I have been humbly honored to speak on a panel after a viewing of the documentary viewing of Angst. This is an event sponsored by Gathered and Grounded in Decatur, GA, opening a much needed discussion and promoting awareness about anxiety within our children, teens and adults in our community.
After the first viewing, I came home glowing with ideas, and suggestions that I wanted to add to the discussion. Time was limited, and we were rushing home to watch the Eagles defeat the Patriots in the LII Super Bowl, so I decided to briefly construct a post to unleash the cognitions within my mind to continue to hopefully add to the discussion and bring awareness about how far our research has come to help heal these “disorders.” And to open the door to options of treatment modalities that are proven to be effective in reducing anxiety within these populations.
The Angst film is wonderful and impactful, but left many in the audience with questions about how to specifically help their children. The movie focuses on a specific therapeutic approach called Exposure Therapy, which has been around for some time and has been proven to be effective, but it is therapeutically led by a trained professional which can be limiting, and often hinges upon expensive and impractical ideologies (i.e. to conquer a fear of heights, one might go skydiving). These types of therapies remain useful and necessary and are indeed effective to certain subgroups. Whatever boat you take to get to the other shore is fine by me. It is all useful. There is no better than here, it is important to remember to use what uniquely works for each individual. But I would like to point out that there are many other advantageous treatments that are more pragmatic, cost effective, and can be led by oneself, meaning once you are taught how to do it, it is a skill that is now acquired and can be used anywhere at anytime without needing a therapist next to you. One such technique is mindfulness meditation and compassion training. I also want to mention that one of our main concerns in psychology and neurology is that in large part it still is being addressed and taught from a neck up model. Leaving everything from the neck down irrelevant. It doesn’t embrace the somatic equation in the healing formula. And the more we learn in our research and neuroscience, we understand how physiological anxiety and trauma are. We have to start including the somatic embodiment of treatment because the mind/body is not separate. I will embark and journey into that dialogue today. I also want to talk today about how we already have everything we need inside of us to heal, we can essentially excavate this knowing and become our own healers. Although it might be pertinent to have guidance of a professional, a lot of what I am discussing involves mindfulness and meditation as a tool that provides you with actual skills that you can learn and take with you on the go, and essentially take your therapist/patient training wheels off, leaving you in charge of your own growth and healing. We are born to do this, and are innately equipped with everything that we already need to survive and flourish. And one advantage with meditation and mindfulness is that it readily uses the breath and fortunately, this is something that we cannot forget or leave behind. We always have it with us.
The movie also stresses the importance of talking about your anxiety to teachers, therapists, and/or family members. I think talk therapy has always been good therapy, and in our culture with our insurance structure it is not going anywhere soon, I think it will in fact, always be around. Therapy provides people a space where they can really get to know themselves intimately, where they can examine themselves in a unique observing technique without judgments, and begin to witness their inner dialogue and negative self-talk. Talk therapy is a step toward reaching an understanding, a more profound awareness and consciousness about oneself. The intimate interchange of people really talking about their deepest feelings and their deepest pain and having people or therapists listen non-judgmentally has always been a very powerful human experience. But it is not the whole of treatment for anxiety and trauma. This is largely because what we now know in neuroscience is that anxiety and trauma impact and impede the areas in our brain that allow us to cognitively understand what is happening, because it is rooted in our bodies. We have to incorporate a somatic component into our treatment modalities for our anxiety and trauma to move out and dislodge from its roots, or we keep it stuck within us in dormancy indefinitely.
What traditional therapy ignores is the sensate dimension of these experiences, and we cannot reduce a somatic experience to talk therapy alone. Wilhelm Reich and Peirre Janet and other leaders like Dr. Van Der Kolk, over the past 150 years or so noticed the somatic dimension of it. Psychology training is still based in the Western medical training model, and it’s amazing how psychiatrists still today don’t pay much attention to the sensate experience of it all. Western culture is astoundingly and uniquely disembodied. We have separated and divided ourselves from body and mind.
