"Trauma has become so commonplace that most people don't even recognize its presence. It affects everyone. Each of us has had a traumatic experience at some time in our lives, regardless of whether it left us with an obvious case of post-traumatic stress. Because trauma symptoms can remain hidden for years after a triggering event, some of us who have been traumatized are not yet symptomatic."
"Some of the frightening and often bizarre symptoms suffered by traumatized people include: flashbacks, anxiety, panic attacks, insomnia, depression, psychosomatic complaints, lack of openness, violent unprovoked rage attacks, and repetitive destructive behaviors."
Levine, P. A. (1997). Waking the Tiger: Healing Trauma: the Innate Capacity to Transform Overwhelming Experiences. North Atlantic Books: California, CA.
Anxiety is a fascinating topic, one that I have learned is integral to the work of therapy. There are many different perspectives upon and ways of understanding anxiety, and I have found the framework provided by psychodynamic psychology in general and ISTDP therapy in particular to be paradigm shifting. What is most important to communicate, I think, at the beginning of therapy, is the difference between fear and anxiety. Fear is a response to an external, clear, and present danger, while anxiety is the activation of this same fear system in response to an internal stimuli. It’s the difference between a tiger jumping out at you and the idea of a tiger jumping out at you. One danger is happening, the other is imagined, predicted, or expected. But our internal reactions in the absence of an external stimuli can be just as powerful – more so, in fact, given that they can perpetuate and effect our bodies in the absence of any clear and present danger out in the world to provoke them. The internal stimuli that cause our individual experiences of anxiety depend very much on how our internal systems are constructed, and this depends upon the things we have experienced. The question is, are we aware of what gets us anxious, and if so, what do we do with that? Developing insight and experience of this is exactly where ISTDP therapy can come in.
1.Take three slow breaths and focus your attention
2. Note FIVE things you can see around you - they can be literally anything within your field of vision.
3. Note FOUR things you can touch around you – the chair you are sitting on, the ground beneath your feet, anything.
4. Note THREE things you can hear - any external sound, even if it is coming from inside your body.
5. Note TWO things you can smell, no matter how faint, or commonplace.
6. Note ONE thing you can taste - what is going on in your mouth? Can you taste your breakfast still, or your cup of coffee?
7. Notice how your body responded to each step of the exercise.
8. Notice how you felt before starting this exercise, and how you feel now.
9. Be present to any changes.
10. Return to your day
Adapted from: https://www.urmc.rochester.edu/behavioral-health-partners/bhp-blog/april-2018/5-4-3-2-1-coping-technique-for-anxiety.aspx
I am always glad for the opportunity to reacquaint myself with this grounding exercise. I find it to be a useful portal to presence – it invites attention to sensory experience, beginning with the most privileged (sight), and focusing more and more on internal roads perhaps less travelled. The exercise involves a gradual turn inward from our habitual looking out position, and for me this is very welcome. I can imagine that some people will feel resistance to the instructions – the mind can rail against this kind of attending, needing some kind of rationale for what might otherwise seem like pointless and meaningless acts. The countdown acts to narrow the focus, and I like that it ends on taste, because this brings the attention down, from the head into the chest and torso, where feelings arise.
One thing that I realized can happen as a result of performing this activity is the discovery of just how far away you were from where you end up – in my experience, how far away I had been from the experience of feeling in the centre of my body when I sat down to perform the exercise. I may have been all up in my head, as is so often the case in this busy life, and I imagine that for people who take refuge in their head (or elsewhere for that matter) because being in their body has been at some point unsafe, this might be a genuine surprise.
The exercise is something I invite you to do at regular intervals throughout your day as a way of building that muscle of attention, or something you could do whenever you feel the activation of your anxiety pathway (whether that be anxious thoughts, tension in the body, finding it hard to think clearly, etc), or simply something I might use with you in session if I feel you have become overwhelmed during therapy and need help in returning to the room.
Thoughts on Therapy and Mental Health