What works in counseling, in my experience.
-Bob Van Oosterhout
August 30, 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 pain and 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. 

PERCEPTION

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:

Frames
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.  

Filters
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.  

Focus
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. 

BALANCE

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.

EXPERIENCING BASIC EMOTION WITHOUT RESISTANCE

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)  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.

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

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

7) 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.

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 create additional emotional tension which complicates 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.

MENTAL FLEXIBILITY

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.

TYPES OF EMOTION

I have found it helpful to classify emotions based on (1) their relationship with perception and (2) how best to deal with them.  This led to identification of four functional categories of emotion with subtypes that are best dealt with differently.

(1)  Filter Emotions consist of what I refer to as “Basic Emotions.” Filter emotions are temporary and require an ongoing stimulus to be enduring.  Even very intense basic emotions pass within minutes in the absence of an immediate stimulus if not resisted through muscle tension or breath holding. There are four kinds of basic emotions which require different responses if health is to be maintained: 

(a) Primary emotions are universal emotions that are a direct response to the perception of experience, such as joy, sadness, hurt, and fear.  Emotional health is restored and maintained during the experience of primary emotions when (1) balance is maintained; (2) thoughts or events which likely stimulated the emotions are acknowledged; and, (3) the experience of emotion is allowed to run its course without resistance.   If a primary emotion is interfering with what needs to be done at the moment, shifting focus away from the stimulus changes the emotional state.  Emotional tension builds when we resist the experience of primary emotions through muscle tension and breath holding.  Thinking or talking about experiences that generated primary emotions stimulates new emotion which can create additional emotional tension if it even partially resisted through muscle tension and breath holding.

(b) Secondary emotion is experienced in response to primary emotions.  Anger is a good example of a secondary emotion.  Secondary emotions do not create problems if one restores balance, clarifies the primary emotion that stimulated it, and deals with that in a healthy manner. Problems result when we allow the strength of secondary emotions to dictate our actions or when we create justifications or explanations that feed and escalate them.

(c) Conceptual Emotions are emotions produced by thought and conceptualization. Examples of conceptual emotions include: frustration, guilt, hate, worry, longing, suffering, discouragement, and defensiveness.  Primary and secondary emotions can also be conceptualized (fear is the most common).  Emotional health is maintained (1) when balance is restored to the musculature and autonomic nervous system, (2) the accuracy and appropriateness of  concepts that generated the emotion are clarified, and (3) basic emotions are experienced without resistance.  Frustration is a common conceptual emotion.  It stems from expectations.  Restoring balance allows one to see how expectations may be unrealistic in a certain situation and to adapt them to fit a more accurate assessment of what may be possible at the time. Dwelling on conceptual emotions tends to build tension which narrows focus and creates a self-escalating process that interferes with clear perception and decision-making.

(d) Structural Emotions are basic emotions that have been restricted by emotional tension, which formed by blocking the experience of emotion with chronic muscle tension and breath holding over time.  Structural emotions can erupt when tension increases to a point where they can no longer be held back.  They are often re-experienced during dreams.  Structural emotions are resolved and emotional health restored when balance is maintained over time and re-experienced emotions are not resisted through additional tension and breath holding or re-stimulated by thought or analysis.

(2)  Frame emotions are integrated with thought.  They include emotions such as resilience, awareness, outlook etc. that Richard Davidson refers to as “Emotional Style” in his book, “Emotion and the Brain.”  Frame emotions tend to endure over time and create problems when they do not fit the needs of a situation.  Developing awareness of patterns of frame emotions makes it possible to adapt as needed.  This is much easier to the extent that physical, mental, and emotional balance is maintained.  Healthy frame emotions fit the needs of a situation and are flexible, adaptable and inclusive.  Frame emotions become unhealthy when tension constricts the experience of emotion and creates a narrow, rigid, frame that tends to emphasize the negative aspects of a situation. 

(3)  Focus Emotions include emotions involved in motivation and attention, such as desire, will, intensity, and the sense of flow that occurs when an effortless focus matches the needs of the situation.  A healthy focus adapts to conditions and allows us to maintain a state of receptive openness and non-judgmental attention.  Focus emotions become unhealthy when they narrow as a result of tension and pressure which wastes energy, diminishes receptivity, and inhibits the ability to adapt to changing circumstances.

(4) Impulse and Intuition are emotionally based drives that provide an overall feeling about a person and/or situation.  Ignoring this feeling can result in actions or decisions that do not fit the current situation. Problems are avoided when this assessment is viewed it as one part of larger picture and potential risks, benefits, consequences etc. are clarified before making decisions that have long-term implications.  Problems often result when we give these impressions too much power and make decisions that have a lasting impact based on “what feels right.”