I decided to start this blog as a way to share some of what I've learned about the nature of human suffering and its alleviation. I'm doing this mostly with an eye on anxious suffering, and my experience with a new approach to psychological health and wellness called Acceptance and Commitment Therapy (or ACT, said as one word). I won't claim to have all the answers. My intent is to share.

Acceptance and mindfulness-based approaches are changing the landscape of psychology, mental health care, medicine, and society. They are based on a very old and radical idea, namely, that a good deal of human suffering is fed by efforts to struggle with and avoid our own psychological and emotional pain. New research from many sources now shows that this war tends to amplify our pain, takes enormous effort, doesn't work very well, and can keep us stuck and suffering.

So, what's the alternative? The alternative is this: paying attention, on purpose, in the present moment, without judgment, with a quality of kindness and compassion (self and other), and with both eyes on living out your values, right here, right now. These are skills that we all can learn and many studies show that people who learn them report more vitality, less illness, better quality of life, and greater freedom too.

Instead of more struggle, we learn to open up to our experience just as it is (not as our minds say it is), to hold our thoughts more lightly, to connect with our values (what we care about in this life), and to carry our minds, bodies, and personal history forward into a more vital and valued life. This set of very simple ideas goes against just about everything we've learned, at least in the West, since kindergarten. That's why they can be so powerful!

We are all in the same soup. Pain, in all its forms, is part of the human condition. Yet, that pain -- whether physical, emotional, psychological -- need not be fed and allowed to mushroom into the suffering that takes over and shrinks lives. There are ways to douse the flames that feed needless suffering -- the spin off that our mind and old history creates -- and to live well with the pains, joys, and sorrows that are part of life. This is where I think ACT can help.

Peace -john

Saturday, January 10, 2009

What to Do About Panic in the Heat of the Moment?

The title of this post is a version of a reader question, and it is a common one. My initial thought was this: "what can I say when nothing I can say will do?" I'll try to explain.

Panic and anxiety are not choices. They happen. And, we have very little control over what our bodies and nervous system are doing in those moments. Yet, we do have control over how we relate with our discomfort. And, in the heat of the moment, it is natural to want it to stop. Nobody likes anxiety and panic. That said, we need to look carefully at what we do when panic or anxiety rears its ugly head and at the costs and benefits of what we try to do to make it go away.

So, the first suggestion I have is this: to not do what your mind and old history compels you to do if that hasn't worked in the long haul, and instead it had left you with many costs (e.g., to relationships, work, health, freedom, connection, community, and even your spiritual life).

Next, see if you can notice the urge to act on the discomfort. Notice what is going on, and I mean really going on. Your mind will manufacture all kinds of doom and gloom scenarios here -- that's what minds do, and it serves us well sometimes when our lives are truly at stake. Ask yourself if you are willing to get curious about thoughts, physical sensations, emotions, and notice them just as they are. Let me say that this isn't going to switch off your nervous system from doing its thing, but it may give you other options.

Third, see if you can meet the hardness of the panic with a softer and more gentle response. If your panic was a newborn infant, how would you respond to him or her? See if you can extend that gentler response to what is happening in the moment. Remember too that what is soft is strong. If you've ever watched water run over and wear away a rocky stream bed, then you know what I mean. Water can wear away hard rock. Meeting panic and anxiety with a softer response can weaken its impact and choke hold on you so that you can have the space to focus on the things that matter to you.

Now, look around and ask yourself this: right now, what do I want to be about? Here, I am focusing on places that you do have control. One choice is to spend time with the panic, appeasing it, trying to make it go away. You could certainly do that (but again, look at how that works in terms of your life). Another choice, and it's a biggie, is to see if you are willing to do what you wish to do even with your body and mind feeding your all kinds of doom and gloom.

Now, I am not saying this is easy. In fact, everything in the deepest recesses of your nervous system will be pulling you to stay put, struggle, cope, breathe, run, etc. Yet, you do have control over how willing you are to have what you are having, and what you do next, and next, and next. This is a courageous move, and a risky one in the sense that you risk getting a different outcome in your life by doing something new. Most people know what they get when they let anxiety and panic run the show, and with that the risk seems great -- more of the same, meaning suffering.

