Transcript A New Perspective on Treating Anxiety and Depression

A New Perspective on Treating
Anxiety, Depression and PTSD
Presentation by Bob Van Oosterhout
MidMichigan Health Park Houghton Lake
NASW-MI State Conference
April 15, 2009
Website: www.bobvanoosterhout.com
Recovery from Anxiety,
Depression and PTSD is a
Natural Process
The role of the therapist is to identify and
remove obstacles to recovery:
• Physical, mental and emotional tension
• Stress, conflict, misperception
• Secondary gain from symptoms
• “Lost heart” – limited opportunities for
growth or fulfillment
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The Heart of Our Work
• The process of recovery results in increased depth of
understanding and appreciation of life and relationships
along with improved clarity of perceptions, values and
priorities.
• It is a personal, cooperative process that is unique to each
situation.
• Treatment tools have no value if the client is not ready to
use them.
• Establishing a limbic connection creates an atmosphere of
acceptance and shared perceptions where timing and
interventions become clear. Tension, impatience,
judgment and thinking in terms of “should” on the part of
the clinician undermine this connection.
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The Nature of Tension
Tension involves resistance
• Physical – continuous contraction of
muscles that develop into habitual patterns
• Mental – narrowing and fixing of
perceptions and patterns of negative
thinking that create physical tension
• Emotional – resisting the full experience of
emotions through breath-holding and
patterns of physical and mental tension
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Physical Tension
• Like pressing your foot on the accelerator
when your car is in park
– Uses up all your energy
– Wears out the engine and transmission
– You have limited control if it slips into gear
• Ongoing process of muscle activity
• Develops habitual patterns of posture and
movement which create additional tension
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Physical Tension (cont.)
Regulated by Autonomic Nervous System (ANS)
• Sympathetic Nervous System (SNS -required for
activity) becomes over stimulated while the
Parasympathetic (PNS - required for health
maintenance) is suppressed (Fight or Flight)
• High levels or intensity of tension stimulates release of
stress hormones which boosts SNS and suppresses PNS
• Creates a self-escalating process when more stress
hormones are released as tension builds, thus
stimulating the release of more stress hormones.
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Mental Tension
• The build up of physical tension is perceived as
an indication of a threat, which
– Narrows focus and perception
– Leads the mind to ask “what’s wrong”
• Thoughts create physical tension when they
indicate a need for action but don’t result in
purposeful activity
• Asking “what’s wrong” from a narrow focus
builds tension, which further narrows focus on
“what’s wrong” creating a self-escalating process
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Emotional Tension
Emotions involve proprioception – Specific muscle
movements are associated with emotions
• Facial expressions are obvious but other muscle groups
move in response to specific emotions
• Resisting emotions involves stopping muscle movement
which creates physical tension
• Tension increases reactivity while decreasing
responsiveness (sunburn, spring metaphors)
• Leads to behavior that creates mental tension
• Release of emotional tension is not necessarily linked
with specific memories (soup metaphor)
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All Symptoms of Anxiety Can Be
Explained by the Build-up of Physical
Tension
Shaking
Heart palpitations
Dizziness
Nausea
Numbness
Tingling
Feel out of control
Excessive worry
Can’t breathe
Chest Pains
Sweating without activity
Feeling of choking
Can’t sit still
Chills/hot flashes
Feel out of
touch/unreality
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Depression Results From Resisting
Emotions which Builds Mental and
Physical Tension
Emotions are physical events which are restricted by
muscle tension. Emotional tension:
• Uses up energy as it narrows focus and responsiveness
• Creates self-escalating mind/body/emotion interaction that
decreases energy and motivation as it limits perceptions and
increases focus on the negative
• Resisting crying increases tension which increases the need to
cry. (Crying is the most effective way to reduce emotional
tension)
• Narrowed, negative perspective leads to hopelessness
• Reduced emotional responsiveness reduces capacity for
pleasure
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PTSD is Caused by Unresolved Deep
Emotional Tension Resulting From the
Perception of Trauma
• Fear is the predominant emotion
• Atmosphere of safety and control is critical
• The amygdala (which bypasses logical thought)
becomes hypersensitive
• Resolution involves clearing “surface tension” and
accepting emotions that arise without resistance
(tension or breath-holding)
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Resolving and Preventing
Physical Tension
• Requires more than relaxation. Balance must be
restored to the ANS
• Rhythmic diaphragmatic breathing stimulates the PNS
and suppresses the SNS
– Precise rhythmic movement of the diaphragm stimulates the
right vagus nerve activating the PNS (proper rhythm is
critical)
– Regular PNS activation over time allows liver to remove
stress hormones from bloodstream restoring balance to ANS
• Grounding reverses patterns of tension while
developing awareness of tension habits.
