Accepting anxiety by noticing thoughts and emotions can slow the brain's amygdala from going into fight or flight.
Welcome to another episode of the Anxiety Therapist Podcast, I’m your host Frank Sasso, I’m a licensed psychotherapist and certified physical fitness trainer out of Chicago, IL. If you haven’t done so already, make sure that you hit the follow button on whatever listening app your using, so that you never miss another episode. In today’s show I’m going to talk about using acceptance strategies to help with calming anxiety. Wouldn’t that be incredible if you had a skill that you could use anytime to help calm your mind and body down? Now, before I being I just want to make a brief announcement. I changed the direction of this show to focus more on mental health issues because I primarily work with individuals struggling with anxiety disorders in my private practice. So, while this show isn’t meant to be a replacement for psychotherapy, I hope the information I share can be useful for everyone.
I was talking to a patient of mine the other day who told me she felt completely out of control because she couldn’t get a handle on her racing thoughts. My patient is this 30 something year old professional woman who has such terrible anxiety symptoms that she can barely function at her job. And like so many of the over 40 million people who struggle with anxiety, she keeps her symptoms so well hidden that she internalizes everything to her detriment. She’s too embarrassed to talk to anyone about it so she just keeps it all packed deep inside. I want to give you an idea of what her symptoms are like. Imagine for a moment that anxiety takes the form of slushy mud, pouring into a bucket. After a while, that bucket becomes filled with so much thick sludge that it overflows and oozes over the sides. That’s how she constantly felt inside.
Do you feel like you’re constantly carrying muddy anxiety with you all the time? Without emptying your bucket, the anxiety has nowhere to go. That’s why this action of acceptance is about being present when your anxiety bucket fills up, so that you can allow it to empty.
Okay so back to my patient, she was exacerbating her problems because she was drinking large amounts of alcohol each night to self-medicate her symptoms. If you didn’t already know, alcohol can make anxiety much worse because it changes the levels of serotonin and other neurotransmitters in the brain – which can leave you feeling a lot more anxious when the booze wears off. If you’ve ever had too much to drink at night, you can easily remember how anxious you felt the next day. When she explained to me that she uses alcohol to help her sleep, I didn’t judge her. In therapy, judgement is the fastest way to create resistance.
Instead, I simply explained that although alcohol may initially help her fall asleep, the heavy drinking disturbs her restorative sleep stage which happens about 90 minutes after going to bed during the REM stage. I’ll talk about alcohol and anxiety in another episode.
After I provided her with some basic psychoeducation on anxiety, we started to get into the self-work on using acceptance as a skill to manage her anxiety. Now in psychotherapy circles, there are many different forms of acceptance approaches for anxiety. One of the most popular methods being used these days is called MCBT – short for mindfulness based cognitive therapy. But for today, let’s focus on the mindfulness part.
Deep inside our brain is this marble shaped area called the amygdala. Now this emotional part of the brain which is part of the limbic system has taken hundreds of thousands of years to evolve to where it is today. Back when early humans hunted and gathered for food, they were under continuous threat of being injured or even killed by predatory animals. As a mechanism for survival, the fight or flight system evolved to automatically respond to a threat without thinking.
Today, our Amygdala, reacts the same way whenever it perceives a future threat or danger ahead. The amygdala tells the adrenal glands to start releasing two specific hormones: Cortisol and adrenaline which play key roles in the fight or flight system. Therefore when you become really anxious, your heart rate accelerates, and you might even become sweaty. Now the problem is when we stay in this fight or flight response mode for a prolonged period of time because your body is releasing different stress hormones. I’ll just get right to it – it’s isn’t healthy to continually stay in this mindset because it’s simply not sustainable.
So here is how I taught my patient acceptance., I tell her that when we try to analyze our anxiety it opens the door to other anxious thoughts. Let me give you an example. Let’s say for a moment that I’m worried about a vacation I’m planning. At first, it just starts out as this miniature thought, right? After a while, I let that thought grow and ruminate in my head for a while. Then this single thought about my vacation begins to grow tentacles and expand. It might go like this, I’m worried about the travel plans for the vacation – then another negative thought enters my brain – what if we’re late to the airport and we miss our flight – then another – man if I miss my flight then I won’t have a vacation at all and I would have waisted hundreds of dollars. I’m screwed!
Do you see how my example of a single negative thought branched out into many thoughts until it catastrophized to the worst place possible? Acceptance is the act of externalizing the thought or what we would call observing the thought without allowing it to grow bigger or immediately trying to fix it.
So, I have my patient to sit down on the couch in a comfortable position where her body can be nice and relaxed. I show her a Himalayan bell and explain to her that we are going to do an acceptance exercise. I then ask her to close her eyes and that on the count of three she will hear the bell.
I think ask her to take a moment and to scan her body, from the top of her head to the bottom of her feet. I ask her to pay attention to any sensations she feels in her body, no matter how slight. After a minute, and after I can see she’s in a good state of concentration, I say to her- before you can completely bring your mind into the present moment, I want you to concentrate your focus to your feet resting on the floor. I don’t know if you will feel the weight of your left foot or your right foot on the ground, but your unconscious mind knows exactly what to do.
