Some patients have tried to convince me that their view is accurate by holding their face at different angles or changing the lighting in the room. “Can’t you see they’re flat?” a young woman asked me about her cheekbones, turning her head and holding it at different angles.Other variations of questioning behavior are asking others how to fix the problem—the best way to curl hair or how to pay for liposuction—or a discussion of the defect and the problems it’s caused. Virtually all one man talked about was his hair—his belief that it was thinning, how his life would be different if it weren’t, and how to fix it. These discussions dominated his conversations with his girlfriend.Reassurance seeking typically causes problems. It can take up a lot of time and be very difficult for family members and friends. Whereas mirror checking, grooming, and picking can be done in private, questioning always involves someone else. If it’s limited to once or twice a day, it’s generally tolerable. But if it’s more frequent, it can dominate and ruin relationships.I’ve been told by many people with BDD that their spouse, girlfriend, or boyfriend left them because they spent so much time talking about, or asking about, their appearance. Other aspects of the disorder—such as avoidance of social situations—often contribute to relationship problems as well. But it’s surprising how often the questioning is considered a major part of the problem.*102\204\8*
Having alluded to failure and some sense of what to avoid, let us proceed to success. The likelihood of success is greatly enhanced if treatment is tailored to the characteristics of the disease being treated. The following factors, always present in the alcoholic, should guide both the planning and process of treatment.
Dysfunctional life-style. The alcoholic’s life-style has been centered on alcohol. If this is not immediately evident, it is because the particular alcoholic has done a better-than-average job of disguising the fact. Thus, the counselor cannot expect a large repertoire of healthy behaviors that come automatically. Treatment will help build these, as well as dust off and rediscover behaviors from the past to replace the warped “alcoholic” responses. This fact is what makes residential treatment desirable. Besides cutting down the number of easy drinking opportunities, it provides some room to make a new, fresh beginning.
Few experiences of handling stress without alcohol. Alcohol has been the alcoholic’s constant companion. It is used to anticipate, get through, and then get over stressful times. Alcoholics, to their knowledge, are without any effective tools for handling problems. In planning treatment, be alert to what may be stressful for a particular client and provide supports. In the process, the counselor can tap skills within the alcoholic to be turned to rather than the bottle.
Psychological wounds. Alcohol is the alcoholic’s best friend and worst enemy. The prospect of a life without alcohol seems either impossible or so unattractive as to be unworthwhile. The alcoholic feels lost, fragile, vulnerable, fearful. No matter how well put together the client can appear, or how much strength or potential the counselor can see, the client, by and large, is unable to get beyond those feelings of impotence, nakedness, nothingness. Even when being firm and directive, the counselor has to have a gentle awareness of this.
Physical dysfunctions. Chronic alcohol use takes its toll on the body. Even if spared the more obvious physical illnesses, the alcoholic must contend with other subtle disturbances of physical functioning. Sleep disturbance can last up to 2 years. Similarly, a thought impairment would not be unusual on cessation of drinking. The alcoholic in the initial stage of recovery will have trouble maintaining attention. There will be diminution of adaptive abilities. During treatment, education about alcohol and its effects can help allay fears.
Chronic nature of alcoholism. A chronic disease requires continuing treatment and vigilance regarding the conditions that can prompt a relapse. This continued self-monitoring is essential to success in treatment.
Deterioration in family function. The family needs as much help as the alcoholic. Better outcomes result when they have a treatment program of their own in conjunction with the alcoholic’s treatment.
ANXIETY DISORDERS: FEAR OF LOSING CONTROL
This is the third most common fear. Our lack of understanding of the disorder accentuates this fear. We feel so much has already happened which we haven’t been able to control, and every day seems to bring with it new symptoms and new fears. We can’t help but feel the time will come when we will lose control completely. People fear they will faint, have an attack of diarrhoea, lose control of their bladder, be sick or literally lose control. Most of these symptoms are a result of the fight and flight response. The more we fear them, the more we turn on the adrenalin. Losing our fear of them turns it off. I will discuss how to in chapter eight.
Loss of control over body
We can feel as if we may lose control of our bowel or bladder, or that we will be sick. Nausea can become our constant companion, and if we look at all our symptoms it is no wonder. Our body does feel as if it is out of control.
When we imagine these events happening, we also imagine our embarrassment and humiliation. Naturally, this only increases the fear.
