BEYOND SHYNESS

by Jonathan Berent

  Far from feeling relieved, Renata became panicked, and even suicidal. Eventually she was referred to a psychiatrist, but when that doctor suggested medication, she balked: Was he suggesting it was all in her head? In search of an alternative, she came to me.

  In our first few sessions, we focused on two things: the reality that Renata’s tests had come back negative, demonstrating no physical cause for the condition, and the possibility that her stress was the cause of her symptoms. As therapy progressed, Renata developed an understanding of stress, and she began to take responsibility for getting well. Soon, she abandoned her search for a physical cause of her problems, and gave herself over to the two vital therapeutic components that saved her. First, she was able to address her own emotional conflicts and social fears. And second, she was able to learn stress management through relaxation training. The quieting response she learned enabled her to self-regulate her nervous system internally so that it no longer overresponded to stress. Soon, the self-awareness exercises translated into better self-expression, which vastly improved her communication skills and problem-solving abilities.

  Relaxation works. This chapter will show you how to make it work for you. There are three components of relaxation-based stress management:

  Learning the Difference Between a Stress Response and Relaxation

  To get in touch with yourself when under stress and when relaxed, finish the following sentences:

  When I feel stress, I feel or experience _________________

  When I feel relaxed, I feel or experience ___________________________

  Do not use the words “stress” or “relaxed” in formulating your answers. Rather, identify the specific mind-body responses that you recognize as your symptoms of stress and your signs of relaxation. For example, if you know your hands become cold and clammy when you are under stress, include those symptoms as part of your definition. If you also know that your hands become warm and dry when you are relaxed, then include that information in your description. Even breathing, moderate pulse rate, loose, limp muscles—all of these signs of relaxation create a concrete mental picture for you to try to achieve. You have worked through other chapters to identify symptoms of distress, and in this chapter you must identify symptoms of relaxation. Relaxation must not be an abstract concept to you. You have to have a mental picture and a verbal definition of both your stress and relaxation.

  Look again at your responses above. Discipline yourself to identify your most basic internal sensations, both in an anxiety state and when you are relaxed. You may not know quite what to call what you are feeling. But if a word or phrase conveys to you what you mean, then use it. For example, one of my clients was at a loss to describe the rapid pulse in her forearms until I asked not “What is the symptom?” but “What does it feel like?” “It feels like I have electric current running through my arms,” she said, giving both of us a vivid picture of what she meant.

  Take a minute to describe in more detail your feelings or symptoms of relaxation and anxiety. Then, use these descriptions as the tags for sensations you do and do not want to experience.

  Relaxation

  _________________________________________________________________

  _________________________________________________________________

  _________________________________________________________________

  Anxiety

  _________________________________________________________________

  _________________________________________________________________

  _________________________________________________________________

  Learning Relaxation Skills

  Renata learned to cure herself of her crippling anxiety by incorporating relaxation techniques into her daily life. They became her natural medicine. Relaxation and internal self-regulation were the key to regaining control of her life. Remember, control starts from within. If you can control your responses to stress, you will be in a far better position to confront your fears and move forward toward self-actualization.

  Applying Relaxation Skills

  Relaxation techniques can be applied creatively and flexibly once they are learned. Jennifer, thirty-six, used to experience emotional and physical anxiety symptoms any time she was in a singles-oriented situation, such as a cocktail party or social group. Because she had a strong desire to overcome her fear, she worked hard to conquer the problem, and in time she became very good at applying relaxation techniques. The relaxation response became so automatic that she merely needed to give herself the suggestion, “My hands are warm,” and the anxiety response would diminish. Learn these relaxation techniques and practice them daily. Even relatively small physiological changes can result in substantial control of anxiety and symptoms. New advances in technology have made it possible to see and hear your stress response through the use of sophisticated noninvasive instrumentation, a practice that actually helped Jennifer learn to adjust her anxiety level. Even without the use of instruments, there are ways to evaluate and readjust your psychophysiological reaction to stress. This chapter explains them.

  Biofeedback-assisted relaxation, internal self-regulation, progressive relaxation, meditation, “the relaxation response” … There are many stress management techniques. How do you know which one is best for you? Try as many as you are able to, and work out the combination that suits you. There are many relaxation exercises introduced here that you can teach yourself, techniques I have relied on to help my clients become more productive and control their anxiety. The biofeedback-based relaxation technique that follows on p. 131 will be especially valuable as a process to train both your mind and your body to relax; practice it every day for three weeks, supplementing your program with the other techniques detailed in this chapter. Remember, any effective combination of the following stress management techniques is appropriate—so long as you feel the techniques enable you to control your anxiety.

  How do you achieve relaxation? These guidelines will help put you in the right frame of mind to begin practicing relaxation techniques:

  1. Give yourself permission to relax. You must nurture yourself. Even if it has been difficult for you to relax in the past, now is a new beginning. It may not be easy at first, but in time, and with practice, relaxation is possible for everyone.