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Resolving and Preventing
Mental Tension
• Clarify thoughts and perceptions
– Identify nature of immediate threat and separate short
from long term issues
– Understand cause and process for resolving SX
– Choosing “Perceptions that Work”
– Identify strengths, reasons for optimism, obstacles,
options and likely outcomes (“if-then thinking”)
• “Thought Focusing” blocks and redirects negative
mental habits
• Regular meditation develops mental discipline and
perceptual flexibility
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Resolving and Preventing
Emotional Tension
• Accept emotion without resistance as
normal response that all humans share
• Identify and reverse patterns of tension
which restrict emotions
• Understand that emotion results from
perception
• Understand process of recovery from deep
emotional tension
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Characteristics of Effective Clinicians
• Balance, defined as the absence of tension, a state
of relaxed receptivity and perceptual flexibility;
• Emotional openness indicated by an ability to feel
and let go of emotions experienced by the client
without building up tension
• Receptivity to the perceptions and emotions, and
experience of the client that is not blocked by ego,
attachment, judgment, or preconceptions
• Ongoing Reflection and commitment to
improvement
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List of Hypotheses
1.
Recovery from symptoms of anxiety, depression and
PTSD is a natural process when obstacles are removed.
2.
People who have fully recovered from symptoms of
anxiety, depression and PTSD demonstrate an increased
depth of understanding and appreciation of life and
relationships along with increased clarity of perceptions,
values and priorities.
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List of Hypotheses (cont.)
3. The primary obstacles to recovery from anxiety, depression, and
PTSD are 1) Physical, mental and emotional tension. 2)
Conditions where symptoms provide secondary gain; and 3)
“Losing heart” where the client perceives being stuck in a
situation that blocks growth and fulfillment.
(Tension involves resistance. Physical tension is a continuous
contraction of groups of muscles that tends to form patterns
outside of normal awareness. Mental tension results from
patterns of thinking and perceiving that create narrow, inflexible
and distorted perceptions and mental habits that create physical
tension. Emotional tension results from attempting to restrict the
experience of emotion through muscle contraction and breath
holding. There tends to be consistent patterns of physical
tension that are associated with resistance to specific emotions.)
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List of Hypotheses (cont.)
4.
Physical tension limits perceptual flexibility, receptivity, and
the ability to experience emotion while limiting awareness and
the capacity for reflective thought. It creates non-productive
negative thinking which builds additional physical tension
contributing to a self-escalating process. When tension builds,
it creates an imbalance in the Autonomic Nervous System
(ANS) where the Sympathetic Nervous System (SNS), which
stimulates muscle effort is over-activated while the
Parasympathetic Nervous System (PNS) which stimulates
health maintenance and recovery is suppressed. The build-up
of tension triggers the release of stress hormones which, in
turn, increase tension levels while limiting the ability to
recover, creating another self-escalating process. Patterns of
tension form habits of posture and movement which build
additional tension on an ongoing basis.
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List of Hypotheses (cont.)
5.
All of the physical symptoms of anxiety can be explained by the
build-up of excessive muscle tension and increasing levels of
stress hormones in the bloodstream. Cognitive symptoms of
anxiety involve mental tension that both result from and
contribute to a build-up of physical tension.
6.
Depression is caused by a build up of emotional tension which
results from resisting emotion through physical tension and
breath holding. This creates patterns of mental tension which
further compounds the problem. The build-up of tension over
time depletes energy and motivation as it diminishes hope and
clarity of self-perception. Depression is resolved by learning to
fully accept emotion without resistance and breaking habitual
patterns of physical and mental tension. Being able to
consistently cry without tensing or breath holding is evidence of
the resolution of depression.