Again, I rarely meet anyone who has had these fears realised, although people speak of their ‘close calls’. When we learn panic anxiety management skills we can take back the power over the fear and anxiety and turn off the fight and flight response.
Literally losing control
This fear can be terrifying. People interpret it to mean they may act uncontrollably and hurt themselves or others. They don’t.
The fear of losing control completely comes from the loss of control we have already experienced. The harder we fight to get control, the more we lose control. Not over ourselves, but over our life.
I have never heard of anyone losing complete control over themselves. Again, if this was going to happen it would have happened with the first attack. It will not happen in the future. Recovery means letting go of the control we are fighting so hard to maintain. Letting go of this control means we gain control. Being in control means we will lose the fear of losing control completely.
MEDITATION FOR ANXIETY DISORDERS TREATMENT: MISCONCEPTIONS
There are other misconceptions which people have about meditation. Some people see meditation as an escape from reality or a selfish preoccupation. It is neither. A normal meditation time is twenty minutes, twice a day. This hardly constitutes an escape from reality, nor can it be regarded as selfish. Everyone needs to have time to themselves. It is not selfish to want time alone, it is natural and normal.
The disorder and agoraphobia mean we cannot contribute as much as we would like to our daily family situation. Practising meditation can mean a major step for our overall recovery. Recovery means we can contribute more, not only to the family but also to ourselves. Wanting to take time out, to help the recovery process, should never be considered selfish.
Taking the time to stop and meditate can be a problem for some people. Meditation is usually practised for two twenty-minute periods each day, although a number of people meditate for only one twenty-minute period each day and still find it beneficial. Other people tell themselves they can spare no time for meditation at all, despite the fact that the disorder may consume them twenty-four hours a day. It is a matter of making a choice in our priorities. It can mean the difference between ongoing anxiety, and our recovery.
Another myth about meditation is the idea that, when meditating, we may be leaving ourselves exposed to other influences. This does not and cannot happen. Even in the deepest phase of meditation we are always in complete control of ourselves. We are always aware of everything within and outside ourselves. When we are asleep we are not consciously aware of anything, yet we will wake up should there be any internal or external threat. In meditation we don’t need to ‘become’ aware because we are consciously aware, and consciously in control, the whole time.
MEDITATION FOR ANXIETY DISORDERS TREATMENT
Meditation has been the subject of research since the late 1960s and is now being used in many treatments in conjunction with conventional medical practices. It is being used to improve the quality of life for people who have cancer, AIDS or high blood pressure, and to help people who have an addiction to narcotics. Meditation also reduces anxiety levels in anxiety disorders. One study showed ‘significant reductions in anxiety and depression’ and that it is effective in panic disorder with or without agoraphobia and generalised anxiety disorder (Kabat-Zinn 1992).
If we have the ability to dissociate, we will find meditation quite easy, because we are already accessing various states of consciousness. We can use meditation as an ‘exposure’ technique to become more familiar with altered states. The more familiar we become with them, the more we will lose our fear of them.
Our recovery depends upon our ability to bring down and keep down our anxiety level. Recovery means having to change some of our previous ways of dealing with certain aspects of our life. Becoming disciplined in a relaxation technique is an important step in our overall commitment to recovery.
MEDITATION FOR ANXIETY DISORDERS TREATMENT: LEARNING TO LET GO
In meditation, as in any relaxation technique, the first requirement is to let the relaxation process happen. It means not only letting go of our thoughts, feelings and emotions, but letting go of our control. As I have already discussed in chapter three, our need to be in control of ourselves and our environment is one of the major factors in the perpetuation of the disorder. Letting go of this control is essential to recovery.
Some of us find the prospect of letting go in meditation quite fearful. It can be too frightening even to think about it. We may think that by letting go we will lose control, and all our worst fears will come true. This is not the case. By letting go we are actually gaining control, not losing it.
Sometimes we may experience a ‘surge’ attack during meditation. If this or other types of attacks happen in meditation, the secret is to let them happen. Not to fight them, but let them come. We keep our mind focused on our meditation technique. Although this may seem frightening as you read this, in actuality it isn’t frightening. When you let the attack happen and keep focused on your meditation, the attack will move through your body and disappear as quickly as it came. This is taking back the power.
