San Diego Therapist Blog: Regina Huelsenbeck, PhD

What does my soul look like? Do I believe in God? Why are we here? Why are you here?

Are you asking the "big" questions. Are you wondering what "the point" of all of this is? At some point in life, most of us grapple with these sort of questions. There's certainly more to life than just making money and acquiring material goods- r-i-g-h-t? Or is that really it? What do you think? Is there a God? What do YOU think? If you're looking for a place to explore these questions try www.soulpancake.com. It was created by actor Rainn Wilson from the TV series "The Office". On his site, they contemplate these questions, and pose some you may not have even thought of yet. If you haven't figured out for yourself what YOU think...his site provides a sort of starter guide to "chewing" on these questions.

Find out what YOU think.

The cancer experience includes many many elements. It's not just being afraid of dying and feeling physically sick, although those pieces are also present. There may also be relationship problems, daily living challenges, children to care for, emotional issues, treatment decisions, side-effects of treatment, insurance debacles and on and on. It feels like a big cyclone of chaos at times. The cancer experience is kind of like a really rough, whipping, bumping, and turning roller coaster ride, the kind you're praying will end soon. You just can't wait till the car pulls to a stop, the safety bar lifts and you can get the hell off of it!

Unfortunately you can't get off the ride, but you can find a way to be where you are at this moment in time. Can you find a way to ride the coaster?

Mindfulness meditation practice can help.

Don't take my word for it. In a randomized clinical trial, cancer patients completing the 7 week meditation condition reported a decrease in depression, anxiety, anger, and confusion AND additionally they reported an increase in Vigor! The patients also reported fewer symptoms of stress and less emotional irritability. If you've ever been on chemotherapy and some of the steroids they give you along with it you know that emotional irritability can be a real challenge. Overall the cancer patients completing the 7 week meditation condition reported a 65% decrease in mood disturbance & 31% reduction in symptoms of stress.

But don't take their word for it. Experience it for yourself...

1. Join this group: "Mindfulness Meditation: A Cancer Support Group". This group meets in Encinitas on the 1st and 3rd Tuesday of every month. Click here for more information.

2. Go to my coping resources page: see books on Mindfulness Meditation and also cancer. A great starting place: "Full Catastrophe Living" by Jon Kabat-Zinn

3. If you want to read more on the study discussed above:     Speca, M., Carlson, L.E., Goodey, E., and Angen, M. (2000). A randomized, wait-list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62, pp.613-622

First time panic attacks are incredibly scary. They are especially scary because you usually don't know you're having a "panic attack". More often than not, you think you're having a heart attack or going crazy.

Here's a very common first experience with a panic attack:

"I woke up in the middle of the night, it was about 2am. My heart was beating really really fast. I felt like I couldn't get enough air. I sat up in bed and I could hear my heart beating, pounding; it was pulsing in my ear. I finally woke up my partner to tell him something was wrong with me and I didn't know what was happening to me. I was really scared. We both sat up in bed and I described my symptoms- my fast heart rate, difficulty breathing, and chest pressure. And then this fog-like haze started coming over me. I couldn't see straight, it was like misty- hazey- I started blinking to try to see more clearly. I felt almost like I was going to pass out or something. We talked about maybe going to the emergency room to get my heart checked out. The more we talked about it, the more I pictured myself at the hospital, and the more I worried about what could be wrong with me, the worse my symptoms got. Finally I jumped up and said, "lets go to the hospital". I was 100% positive: I was either having a heart attack or I was going to have one! We got to the ER around 4am, they hooked me up to all these heart monitors and took my blood. I sat on the table donning a hospital gown, freaking out, waiting for the results. It was humiliating. Finally they came back and told us that all the results were normal. My heart was fine".

This woman is not a hypochondriac and she's not losing her grip on reality. The bodily sensations are very real, and her interpretation of these sensations is extremely common. Many people who have a problem with panic, worry that they might be losing their mind and feel frustrated that they cannot just "get a hold" of themselves, or believe they are having a heart attack.