The interesting piece here is that panic and anxiety may morph when you meet it will willingness to have it, and with a kinder and gentler response. I know this is hard. Many people, including me, have years of experience meeting anxiety and panic with resistance and struggle -- that is, panic is a problem demanding a solution. You can learn to be with panic and anxiety just as it is, and without fighting with it, and with that there is a possibility that the intense emotional pain may change and your life too. Basically, here you are removing the "do something now" from the panic, and so you are left with panic plus do something else (e.g., just acknowledge it, bring kindness, mindfulness, and willingness to it, or notice your mind judging it and you and just let that be). Let your experience guide you, and here look at your life more so than your emotions. Nobody will remember you for your anxiety or panic, but they will remember you for what you did elsewhere in areas of life that matter to you.

This approach takes time to learn, but you can learn to do it, one small baby step at a time. I've found it helpful here to think of myself as being perfectly imperfect, meaning that there is no right or wrong way to go about this. What we all need to do is ask "is what I'm doing working?" The working and doing is key, and it is here that we create -- one small step at a time -- a life worth living.

To summarize: notice the moments of manufactured dread, see if you can meet it with a softer response, and then focus on what you want to be about, right in the moment. A friend once said that when he finds himself in the midst of a panic attack, he simply says "ok, I've be sucker punched, now what?" He ended up finding space to accept himself and his body doing its thing, take 3-5 seconds to just let it ride, and then re-focuses on what he'd like to do, even with anxiety and panic being there as he does whatever that might be.

The good news is this: everything we know about anxiety and panic tells us that it will pass and without us having to do much to facilitate that passing. What gets people into trouble is changing their behavior and lives in the service of avoiding the panic and anxiety. And, for many, these changes get in the way of activities that they care about in life, and so they suffer with the panic and their lives shrinking.

So remember, panic and anxiety is not a choice. You have a great deal of control over how you relate with your emotions and thoughts, and what you do with your hands, feet, and mouth.

Words will not do here. Each of us has to take a bold step to do something new, and that's how we get a different outcome in our lives.

Take it slow. A life isn't created overnight, but rather one small step at a time.

I wish you all well and hope that you had a vital start to the new year!

With a Kind Heart,

John P. Forsyth
Author of The Mindfulness and Acceptance Workbook for Anxiety, Acceptance and Commitment Therapy for Anxiety Disorders, and ACT on Life, Not on Anger.


Sarah♥ said...

This is exactly the thing that stops me from recovery. I KNOW the way i react when panic hits like a ten ton brick and its NOT pretty. I completely lose a grip on reality and i basically fear the worst. The last time i felt like that i was in a bank with my mother but she'd been take off upstairs through 5 LOCKED doors and i sat downstairs and waited. I was there for a good 20 minutes before i started to feel panicky but it was like hitting a brick wall - its just there, right in front of you, AND that is the point where i usually just lose the plot.

This post is very helpful.

nikk said...

Great post - really inspiring. It really does make complete sense. Like the last poster - the trouble is remembering this when you are in the midst of losing the plot, and feel like a dribbling wreck (ha ha writing that made me chuckle) - all sense seems to fly out the window. I guess it's just a case of practise, practise, practise.

Tony Chen said...

Dr. Forsyth,

I think the consequence of my having anxiety is deteriorating shoulder pain. Your post is really refreshing! Now, I am aware that the more I fight with my anxiety, the stronger it will be. Although I might not fully understand everything you said in the post, I even feel the release of my shoulder muscle while I was reading this post. Thanks again.


Omar said...

Hi John,
I liked the part that you said about taking one step at a time. I used to always be in a hurry, until I started getting episodes. I was always trying to do to much. Sometimes we need to learn how to relax and live a little. There are somethings in life we can not control, we got to learn how to let them go. I have learned how to control my anxiety, but no matter what its something that will always be there.

Think more positive for those of you who lose your grip. The way I see it, anxiety has made me more mentally stronger and has taught me, like John said, how to live a little slower and put one foot in front of the other.

Don't be scared to LIVE,

catler said...

Hi John
great post. When you see it in black and white and written out in front of you and taken one step at a time it seems so easy. The hard bit as you rightly say is actually following it through, its risky but rewarding. Keep up the great work

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