1. A New Perspective on Treating Anxiety, Depression and PTSD Presentation by Bob Van Oosterhout MidMichigan Health Park Houghton Lake NASW-MI State Conference April 15, 2009 Website: www.bobvanoosterhout.com

2. 2 Recovery from Anxiety, Depression and PTSD is a Natural Process The role of the therapist is to identify and remove obstacles to recovery: Physical, mental and emotional tension Stress, conflict, misperception Secondary gain from symptoms “Lost heart” – limited opportunities for growth or fulfillment

3. 3 The Heart of Our Work The process of recovery results in increased depth of understanding and appreciation of life and relationships along with improved clarity of perceptions, values and priorities. It is a personal, cooperative process that is unique to each situation. Treatment tools have no value if the client is not ready to use them. Establishing a limbic connection creates an atmosphere of acceptance and shared perceptions where timing and interventions become clear. Tension, impatience, judgment and thinking in terms of “should” on the part of the clinician undermine this connection.

4. 4 The Nature of Tension Tension involves resistance Physical – continuous contraction of muscles that develop into habitual patterns Mental – narrowing and fixing of perceptions and patterns of negative thinking that create physical tension Emotional – resisting the full experience of emotions through breath-holding and patterns of physical and mental tension

5. 5 Physical Tension Like pressing your foot on the accelerator when your car is in park –Uses up all your energy –Wears out the engine and transmission –You have limited control if it slips into gear Ongoing process of muscle activity Develops habitual patterns of posture and movement which create additional tension

6. 6 Physical Tension (cont.) Regulated by Autonomic Nervous System (ANS) Sympathetic Nervous System (SNS -required for activity) becomes over stimulated while the Parasympathetic (PNS - required for health maintenance) is suppressed (Fight or Flight) High levels or intensity of tension stimulates release of stress hormones which boosts SNS and suppresses PNS Creates a self-escalating process when more stress hormones are released as tension builds, thus stimulating the release of more stress hormones.

7. 7 Mental Tension The build up of physical tension is perceived as an indication of a threat, which –Narrows focus and perception –Leads the mind to ask “what’s wrong” Thoughts create physical tension when they indicate a need for action but don’t result in purposeful activity Asking “what’s wrong” from a narrow focus builds tension, which further narrows focus on “what’s wrong” creating a self-escalating process

8. 8 Emotional Tension Emotions involve proprioception – Specific muscle movements are associated with emotions Facial expressions are obvious but other muscle groups move in response to specific emotions Resisting emotions involves stopping muscle movement which creates physical tension Tension increases reactivity while decreasing responsiveness (sunburn, spring metaphors) Leads to behavior that creates mental tension Release of emotional tension is not necessarily linked with specific memories (soup metaphor)

9. 9 All Symptoms of Anxiety Can Be Explained by the Build-up of Physical Tension Shaking Heart palpitations Dizziness Nausea Numbness Tingling Feel out of control Excessive worry Can’t breathe Chest Pains Sweating without activity Feeling of choking Can’t sit still Chills/hot flashes Feel out of touch/unreality

10. 10 Depression Results From Resisting Emotions which Builds Mental and Physical Tension Emotions are physical events which are restricted by muscle tension. Emotional tension: Uses up energy as it narrows focus and responsiveness Creates self-escalating mind/body/emotion interaction that decreases energy and motivation as it limits perceptions and increases focus on the negative Resisting crying increases tension which increases the need to cry. (Crying is the most effective way to reduce emotional tension) Narrowed, negative perspective leads to hopelessness Reduced emotional responsiveness reduces capacity for pleasure

11. 11 PTSD is Caused by Unresolved Deep Emotional Tension Resulting From the Perception of Trauma Fear is the predominant emotion Atmosphere of safety and control is critical The amygdala (which bypasses logical thought) becomes hypersensitive Resolution involves clearing “surface tension” and accepting emotions that arise without resistance (tension or breath-holding)

12. 12 Resolving and Preventing Physical Tension Requires more than relaxation. Balance must be restored to the ANS Rhythmic diaphragmatic breathing stimulates the PNS and suppresses the SNS –Precise rhythmic movement of the diaphragm stimulates the right vagus nerve activating the PNS (proper rhythm is critical) –Regular PNS activation over time allows liver to remove stress hormones from bloodstream restoring balance to ANS Grounding reverses patterns of tension while developing awareness of tension habits.