The truth is, sometimes we simply are not cognitively aware of how over stimulated and stressed we are. Panic attacks are infamously reported as an experience that seemingly came on "out of the blue". But truly a panic attack is not entirely out of the blue.

Panic attacks sometimes occur when a person is experiencing an extreme acute stress (just lost their job, heard they have cancer or learned they're daughter is going to prison). But more often than not, they occur for the first time when a person is under chronic stress for a prolonged period of time with little or no break. Chronic stress includes the big unexpected stressors of life and also the general stress of daily living (relationship, children, financial worries, job stress, lack of exercise and self-care, etc.).

We have an internal stress response system designed to respond to and save us from dangerous situations (for more on the stress response see "The Stress Response"). When we experience fear or anxiety the stress system gets activated. If this stress response system is activated too often for long periods of time, with very little time to recover, the system can actually become more highly sensitized to stress, making panic reactions more likely.

The first step is to figure out whether or not you've had a panic attack. Review the list of symptoms below. It's also wise to get a medical evaluation by a physician, just to rule out anything organic (hyperthyroidism for example).

What are the symptoms of a panic attack?
The DSM-IV TR says, "The essential feature of a Panic Attack is a discrete period of intense fear or discomfort in the absence of real danger that is accompanied by at least 4 of the 13 somatic or cognitive symptoms"
1. palpitations, pounding of the heart or an accelerated heart rate
2. sweating
3. trembling or shaking
4. shortness of breath or sensation of smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal stress
8. feeling dizzy, lightheaded, unsteady or faint
9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. fear of losing control or feel like you are going crazy
11. fear that you are dying
12. numbness or tingling sensations (paresthesias)
13. chills or hot flashes

If you have had a panic attack, get some help before it develops into panic disorder. Panic Disorder is characterized by the "presence of recurrent, unexpected panic attacks followed by at least 1 month of persistent concern about having another panic attack". People who develop panic disorder often begin to avoid situations, people and places where they have had panic attacks in the past.

Please remember that having a panic attack or panic disorder does not make you insane or weak. It just means you're human and you're overstressed. Your body is simply letting you know that you could use some help. 

The point of intervention can occur at many places to stop attacks. A pre-emptive strike could mean changing some habits and taking better care of yourself, or looking at some ways to reduce your stress level. Ask for help. Another intervention point occurs at the point in the woman's story where she sat on the bed with her partner talking and worrying about her symptoms: We talked about maybe going to the emergency room to get my heart checked out. The more we talked about it, the more I pictured myself at the hospital, and the more I worried about what could be wrong with me, the worse my symptoms got.

Once the fear system (which is mediated by the amygdala) has been activated and we are feeling the bodily sensations associated with panic attacks, we can either keep it going or turn it down with the thoughts that we think. The amygdala is an old part of our brain, it's an automatic, highly reactive, fast acting little sucker. However, the higher functioning parts of our brain- those responsible for cognitions have the ability to act upon the amygdala.  In the situation detailed above, the woman did not know she was having a panic attack; she was fully convinced that she was having a heart attack. Her fearful thoughts (I'm going to die", "I'm having a heart attack") about her body's sensations perpetuated the fear response, which serves to perpetuate the fight or flight reaction - increasing the bodily sensations and the panic attack.

Most importantly, if you've experienced panic attacks, have compassion for yourself. Ask for help and regain control over that pesky amygdala.

If you fall down (and we all fall down) you will learn to get back up again. It's just a part of life, and actually a fairly big part of life. Suffering is the first noble truth of Buddhism---meaning: suffering is unavoidable. To suffer is to endure pain or distress; sustain loss, injury, harm or punishment (dictionary.com). Paradoxically, finding your way through difficult times - finding a way to get back up again bares some of the sweetest fruits of life. From frustration you find the inner resource, somewhere, somehow. Whether you're wrangling with a cancer diagnosis, the death of a loved one, the depths of clinical depression, or out-of-your-skin anxiety....even with seemingly impossible circumstances, you can learn how to get back up again...If you haven't seen Nick Vujicic's "Are you going to finish strong?" please click this link and find the hope to get back up again.

