Anxiety – A Case Study

The following was written for a 21-year old female client with a specific request to assist her with anxiety. It explicates the nature of her anxiety and the interconnectedness between the three apparently disconnected concerns with which she presents.

It also speaks to the idea that cessation, the stopping of a behaviour, feeling, idea or thought may be more profound and helpful than doing more. From the analysis it moves to direct advice about how to remove “being frightened and anxious” using a set of both inside and outside principles and rules.

At the start of this process I put a simple question to you “What is currently going on in your life at 21 years of age that, at 25, you no longer want to be part of your life?” Your response was, “When I turn 25, I don’t want ‘being frightened and anxious’ to be part of my life”. You also added that at 25 “I don’t want my life regularly spinning out of control” and “I don’t want to have crazy messed up thoughts and feelings about my body”.

After discussing: 

• Being frightened and anxious 
• Life regularly spinning out of control 
• Crazy, messed up thoughts and feelings about your body … 

… you settled on the idea that, if you could stop “being frightened and anxious”, then your life probably wouldn’t “spin out of control” as much, and you probably wouldn’t have the same “crazy messed up thoughts and feelings” about your body, or at least you’d be in a better position to manage these. That’s how we came to the idea that we should find a way for you to stop “being frightened and anxious”. 

I also suggested you try stopping one thing at a time, not all three at once. Being perpetually “frightened and anxious” is extremely difficult to live with and deal with, especially when it escalates to the point where you are internally paralysed and can do nothing about it. It consumes you emotionally, it consumes your brain, it consumes your whole body and being.

Change happens when you call a halt to things that paralyse your life; when you call a halt to useless, negative, self-destructive beliefs, ideas, thoughts and feelings that rattle around “inside” your head, and when you call a halt to the endless, repetitive, negative, self-destructive exchanges you find yourself willingly or unwittingly participating in, on the “outside”, in your social world, with your peers, at work and with family. This is what makes you miserable. 

More often than not the “inside” reinforces the “outside” and vice versa and so life inexorably goes on, with you caught in the middle of this neural and relational vortex with no obvious way out. The patterns of thinking and feeling “inside” your brain and body are directly linked to every minute exchange and interaction you have with people in the world around you, especially those closely and intimately connected to you. This is what “being anxious and frightened” is about. 

“Being anxious and frightened” shrinks the world around you and the more your world shrinks, the more intense these exchanges, the more influential they are, the more paralysed you become. Ordinarily, you only need to call a halt to one thing at a time, as stopping several things at once is often counterproductive and tends to be unsuccessful and one thing can cancel out another – failure comes too easily. What we want is 100% certainty of success, and that can be difficult to achieve, especially with emotional matters like “being frightened and anxious”.

When you call a halt to something “inside” your head or “outside” in your everyday relational life, you create a space in your life, an emotional, behavioural, cognitive, relational, interactional and psychological space “inside” and “outside” your head. It is the creation of that space that allows change to occur, and for that change to occur spontaneously and unforced. We remove obstacles to change, and that is often an emotional obstacle like “being frightened and anxious”. 

In effect, what we are doing is managing your “back brain” so your “front brain” can do its legitimate business. In evolutionary terms your “back brain” is your primitive, reptilian brain, your emotional brain. Your “front brain” is a more recent development, it is your reasoning and logical brain. We all must manage our emotional “back brain” so our purposeful, reasoning and logical “front brain” can reason, be purposeful and logical. In ceasing “being frightened and anxious” you create an emotional space so your “front brain” can spontaneously be and do what it knows best to be and do.

When you’ve been “frightened and anxious” for a long time, it may no longer be immediately relevant what caused you to be “frightened and anxious”. This is not to suggest that what caused this is irrelevant, it is not, but understanding and unpacking whatever caused you to become “frightened and anxious” may not produce the change you are looking for. It’s a matter of “cause” and “effect”, and the reverse may be true, that you may now need to cease the “effect” to get to and understand the “cause”, that the “effect” may have become a self-reinforcing, self-fulfilling, prophesy well beyond what caused you to become “frightened and anxious” in the first place. 

