What if I’m going crazy? What if it's contaminated? What if I lose her? - How to Be Free of OCD

OCD refers to obsessive compulsive thoughts and behaviour. These can include obsessive thoughts around four types of vulnerabilities which are: 1) health and illness, 2) danger, 3) poverty and 4) losing control.  Specifically, we can think obsessively about sex, death, relationships and contamination, amongst others. We may behave compulsively by cleaning, checking and double-checking or repeatedly asking our partner the same question. We also tend to avoid certain situations which make us feel particularly anxious. On a physical level, it is common to experience a tightness in our chests, shallow breathing, sweaty palms, palpitations, dizziness or brain fog when in the grips of obsessive and compulsive thoughts and behaviours. We may also generally feel low in mood, lonely, empty and tired because of our condition. 

What If?

Underlying the specific nature of the thoughts and behavour is the ‘what if’ question. For example, ‘what if I didn’t lock the door on my way out?’ Or, ‘what if the food I am eating is contaminated?’ Or, ‘what if I picked up the knife and tried to stab someone else (or myself) and what if this means that I am going crazy? In his highly acclaimed book, ‘Freedom from Obsessive-Compulsive Disorder: A Personalised Recovery Program for Living with Uncertainty, Dr Jonathan Grayson explains that regardless of what the specific nature of the OCD is, the bottom line is the difficulty living with uncertainty. He goes on to say that whilst we all struggle with uncertainty to an extent, particularly around the existential uncertainties in life such as birth, death, life changes etc., those with OCD find uncertainty and the resulting anxiety, particularly difficult to manage. This is at the core of the disorder, regardless of the specific thoughts and behaviours. Indeed, it is common for the nature of the OCD to change over a lifetime. One might start with obsessive thoughts about killing oneself or another and then move on to obsessive thoughts about whether we really love our partner. It is common for OCD symptoms to disappear for months to years or to at least subside and feel more manageable and then to reappear or worsen at life transitions such as graduation, changing profession, getting married, having children or retiring. We can imagine the present subject or subjects of our OCD as the current actors on the stage whilst the difficulty with uncertainty, the backdrop to the scene, remains the same. The scenes and the actors come and go but it is the backdrop, the difficultly with uncertainty which does not change. I use this metaphor because in terms of treatment it can feel tempting to want to ‘talk out’ the OCD. Often this might lead to feeling better temporarily, however since the underlying issue is around uncertainty and no therapist can give us 100% assurance on a ‘what if’ question, it is far more fruitful initially to focus on the difficulty with uncertainty.

Why do some individuals find uncertainty so difficult?

Clinical research shows that there can be neurological differences in some OCD sufferers. To simplify greatly, this means that there are some neural pathways going from the orbital frontal cortex to the cingulate gyrus, to the thalamus and back to the orbital frontal cortexwhich act as a negative feedback loop. See this explanation from the BBC http://www.bbc.co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml

These parts of the brain are responsible for OCD like behaviour. When one of these parts is not working properly then we can have OCD symptoms. Other research suggests that OCD is linked to a  low level of serotonin. For this reason it is worthwhile considering the option of taking an SSRI or anti-anxiety medication, particularly if therapy alone does not help or if there is also low mood, dysthymia or depression. In my experience, clients are often wary of becoming reliant or medication or think that they should be able to ’sort their problems out on their own’. I suggest that taking medication should be discussed with a psychiatrist but can been viewed as an additional support. Sometimes we feel too overwhelmed with our OCD symptoms to be able to engage in therapy. In these cases, medication can help take the edge off, particularly since starting therapy can sometimes temporarily increase our anxiety and worsen our symptoms. However in my clinical experience, whilst medication can improve symptoms, it is not enough to stop them and this is why therapy is also necessary.

What is the treatment for OCD? 

Exploration of Adverse Childhood Experiences

Whilst some argue that OCD is purely a biological matter, I have found that all OCD clients have experienced significant circumstances in their childhood where there was a backdrop of uncertainty and a feeling of not being in control. Sometimes it takes bit of exploration to identify this. Many of us feel very protective of our parents. We might feel guilty exploring childhood difficulties with a therapist, as if we are betraying our parents. It is also fairly common not to remember too much about our childhood or to emphasise how we were so lucky and had such a good childhood. The fact is that however good our childhood was, we all experienced some hurts, upsets, minor traumas or full-blown trauma along the way. This is simply because our parents are human and no human is perfect. Even the most well -meaning parents may have unintentionally negatively impacted their child or children. Whether it is because they parented in the same way as they were parented so thought that their behaviour was normal. Or because they were not fully available to their child due to overworking, depression, alcoholism or OCD, amongst others. In fact it is common for an OCD sufferer to have a parent who also struggles. Sometimes the parental wounding can simply be because you have different temperaments. For example, an outgoing mother with a shy introverted child might unintentionally wound the child when she insists that they sing in front of the whole family at every family gathering. 