Understanding our emotions, tolerating them, and expressing them appropriately is a skill. It's both a learned and a practiced skill. We first learn this skill during childhood. Just like we learn how to use the potty, self-soothe, ride a snowboard, and tie our shoes, we also learn how to be emotionally intelligent. Mom/Dad/Guardian teach us how to become conscious of our feelings, how to tolerate them, and express them appropriately.

When we experience an emotion, mom/dad/guardian help us to identify that feeling. "Oh you're crying right now because you're tired", or "You're feeling angry because you can't play with that toy right now". And then how to handle, be with or express that feeling. "I know you're sad, I'm staying with you, I'm here" or "I know you're tired, it's time to go to sleep" or "I know you're angry, it's alright to feel angry, but it's not alright to hit". Over time, the child then learns how to do this for him or herself, just like they learn to recognize the signs that they need to use the potty. The child learns how to identify their emotional state and then communicate it accordingly.

The foundation for emotional intelligence is consciousness. A parent/guardian has to become conscious of the child's experience and be able to identify it for him or her. Likewise, as a adults, we have to become conscious of our own emotional world. The first step is attuning to what we are actually experiencing inside.

You can LEARN and practice emotional consciousness now, regardless of whether or not you had great emotional training as a child. It's important to do so because pretty much Everything (social, familial and romantic relationships, physical health, ability to hold a job, academics/learning ability) is built upon the foundation of emotional intelligence.

As I said at the beginning emotional consciousness is both a learned and a practiced skill. To begin increasing your emotional consciousness check in with yourself a few times throughout your day and take your emotional temperature:

~At work especially after a particularly challenging phone call or meeting. Sit quietly at your desk and just ask out loud, just like a parent might help a child- what are you feeling right now? are you angry? are you sad? are you nervous? are you happy? 

~Become conscious and then just like a loving parent to a child- help yourself to express it appropriately. If you're tired, find a way to get yourself some rest. If you're angry, talk to yourself about it- listen like a loving parent- no judging, no changing it- just acceptance. Then decide, from this conscious place how you wish to handle your situation. 

~If you're not able to identify your emotional state, try identifying how your body feels. Are there any physical pains? What sensations are you having? Any tingling or numbness? Spend time becoming aware of and describing any sensations or lack of sensation to yourself. The body is a great doorway to our emotional states- becoming conscious of body sensations will ground you to where you are at this moment.

Ever get to that point when your mind just won't stop? During the holiday season the mind often has plenty of material to work with. Your mind worries: "The holidays are almost here and you still haven't gotten gifts for half the people on your list??! It's not like you didn't know the holidays were coming! It's the same time every year!!" Or maybe your mind is worrying because you don't have "enough" money for gifts. Or maybe it's worrying about how you will survive your family or lack of family and loved ones this year.

Whatever the thought or worry, whatever your situation may be this holiday season, not enough or too much, if you find yourself in full on "mind spin"----worrying, becoming depressed or anxious about your situation...try a few of these de-mind spin tips:

1. First of all accept that you are not alone. You can be absolutely sure that most people are worrying about something - maybe not the same thing that you are worrying about- but something this holiday season, just like you.

2. Second, take a minute and breathe. Ask yourself right now if you are alright, just right now in this very moment. Not tomorrow, or in the future or yesterday, but right now, are you ok? alive? breathing? This is an important question to ask because, often the pain of the holiday season comes to us because of our worries...and worries are most always about the future or the past. Worries about what the holidays have been like in the past, and are not now. Or what the holidays will be like this year- worries and anxieties usually exist in the present -----but are almost always about the future and or the past.

Another way to take yourself out of the worries or "mind spin" is by changing your focus. #3 and #4 are hands on mind tools:

3. Mindfully take three deep breaths. Take three slow deep breaths and pay attention only to your breath for just 3 full breaths---following the sensation of the breath the entire time.

