The Courage to Be Present

Ancient wisdom from Buddhism for today's therapists and clients.

Working Mindfully with Anxiety

A Buddhist Approach to Anxiety & Fear

Lately, many of my therapy clients have been dealing with anxiety. Their first hope is that I will be able to tell them how to get rid of it as quickly as possible-preferably in the next hour. That's certainly understandable. Anxiety is one of the most uncomfortable feelings. Sometimes my clients know why they're anxious, and other times there's no clear reason. Still, they may have a sinking or tight feeling in their stomachs, sweaty palms, shakiness, worrying thoughts, and, most painfully, a sense of fear. Often they have trouble sleeping or have turned to alcohol or drugs in the hope of escaping the awful experience of anxiety. They may feel frozen with fear or so agitated they feel as though they can't hold still. The most common reaction to anxiety is to struggle to get away from it.

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A Buddhist-based mindfulness approach to working with anxiety suggests a couple of things. First, of course, if there's an easy way to relieve one's anxiety-a way that doesn't involve masking it or just distracting oneself-that should be used. The second approach is to work with anxiety by bringing mindfulness to the actual experience. For most of us, this feels counter-intuitive. We want to get rid of our anxiety, not get to know it better!

Let's look at a few examples. Louise was anxious because she hadn't heard from her daughter, Elise, for about two weeks, and they usually spoke by phone more often. Louise imagined all sorts of scary scenarios: maybe Elise was hurt and in the hospital and couldn't get in touch; maybe she'd gotten into drugs like Louise's own brother; or maybe Elise didn't want to talk with Louise. She was afraid that if she contacted Elise, she would think that she had a crazy, over-protective mom. When we explored that fear together, Louise recognized that it really wasn't an accurate portrait either of herself or of her relationship with Elise. She gave Elise and call and was immediately relieved to hear that everything was okay. Elise had been unable to call her because she'd lost her cell phone, hadn't realized her mom would worry so much, and had only just that day gotten a replacement.

In this case, Louise was able to solve her anxiety by examining her own assumptions, dismissing them as unrealistic, and then taking direct action.

More commonly, we can't relieve anxiety so simply. Claire had been to the doctor because of some abdominal discomfort. The doctor told her to try a few things but to also get a pelvic ultrasound to rule out any issues related to her reproductive organs. Claire had to wait a couple of weeks to get the ultrasound, and then she had a trip planned out of town. Claire went in for the ultrasound. If you've ever had a pelvic ultrasound you know that it requires drinking a lot of water an hour earlier. Sitting, quite uncomfortably, waiting for the ultrasound, Claire felt so nervous she was shaking. What if it was cancer? Would she have to, at the very least, cancel her trip and have surgery? Would her whole life change? Would she die like colleague at work had? Leaving the hospital where the ultrasound was done and walking out into the bright sunshine of parking lot, Claire started to cry with fear and also with relief that the procedure was over. At least now she'd know something. Like Louise, Claire's anxiety fed on uncertainty.

The doctor called a few days later with the results. Those few days had been hard as Claire kept up her litany of fearful thoughts. The doctor said that it was okay to go on her trip, but when she got back, she should see a gynecologist for further follow up. There was some kind of a mysterious cyst that should get checked out. During her trip, Claire did her best to ignore the upcoming appointment with the gynecologist. She kept busy in an attempt to distract herself. She drank more alcohol than she usually did and slept poorly. Once she got home, there was another week and a half to wait. During that time, she and I had a therapy session.

We addressed her anxiety in two main ways. First, we worked with helping Claire become grounded in the present moment. This entailed her paying attention to her actual bodily experience. She turned her attention to the places that felt tight or shaky and just felt how they felt. We didn't try to change anything. As she paid attention to her belly, especially, she found that she could stay present with how she was the feelings of soreness and tightness. She noticed that her breathing was quite shallow, and again we worked with letting it be just how it was. As she brought gentle attention to what was happening, her belly began to soften a bit and her breathing slowed down a little. The goal wasn't to get those things to change particularly. The goal was to come into the present moment and to interrupt the pattern of projecting fearful thoughts into the unknown future.