It may take some time for people to gain the confidence to begin to let go of their control. Other people are able to let go within meditation immediately, and as they let go they can meditate naturally and easily. This is the beginning of full recovery. It is a very important step, because meditation teaches us that it is all right to let go of the control we are trying so hard to maintain. As we let go of this control we realise our major fears don’t come true, and as our practice continues over time we begin to understand why they never will.
MEDITATION FOR ANXIETY DISORDERS TREATMENT: GUIDE TO SUCCESSFUL MEDITATION
Don’t set an alarm clock to time your meditation. There is nothing worse than being brought out of meditation by a loud noise. It is quite easy to time your meditation. Most of us place a watch in a convenient position and during the meditation will open our eyes to check the time. After a few days most of us are able to gauge when the twenty minutes are over without needing to check.
Sometimes the twenty minutes are over so quickly we wonder if our watches are working correctly; on other occasions the time seems to go very slowly and we become irritated. If this happens, it may be beneficial to end the meditation session and try again later.
When the meditation session is over, we sit quietly with our eyes closed for a couple of minutes before getting up. This allows us to re-orient ourselves gently and naturally. There may be times when we will need to break our meditation session for one reason or another. If this happens, try to return to it as soon as possible to finish the remaining time. Outside noises may interfere. Acknowledge that they are happening, but don’t become caught up in them. Let them happen and let go of the irritated thoughts.
ANXIETY DISORDERS: ACCEPTANCE
Understanding our disorder is the first step in taking the power back. Acceptance is the second step. When we have been diagnosed as having an anxiety disorder we need to accept it, otherwise we will not be able to recover.
The starting point is to accept: ‘This is me and I have an anxiety disorder’. We need to totally accept the disorder and ourselves, not with fear and not with shame or humiliation, but with understanding and compassion. When we can fully accept ourselves as we are at the moment, we can begin to work towards the future when we won’t have an anxiety disorder.
Even when we have accepted the anxiety disorder it can still dominate our life. Through our fear we remain passive. If we feel angry or frustrated we take it out on ourselves. Why? Why aren’t we angry at the disorder? It is destroying our lives. We need to take the power back. We need to dominate it. Everyone wants to recover, but we need to reach a point where enough is enough. The power of our anger and frustration can motivate us in developing an attitude of, ‘I will recover no matter what!’
‘No matter what’ means our recovery is number one priority. We become disciplined in our approach to meditation or relaxation and our other management strategies.
As our power and confidence develop, ‘no matter what’ means we challenge our thoughts. We challenge our fear. We challenge the anxiety and our attacks. How dare they do this to us?
Have you ever tried to have an attack? Have you ever tried to be anxious? Try. See what happens.
As I mentioned in chapter four, our anger can be the ‘rocketship’ to recovery. We can use our anger and frustration against the disorder, instead of against ourselves. Our anger and frustration can help break its dominance. Our anger at this level of acceptance is stronger than our fear. We take back the power. The dominance of the disorder is broken permanently.
The disorders do feel as if they push us to our limits, physically, mentally, emotionally and in some cases spiritually. We survive
MEDITATION FOR ANXIETY DISORDERS TREATMENT: THE MEDITATION TECHNIQUES
The word technique
The first meditation technique I will discuss is derived from a yoga discipline called mantra yoga. While hatha yoga uses breathing and physical exercise to enter the meditative state, mantra yoga uses a mantra
MEDITATION FOR ANXIETY DISORDERS TREATMENT: THE RELEASE OF STRESS
Each meditation session should be for twenty minutes. In the case of meditation, more is not necessarily better. Within the twenty minutes, accumulated stress and emotions are being released. It is better if this release is done slowly and gradually. If our meditation time is extended, it is possible that feelings such as grief, sadness or anger, of which we were unaware, may arise. As I said, it will sometimes ‘throw out a file’ for us to look at.
On rare occasions this may happen during the twenty-minute sessions. If it does and if we feel distressed, we can reduce the meditation time to ten minutes, gradually building back up to twenty minutes. It is better to cut down the length of meditation time than to stop meditating altogether.
After twelve or eighteen months of regular meditation, session times can be slowly extended up to an hour. The releasing process is an ongoing one, but with experience people are able to understand and not become hesitant if they experience a release of feelings or emotions. Many people actually cultivate such releases because they see how beneficial they are in the long term.
The daily practice of meditation does require discipline, but we shouldn’t feel guilty if we miss a meditation session. Missing one or two sessions happens to everyone. Only after days or weeks without meditating should we seriously question our motivation