Once she nods to me that she can feel the weight of her feet on the ground, that’s my signal that I know her mind is 100 percent focused on the present moment. She’s slowly starting to come out of fight or flight. I then ask her to tell me the situation that’s she’s been worried about. At this point, her breathing has become much slower, and her body is much more relaxed. She says to me in a soft voice “I’ve been worried about my relationship”. Hearing her words, I validate what she’s said to me and then ask her to repeat back to me her anxious thought. She again says, “I’ve been worried about my relationship”.
I instruct her to notice this thought but not allow herself to follow it down the rabbit hole of worry. Instead, I ask her to say to say aloud to herself, “I’m okay, even though I am feeling worried about my relationship” I again tell her to ACCEPT the thought that she is worried about her relationship and to realize that a thought is only a thought. It can only grow as big as we allow it. I explain to her concepts from cognitive behavioral therapy and ask her to avoid using words to describe her thought like should, must and ought. Here’s an example, “ I must be a terrible girlfriend because I’m worried about my relationship”. I gently let her know that attaching should, must and ought to her thoughts is only increasing the anxiety because she’s mentally beating herself up. Once she’s refocused, I say, simply surrender to the unpleasant thought about your relationship and allow yourself to experience the discomfort of it. It might not feel great but accepting can help to shut the amygdala off from pushing out more stress hormones. After another couple of mins, I say There is a part of you that is experiencing this thought in the here and now, and another part of you that is ready to let it go whenever you’re ready. Everyone knows that a thought can float away like a plum of smoke into the air.
After doing this mental exercise, she opens her eyes. On a scale of 1 to 10 – she tells me that her anxiety has come down from an 8 down to a 2.
So just remember, that acceptance is not the same thing as avoidance. When we try to avoid the thought that’s causing us anxiety and just push it away, it can often ruminate and come back stronger. By the way, I use the bell during the session to help focus attention but it’s not necessary for being mindful or acceptance. If you want, you can download your own meditation bell on almost any app store.
Okay, let’s move on to today’s listener email segment.
This week’s listener email comes from Logan in Seattle Washington. He actually contacted me through Facebook but it’s still a message all the same. I’m going to read you what he sent me and then tell you the response I gave him.
Hi Frank, I’ve been home schooling my kids for a year and haven’t been able to do much exercise Now that the gyms are open, how can I find the motivation to start all over again? I feel like I’ll never be in the shape I used to be in. Are other parents dealing with this too?
Alright, well before I share my response to him with you. I am wondering how many of you out there are struggling with exercise motivation. In my private therapy practice, this has been a major concern for many of my patients. I haven’t shared with you before but I’m also a certified physical fitness trainer.
Well here is what I wrote back to his question.
Hi Logan, I want to say thank you for listening to this podcast and I’m so glad that you find it useful.
Okay, let’s get into what’s happening for you right now. I’m thinking that you are going through some of the issues that a lot of my own psychotherapy patients are facing right now - and that is the uncomfortableness with re-entering back into society. This sort of re-entry anxiety can happen because of being isolated for so many months during the pandemic. It’s like time froze during the time froze into place when Covid -19 started, causing millions of people to completely stop their normal day to day lives.
But the good news is things absolutely can get better.
Logan, I want you to use your imagination and concentration to think about these grey clouds that are overhead. They can be any shade or color you like. Sometimes these clouds can fill the air with scary lightning and loud thunder. When it gets really bad, these storm clouds can seem so stubborn because it’s almost as if they want to stick around for eternity. You might notice as your imagining this that all the birds in the sky disappear, and the grass seems to lose some of its bright color. This is normal during a bad storm. But before you can start to feel more motivated, I want you to use your imagination a little more.
This time, think deeply about what happens after it rains – after that terrible storm passes over. You might notice that the sun begins to slowly shine again on the horizon and that you can hear the sound of birds singing in the distance – that mother nature has given the hands up for life to begin again. Can you imagine how good you will feel once you start exercising again?
Logan, I want you to know that it’s okay for you to find meaning in your life again – that you can give yourself permission to start slowly on your journey of getting back into shape. Over time, I think you will find that you will be back in the happy place that you were before this entire pandemic started. It’s just going to take a little time.
Okay, wow, we really went over a lot of good stuff today! We talked about some of the history and neuroscience behind the brains fight or flight system. Then we discussed using acceptance as one of the many tools you an use to tamper down panic and anxious thoughts. If that wasn’t enough, I walked you through a mindfulness-based acceptance exercise that I did with one of my patients. That was quite a lot, wouldn’t you say?
I want to thank you for taking the time out of your day to listen to this podcast. I have been seeing some of the positive feedback in the reviews and they just motivate me to want to create more episodes for people. I produce, edit and record this show all on my own and it really means a lot to me when I see people out making positive changes in their lives. All of my patients know they can follow me on Social Media by going to https://www.anxietytherapistpodcast.com/
You can also contact me by visiting the website at anxiety therapist podcast . com. Again that’s anxiety therapist podcast dot come. There you can leave me a voice mail by clicking the green button, or you can send me an email message on the contact page. While you’re on the site, please subscribe. I guess the more subscribers this show has the better it appears in the search results. Check out the blog as long as you are on the website.
I’m Frank Sasso, and this has been another episode of the Anxiety Therapist Podcast.