Bob Van Oosterhout

What Works in Counseling in my experience
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Anxiety, Depression, PTSD
Behavioral Health Integration with Primary Care
Bring Truth to Fear: We CAN Work Together
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What works in counseling, in my experience

-Bob Van Oosterhout December 4, 2012


From my experience, people who recover from or effectively manage mental health disorders restore and maintain the capacity to:


(1) Experience perceptual shifts - they are able to see a larger picture, more clearly.

(2) Restore balance to the autonomic nervous system and muscular system - to recover from and prevent chronic muscle tension, which appears to limit perception and restrict the experience of emotion.

(3) Accept and experience painful emotion without resisting them through breath holding and muscle tension.

(4) Be mentally flexible.  They are able to focus and redirect thinking away from directions that create problems and toward directions where problems can be managed or solved.  They are able to separate thought from emotion.



I have found that explaining perception in terms of a metaphor from photography which includes frames, filters, and focus helps people to quickly grasp how to create perceptual shifts:



Our view of reality is limited in much the same way as a frame of a picture limits what we see of the landscape that it captures.  Perceptual frames are made up of expectations, beliefs, assumptions, interests, intent, and understanding.  People with different experiences and background view the same situation through different frames. Healthy frames are large and flexible.  They adapt to changing circumstances and allow us to see what is unique in each person and situation. Frames that are fixed, rigid, or narrow severely limit the amount and kinds of information we process and tend to result in judgments and actions that are less likely to fit the needs of a situation or the people involved.  Problems can more effectively be resolved when we are able to view a situation through another’s frame. 



Photographic filters color and shade a picture, emphasizing some features while diminishing the impact of others.  Perceptual filters reflect basic emotions, mood, attitude, outlook, and bias.  They affect how we define and interpret experience.  A person who is optimistic sees a very different picture than one in the same situation who is pessimistic.  Filters offer temporary but potentially important input that tends to become distorted the longer it endures.  For example, fear helps us spot potential dangers that could be easily overlooked but sustained (conceptually stimulated) fear creates a filter that leads to excessive caution and over-reaction, leaving no room for joy or love.  We can only communicate effectively with someone to the extent that we are aware of what a situation looks like through their filters. 



Our attention is drawn to what is in focus in a photograph.  Perceptual focus indicates what we pay attention to.  It determines priority.  Problems usually result when focus gets stuck or scattered.  A healthy focus is receptive to relevant input and adapts to priorities of the moment, it maintains a balance between short and long term views.




I have found the role of chronic muscle tension and imbalance in the autonomic nervous system to be critical factors in recovery from a wide range of mental disorders, but particularly anxiety, depression, and PTSD.  (Every symptom of anxiety in the DSM IV can be explained by excessive muscle tension)


In my understanding, chronic muscle tension involves habitual overstimulation of the sympathetic nervous system and the corresponding release of stress hormones.  I use simple terms to explain how this works and demonstrate how to resolve chronic tension by regularly stimulating the parasympathetic nervous system (through precise rhythmic movement of the diaphragm which likely stimulates the right vagus nerve) and restoring balance to tense muscle groups (with gentle postural reminders and simple exercises).  Symptoms of anxiety and even severe panic are consistently resolved with regular practice of these techniques (even by online students, whom I never meet).


The build-up of chronic tension has a direct effect on mind and emotion.  Tension affects perception by forming narrow and rigid frames, darkened, negative filters and a scattered or fixed focus.  It also inhibits the awareness and experience of emotion.  Restoring balance to the autonomic nervous system and resolving and preventing the build-up of chronic muscle tension increases awareness and receptivity and leads to larger, more flexible frames, clear and adaptable filters, and a receptive focus that appropriately adapts to the needs of the situation.




I have found that providing a simple explanation of the nature of emotion greatly facilitates people’s ability and capacity to deal with it in a healthy way.  This explanation includes the following principles:


1) Basic emotions are part of human nature and are universal.  Every healthy person and many animals experience the same basic emotions in response to perceptions of similar situations.


2) Basic emotions are temporary.  They change with perception.  Perceptions that endure over time stimulate repeated emotions.  Emotion draws our attention and easily leads to thought that stimulates what feels like lasting emotion.


3) Basic emotions involve proprioception.  This is most obvious in muscle movement in the face, but also involves various muscle groups in the torso that can be consistently observed with experience.


4)  Tensing muscle groups associated with various emotions diminishes and obstructs the experience of emotion.  (This is obvious when one tries to stop crying.)


5) Chronic tension builds in muscle groups when emotion is resisted over time.  As tension increases, emotions either become intensified, reactive or numbed.


6) Full and deep crying releases emotional tension.  Episodes of crying tend to last a few minutes if there is no resistance.  Tensing and breath holding while crying builds emotional tension and leads to prolonged crying and/or additional emotional tension.


7)Strong emotional experiences tend to come in waves that last a few seconds to a few minutes if they are not resisted through muscle tension and breath holding.


8) Emotions are re-experienced over time as chronic tension is resolved.  Accepting these emotions without resistance through tension and breath holding eventually resolves emotional tension.  In cases of severe emotional tension, such as PTSD, this process recurs a number of times over a period of months (as long as balance is maintained) and then appears to be fully resolved.


9)  Accepting and experiencing the release of emotional tension can produce a wide range of memories of past fears or experiences. However, emotional memory is non-linear and very different from conceptual memory.  Linking the re-experience of emotion to specific events and exploring conceptual memories of trauma tends to stimulate new emotions which can create additional tension and complicate the recovery process.  Separating thought from emotion while simply experiencing the emotions without resistance simplifies and facilitates recovery.


10)  Emotion can easily be separated from thought once balance is restored and basic skills are developed.  Thought can stimulate emotion.  Analyzing, talking and thinking about emotions tends to complicate and lengthen the recovery process.





I have found it very helpful to use the metaphor of roads to describe how thoughts and memories are formed in the brain.  My understanding is that this is a reasonably accurate description of the formation of patterns of connections between neurons involved in thought and memory.  Once people are aware of this concept and physical balance is restored, they can rather easily learn to distinguish patterns of thinking that are helpful and productive (“roads that take you where you want to go”) from mental habits that increase tension and narrow perspective (“paved, downhill roads that take you into a swamp”).  I describe well-traveled mental roads that define and limit a reality that is often not of our choosing as “train tracks,” which severely limit perceptions and options.  Providing simple tools such as meditation, labeling (“putting up road signs”),  and a technique that I refer to simply as “Thought Focusing” or “Using a Rhythm Phrase” (a phrase that matches the natural rhythm of diaphragmatic breathing) help people develop the ability to effectively direct their thinking and expand their perceptions.  This becomes significantly easier with regular practice when physical balance is restored and maintained.   Combining techniques that restore balance to body and mind simultaneously is often most helpful in developing and maintaining mental flexibility.