4. Another option: Go outside or look out a window and focus fully on every detail of the object you are looking at. If it's a tree, what color is it? What about the leaves? Describe the tree bark. How tall is the tree, can you see the roots, how is it sitting in the ground etc.? Focus your mind fully on describing the object. Spend a few minutes on this.

Presence is the key to meditation experience and furthermore- life experience. What actually causes unbearable stress, pain, suffering, and sometimes mental illness is our avoidance of whatever is arising internally: the repeated avoidance of your own internal experience will create problems.

Staying with the present moment, especially negative emotions, is counterintuitive. We have to reprogram ourselves to STAY. This is why formal meditation practice helps. When you learn to stay with what you're running from internally- it's incredibly freeing. It builds confidence and you simply feel more in control of your life. You stop trying to escape yourself and then a whole new world begins to open in front of you...and it's truly beautiful.

In formal meditation practice we refuse to leave our present experience. We don't run away, we don't numb out, we don't leave. We simply STAY with the present moment, with this breath, with this sensation. That is the practice. We pay attention on purpose, compassionately, to what we are experiencing right now.

Here are a few options to get started:

1. Take an introductory meditation course like this one: "The Mindful Lunch"

2. Email or call for private sessions

3. MBSR: Mindfulness Based Stress Reduction course at UCSD Center for Mindfulness

4. See resources page for mindful meditation books

Learn to stay: Practice 

I had a professor in my graduate education who always said to us, “be prepared”. He said it so often in fact that I don’t know if I ever really heard him. However, I think now that it’s likely one of the very best pieces of advice I ever had the privilege of hearing.

"Being prepared" for life and it’s challenges is really a fairly simple thing, we just have to keep our instrument tuned up- our mind, body, and spirit. It is simple, but it not necessarily easy. Preparation takes practice, commitment and discipline. Sort of like clean teeth, if you want clean teeth, you brush and floss every day, not just right before your dentist appointment or whenever you have a toothache. Nope, you brush now, you prepare now, a little bit, every day.

Being prepared for life is the same thing. You never know when you’ll be hit with a crisis, a major decision or a serious conversation. But I'm certain that you will want to have  every bit of your brain power, wisdom and emotional equilibrium in check - accessible for use.

How can you “be prepared” for what life will serve up?  It takes daily attention, and it takes practice. When we routinely pay attention to ourselves, our patterns, our pitfalls and abilities, we are better suited to withstand the storms when they come rolling in. When we aren’t taking good care of our mental and emotional health, the storms crash down much harder, much, much harder, because we aren’t prepared.

A few tips to tune up your emotional and mental instrument:

1. Exercise, a recent study out of Duke University cited as regular exercise as more effective at alleviating depression than some antidepressant medications.

2. Journal, begin to record your thoughts and emotions, your daily life, you will begin to see patterns and get to know how you’re moving through the world- essentially become more conscious of relationship patterns, mistakes  or coping mechanisms that you regularly use (the good and the ugly). Plus it’s also a great way to purge what is rumbling around in your mind.

3. Take inventory of your day. What were you most grateful for today? What would you like to have handled differently?  You can also begin to record these things in your journal. It's also a great practice to share with a loved one.

4. Take a time out each day either in the morning or at lunch, or even in the heat of an argument and breathe. Especially elongate the outbreath. This alleviates a bit of the amygala activation in the brain and will help you think a bit more clearly. 

5.Try this mindfulness meditation exercise: After accumulating a few dishes, fill your sink with very warm soapy water, and begin to wash your dishes- only this time- pay extremely close attention to cleaning each dish - clean them like you've never cleaned them before- with your full attention. If you find yourself thinking about other things, simply bring your attention back to what you're doing. Take notice of how the water feels, how the dish feels in your hand, and take care to place each one delicately into the rack. This can be very pleasurable and relaxing- believe it or not- and it's a great way to re-tune yourself!

Keep your instrument tuned and you will likely play beautiful music. Rock on!