  2. Create the right environment. This means no distractions: no TV, no telephone, no music, no food. This is a time for you to be at peace with yourself. Wear comfortable clothing and allow yourself to focus only on the present. Allow yourself to let go, to relax emotionally as well as physically. Be careful not to think of letting go as losing control. The opposite—holding on—is what causes heightened anxiety. To really control anxiety, you have to let go of it, become familiar with it, and then find a new way to lessen its intensity. The process of letting go and achieving relaxation can sometimes feel uncomfortable. But it is this uncomfortable feeling that has to be worked through to achieve success.

  3. Learn diaphragmatic breathing. Diaphragmatic breathing is the basis of all relaxation and internal self-regulation. Often, breathing exercises of this type are in and of themselves a good means of stress management. Start breathing deeply to slow your body and mind down in preparation for relaxation. Conscious breathing is an essential part of this exercise. Inhale through nose, draw slowly into stomach (diaphragmatic region) and exhale through your mouth. This process should be done slowly and rhythmically.

  4. Learn muscle relaxation. This is fairly easy to learn. The first step is to become aware of the difference between tense muscles and relaxed muscles. Then, learn to make your muscles feel limp and heavy.

  5. Cultivate warm, dry hands. As you relax, your blood vessels dilate and the peripheral blood flow (at the skin’s surface) increases, resulting in warm hands. Anxiety is related to the fight-or-flight response. When confronted with stress, the body naturally sends blood away from extremities toward the torso in preparation for escape. While normal body temperature is 98.6 degrees
, hand temperature is slightly cooler, and varies considerably depending on the degree of stress or relaxation. Don’t confuse the two—extremities are always cooler. Remember the mood rings of the 1970s? True, they were a gimmick, but they relied on stress-related surface temperature changes to create the desired effect. Bio-dots and stress cards available today work the same way, and can be a useful tool in learning to bring yourself down from an anxiety state. Still, you may not need a machine or other equipment to tell you how cold your hands are. If your hands feel cold to you, they are responding to stress. If your hands are warm and dry, you’ve achieved relaxation.

  A PERSPECTIVE ON MEDICATION

  Most of my therapy is based on the concept of individuals taking responsibility for themselves and the quality of their interactions. My goal is for people to be as qualitatively independent as possible. In my practice, we try to do our work without medication to the fullest extent possible. If clients come in who are already on medication, it is often an eventual goal to get them off drugs when appropriate, especially if they are relying too heavily on medication to mask their uncontrolled anxiety. Of course, there are situations and conditions that warrant medication. But I believe medication is appropriate for anxiety sufferers only when it gives the short-term relief necessary to focus on appropriate emotional and psychological issues. In recent times I have seen a definite pattern in which adults and teenagers are relying on alcohol to relieve anxiety. Remember, alcohol is the most commonly used drug in our society. I would like to caution anxiety sufferers that: dulling the physiological sensations with prescription or other drugs or even alcohol enables avoidance by taking the edge off. Action—confronting that which you fear—is what will ultimately relieve anxiety. Controlling your symptoms naturally is the most productive way to nurture yourself toward action.

  METHODS OF RELAXATION

  Any of the following methods could be the answer to controlling your stress response. Everyone is able to learn relaxation scientifically. It is not always easy, and it does take discipline, but the results will change your life! People learn at different speeds. It is possible to affect your own hand temperature after the first few practice sessions, or it could take thirty sessions. For example, often your hand temperature will first decrease before relaxation sets in and then increase. Everyone is different. The important thing is to remain committed to learning. Where relaxation is concerned, the control lies in letting go. Consider all the self-help methods described below and follow the specific instructions for each. After each exercise, be sure to evaluate how you feel and determine which symptoms of both anxiety and relaxation are present.

  Biofeedback

  Biofeedback is a scientifically based stress management technique that allows you to gather information about your stress and then use that information to develop control over how you react to stress. You can learn some biofeedback techniques on your own, by concentrating fully on your response to stress; several biofeedback techniques are described in this chapter. As we discussed in Chapter 1, an anxiety attack is a psychophysiological, or mind-body, response that is one example of distress. You can actually view your stress response on a biofeedback machine, and see the cause and effect. The learning process involved in controlling anxiety with biofeedback is the same as in learning any other physical skill—namely, trial and error. For example, a person learning to throw darts makes an initial throw, sees the result, then tries to adjust for inaccuracy, to correct his or her aim on the next throw. “Information” about the accuracy of the first attempt at controlling nervous tension “feeds back” into the learner’s autonomic nervous system, and he or she can practice relaxing. Without this feedback—without knowing where the darts landed last time—you could not learn to hit bull’s-eyes.