Schema Therapy

A common theme in childhood experience of OCD sufferers is having felt ‘not good enough’ or insignificant. Perhaps there was conflict in the marital home and the child was not given the attention they needed. Perhaps one had to compete with other siblings who demanded more of our parents’ attention due to special needs. Maybe we were bullied at school and didn’t tell anyone so didn’t get the support we needed. Perhaps we had a parent with a volatile temper and felt as if we were constantly living on egg shells. We might at times have felt alone, insignificant and lacking the reassurance and empathy we needed from one of our key care givers. Dr Jeffrey Young created Schema Therapy which is an effective tool for uncovering childhood situations which have left an unhealthy mark on our psyche. Schema Therapy also provides a treatment model for how to heal these schema. Schema is the name coined to refer tothe particular type of difficult childhood circumstances we experienced that still impact us in an unhelpful way today. These do not need to be ‘ Big T’ traumas. Often ongoing and seemly low-grade traumas such as a parent being preoccupied with depression can have just as damaging an effect.  There are around 18 different schema and the one which relates to OCD is the Vulnerability to Harm and Illness schema.

Gestalt Therapy 

Gestalt therapy posits that anxiety is the feeling of excitement when we are not allowing ourselves to fully breathe. The Gestalt definition of excitement refers to the whole range of outward going and forceful e-motions including not only excitement but all types of anger from feeling irked, irritated, annoyed, frustrated, angry, enraged, hateful, spiteful, malicious, vindictive and murderous, to name but a few. In my experience, clients with OCD often have a difficult relationship with anger. They believe that anger is a ‘bad’ emotion and that it is unhealthy. They may try to bypass their anger. Either we don't feel anger at all or we bottle it up or get angry with ‘the world’, current affairs or  public transport services, for example. We find it difficult to own and express anger assertively and directly to another, usually a significant other. We might be passive-aggressive or deflect our anger by getting irate with the shopkeeper who short-changed us rather than our partner who pissed us off. We fear that expressing anger directly is risky and that we may end up losing the person we love if we do so. We have normally learned early in our childhood that getting angry is risky. We may instead internalise our angry feelings and become angry with ourselves. A common denominator in all OCD clients I have worked with is the very critical inner voice. Often clients are accompanied by a constant narrative about just how terrible, incompetent or ridiculous they are for having OCD symptoms. They blame and get frustrated with themselves. This then causes us to feel even worse about ourselves and never resolves our OCD. Therefore an important part of therapy is exploring how we learned that expressing anger was risky, how we can learn to express it appropriately, and how we can develop a more compassionate voice to ourselves.  Often this  includes experiential work where we look at where the misplaced anger really belongs and where we fight back against the original person who made us feel bad as a child.

CBT

This is clinically proven to be effective in the treatment of OCD. It is premised on the idea that our thoughts affect our feelings which then affect our behaviours. For example a thought such as ‘what if I were to pick up that knife and cut my wrists?’ leads to a feeling of anxiety and a behaviour of eliminating all knives from the house. If we can challenge our thought and replace it with something more helpful then we don’t feel anxious and we are ok with knives in the house. Challenging the thoughts and beliefs entails firstly logging them to see what kind of unhelpful inner talk we have, and then analysing them for cognitive distortions such as catastrophic thinking, ‘black and white thinking’, fortune telling, amongst others. See this link for a full list and explanation of thinking errors. We also look for the evidence to suggest our thought has significance. For example is there any evidence which supports the idea I might cut my wrists? Have I ever done that before? Probably not. The second part of CBT is the behavioural part where we start to expose ourselves to situations and thoughts that are difficult for us until they no longer affect us. For example we tolerate eating with a fork that might be contaminated and when we do it enough times, we realise we can handle the uncertainty and the anxiety that accompanies it and it is no longer a big deal for us.

Mindfulness

To oversimplify, this is holding the knowing that all our experiences are temporary and often momentary. By reframing how we view our symptoms, we give them less power. For example, think about how different it feels to say to yourself, ‘In this moment I am feeling anxious’ or ‘right now i am having a thought that the spoon may be contaminated’ rather than simply focussing on how anxious you feel or how dirty the spoon might be. Mindfulness Based Cognitive Therapy (MBCT) has also been clinically proven to be effective for working with mental health disorders including depression and OCD. A great resource to learn more about mindfulness is Tara Brach's website.

Sensorimotor Therapy

Dr Pat Ogden, co-author of Sensorimotor Therapy offers an alternative to the CBT approach. The idea is that we can alter the faulty neural pathways that lead to OCD and anxiety by introducing somatic interventions. Dr Ogden describes the building blocks of experience which include 1)our thoughts, 2)emotions, 3)body sensations, 4) movements and 5) remembered images, smells or sounds that may come to mind as we focus on these. If we can change one of the building blocks in our well-trodden neural path then we can break the path and behave differently.  This might mean having the ‘what if’ thought but not allowing it to take hold. One of the ways we can break the old pattern is by working directly with our bodies. For example making the opposite movement that our body wants to make when we are feeling anxious such as lowering our shoulders and standing straight rather than raising our shoulders and hunching over. Somatic interventions are also offered for the client to try which help to reduce anxiety. Learning techniques to master anxiety gives us a sense of mastery and can give us the confidence to engage in the next steps of therapy.

I believe that having expertise of all these approaches means that the client and I have a highly equipped tool box for tackling OCD. Some clients are ready to get started with CBT straight away and others find this more difficult in which case we may start with exploring key schema, mindfulness and anxiety management techniques until they feel ready to start CBT. Others respond well to the benefits of a containing and nurturing therapeutic relationship and a Gestalt Therapy approach.

How To Improve Self-Esteem and Self-Confidence.

Get over yourself! How leading a life more ordinary can lead to the Extraordinary!

I was facilitating a therapy group the other day and one of the members talked about what she was learning from struggling academically with a very heavy postgraduate course. She described it as coming to terms with the fact of her ordinariness. By this she meant accepting that she was not special, more gifted or more able to by-pass the struggles that others faced academically. It meant acknowledging her averageness, that she was a fallible, little bit broken and imperfect human being like the other 6.4 billion wandering the earth.

This resonated with me. I thought back to when I failed my dissertation in the final year of my MA in Gestalt Therapy Theory Studies. Up until this point I had always passed assignments well enough to satisfy my ego’s expectations. When I failed my dissertation, with the blood, sweat and tears that went into it, my ego was dealt what felt like a severe and merciless blow. The pain I felt was as much from anticipating re-writing the whole damn dissertation as about the dent in my self-image.

The blow to my ego led to me growing up, and that meant adjusting my self-image by lowering and widening the lens through which I viewed myself. As a child, I was told - as many are, which is both a fortunate and unfortunate thing, that I could achieve anything. Failing was a punch in the face to that belief. It demanded that I accept my ordinariness.

If our self-esteem is based on achievements and praise it is like the little pigs' House of Straw. One puff and it is all blown down. What is missing is a robust and continuous sense of self-worth which is independent of our achievements whether they be glorious, embarrassing, admirable or downright disappointing.

Failing demands we unshackle our sense of self from our performance. It means we separate our sense of being a lovable and worthy human being from the sometime idiotic, regrettable acts we might commit as a fallible person. It means growing up and connecting with our innate sense of self- worth rather than viewing ourselves through the lens we think others see us through.

Accepting our ordinariness means…

·      we are less caught up in demanding perfection of ourselves

·      we are free to do and try without the pressure of having to be so amazing that we do not try at all

·      we feel less anxious and less depressed

·      we get more stuff done

·      we are more able to differentiate between the sometime disappointing and passing behaviours of others and their innate worthiness of our love and esteem.

·      we can incrementally accomplish extraordinary feats

Achieving the extraordinary means…

1)    Identifying and deleting ‘Basic Musts” thinking

Albert Ellis’ Rational Emotive Behavioural Therapy talks of the ‘Basic Musts’ which form part of the erroneous beliefs that lead to unhappiness. We take on these beliefs unconsciously because of past social conditioning, without analysing their validity or the evidence that they are based on. We believe them to be true. Without becoming aware of them and challenging them we go on blindly believing them with all the anxiety, depression, shame, rage and fear that they produce.

These ‘Basic Musts’ include 1) “I must do well and if I don’t then I’m a failure’, 2), ‘I must win the approval of others, if not I’m not worthy’, and 3) ‘life must go my way otherwise it is a catastrophe’. REBT challenges us to separate our actions and behaviours, which may or may not be successful, from our innate self-worth. It challenges us on whether it is possible to be approved of by everyone and asks us to accept that regardless of whether we are liked by some people or not, we are still beings worthy of love. It challenges us to accept that life is not fair and that sometimes shit happens and it sucks but it is always bearable. It is a more helpful way of thinking and provides a sense of inner space and relief.

2)    Practicing zero tolerance of ‘all or nothing’, ‘catastrophising’ and ‘I-can’t-bear-it’ thinking errors.

When I first failed my dissertation I (inwardly) threw a tantrum of distress and despair, telling myself that I wanted nothing more to do with study, that it was ‘all hopeless’. This is ‘All or Nothing’ thinking, one of the Cognitive Behavioural Therapy ‘thinking errors’. Growing up is accepting that we do things and sometimes they work out and sometimes they don’t work out but that doesn’t mean we are hopeless. It is also an example of ‘catastrophising’. In fact, failing wasn’t literally the end of the world. My life continued and the disappointment didn’t last. Lastly, even though I thought that I couldn’t bear it, I could.

Here’s how the “Basic Musts’ can negatively impact us. If we anticipate giving a public presentation we might erroneously think that we need to do a fabulous job, in order to get everyone’s approval and to validate our worthiness. We fear that we will mess it up and die of humiliation and embarrassment. In fact, if that were to happen we would bear it. I’m sure we can all think of situations like that when we did. Furthermore, it is highly likely that the thinking errors themselves lead to the heightened anxiety which lead us to messing up. The anticipation of doing a bad job and the fear of being condemned to a state of unworthiness and  'unbearable; shame and humiliation mean that we probably don’t even try giving the presentation. Or if we do get up on the podium we freeze with crippling fear. Allowing ourselves to do the presentation whilst accepting that we are fallible, imperfect and a little bit broken, and knowing that we are still innately worthy and lovable, takes the edge off and allows more space for the extraordinary to shine through.

3)    Identifying things you would like to do and start doing them!

Put yourself out there even if what you produce is ‘crap’ and allow yourself to achieve ordinary accomplishments. I did this with my final year dissertation which I passed the second time around. I just kept writing even if I didn’t think what I was writing was any good. Accepting my ordinariness also enabled me to reach out for support from experts as I was no longer so fearful about protecting my ego from ‘unbearable’ criticism.

Accepting my ordinariness also allowed me to build a successful career as a psychotherapist. I took the risk of sending my CV off to numerous private clinics and got an interview and job offer with one of them.

Accepting my ordinariness allowed me to apply for a competitive role as group facilitator on a university course when I thought I had no chance at all. When preparing for the interview I allowed myself to be ordinary and decided instead to enjoy the preparation process. I got the job!

As Arnold Beisser, who had a strong influence on Gestalt Therapy says,

 “change occurs when one becomes what he is, not when he tries to become what he is not. Change does not take place through a coercive attempt by the individual or by another person to change him, but it does take place if one takes the time and effort to be what he is — to be fully invested in his current positions.”

Arnold Beisser, MD.  

So I invite you to  get over, under, through, around and about yourself until you discover the Extraordinairyness that lies there sparkling and has been there all along!

When your heart shouts ‘yes’, your ‘gut’ grunts ‘no’ and your head screams ‘I don’t f**king know!!’ - 3 Easy Ways to Make Hard Decisions

3 Easy Ways to Make Hard Decisions.

What should I do? This is a question that takes up a lot of headspace in a lot of people, a lot of the time. I hear it from my clients. I hear it as I ask myself the same question. “Should I relocate to the town or country?” “Should I quit my job or not?” “Should I stay with him/her or go?” “Should I invest or save?” “Should I buy the dress or the jeans?”

Decisions. Why are they often so difficult? How come we can get so tied up in knots trying to make them? For many reasons. Often our minds are filled with ‘shoulds’ about how we should be and act. In Gestalt Therapy theory we calls these ‘introjects’, cultural beliefs we have unconsciously swallowed hook, line and sinker. An example could be ‘life is a struggle’, ‘money is hard to come by’, ‘good things come to those who wait’, ‘duty before pleasure’. If we are trying to make our lives fit into those maxims then it will be difficult to make a decision when what we actually want conflicts with that.

Decision-making is also difficult because it means there is a time of uncertainty. And uncertainty breeds anxiety. Some of us are better than others at living in uncertainty but many of us control freaks freak out when we don’t know. We may grab onto the first decision that unfurls, grabbing it like it was the only sail on a boat in a hurricane. Then we implement the decision, clinging on to it for dear life, even if it kills us.