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List of Hypotheses (cont.)
7.
PostTraumatic Stress Disorder is caused by deep emotional
tension resulting from the perception of trauma. Fear is the
predominant emotion in PTSD. The amygdala, which is
activated during times of intense fear and can stimulate
reactions which bypass the areas of the brain involved in
logical thought, becomes hypersensitive in PTSD. Recovery
from PTSD involves resolving emotional tension by learning
to experience emotion without tension and breath holding in
an atmosphere of safety and control while restoring normal
sensitivity to the amygdala. Resolution of physical and mental
patterns of tension contributes to process.
8.
Full recovery from built-up tension requires restoration of
balance to the Autonomic Nervous System as well as the
ability to accept emotions without resistance, shift perceptions
and redirect thoughts.
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List of Hypotheses (cont.)
9.
The resolution and prevention of relapse for symptoms of
anxiety, depression and PTSD involves 1) Understanding the
nature of the disorder, causes of symptoms, and the process
of recovery; 2) Restoring and maintaining balance of the
Autonomic Nervous System; 3) Awareness of when tension
starts to build and the ability to intervene to prevent it; 4) The
ability to accept and fully experience emotion and crying
without tensing or breath-holding. 5) Awareness of when
perceptions begin to narrow and the ability to reframe them;
and, 6) The ability to recognize thoughts that build tension
and redirect them.
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List of Hypotheses (cont.)
10. The clinician’s role in the recovery process involves: 1)
Creating an atmosphere where the client feels understood, that
their symptoms make sense, and their emotions are a normal
response to perceptions of their experiences. 2) Identifying
obstacles to recovery including stress, relationship or health
issues, addictions, problems, and conflicts while assisting in
the process of removing them; 3) Timing interventions to
match the readiness of the client to understand and act upon
them.
Effectiveness requires 1) Balance, defined as the absence of
tension, a state of relaxed receptivity and perceptual flexibility;
2) Emotional openness indicated by an ability to feel and let go
of emotions experienced by the client without building up
tension; 3) Receptivity to the perceptions and emotions, and
experience of the client that is not blocked by ego, attachment,
judgment, or preconceptions.
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Sources:
Lusseyran, Jacques, And There Was Light, Little, Brown & Co., 1963 and Against the
Pollution of the I, Parabola Books 1999.
Merton, Thomas, The Way of Chuang Tzu, Shamhala Press, 2004 (originally published in
1965) and No Man is an Island, Harcourte Brace, 1955.
Beck, Charlotte Joko, Everyday Zen: Love and Work, Harper & Row, 1989 and Nothing
Special: Living Zen, Harper/Collins, 1993.
Dalai Lama, The Art of Happiness: A Handbook for Living, Riverhead Books, 1998
Chodron, Pema, Start Where You Are: A Guide to Compassionate Living; Shambala, 1994
and When Things Fall Apart: Heart Advice for Difficult Times, Shambala, 1997.
Chittick, William, The Sufi Path of Love: The Spiritual Teachings of Rumi, State
University of NY Press, 1983.
May, Gerald, G. The Awakened Heart: Opening Yourself to the Love You Need, Harper
Collins, 1991.
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Sources (cont.):
King, Martin Luther Jr., Strength to Love, Fortress Press 1981.
Maritain, Jacque, The Person and the Common Good, C. Scribner Sons, 1947.
Mandela, Nelson, Long Walk to Freedom, Little Brown & Co., 1994.
Tutu, Desmond, God Has A Dream: A Vision of Hope for Our Time, Doubleday,
2004.
D’Agular, Fred, Feeding the Ghosts: A Novel, Ecco Press, 1997.
Rawicz, Slovormir, The Long Walk: The True Story of a Trek to Freedom, Lyons
Press, 1956.
Keenan, Brian, An Evil Cradling, Random House, 1992.
Nuernberger, Phil, Freedom From Stress: A Holistic Approach, Himalayan Institute
Press, 1981.
Lowen, Alexander, Depression and the Body, Pelican Books, 1972
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