With new developments in research, psychology and neuroscience we are coming to conclusions that anxiety and trauma are sensory experiences. Anxiety and trauma lodges in the body. Some experiences imprint themselves beyond where language can reach. There are new state-of-the art therapeutic treatments including meditation and mindfulness, yoga, body work, eye movement therapy (EMDR), emotional freedom techniques (EFT), biofeedback therapy, Feldenkrais, or craniosacral work, or rolfing. Most of these therapy treatments have been around for millennium, but unfortunately they still remain on the edges.
Anxiety and trauma perpetuate within someone when they cannot integrate what is happening within their bodies and mind to their actual realities. Their reactions are grandly disproportionate to the events that are happening. For example, planning a dinner party for 25 people can be interpreted as a run-for-the-hills emergency triggering the threat response. This is painful and debilitating and can cause immobility in some. But this is how someone with anxiety and trauma scans their everyday world. There perceptions are being colored from the amygdala part of the brain, where we perceive danger. It is over-activated and on high alert. Unfortunately the amygdala still holds a sentinel position within our brain, although our society has become much more sophisticated since we were hunters and gatherers, and it no longer requires this type of fear-based scanning of our environment. For people with anxiety, we need to essentially up-regulate their para-sympathetic nervous system and help them become agents in their own recovery by regaining a sense of safety within their own bodies. We do this by recognizing what exactly is going on within our bodies and our minds. We are essentially strangers to ourselves and when we don’t feel safe within our own self, if even the slightest occurrence of life bumps into us from our external environment, we are sent into overload. This is a
very painful existence day in and day out and leaves one feeling exhausted, overwhelmed, and stuck. Before we end up in the downward spiral, I want to point out that I see continuously an astounding amount of integrity and creativity, good-will, resiliency, and benevolence around me every single day. I see and hear people who are facing their adversity, emerging from underneath it and still maintaining great humanity and faith that we are survivors. I hear from people who have experienced horrendous things, but at the same time they are healing themselves, carving out more consciousness and compassionately spreading more democracy around the world. We are innately compassionate beings, and we are fully capable of flourishing and cultivating our own well-being to thrive in this world.
The good news is, we are an incredibly resilient species, we are wired for our survival and part of that survival depends on our co-regulation and connection with others. If we are around people who love us, provide us with safety, security, and nurturance, then we can survive even the most horrendous events. But particularly wounding trauma and paralyzing anxiety occurs when we are hurt or betrayed or wounded or harmed in some way, at the hands of people who are supposed to take care of you, love you and protect you. In these instances, you were not allowed to feel what you feel, to know what you know. This is traumatic. And we don’t feel understood. When we are only allowed to feel two emotions (i.e. “fine” and “happy”) we corner ourselves into self-damaging territory that if we feel anything else, something perhaps is wrong with us. Our mind cannot integrate what is going on, and you get stuck in an anxiety loop. So the social context in which this type of stress occurs is fantastically important. We need to reintegrate what is happening in the interpreting, projecting mind into a story, a narrative that can help the body recognize the present moment as not threatening and relax in the present moment. People who suffer from anxiety and trauma continue to have the same story ruminating in their cognitions. They cannot transform it to match their actual reality, which is usually not impending doom like being chased on a savannah by a saber toothed cat. But to do this, we start with introspective awareness into our bodies. Discover what is happening within our inner landscape and become familiar and intimate with it. Become safe in our own bodies.
Traumatized and anxious individuals have a repetitive fear based narrative that becomes body memory. It is a neural net of memory and not just about words that you can formulate. It can become implicit memory, which just means, not conscious memory. This is not something you can think your way out of, or something you can just figure out by talking about it. This is about your body, your organism, having been reset to interpret the world as a terrifying place and yourself as being unsafe. This has nothing to do with cognition. And this is why it can be so very frustrating to someone who suffers from anxiety when people say to them, “You shouldn’t feel that way,” or, “You’re not a bad person,” or “It’s not your fault.” Because the anxious person will respond, “I know that, but I feel that it is.” This is not cognitive, it’s somatic. So to reduce it, ease it, we need to work somatically with it to get it unstuck.