Others of us, myself included, have made angry decisions. Decisions based on a ‘f**k you’. An example is, ‘”well you didn’t appreciate my work so I’m leaving this job”. Or, “so you kissed that woman in the club, I’m leaving you f**ker!” I’m not saying these decisions are never the right ones but they can sometimes be likened to a childish tantrum. In the aftermath of the decision we start to regret it and feel worse off. Perhaps the more grown-up thing would have been to communicate our pain, disappointment or hurt directly and see if we can change our situation without having to leave it.

So how can we make effective decisions?

One Gestalt Therapy experiment I use with clients is inviting them to map out in a room their different options. For example they designate one spot in the room to represent one option. Another spot in the room symbolises another. Another spot a third, and even more depending on how many options they are deciding between. Then I ask them to stand in each spot and to visualise themselves having chosen that option. I ask them to scan their bodies to notice physical sensations such as tension, ease, excitement, numbness. I then ask them what feelings they associate with the body sensation. There will often be marked differences between the options. Finally I get them to stand at a point where they can survey all the locations in the room and check to see which they feel drawn to. Whilst trying this at home might not lead to the crystal clear ‘a-ha’ moment you are looking for it will certainly help you get a lot more clarity and less headspace taken up with the same old thoughts going around and around.

Another Gestalt experiment is called ‘Head, Heart, Belly’. You got it, I ask my client to speak from these separate parts of their body. That might sound strange but it is simply about getting in touch with that body part and then speaking in the present tense as ‘I’ from that body part. For example my heart might say, “I really want to leave this job, I hate it”. My head might say, ‘I can see reasons why and reasons why not’. My belly/gut might say, “hold on a sec, do you need to leave just yet? Is it so bad? Remember financial security is really important to you. It may be better to build up your options before leaving.”

This experiment can be really enlightening and sometimes a client will get very clear statements from the different body parts, which helps them to decide. However I for one struggle with a ‘knowing’ in the gut and I’m guessing I’m not the only one. For that reason a third technique comes from Marsha Linehan and her Dialetical Behavioural Therapy programme, originally designed for those diagnosed with having Borderline Personality Disorder but actually useful for many different client groups and even non-clients. The concept is Wise Mind, which is different from Emotional Mind and Reasonable Mind. It is a synthesis of the two and she describes it as ‘the inner wisdom that each person has’. A way to access it is to sit still and breathe. We think of our question. Then, as we breathe in we say to ourselves ‘wise’ and as we breathe out we say, ‘mind’. As we repeat this, our attention stays on the area just beneath our belly button, our gut. We do this until our answer comes. If it does not come we trust that the answer will come when it is ready. I have been surprised by ‘knowing’s bubbling up from that area.

One final thing to bear in mind, which is part of Gestalt Therapy theory and also features in Linehan’s book, is that of polarities co-existing. Rather than needing for things to be either/or, both/and is possible. Just as day exists at the same time as night (think different hemispheres), just as we can momentarily feel hatred for someone we love, just as we can want to stay up for late-night movie and want to sleep at the same time. In the same way it is possible to stay in my job and build up my freelance work. It is possible to relocate to the country and commute into the city. It is possible to buy a slightly less expensive dress and still save money. It is possible to stay with our partner and make it very clear we didn’t like the betrayal and wont’ stand for it again. Children tend to make things black and white. Someone or something is all bad or all good. When we grow up we can be left with this hangover. To embrace both poles may feel unfamiliar but it is often the more grown-up choice. A good indicator of whether we have made the right decision for us at this particular point in time is if we end up feeling balanced. Rather than our heart, gut and head screaming in different directions“I don’t know’, we are listening out of a slightly more muted and choral, ‘here we go, here we go, here we go!’

The key to contentment - self approval

A common thread that runs through a lot of the issues my clients bring is validation. By validation I mean the process of being confirmed as ‘ok’, ‘acceptable’ or ‘good enough’.  For many individuals this sense of being ‘ok’ is derived from others or how we imagine others think of us. We need others to consider us interesting in order for us to feel interesting. We need others to think that we are beautiful in order to feel beautiful. We need others to think that we are intelligent in order to feel intelligent. We need others to give us permission to feel ok before we give ourselves permission to feel ok.

And what’s wrong with that you might ask? On the one hand we are social animals so of course what other people think of us is important. If we were not influenced by others’ perceptions, what that would make us? Psychopaths?