  How does machine-assisted biofeedback work? Sophisticated instruments measure muscle tension, skin resistance, skin temperature, and brain waves and provide scientific data about your stress responses.

  EMG (electromyograph): Measures muscle tension and relaxation in terms of microvolts at various locations on the body.

  GSR (galvanic skin response): Monitors emotions as information is provided about your arousal system and “mental” energy. Measures skin resistance or perspiration.

  Temp (thermograph): Measures temperature on the surface of the skin, which is the result of your peripheral blood flow. Changes in the dilation or constriction of blood vessels lead to changes in blood flow.

  EEG (electroencephalograph): Measures brain waves (beta, theta, alpha, and delta).

  Under the guidance of a trained biofeedback professional, Renata learned to relax by checking the biofeedback results in front of her to determine her level of relaxation. As she practiced, alternately thinking calm, then thinking about an anxiety-producing situation, the machines took her readings. One sensitive receptor, held on her finger by a cloth ring with a Velcro closure, fed the skin temperature reading into a digital display facing her. A second finger strap conveyed the degree of skin resistance—moisture or clamminess—to a display on a second machine. The third machine informed her by means of a sound-equipped dial, whose clicking sounds conveyed the degree of muscle tension in the face, fed from three receptors on the forehead that were held in place by a loose headband. In time, supplemented by relaxation tapes for home use, Renata learned to relax. A biofeedback program is an excellent way to learn internal self-regulation and stress management. As Renata’s internal self-regulation skills increased, she used biofeedback as a maintenance program, checking back periodically to track her success. (If you wish to make machine-assisted biofeedback a component of your self-help program, and need information on how to locate a qualified professional, write to the Association of Applied Psychophysiology and Biofeedback, 10200 West 44 Ave., Wheat Ridge, Colo., 80033.)

  Is biofeedback only possible in a clinical setting? No. In fact, you probably already use a kind of biofeedback throughout your day. Every time you gather information that changes the way you proceed, you are letting your observations “feed back” into your brain to inform your course of action. Even something as simple as stepping on a scale, determining you are overweight, and adjusting your diet is a type of biofeedback process.

  While machine-based biofeedback training is effective, there are other ways to learn biofeedback-based relaxation. Think about how simple biofeedback is. You now know that warm, dry hands are a symptom of relaxation. You can check your body against that ideal, and then give yourself the suggestion, “My hands are dry and warm,” to elicit that physical response. Look at your face in the mirror. Tense and relax the muscles. Furrow your brow. Then release. This give you the information you need to alter your state of mind.

  In using the biofeedback-based response that follows, you are familiarizing yourself with your own mind-body responses. After you have learned to distinguish relaxation from tension, you will be able to get in touch with your relaxed self by referring back to this exercise.

  A Relaxation Exercise

  This biofeedback-based relaxation exercise is designed to help you learn, step by step, how to relax. Practice this exercise for 21 days in a row. Set time aside for it when you are alert, not tired. The goal is relaxation, not sleep, so do not begin this exercise after a heavy meal or right before bedtime. Remember, you are trying to learn a new skill, and the learning process deserves your full attention and energy. If you do fall asleep, it may be a signal that you are burnt out (emotionally and physically exhausted) or depressed.

  Before you begin, make a list of the physical sensations you are aware of. Use whatever words come to mind. Use this list as a basis of comparison for what you are experiencing now to what you feel when the exercise is over.

  Before:

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  Wearing loose clothing, ass
ume a comfortable position in a chair. Hold your head, neck, and back in a straight line. Try not to slouch or arch your back. Your feet should be resting flat on the floor, and your hands should rest on your thighs; there should be no tension, so do not let them hang at your sides. If you wish to use armrests, you may do so, as long as your shoulders are not hunched as a result. You should not feel any pull or strain on your shoulder muscles. The goal is comfort and ease. The more comfortable your body is, the less it will distract you.

  Give yourself permission to be passive. Concentrate only on this exercise, and on how your body is feeling. Activate your positive mental attitude (if you like, you can imagine a switch in your mind that turns your positive mental attitude on full throttle).

  If you find yourself losing concentration or experiencing any intruding thoughts, let them flow through you until they pass. Allow yourself to breathe them in, then out.

  Now focus on your breathing. Take your time, breathing slowly in and out. Inhale through your nose, slowly drawing the oxygen down into your abdomen. Hold it for a few seconds. Now slowly exhale … 5 … 4 … 3 … 2 … 1 for a total of up to ten seconds (with one to two seconds between counts). Again inhale, hold it, and exhale … 5 … 4 … 3 … 2 … 1. Remember, don’t push or force the air in and out of your body. Continue to breathe slowly and deliberately, until the pace feels natural. Concentrate on the process. Inhale the oxygen, exhale the carbon dioxide. Inhale the energy, exhale the excess tension. Feel yourself settle further into your chair, and continue breathing in a normal and relaxed way.