I’m suggesting that the “effect” has become the “cause”. While the original “cause” is long past, it’s had a profound impact on your life, on your cognition, emotions, behaviour and interactions with people. You are now more likely to be hard-wired in your brain and in your social interactions for “being frightened and anxious” and it is in this “effect” that the immediate “cause” of your current difficulties may lay, that you have to remove or get around this hard-wired “inside” and “outside” to produce the change you say you want by 25 years of age. The “effect” has become the “cause”, the immediate “cause” is in the present, not the past, the original “cause” is in the past, not the present. We need to deal with the present to get to the past. The question or conundrum is: “How do we do that?”

Ordinary, everyday problems are different to serious and enduring problems. Physical problems are different to emotional problems. The most serious problems are those that threaten to strip you and your life of the future. That’s what a serious physical illness does, it takes your future away. “Being frightened and anxious” for you is so physically and emotionally debilitating that, when you experience “being frightened and anxious”, you are totally preoccupied with yourself in the “here and now” and your whole future seems to evaporate. This panics you into a “panic attack” that takes you over, on an almost daily basis. 

As a result, it is very difficult for you to see a future for yourself through that blue haze of being frightened, anxious and panicked. This means you become convinced there is something seriously wrong with you on the “inside” of your head, in your brain, in you neuro-biology. This is the way “being frightened and anxious” mimics physical illness, because you literally and genuinely feel physically ill. With a physical illness the “cause” and the “effect” are both treated, but the balance depends on the illness. With a heart condition we treat both “cause” and “effect”, whereas with a broken leg we treat the “effect”, primarily because the cause of the break doesn’t usually travel with the leg, unless we consider our own stupidity a “cause”. The “effect” of a heart attack is usually treated before the “cause”, otherwise the patient would be dead, their future snuffed out and no “cause” to get to.

The fact that a psychological and emotional condition such as “being frightened and anxious” (or “panic” or “panic attack”) takes on the characteristics of a serious physical illness must not be treated lightly. Humans are neuro-biologically and physically arranged for such confusions to occur and these confusions are important in terms of our evolutionary success as a species on this planet. Such confusions are integral to our sophistication as “modern man” and to this extraordinarily complex and differentiated brain with its ability to do things no other species-brain on the planet can do. 

When a psychological and emotional condition mimics physical illness it preoccupies that person in “time present” and “time past”, it preoccupies that person with their “inside” neuro-biology, and in doing so it systematically strips that person of not only their future but of their relational context. In effect, the two great analogues of human experience, space and time, are fractured or dismembered. The continuity and recursion implicit in the temporal and spatial analogues of experience is disrupted, perhaps momentarily from an outsider’s perspective, but for the person experiencing “being frightened and anxious” (or having a “panic attack”) it is experienced as a permanent and life-threatening condition.

To treat the “effect” is to restore continuity and recursion to the temporal and spatial analogues in the world of the person experiencing “being frightened and anxious” (or a “panic attack”). It is to restore the future to its rightful place in the relatively differentiated temporal cognition of the person. It also restores continuity and recursion to the “inside-outside” spatial analogue in the individual cognition of the person, and to the collective cognition of the attached relational world around that individual person. Cognition is both individual and collective.

My view is that you invent the future first, and you do this by inventing what the future won’t include rather than what it will include. What it will include can come later once the way is clear for that positive, good and right future to happen. You want a future that doesn’t include “being frightened and anxious”, “life being out of control” or “messy, crazy thoughts and feelings about your body”. Already we have determined that removing “being frightened and anxious” may be the better way forward to begin with, as the other two will be easier to remove later or may even spontaneously resolve themselves. 

Second, you remove the hard-wiring “inside” and “outside” your head that leads to you “being frightened and anxious”. These are the hard-wired neural pathways and loops “inside” your head and the equally hard-wired interactions you have with people over this matter “outside” your head. We need to clear your head and your relationships so you can invent a future that doesn’t include you “being frightened and anxious”. Then you may be in a position to look at the past and work out what this is all about, what caused you to be this way, what it means and how to manage it. The task is to remove the hard-wiring for “being frightened and anxious”, both in time present “inside” your head and in time present “outside” your head. That also means removing the endemic secrecy in your life and its opposite, talking too much about this to the wrong people at the wrong time and how that binds everything together and holds it in place. You swing wildly between deep secrecy about “being frightened and anxious” to talking too much, to too many people, about it.