13. 13 Resolving and Preventing Mental Tension Clarify thoughts and perceptions –Identify nature of immediate threat and separate short from long term issues –Understand cause and process for resolving SX –Choosing “Perceptions that Work” –Identify strengths, reasons for optimism, obstacles, options and likely outcomes (“if-then thinking”) “Thought Focusing” blocks and redirects negative mental habits Regular meditation develops mental discipline and perceptual flexibility

14. 14 Resolving and Preventing Emotional Tension Accept emotion without resistance as normal response that all humans share Identify and reverse patterns of tension which restrict emotions Understand that emotion results from perception Understand process of recovery from deep emotional tension

15. 15 Characteristics of Effective Clinicians Balance, defined as the absence of tension, a state of relaxed receptivity and perceptual flexibility; Emotional openness indicated by an ability to feel and let go of emotions experienced by the client without building up tension Receptivity to the perceptions and emotions, and experience of the client that is not blocked by ego, attachment, judgment, or preconceptions Ongoing Reflection and commitment to improvement

16. 16 List of Hypotheses 1.Recovery from symptoms of anxiety, depression and PTSD is a natural process when obstacles are removed. 2.People who have fully recovered from symptoms of anxiety, depression and PTSD demonstrate an increased depth of understanding and appreciation of life and relationships along with increased clarity of perceptions, values and priorities.

17. 17 List of Hypotheses (cont.) 3.The primary obstacles to recovery from anxiety, depression, and PTSD are 1) Physical, mental and emotional tension. 2) Conditions where symptoms provide secondary gain; and 3) “Losing heart” where the client perceives being stuck in a situation that blocks growth and fulfillment. (Tension involves resistance. Physical tension is a continuous contraction of groups of muscles that tends to form patterns outside of normal awareness. Mental tension results from patterns of thinking and perceiving that create narrow, inflexible and distorted perceptions and mental habits that create physical tension. Emotional tension results from attempting to restrict the experience of emotion through muscle contraction and breath holding. There tends to be consistent patterns of physical tension that are associated with resistance to specific emotions.)

18. 18 List of Hypotheses (cont.) 4.Physical tension limits perceptual flexibility, receptivity, and the ability to experience emotion while limiting awareness and the capacity for reflective thought. It creates non-productive negative thinking which builds additional physical tension contributing to a self-escalating process. When tension builds, it creates an imbalance in the Autonomic Nervous System (ANS) where the Sympathetic Nervous System (SNS), which stimulates muscle effort is over-activated while the Parasympathetic Nervous System (PNS) which stimulates health maintenance and recovery is suppressed. The build-up of tension triggers the release of stress hormones which, in turn, increase tension levels while limiting the ability to recover, creating another self-escalating process. Patterns of tension form habits of posture and movement which build additional tension on an ongoing basis.

19. 19 List of Hypotheses (cont.) 5.All of the physical symptoms of anxiety can be explained by the build-up of excessive muscle tension and increasing levels of stress hormones in the bloodstream. Cognitive symptoms of anxiety involve mental tension that both result from and contribute to a build-up of physical tension. 6.Depression is caused by a build up of emotional tension which results from resisting emotion through physical tension and breath holding. This creates patterns of mental tension which further compounds the problem. The build-up of tension over time depletes energy and motivation as it diminishes hope and clarity of self-perception. Depression is resolved by learning to fully accept emotion without resistance and breaking habitual patterns of physical and mental tension. Being able to consistently cry without tensing or breath holding is evidence of the resolution of depression.

20. 20 List of Hypotheses (cont.) 7.PostTraumatic Stress Disorder is caused by deep emotional tension resulting from the perception of trauma. Fear is the predominant emotion in PTSD. The amygdala, which is activated during times of intense fear and can stimulate reactions which bypass the areas of the brain involved in logical thought, becomes hypersensitive in PTSD. Recovery from PTSD involves resolving emotional tension by learning to experience emotion without tension and breath holding in an atmosphere of safety and control while restoring normal sensitivity to the amygdala. Resolution of physical and mental patterns of tension contributes to process. 8.Full recovery from built-up tension requires restoration of balance to the Autonomic Nervous System as well as the ability to accept emotions without resistance, shift perceptions and redirect thoughts.

21. 21 List of Hypotheses (cont.) 9.The resolution and prevention of relapse for symptoms of anxiety, depression and PTSD involves 1) Understanding the nature of the disorder, causes of symptoms, and the process of recovery; 2) Restoring and maintaining balance of the Autonomic Nervous System; 3) Awareness of when tension starts to build and the ability to intervene to prevent it; 4) The ability to accept and fully experience emotion and crying without tensing or breath-holding. 5) Awareness of when perceptions begin to narrow and the ability to reframe them; and, 6) The ability to recognize thoughts that build tension and redirect them.

22. 22 List of Hypotheses (cont.) 10.The clinician’s role in the recovery process involves: 1) Creating an atmosphere where the client feels understood, that their symptoms make sense, and their emotions are a normal response to perceptions of their experiences. 2) Identifying obstacles to recovery including stress, relationship or health issues, addictions, problems, and conflicts while assisting in the process of removing them; 3) Timing interventions to match the readiness of the client to understand and act upon them. Effectiveness requires 1) Balance, defined as the absence of tension, a state of relaxed receptivity and perceptual flexibility; 2) Emotional openness indicated by an ability to feel and let go of emotions experienced by the client without building up tension; 3) Receptivity to the perceptions and emotions, and experience of the client that is not blocked by ego, attachment, judgment, or preconceptions.

23. 23 Sources: Lusseyran, Jacques, And There Was Light, Little, Brown & Co., 1963 and Against the Pollution of the I, