate relationship and at work. Leah said “I always have been too nice; I like to please people and put others first.” I found out that she was afraid of conflict in her relationship, in her family, and at work. Her strong desire for approval prevented her from confronting her boyfriend when he treated her disrespectfully, and at work she was afraid to stand up and defend her ideas. In counseling sessions we explored these issues and sifted through layers of personal beliefs, she realized that underneath her desire for approval was a feeling of shame and a belief that she was not good enough, not worthy. Leah began to see how she viewed herself, her relationship and her work through those glasses; these filters not only created a great deal of suffering but also prevented her from seeing the riches within herself.
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