There is nothing wrong with being influenced by others. However if you imagine there is a continuum going from one extreme of needing others to validate our experience to the other extreme of not needing anyone to validate our experience, I suggest that being closer to the centre of the continuum would feel better. Firstly, if we are dependent on others’ validation in order to feel ok then we can never feel ok within ourselves. Instead we feel anxious and uncertain each time we think we have upset them.

Secondly it takes up a lot of energy to be constantly evaluating oneself on whether we are worthy of approval. It’s tiring! Not to mention how frustrating and irritating it is to strain so hard for others’ confirmation. Although often we hide these angry feelings from ourselves, they show up when our attempts to get approval from another are rejected. Then we might think, ‘how dare they not like me when I was trying so hard’. We might react to the rejection in a way that is disproportionate to the situation for example feeling furious or devastated.

Lastly, it is often a futile task. Think about the people that you find most interesting or attractive.  They often have an easy-ness about them, the ease of being ok with themselves, the ease of not having to try too hard to please. This enables them to be spontaneous and to feel excited in the moment about their encounter with you. This is what makes them attractive to others. Indeed it is precisely this element of openness and spontaneity that we lose when we are trying so hard to be validated. We may succeed in portraying a polished image however in exerting such control over ourselves we also manage to polish away qualities such as openness, vulnerability, ability to be with uncertainty and sensitivity to the environment and to others. These are qualities which we find endearing in others We’ve probably all been in the presence of people who seem to have mastered the social game and yet they do it by not allowing anyone else a word in edgeways, or by asking lots of questions without giving anything away themselves. Somehow we find ourselves glazing over or getting bored.

So how do we feel more ok with ourselves? Well I can’t offer a ‘magic wand’ cure. However the journey starts with learning to validate oneself more. In order to do this we need to get to know ourselves so that we can connect with our own signs and signals that we are doing ok.  The route to this is through our bodies. Our body sensations and emotions provide important messages about ourselves. From time to time throughout the day try asking yourself the simple question, ‘am I doing ok in this moment here and now?’ Then close your eyes and go inside to feel the answer.  Wait for the voice that may be weak that tells you that you are doing ok. Be patient and let it tell you exactly how you are doing ok in this minute. Notice the body sensations and emotions that go with it. For example a client in therapy looks at me as if seeking my approval on what she is saying. I ask her to see if she can approve of herself. She takes a moment to reflect, notices a warm steady glow in her chest, a quietness and absence of anxiety. She connects these sensations and emotions with something positive. She realises and tells herself that actually she is doing ok right now with me. She even manages to elaborate on why this is. She is self-reflecting, courageously exploring herself and taking the risk of sharing difficult material with me. Indeed therapy is hard so dammit she is doing more than just ok!

So go on, try it and let me know how you get on?

Getting Grounded

I mentioned in my previous article on social anxiety that it was important to get as grounded as possible. When we feel anxious we tend to breathe more quickly and less fully. As a result we can become heady and have physical symptoms such as feeling dizzy, spaced out or numb. Consequently we no longer feel balanced and find it difficult to get in touch with other more supportive states that counter the anxious thoughts for example excitement, curiosity or confidence. Grounding involves being more in our bodies and less in our heads.

I’m not saying that it’s as easy as getting grounded to beat anxiety. Many of my clients have, out of their awareness, chosen precisely not to feel grounded. Feeling one’s body can bring up uncomfortable emotions. Emotions originate in the body and are linked to physical sensations for example a sinking heart and disappointment, a tight chest and anxiety, a fluttering in the stomach and excitement. An individual who has experienced trauma may have ‘escaped’ to their mind or disassociated in order to avoid the harrowing experience and accompanying anxiety. This then becomes a habitual pattern.

However even those of us with no trauma that live in cities are often ungrounded due to our environment. Many of us work in offices surrounded by electronic equipment and the latest technology, spending large amounts of time interacting digitally, being constantly bombarded with news feeds, text messages, television, You Tube, emails, Twitter etc.

So getting grounded is important for all and yet it can be unfamiliar and challenging. For this reason approaching getting grounded with compassion and curiosity rather than with an, ‘I must get grounded’ attitude works best. Here is one exercise to try.