As part of coming into the present moment, we worked also with noticing her sense perceptions: what could she see, hear, smell, taste and touch? Moreover, I invited her to connect with me in the present moment. I suggested that she tune into her own inner experience and alternate that with looking at and connecting with me.

As we did those things, I worked with my own direct experience. I noticed that I was feeling a bit shaky and even anxious. I suspected this was a combination of my own fears about staying healthy as I'm growing older and also some "exchange" with Claire (see the two previous postings). I brought a sense of open acceptance or "maitri" and mindfulness to my own experience. Perhaps Claire exchanged with my own willingness to stay present and not to escalate into further speculation about the future.

The second way we addressed her anxiety was to deal with those scary thoughts and to recognize that they were just thoughts. She was able to "take a step back" and witness the process of thinking. This is often very helpful to clients (and to anyone else): recognizing that thoughts are thoughts and then not particularly "buying them." Especially pernicious for Claire were habitual self-critical thoughts: "I shouldn't be such a baby; pull yourself together!" Most of the time we believe that our thoughts are a true representation of reality. Buddhism teaches us to question that. So, Claire watched as thoughts arose and dissolved and practiced not getting caught up in them. This brought some relief as well.

Claire's "homework" was to practice what we had done in our session: first, bring attention to her present moment experience, especially of her body and breathing and let them be exactly as they were. Doing this while she went for a walk was one option she considered. Second, she was to practice watching her thoughts as we had in our session. In other words, she was to practice dropping the struggle to get rid of how she felt. As we saw in an earlier blog posting (12/24/09), it is the struggle to escape our experience that creates most of our suffering.

She reported the next week that both of these techniques had been helpful. They didn't make her anxiety go away, but it made her experience workable. Sometimes she got caught up in her thoughts, but just as meditation practitioners do, sooner or later she came back to the present moment and had the opportunity to recognize her thoughts as "thinking." She had a couple of days still to go before her appointment with the gynecologist, but she was sleeping better and not indulging her catastrophic thoughts. She was still nervous, but she wasn't feeling overwhelmed anymore.

Another client, Fritz, worked with deep-seated fear that he couldn't attach to any particular reason. He knew that he'd felt it as long as he could remember. Together we speculated that it had much to do with suspected, but unremembered, traumatic events from his childhood. He, too, worked with increasingly allowing himself to feel his direct physical experience. As Chögyam Trungpa, a Tibetan Buddhist meditation teacher, taught, the way to go beyond fear is to go toward the fear. In the context of our relationship, Fritz felt that he could begin to touch into his fear directly. We went slowly, step by step. He could touch into the trembly physical sensations of fear, and then back off. Like many of us, he already knew a good deal about not staying in the present moment.

When he could stay present with the physical, emotional, and mental experience of fear, it began to change without his doing anything deliberate to make that happen. Underneath fear, we often find tenderness and sadness, and this was true for Fritz. These were unfamiliar feelings for him, and they took some to get used to as well. I have found that it is frequently true for men who are often taught growing up that they should be strong and not feel tender emotions.

With Fritz, too, we also worked with any thoughts that arose. In his case, these had more to do with doubts about himself and his ability to tolerate his experience. Like Claire he had some judgments about how he ought to be strong and not feel afraid.

It is important in dealing with any emotions that we not add to our difficulties by pushing ourselves to go too deeply or quickly into them, if we're not ready. For Fritz and Claire this meant going as far as they could without pushing too hard and then backing off. Then, repeating that alternation again and again.

A Buddhist approach to emotions, and especially to fear and anxiety, then, is to bring curiosity, respectful attention, and gentleness to them and to ourselves.

 

 

Karen Kissel Wegela, Ph.D., is a professor at Naropa University and the author of The Courage to Be Present.

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