I suffer with anxiety – not the kind of wobbly stomach you
get before exams, but the kind that has caused me to self-harm with a razor
blade and seriously contemplate suicide. The problem is the thoughts ceaselessly
spinning around in my head – a never ending background chatter, a mixture of
nonsense, serious thoughts, and dark, unwanted thoughts. I’m writing this
because too many people feel ashamed to speak about their mental health. And I
hope this helps someone to get help before they spiral out of control like I’ve
done.
What does anxiety
feel like?
An anxiety disorder is something equivalent to the fire of
hell raging in the mind. I find myself overthinking every possibility, event,
and conversation, obsessing over thoughts both dark and mundane,
catastrophising the future, repeating bits of nonsense to myself, attempting to
discern the thoughts of others and anticipating hypothetical conversations.
It’s exhausting. The emotional life is no better with feelings of despair,
dread, angst, terror – anxiety seems like too small a word to capture the
inward agony of mind. Some of the thoughts are dark, intrusive, disturbing,
even terrifying. I find myself feeling tearful, frustrated, angry with myself
and others, upset, and low to the point of death. It’s a frightening place to
be. I feel the dread physically in my chest, throat, and stomach, the pounding
of my heart, the walls closing in, a sense of shutting down, feeling unreal,
distant. Dead.
Getting Help
It took sometime before I went to see the GP. I was ashamed
of myself. But I should’ve gone much sooner and perhaps the worst of this could
have been avoided. The GP was lovely – a wonderful help to me. Since then I’ve
been referred to a crisis team who’ve been looking after me for a while with
nurses coming to the house every other day. And I’ve recently been introduced
to my community psychiatric nurse who will be taking over my care in the near
future. The various medications have helped greatly – citalopram for anxiety
and depression, chlorpromazine (an antipsychotic) to take the edge of the worst
of the anxiety, pregabalin which stops my brain from releasing the chemicals
that make me feel anxious, and zopiclone to help me sleep at night. These
tablets have helped – there’s no shame in needing them – and have brought me to
a place of some stability and calm.
Alongside the tablets, the crisis team have helped me with
talking therapy and a form of CBT known as Acceptance & Commitment Therapy
(ACT). They’ve helped me get my thoughts off my chest and out into the open.
Just talking about these things does the soul a world of good. It is a release
it itself.
ACT Therapy &
Mindfulness
ACT therapy is about accepting thoughts as they come and go
and making commitments – small at first – to help improve wellbeing and social
interaction according to wholesome values such as kindness and compassion.
The therapy uses mindfulness practices to help bring you
into the present moment rather than worrying about the future or ruminating on
the past. Mindfulness is not about
emptying the mind, but about noticing thoughts as they come and go with a soft
focus. The aim is not to get rid of thoughts, but simply to learn how to let
them come and go without struggle. Mindfulness is about bringing awareness to
the here-and-now experience with curiosity and friendly interest. For example,
to ground myself in the present moment, I notice 5 things I can see, three
things I can hear, and two things I can smell or feel. It may seem a simple
exercise, but it works – even when the thoughts are spiralling out of control,
it really helps.
Mindfulness encourages a soft focus on the present through
bringing attention to the breath. As your breath is always with you (unless, of
course, you’re dead!), it always brings you into the present moment. It is
surprising how simply focusing on just ten breaths – in and out – can help
alleviate some of the distress caused by anxiety. At first it was hard just to
focus on ten breaths, but with practice I now find myself able to sit for ten
to fifteen minutes just breathing in the present. I find it helps to count the
breath – one to ten, ten to one, especially when I have trouble focusing.
Thoughts will come and go. And I may find myself distracted or hooked by some
thoughts, but eventually I bring my awareness back to the breath. And it’s okay
for the mind to wander, it’s okay for thoughts to come and go, but as soon as I
notice my mind has meandered away I bring my focus back to the breath – to the
present, the here-and-now. I’ve found the Headspace app for my mobile phone and
computer very helpful in guiding me through the breathing exercises and mindfulness
meditations. The first ten exercises cover the basics of mindfulness and are
free to use, while the others require subscription and go in to greater depth by
introducing other ways of calming the mind. Headspace has been a lifesaver for
me.
In addition to mindfulness, there are six core principles of
ACT therapy: cognitive defusion, acceptance, contact with the present moment,
the observing-self, wholesome values, and committed action.