We are learning how imperative it is to reintegrate people with debilitating anxiety and trauma with their bodies. Mindfulness and yoga are some of the best modalities that are proven to be effective and help people with anxiety and trauma because it gets them back into their bodies. When you have chronic anxiety and trauma the sense of safety and goodness essentially disappears out of your body. So reintegrating with present moment awareness and feeling relaxed and safe and totally enveloped with goodness within oneself again is critical in recovery. Mindfulness and compassion training focuses entirely on coming back into the somatic sense of oneself, creating an intimate connection within your body and reigniting a sense of safety and protection. The core experience of ourselves is somatic and the function of the brain is to take care of the body, so we need to work with integrating them into the same narrative. When this is practiced and accomplished, proper healing can happen. Resiliency is born and an individual can learn to lean into whatever arises within their life. Difficulty, adversity, stress, happiness, joy, whatever arises is okay, because they have learned to surf on the waves of their emotions and thoughts and not drown in them. In mindfulness we disentangle ourselves from our thoughts and in yoga we disentangle ourselves from the stuck energy within our bodies. We build a safe, strong and secure platform from which we can launch from into our lives fearlessly.
What we can see clearly trending up in the new neuroscience research is that the parts of the brain that help people see their realities clearly and their ability to perceive and observe things as they actually are gets interfered with by anxiety, fear and trauma, and the imprint of anxiety, fear and trauma is in areas of the brain that really have no access to cognition. There is an area called the periaqueductal gray, which has to do with the freeze/immobility state and the total safety of the body. And the amygdala, which is the smoke detector signaling danger to your brain, which is where trauma and anxiety land, and makes that part of the brain hypersensitive or renders it totally insensitive.
Another thing that happens in the midst of extreme anxiety, panic, fear or trauma, and this has happened to most all of us, is when we get really upset with someone, say your kid, you suddenly take leave of your senses and you say things that you don’t mean. The part of the brain that is affected here is called Broca’s area and during these high anxiety ridden states it shuts down. This part of the brain is responsible for and helps you say reasonable things, and when it shuts down your whole capacity to articulate in wise responsible ways disappears. You “flip your lid” so to speak. Meaning your pre-frontal cortex has literally detached from the signaling of your amygdala and the amygdala is now in charge of everything. This is a very important finding, because it helps us realize that if people want to overcome anxiety and trauma, we need to also find methods to bypass what they call the tyranny of language. The anxiety and trauma is not about being reasonable or articulate. When the reptilian part of the brain, the amygdala, the most primitive part of the brain takes over, that feeling to the present moment and our connection to our body and sense of self vanishes. Mindfulness and somatic practices like yoga that focus on using the breath, allow for a pause, and reset our relationship to our actuality or our present moment.
Anxiety and trauma have the powerful ability to cut one off from their own relationship to their body. In 1872, Charles Darwin wrote a book about emotions in which he talks about how emotions are expressed in things like heartbreak and gut-wrenching experience (Van Der Kolk). We can grasp this right? The understanding that you feel things in your body. And then to Darwin, it became obvious that if people are in a constant state of heartbreak and gut-wrench, they do everything to shut down those feelings to their body. One way we continue to do this is by taking drugs and alcohol, and the other thing is you can just shut down your emotional awareness of your body. So a very large number of anxiety ridden and traumatized people have a very cut off relationship to their bodies. They may not feel what is happening in their bodies. They may not register what goes on with them. What becomes clear is that we need to help people for them to feel safe, feeling the sensations in their bodies, to start having a relationship with the life of their organism and be able to turn inward as a safe place of refuge.
Yoga and meditation are wonderful methods for anxious and traumatized people to activate exactly the areas of the brain that allow a sense of cautiousness when things are actually dangerous, or just being perceived as a threat and being able to use discernment between the two. Yoga and meditation also activate areas of your mind that you need in order to regain ownership over yourself. These of course are not the only ways, but they are an important component of an overall healing program. It engages your body in a very mindful and purposeful way, with a lot of attention to breathing in particular that is a powerful reset button to some critical brain areas that get very disturbed by trauma and paralyzing anxiety. It really activates the sense of the experiences of feeling weight and feeling your substance, really feeling your body move and the life inside of yourself can be seen as safe and nourishing is critical.