This is Jeff's story:

"My wife, Mary, and I were invited by an old friend, Steven, to join his balloon crew at the annual hot air balloon festival...We said yes enthusiastically. As crew members, Mary and I joined a team of several others, all of whom were needed to handle our balloon...

Now, to be perfectly honest, I have never been that comfortable with heights...[but] I have learned to work with it over the years, and it has not limited my activities...

Everything was fantastic for the first few minutes, as the ground fell away and I looked around, feeling the cool air and captivated by the spectacle of other balloons rising in the beautiful Albuquerque dawn. Then I felt the basket move sideways as the balloon caught a wind current. I looked down over the railing and saw the ground crew, the vehicles, buildings, everything, shrinking. Then I felt the first wave of fear. 

My experience of fear was the usual one. There was a feeling of slight dizziness, some weakness in the knees, a sense of my heart pounding, and a tightening in the throat and gut. My hands were already clutching the railing. I didn't want to move in any direction and wasn't sure that I could...

I wished I had stayed on the ground, but knew at that point there was no going back.

The realization that I had to cope was actually helpful.
There was no choice except to deal with the fear. There was literally no way to get relief until the balloon landed. I remembered that I did have many years of meditation experience and decided that I would likely need all of it! So I began to focus my attention very deliberately and sharply on the experience of my breathing.

Just as I had been taught and had done in my own meditation practice over the years, I let the breath be just as it was and let the situation be just as it was.

I directed my complete attention to the unfolding sensations of my breath, especially my outbreath. After just a few breaths, I noticed some relief. I was able to locate the feelings of fear in my body. I was able to breathe in and out with the fear, holding the sensations in the cradle of the breath. I was able to soften some around the sensations and the situation...I started to move about in the basket and began to take more interest in the ride.

I rode quite a distance with fear that morning. In fact, fear came and went and came back again many times. But each time it came, I was able to meet it the same way, using awareness of the breath as an anchor and consciously breathing in and out with the unfolding experience.

Through this practice of mindful breathing, I was able to change my relationship to the fear experience in a fundamental way. I was able to stop relating from the fear, or as the fear, and instead relate to the fear..."

I tell Jeff's story because I think it is an excellent example of effectively utilizing mindfulness practices in real world situations.

Jeff was completely stuck in this situation, there was literally no way out but through (as is such in so many of life's challenging experiences, we often can't just stop the ride!).

Jeff stopped fighting against his experience and essentially surrendered to it; he began breathing through it. He remembered the ANCHOR - his breath. He surrendered & took control simultaneously in remembering and using this ever constant friend. 

Jeff Brantley's above experience was quoted directly - almost verbatim- from his book "Calming your anxious mind". This book is an excellent resource for coping effectively with fear, anxiety and even panic disorder.

Dr. Jeff Brantley is the founder of the Mindfulness Based Stress Reduction Program at Duke University's Center for Integrative Medicine.

Have you ever heard that the psyche speaks another language? Psyche's language consists of images, symbols, music, and poetry. For this reason, many psychoanalysts encourage their clients to draw and paint. The active use of this imaginal muscle gets things to shift inside, often shifting things which have been stuck for a very long time. For this same reason people are encouraged to pay attention to dream images. Dream images are theorized to be important and decodable messages from the unconscious--- they are spoken in psyche's imaginative symbolic language...

"What we call a symbol is a term, a name, or an image which in itself may be familiar to us, but its connotations, use, and application are specific or peculiar and hint at a hidden, vague, or unknown meaning...A term or image is symbolic when it means more than it denotes or expresses" ~Carl Jung  

Symbolic language and images point beyond themselves.

These elements (images, poetic and symbolic language) have the power to shift us from the inside out. Sometimes, actually often times, the shift takes place without conscious comprehension/understanding of what has taken place, just like poetry.

"Love after Love"  by Derek Walcott

The time will come
when, with elation,
you will greet yourself arriving
at your own door, in your own mirror,
and each will smile at the other's welcome.

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

~Derek Walcott
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"Feast on your life",

Regina