Belly breathing

In a private space, place your hand so it is gently covering your belly. Start by taking a normal breath in and then breathing out normally (not trying to do anything to the breath like extend it or deepen it). When you come to the end of the out-breath and are ready to breath in again, pause for five seconds without breathing. As you pause, push your lower belly out as far as it can go as if you had just eaten a meal that had made you feel bloated (this in itself can be difficult for those who are not comfortable with their body image). After five seconds relax your belly and breathe in. You will notice that you breathe in more deeply as you want to get more oxygen in after holding the breath. Continue doing this for three minutes and building up to ten minutes. Ideally you would do this twice a day. Clients sometimes report having tried breathing when they are feeling anxious and finding that it does nothing at all to help them in that moment. However the best way to benefit from these types of breathing exercises is to do them regularly as a way to keep general anxiety levels down. In that way we are less likely to get into a highly anxious state.

And the science shows that breathing exercises really do work. The reason being that anxiety has a direct effect on our physiology. As I am sure you are all familiar, when we are anxious our flight or flight system kicks in., our sympathetic nervous system. Our adrenal glands, located above our kidneys, start to produce more adrenaline and noradrenaline. Our heart rate increases and we experience physical symptoms of anxiety such as sweating or dizziness, amongst others. By belly breathing we activate the hypothalamus that transmits neurohormones, which cause the body to relax. Deep breathing also directly affects the kidney and adrenal area, also promoting relaxations. Deep breathing therefore activates the mechanisms that cause the body to slow down and relax, the parasympathetic nervous system. So why not give it a try? Set yourself a 30-day challenge of just three minutes a day and notice how much grounded you feel. It is also a useful exercise to do before a big moment such as a job interview or first date as it helps to counter the nervousness that can get in the way of performing your best. I’d be interested to hear what your experience with it is so drop me a line and let me know.

3 Steps to Beating Social Anxiety

I have many clients and potential clients approaching me, wanting to resolve their social anxiety. They describe difficulties in certain social situations, feeling unable to interact with others without experiencing heightened self-consciousness, uncomfortable feelings and accompanying physical symptoms. These can include feeling nervous, stammering, wanting to run away and be alone, sweating, dizziness, feeling numb and palpitations, amongst many others.

Social anxiety is the inner voice that tells us, whilst we are in, or are contemplating being in a social situation, that we are not good enough, not interesting enough, that others are judging us negatively. It can be accompanied by shyness however we can have social anxiety without being shy. This critical inner voice can become so insistent and powerful that it builds a wall between the other/s and us, and we are no longer fully present and available to engage freely with them. Rather than focussing on the interaction we become fixed on our critical voice, which is disapproving of our behaviour. We start to feel a whole host of emotions including anxiety. As a result we feel more and more ungrounded until we are overwhelmed and the only option is to flee.

Social anxiety can lead to avoiding or struggling in certain social situations. These vary according to the individual. Some avoid one-to-one relationships, others avoid group scenarios, for some it manifests at work and stops them applying for roles with more responsibility or a higher profile which includes public speaking.

Why is it? The socially anxious individual considers themselves deficient in certain social situations. Therefore the basic self-belief is, ‘I’m not good enough’. At the heart of this issue is non self-acceptance. Ultimately the key to change is to be in better relationship to oneself: self-acceptance.  This is a theme that is widely talked touted in spiritual and self-help books. I imagine that it is certainly not new to the reader.  But what does that mean? It sounds so simple and yet seems so difficult for many of us to truly understand or put into practice.

Firstly it can help to consider and become more aware of how it is that we have such a harsh relationship with ourselves. I sometimes invite clients to advise an imaginary friend who shares the same social anxiety issues that they have. They speak to their ‘friend’ in a much gentler and more forgiving way than they do to themselves.

In Gestalt therapy we talk about ‘introjects’. These are beliefs that we have taken to be true due to hearing them voiced by our carers when we were too young to analyse them objectively and then perhaps reject them.  ‘You bad girl’ could be one such belief. ‘You ugly thing’ could be another. These are extreme examples however these parental messages can also be implicit. A parent ignoring us when we are angry in order to teach us a lesson, a parent who becomes anxious when we act vivaciously. We deduce from these situations that what we did was ‘not ok’. As a child the next step from that is that “I am not ok’. Children also often pick up these messages about themselves when parents separate or when the family is undergoing huge stress and transition or when a parent becomes less available due to sickness, depression or addictions, amongst other things.