The notion that you can do things to change the harmony inside of yourself is still new to our Western society. It is not something we teach in our schools, to our children, in our churches or in our religious practices, or in our culture. If you look outside of the U.S. many cultures at large have inculcated the mind/body connection since birth. Children are raised with a conscious awareness that mental and somatic experiences are an integrated whole. This connection is the path forward to our health and well-being. We are pioneers and this is a new frontier. As Thich Nhat Hanh says, “The way out, is in.” Come home to yourself through your breath awareness. Heal yourself by healing your body. Let’s follow our great leaders like Maya Angelou, Toni Morrison, His Holiness the Dalai Lama, who have faced their adversity, their insecurities, vulnerabilities, their suffering by leaning into it with fearlessness. We can overcome our anxieties, and fears by practicing mindfulness techniques and moving our bodies in mindful exercises. We are designed to flourish and already have everything we need to promote our well-being, health and happiness.
I would like to end today with a short parable by Pema Chodron on how to defeat fear. I taught this parable to my son at age 7 (he is now 11 and still quotes it).
I hear from so many parents, teens and children that they are fearful to do what they really want to do, or try. They ask, “How do I deal with that fear?
Chodron offers a practical solution: feel the fear, honor the fear, even hear out the fear. But never, ever do what fear tells you to do.
So, if we can make friends enough with our fear, we’ll be able to distinguish between our relationship with fear and action based on fear. Just don’t act on the fear. Then you’re in control.
Here’s Pema Chodron’s parable:
“Once there was a young warrior. Her teacher told her that she had to go to battle with fear. She didn’t want to do that. It seemed too aggressive; it was scary; it seemed unfriendly. But the teacher said she had to do it and gave her the instructions for the battle. The day arrived. The student warrior stood on one side, and fear stood on the other. The warrior was feeling very small, and fear was looking big and wrathful. They both had their weapons. The young warrior roused herself and went toward fear, prostrated three times, and asked, ‘May I have permission to go into battle with you?’ Fear said, ‘Thank you for showing me so much respect that you ask permission.’ Then the young warrior said, ‘How can I defeat you?’ Fear replied, ‘My weapons are that I talk fast, and I get very close to your face. Then you get completely unnerved, and you do whatever I say. If you don’t do what I tell you, I have no power. You can listen to me, and you can have respect for me. You can even be convinced by me. But if you don’t do what I say, I have no power.’ In that way, the student warrior learned how to defeat fear.”
Dorsal periaqueductal gray-amygdala pathway conveys both innate and learned fear responses in rats.
Kim EJ, et al. Proc Natl Acad Sci U S A. 2013.
· 1Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA. Citation: Proc Natl Acad Sci U S A. 2013 Sep 3;110(36):14795-800. doi: 10.1073/pnas.1310845110. Epub 2013 Aug 19.
Connections between the central nucleus of the amygdala and the midbrain periaqueductal gray: topography and reciprocity.
Rizvi TA, et al. J Comp Neurol. 1991.
· 1Department of Anatomy and Cell Biology, University of Cincinnati, College of Medicine, Ohio 45267-0521.
J Comp Neurol. 1991 Jan 1;303(1):121-31.
Brain rostro-caudal interactions in memory and emotion
Role of the amygdala and periaqueductal gray in anxiety and panic
Laboratory of Psychobiology, FFCLRP and Center for Neuroscience and Behavior of the University of São Paulo, Campus of Ribeirão Preto, SP 14040-901 Brazil
Department of Pharmacy and Pharmacology, CCBS, State University of Maringá, Maringá Brazil
Received 1 January 1992, Accepted 1 October 1992, Available online 7 March 2003.
Complementary roles for amygdala and periaqueductal gray in temporal-difference fear learning
Graeff, Frederico & Cristina L. Silveira, Maria & Nogueira, Regina & Audi, Elisabeth & Oliveira, Rúbia. (1994). Role of the amygdala and periaqueductal gray in anxiety and panic. Behavioural Brain Research. 58. 123-131. 10.1016/0166-4328(93)90097-A.
Neural Correlates of Fear in the Periaqueductal Gray
Thomas C. Watson, Nadia L. Cerminara, Bridget M. Lumb and Richard Apps
Neuroscience and Psychoanalysis
Book by Allan N. Schore, Bessel van der Kolk, David Mann, and Georg Northoff
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Book by Bessel van der Kolk