Cognitive Defusion
Cognitive defusion has taught me how to defuse unwanted
thoughts by learning to view my thoughts as little more than bits of language
in the mind as opposed to how they often appear as threatening, terrifying
realities. For even my darkest thoughts are only thoughts – just bits of
language, words and pictures in the mind. Simple ways to defuse a thought
include acknowledging the thought and saying ‘thanks mind’. Singing a thought
to some nonsense tune over and over like Happy Birthday can make light of even
the darkest thoughts. And putting some distance between yourself and the
thought by saying, ‘I’m having the thought that ….’, realising that it’s only a
thought and not reality.
Acceptance
Acceptance is about allowing thoughts to come and go –
making room for unpleasant thoughts and feelings in the mind. I find it helpful
to think of my thoughts like clouds passing in the sky – sometimes the sky is
stormy and terrifying, sometimes calm. But behind the clouds, there is always blue
sky. Behind a frowning providence, God hides His smiling face. There is always
a place of peace and calm, even in the midst of a storm. Acceptance trains the
mind to let thoughts pass by without struggle, letting them come and go without
giving them too much credence or attention.
Contact with the
Present
Contact with the present moment trains the mind to be in the
here-and-now rather than morbidly reflecting on the past or catastrophising the
future. It encourages contact with the here-and-now reality – the present –
through mindfulness. It brings awareness to moment by moment experience – the
breath in and out – and to consider this moment with openness, friendly
interest, and a soft focus on whatever you are doing, being aware of the
sights, sounds, smells, and senses. Instead of washing the dishes worrying
about tomorrow, mindfulness allows you to enjoy the sounds of the cutlery
clanking, the feel of the bubbles against the water, the smell of fairy liquid,
and the sound of the birds tweeting in the garden. It brings you to the
present. Why worry about tomorrow? Each day has enough trouble of its own.
The Observing Self
The observing-self is the transcendent sense of self – the
soul, a place of constant awareness, consciousness, perhaps a fragment of the
divine image. That part of the mind that is unchanging, ever-present, and
invulnerable is known in ACT therapy as the observing self. No thought can harm
the true self. For from the viewpoint of the soul, no thought is ultimately
harmful. It’s just a thought. And even the darkest thoughts will pass away, but
the soul will remain immortal. ACT does not shy away from the spirituality of
human experience – the transcendent sense of self is able to observe with
interest, openness, and friendliness all that passes through the mind and the
senses.
Values
Connecting with your values is a key principle of ACT
therapy. It’s important to clarify what is most important to you in life – your
faith, your family, your vocation. Deep in your heart, what matters the most to
you? What kind of person would you like to be? Think of wholesome values.
Compassion, kindness, love towards family, friends, colleagues, and neighbours.
ACT encourages you to think about what is significant and meaningful in your
life – what you stand for and believe in. Reflecting upon your values brings
more wholesome thoughts into you mind and awareness. Your values give you
something to life for – a sense of meaning and purpose.
Committed Action
Committed Action is about setting your values in motion.
Putting reasonable goals in place and acting to fulfil them. They may be small
at first, especially if you’ve struggled with anxiety or depression, like going
to a coffee shop with a friend or cooking a meal for your family. Long term
goals may include working towards a qualification, getting a promotion at work,
changing jobs, retraining, studying at university, learning a new skill or
language. Committed action gives you something to do, taking your mind away
from dark thoughts to something constructive and wholesome for your general wellbeing.
These principles have helped me as much as the medication to
retrain my mind to focus on the present and the things that really matter. With
the support of nurses and doctors, I hope to get better. It’s a long way yet,
but these practices and principles have helped me greatly, and I hope they’ll
help readers of my blog to get help sooner if they need it and to practice
being in the present moment rather than worrying about the past or the future.
Recommended Reading
Baer, Ruth, ‘Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review’, Clinical Psychology: Science and Practice, 10, 2 (Summer, 2003), 125–43.
Harris, Russell, ‘Embracing Your Demons: An Overview of Acceptance and Commitment Therapy’, Psychotherapy in Australia, 12, 4 (August, 2006), 2–8.
Harris, Russell, ‘Mindfulness without Meditation’, HCPJ (October, 2009), 21–24.
Harris, Russell, The Happiness Trap (2008).
Hayes, S. C. & Chad, Shenk, ‘Operationalising mindfulness without unnecessary attatchments’, Clinical Psychology: Science and Practice, 11, 3 (2004), 249–54.
Hayes, S. C., Masuda, A., & De Mey, H., ‘Acceptance and Commitment Therapy and the third wave of behaviour therapy’, in Gedragstherapie (Dutch Journal of Behavior Therapy), 2 (2003) 69-96.
Kabat Zinn, Jon, Wherever You Go, There You Are (2004).
Stanton M, Dunkley C, ‘First Steps in Mindfulness Skills’, Nursing Times, 107, 6 (2011), 22–24.
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