Once we have increased our understanding of the origins of the critical voice then we can start to become more aware of it in our daily life. When we catch our critical voice calling us ‘fat’, ‘lazy’ or ‘stupid’ we observe it. We don’t give ourselves a hard time about it, that’s just being critical about our critical voice (which defeats the purpose!). According to the foundational text of Gestalt therapy theory ‘awareness is like the glow of a coal which comes from its own combustion’ (PHG, 1951:75) i.e. awareness alone is enough to cause change. Therefore simply by noticing our critical voice and how insidious it is, we are already setting in motion a change. After a period of of simply increasing awareness, we can move on to challenging the critical voice. If it accuses you of being lazy how might you reframe that? How would you respond to a friend that described himself or herself as lazy for not preparing for a job interview? You would probably look for other explanations. Maybe their fear of getting things wrong has got in the way of job preparation. Or maybe they don’t really want the job and doing the interview because they think they should, that it’s the kind of job they ought to be doing rather than a job they enjoy. Or perhaps they simply do not have the time as they are also working full-time, running a household and looking after two young children. I invite you to try and speak to yourself from that place of compassion, looking for the good in you rather than what is not good enough. It won’t be easy and it won’t happen every time or even at all to begin with. However it is the first step towards building a better relationship with yourself. And remember, if you do catch yourself repeatedly slipping up then that does not matter at all, just don’t give yourself a hard time about it!

A second way to tackle social anxiety is to become aware of how we ‘project’ our critical voice on to others. Projection is a natural phenomenon common to most of us. It simply means ‘‘a process of disowning an aspect of myself which is then co-created as a relational experience’ (Joyce and Sills, 2010, p115)’ It comes in handy for appreciating the arts such as a painting or a piece of music. It is also necessary for empathy. Through projection we can step into the others’ experience and imagine how they are feeling based on how we might feel in a similar circumstance. However projection is less helpful when we imagine that others are criticising us the way we criticise ourselves. Clients often say, ‘well that’s terrible that I project onto others’. They start to become critical of themselves. I always react with ‘ouch’ when I hear them say that. Firstly I explain that projection occurs at a subconscious level therefore we are not aware that we are projecting. Secondly, giving oneself a hard time about a natural mechanism is simply allowing the critical voice to stamp all over us again. An awareness experiment I suggest instead is a tried and tested Gestalt technique called ‘I notice, I imagine, I feel’. I ask my client to look at an image or if they are up to it, myself and to state what they notice. The aim is to simply state what is noticed such as ‘I notice brown hair’, ‘I notice a leather jacket’, ‘I notice lines on the forehead’. Often individuals doing this exercise say things like ‘I notice she looks happy’ or, ‘I notice she seems strict’, and I point out that this is no longer noticing but imagining. I then ask them as a second step to go with their imagination and say what they notice and imagine. For example ‘I notice the sleeping cat and I imagine it is dreaming’, or ‘I notice the lines in his forehead and I imagine he is angry’. The last step of the exercise is to state the feeling that occurs. For example, ‘I notice the lines in his forehead and I imagine he is angry and I feel worried’. Here we can clearly see how it is easy to imagine all kinds of things about the other based on what we notice, our subjective reality. Individuals who suffer from social anxiety will often imagine that others are viewing them negatively and this experiment is helpful for becoming aware of the projection process and challenging those assumptions.

A third way to beat social anxiety is to feel as grounded as possible. What does grounded mean ask some of my clients. That is a good question in itself and can mean different things to different people. What does it mean to you? There is definitely a link with having a sense of one’s body. The opposite of grounded is feeling light-headed, spaced out, insubstantial. When we are feeling anxious, tight chested and breathless then we are not grounded. When we feel dizzy or have numb or tingling fingers that can accompany anxiety then we are not grounded.  When we are grounded we feel calm and we are often in touch with the feeling of our feet in contact with the ground. Our toes may feel warm and tingly. When we are grounded we breathe lower down in our bellies. When we are grounded we feel balanced.  Some exercises to get grounded include belly breathing, shaking, and body awareness mindfulness exercises, amongst others. I will describe these more in another article.

Conclusion

Just as I have had many clients approach me wanting to resolve their social anxiety, I have had many clients leave therapy with their social anxiety a ‘non-issue’.  Of course there is no magic wand and I am not saying that all it takes is to read and engage with this article.  Each person has their own story with their own particular circumstances that have led to social anxiety. Nevertheless in my experience at the core of social anxiety is always the inability to accept oneself. I’m not saying it is an easy task to change this and it can take time. Often the support of a therapist is necessary. However as we start our journey we find lots of other hidden treasures along the way.

Joyce, P. & Sills, C. (2010). Skills in Gestalt Counselling & Psychotherapy. London: Sage.

Perls. F, Hefferline, R, Goodman, P, (2009). Gestalt Therapy: Excitement and Growth in the Human Personality. London: Souvenir Press Ltd.