So how exactly do you remove “being frightened and anxious” from your head and your interactions with people? You do it by following a set of “inside” and “outside” principles and rules, which are: 

• Immediately after you wake in the morning, you perform a brief ritual. About ten minutes, a meditation, an exercise programme or yoga. it doesn’t matter what the ritual is, as long as it’s brief, physical, and you do it every day without fail 
• During this ritual you focus your attention on not “being frightened and anxious” today. This is not about tomorrow or the next day. 

The ritual you have devised is: 

• The ritual must be done twice daily, first thing in the morning, and last thing at night, with minor variations on the morning ritual. 

It’s important to include the negative statement (“today I will not be frightened or anxious”) in your ritual, as it’s the removal of “being frightened and anxious” that will make the difference to you and your life and create the emotional and psychological space for positive, good and right things to occur. 

• The morning ritual must include an unambiguous decision, for this day only, about not “being frightened and anxious” today. You will remove “being frightened and anxious” one day at a time. 

This decision must be immediately written down as a text or email message and sent to me. Each message is headed by the day number in reverse order e.g. “Day 30”, “Day 29”, Day 28”, and so on counting back to zero. I will acknowledge your message with “ok” or similar. You can include other people in this process, now or later, if you choose. If you want a longer response you must let me know by text or email. 

• The night ritual involves you reflecting on how you’ve handled not “being frightened and anxious” today and sending me a detailed text or email about this. 

“Being frightened and anxious” will not magically disappear from your life, but it can be removed, one day at a time, by you taking command of it and the situation and exercising appropriate responsibility to make this happen. I’m insisting that the authority you exercise over “being frightened and anxious” is matched by the responsibility you take to deal with it, and this is done by creating an “outside” interactional loop between you and me and perhaps others. This may look and feel like accountability but that’s not the intention even if this “outside” loop does function that way at times. My intention is to shift the locus of change from “inside” to “outside” your head.

You will have the full repertoire of feelings, thoughts and dreams about “being frightened and anxious” during this process, and part of this process is ensuring you report these feelings, thoughts and dreams to me in your twice daily text or email messages. This takes these feelings, thoughts and dreams from the “inside” of your head into the “outside” loop we have created.

Of importance is the breaking of secrecy around this, primarily to stop you or others reverting to old solutions, which involved you alternately trying to solve “being frightened and anxious” from “inside” your head or handing the problem to someone else to solve. Neither solution works because they split responsibility and authority. “Inside” your head is where the problem lies, and the solution is not likely to come from there. 

“Inside” your head you have limited authority over the neural loops that reflexively bind “being frightened and anxious” in place, no matter how much responsibility you take, making it very difficult for you to exercise responsibility exclusively from “inside” your head. When you hand authority to someone else these “inside” neural loops are hard-wired to resist any approach except medication. You and I must work out how we share responsibility for this problem and equally we must work out how we share the authority to do something about it. We can genuinely share authority and responsibility more equally, in the “outside” loop we’ve created between us, and by inventing a future that does not include “being frightened and anxious”. 

Strictly limit the group of people you speak to about “being frightened and anxious”, as this invites others to exercise responsibly and possess authority in relation to you and this problem. They cannot, and this has a serious impact on this process.

Initially we do this for 30 days to see how you go. Each text or email message commences with the “Day Number” in reverse day order e.g. “Day 30”, “Day 29”, “Day 28”, counting back from 30 to 0. We review the process face–to–face weekly, and after 30 days we refine the process and move to 100 days using the same structure, except we meet fortnightly. Then 234 days meeting monthly, then 365 days meeting bi-monthly. The whole process takes two years, however for a young person we may shorten that. This is up to you and I to negotiate based upon your requirements and progress.