Bob Van Oosterhout

Presentation Outline: NASW MI 2009
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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