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Giving up the struggle

Your most effective defense against anxiety attacks will involve the use of paradox. Dr. Claire Weekes, in her book Simple, Effective Treatment of Agoraphobia, recommends four methods of managing symptoms of anxiety: face the symptoms - do not run away; accept what is taking place - do not fight; float with your feelings - do not tense; let time pass - do not be impatient.

Each of these is a paradoxical response, one that seems contrary to logic. Logic tells us that in a threatening situation we should flip on our Emergency Response, tense the body, and immediately begin fighting. Or if we imagine we will lose, run like the devil before we get hurt.

Instead, what I am suggesting is that you flip on your Calming Response, relax the muscles of the body, don't fight your physical sensations, and don't run away.

It's much like those Chinese finger cuffs we played with as kids. Do you remember them? They were made from a cylinder of thin woven bamboo, just large enough to fit the first finger of each hand into each end. You would give the finger cuffs to an unsuspecting friend and instruct him to place his fingers inside. That was the easy part. When he attempted to remove his fingers, the cuffs tightened. The more he tugged, the tighter the cuffs were. Those darn cuffs defy all logic because they are created paradoxically. To remove your fingers your need to push the bamboo together again with your free fingers, not pull them apart. It is the same with quicksand. If you struggle, you sink. If you remain very still (going against all your instincts), you have your best chance of remaining on the surface.

One of my patients, Michelle R., became so fearful of panic that she stopped driving and avoided taking walks, staying home alone, or shopping alone. After a few sessions she realized that she was contributing to her panic symptoms by her negative comments, which I call her Worried Observer (see Don't Panic, chapter 14) thoughts. One morning, just prior to a business meeting, she caught herself thinking questions such as, "What happens if you feel overwhelmed? Or if you get that panicky feeling?" While asking herself these questions she began to develop symptoms, and moments later she produced an anxiety attack. At that moment she recognized that her fearful thoughts of panic can lead directly to her actual panic symptoms.

From this awareness, Michelle made rapid progress. Several weeks later she began to practice driving alone and to take a few short walks. Her Worried Observer comments continued to hinder her:

"We agreed last week that I would return home from the session by driving on the freeway, and I did. Right before I got on the road I started to feel anxious. I thought, 'What if I get a panic attack and I can't get off the highway?' I remained tense most of the drive, and my hands were perspiring. But I started thinking that I had an option to continue or to stop, and I really wanted to continue. I felt good that I made the progress. The worst part was anticipating the drive, not the drive itself."

Notice how Michelle succeeded in switching from her Worried Observer comments to what I call a Supportive Observer stance. She said that her worst time was before starting the drive, because that is when her Worried Observer typically runs through a series of negative fantasies about the future. She began by worrying about some catastrophic event that might take place if she kept driving. Once she began the drive she shifted into a permissive attitude, giving herself choice. "It's OK to stop driving if I need to. Or I can choose to keep going if I want." By always giving herself supportive options, she gained the confidence to continue. And she was able to follow through on her desire, which was to complete her task.

To handle panic paradoxically is to go against our basic instincts. I knew that Michelle needed to experience some success in managing her anxiety before she would be ready for my next instructions. Now that she was able to persist through mild symptoms and continued Worried Observer comments, I presented the idea of paradox: if you stop fighting panic, it will disappear. For the coming week I gave her the following instruction: "The next time you have fearful thoughts about panic, I want you to try, at that very moment, to have a full-blown panic attack. Tell yourself to increase your heart rate, to become dizzy. Try to produce all your negative physical symptoms."

As you can imagine, Michelle nervously laughed at my suggestion and questioned my seriousness. I explained the rationale behind this seemingly illogical advice. When we become afraid of symptoms we are supporting those same symptoms by establishing an oppositional relationship. The more fearful we become, the stronger they grow. By removing our fear we destroy this complementary relationship. We drain all the strength out of panic, because it requires our resistance in order to live.

In this same way, if you attempt to stop the symptoms or try to fight them, you are simply supporting and prolonging them. If you practice some kind of relaxation technique and then anxiously wait for it to reduce your symptoms, you will be disappointed. As I spelled out in Step 3, techniques will not conquer panic; attitude will.