A New Perspective on Treating Anxiety, Depression and PTSD
Standing ovation - heart of SW
Not
                                    new - concepts from Tibetan & Zen Buddhism, Chinese Philosophy, Christian monastic and Sufi tradition, Yoga, Bioenergetics
                                    - list of sources
Summary - list of hypotheses
Questions at end
Website for more info
Recovery
                                    from Anxiety, Depression and PTSD is a Natural Process
Similar to healing from a cut - Rachel Remen - surgeon
                                    "pruning"
The role of the therapist is to identify and remove obstacles:
Physical, mental and emotional
                                    tension = primary, common to all others = focus of presentation
Stress, conflict, misperception
Secondary gain
                                    from symptoms
"Lost heart" – limited opportunities for growth or fulfillment
The Heart
                                    of Our Work
Quote Pema Chodin - heart p91
Clients don’t simply recover to previous state
The
                                    process of recovery results in increased depth of understanding and appreciation of life and relationships along with improved
                                    clarity of perceptions, values and priorities. 
It is a personal, cooperative process that is unique to each situation.
Treatment
                                    happens BETWEEN - not client or therapist centered
Research re: effectiveness more dependent on clinician than approach
Human
                                    experience cannot be defined by drawing straight lines or breaking it into little pieces
These are tools for research
                                    and learning, not practice
PENCIL, WATER/COFFEE METAPHOR
Treatment tools have no value if client is not ready
                                    to use them.
Treat person not DX
OUR NATURE is to open our heart - to learn to love
Supported by all major
                                    religions
What works - 
Jacque Luseyrann 
increased life expectancy, satisfaction, fulfillment
Establishing
                                    a heart-to-heart (limbic) connection 
creates an atmosphere of acceptance and shared perceptions
timing and interventions
                                    become clear. 
Tension, impatience, judgment and thinking in terms of "should" on the part of the clinician
                                    undermine this connection.
The Nature of Tension = factor in every DX
Tension involves resistance
                                    - 
we resist life when we tense
opposite = acceptance
Physical – continuous contraction
                                    of muscles that develop into habitual patterns
Mental – narrowing and fixing of perceptions and
                                    patterns of negative thinking that create physical tension
Emotional – resisting the full experience
                                    of emotions through breath-holding and patterns of physical and mental tension
Physical Tension
Like
                                    pressing your foot on the accelerator when car is in park
Uses up all your energy
Wears out the engine and transmission
You
                                    have limited control if it slips into gear
Ongoing process of muscle activity
Develops habitual patterns of posture
                                    and movement which create additional tension
TENSE UP - DEMO - 
Physical Tension (cont.)
Regulated
                                    by Autonomic Nervous System (ANS)
Sympathetic Nervous System (SNS -required for activity) becomes over stimulated
                                    while the Parasympathetic (PNS - required for health maintenance) is suppressed (Fight or Flight)
High levels or intensity
                                    of tension stimulates release of stress hormones which boosts SNS and suppresses PNS
Creates a self-escalating process
                                    when more stress hormones are released as tension builds, thus stimulating the release of more stress hormones.
(#9)
                                    All Symptoms of Anxiety Can Be Explained by the Build-up of Physical Tension
Student anxious 20 yrs, resolve
                                    before class start
Guy drop out college 3 yrs, panic - seen 1x - referral
 
(#12) Resolving
                                    and Preventing Physical Tension
Requires more than relaxation. Balance must be restored to the ANS
Rhythmic
                                    diaphragmatic breathing stimulates the PNS and suppresses the SNS
Precise rhythmic movement of the diaphragm stimulates
                                    the right vagus nerve activating the PNS (proper rhythm is critical)
Regular PNS activation over time allows liver to
                                    remove stress hormones from bloodstream restoring balance to ANS
Grounding reverses patterns of tension while developing
                                    awareness of tension habits.
