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STEP 6: Use Paradox
Giving up the struggle
Your most effective defense against anxiety attacks will
involve the use of paradox. Dr. Claire Weekes, in her book Simple, Effective Treatment
of Agoraphobia, recommends four methods of managing symptoms of anxiety: face
the symptoms - do not run away; accept what is taking place - do not
fight; float with your feelings - do not tense; let time pass
- do not be impatient.
Each of these is a paradoxical response, one that seems
contrary
to logic. Logic tells us that in a threatening situation we should flip on our
Emergency Response, tense the body, and immediately begin fighting. Or if we imagine we
will lose, run like the devil before we get hurt.
Instead, what I am suggesting is that you flip on
your Calming Response, relax the muscles of the body, don't fight
your physical sensations, and don't run away.
It's much like those Chinese finger cuffs we played with as
kids. Do you remember them? They were made from a cylinder of thin woven bamboo, just
large enough to fit the first finger of each hand into each end. You would give the finger
cuffs to an unsuspecting friend and instruct him to place his fingers inside. That was the
easy part. When he attempted to remove his fingers, the cuffs tightened. The more he
tugged, the tighter the cuffs were. Those darn cuffs defy all logic because they are
created paradoxically. To remove your fingers your need to push the bamboo together
again with your free fingers, not pull them apart. It is the same with quicksand. If you
struggle, you sink. If you remain very still (going against all your
instincts), you have your best chance of remaining on the surface.
One of my patients, Michelle R., became so fearful of panic
that she stopped driving and avoided taking walks, staying home alone, or shopping alone.
After a few sessions she realized that she was contributing to her panic symptoms by her
negative comments, which I call her Worried Observer (see Don't Panic,
chapter 14) thoughts. One morning, just prior to a business meeting, she caught herself
thinking questions such as, "What happens if you feel overwhelmed? Or if you get that
panicky feeling?" While asking herself these questions she began to develop symptoms,
and moments later she produced an anxiety attack. At that moment she recognized that her
fearful
thoughts of panic can lead directly to her actual panic
symptoms.
From this awareness, Michelle made rapid progress. Several
weeks later she began to practice driving alone and to take a few short walks. Her Worried
Observer comments continued to hinder her:
"We agreed last week that I would return home from the
session by driving on the freeway, and I did. Right before I got on the road I started to
feel anxious. I thought, 'What if I get a panic attack and I can't get off the highway?' I
remained tense most of the drive, and my hands were perspiring. But I started thinking
that I had an option to continue or to stop, and I really wanted to continue. I felt good
that I made the progress. The worst part was anticipating the drive, not the drive
itself."
Notice how Michelle succeeded in switching from her Worried
Observer comments to what I call a Supportive Observer stance. She said
that her worst time was before starting the drive, because that is when her Worried
Observer typically runs through a series of negative fantasies about the future. She began
by worrying about some catastrophic event that might take place if she kept driving. Once
she began the drive she shifted into a permissive attitude, giving herself choice.
"It's OK to stop driving if I need to. Or I can choose to keep going if I want."
By always giving herself supportive options, she gained the confidence to continue. And
she was able to follow through on her desire, which was to complete her task.
To handle panic paradoxically is to go against
our basic instincts. I knew that Michelle needed to experience some
success in managing her anxiety before she would be ready for my next instructions. Now
that she was able to persist through mild symptoms and continued Worried Observer
comments, I presented the idea of paradox: if you stop fighting panic, it will
disappear. For the coming week I gave her the following instruction: "The
next time you have fearful thoughts about panic, I want you to try, at that very moment,
to have a full-blown panic attack. Tell yourself to increase your heart rate, to become
dizzy. Try to produce all your negative physical symptoms."
As you can imagine, Michelle nervously laughed at my
suggestion and questioned my seriousness. I explained the rationale behind this seemingly
illogical advice. When we become afraid of symptoms we are supporting those same symptoms
by establishing an oppositional relationship. The more fearful we become, the stronger
they grow. By removing our fear we destroy this complementary relationship. We
drain
all the strength out of panic, because it requires our resistance in order to
live.
In this same way, if you attempt to stop the symptoms or try
to fight them, you are simply supporting and prolonging them. If you practice some kind of
relaxation technique and then anxiously wait for it to reduce your symptoms, you will be
disappointed. As I spelled out in Step
3, techniques will not conquer panic; attitude will.
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