Mental Tension
The build up of physical tension is perceived as
                                    an indication of a threat, which
Narrows focus and perception
Leads the mind to ask "what’s wrong"
Asking
                                    "what’s wrong" from a narrow focus builds tension, which further narrows focus on "what’s wrong"
                                    creating a self-escalating process = TRAP
Thoughts create physical tension when they indicate a need for action but
                                    don’t result in purposeful activity
TEST LA-Z Boy 
VENTING CAN CREATE TENSION
Tension always comes
                                    from focus on past or future
GET TRACTION ONLY IN PRESENT
PAST = MUD
FUTURE = ICE
Brain is plastic,
                                    ever-changing E.G. LONDON CAB DRIVERS
Creates pathways that become habits
ROAD METAPHOR 
(#13) Resolving
                                    and Preventing Mental Tension = CLARIFY
CLARIFY perceptions 
Human vision =
                                    one direction
toward or away from life
STAND BEHIND BARN, SEE ONLY BARN - BACK UP TO SEE LARGER PICTURE
MOMENTS
                                    OF JOY
Enlightenment means to bring into the light
bring into the sun vs. give a flashlight
Perceptions
                                    that work
compassion - Dali Lama - our true nature
Hope
Personal responsiblity
Humility
TX =
                                    Focus on recovery rather than source of problems
Identify nature of immediate threat and separate short from long term
                                    issues
Understand cause and process for resolving SX
Identify strengths, reasons for optimism, obstacles, options
                                    and likely outcomes ("if-then thinking")
Solve problems that create context for negative habits of thinking
CLARIFY
                                    thoughts
Break up negative habits of thinking
Clarify direction of thinking
Labeling - ROAD
                                    TO SWAMP - SIGN DEAD END
"Thought Focusing" blocks and redirects negative mental habits
Develop mental
                                    discipline and perceptual flexibility through meditation
SEE CLEARLY VS. POSITIVE THINKING - UC woman w/ baby
Self-esteem
                                    = seeing self clearly
 
Emotional Tension
Emotions are natural events
Momentary
                                    response to perceptions
Regulated by limbic system
mostly intact at birth
dominates until development of
                                    logical thought
Basis for forming relationships
TOM - "I KNOW EXACTLY WHAT YOU ARE FEELING..."
Emotions
                                    involve proprioception – 
Specific muscle movements are associated with emotions
Emotions are physical events
                                    which are restricted by muscle tension.
Facial expressions are obvious but other muscle groups move in response
                                    to specific emotions
Resisting emotions involves stopping muscle movement which creates physical tension E.G. STOP CRYING
Tension
                                    increases reactivity while decreasing responsiveness (SUNBURN, SPRING METAPHORS) 
Leads to behavior that creates mental
                                    tension
(#10) Hypothesis: Depression Is Caused by Resisting Emotions (Emotional Tension) which Creates Mental
                                    and Physical Tension
Resisting emotion
Uses up energy as it narrows focus and responsiveness
Creates
                                    self-escalating mind/body/emotion interaction that decreases energy and motivation as it limits perceptions and increases
                                    focus on the negative
Is created when we resist crying increases tension which increases the need to cry. (Crying is
                                    the most effective way to reduce emotional tension)
Leads to 
narrowed, negative perspective leads to hopelessness
Reduced
                                    emotional responsiveness which reduces capacity for pleasure
(#11) PTSD is Caused by Unresolved Deep Emotional
                                    Tension Resulting From the Perception of Trauma
Fear is the predominant emotion 
Atmosphere of safety
                                    and control is critical
The amygdala (which bypasses logical thought) becomes hypersensitive
Resolution involves
                                    clearing "surface tension" and accepting emotions that arise without resistance (tension or breath-holding)
Resolving
                                    and Preventing Emotional Tension
Separate thoughts from feelings
Accept emotion without resistance as
                                    normal response that all humans share FEAR STORY PEMO CHODIN
Identify and reverse patterns of tension which restrict
                                    emotions
Understand that emotion results from perception and focus
Understand process of recovery from deep emotional
                                    tension
Clarify that emotions experienced when resolving emotional tension are not basis for decision-making
Release
                                    of emotional tension is not necessarily linked with specific memories (soup metaphor) E.G. MARY PTSD
Characteristics
                                    of Effective INTERVENTIONS (No "effective Clinicians")
Balance, defined as the absence of tension,
                                    a state of relaxed receptivity and perceptual flexibility; 
PREP DEAL WITH VIOLENCE - CARO
Emotional
                                    openness indicated by an ability to feel and let go of emotions experienced by the client without building up tension
KNOW
                                    VS. KNOW ABOUT
Receptivity to the perceptions and emotions, and experience of the client that is not blocked
                                    by ego, attachment, judgment, or preconceptions
Ongoing Reflection and commitment to improvement
33
                                    YEARS
30 yrs - saw as dangerous man
I saw him as a man in pain
Staff person saw him as man alone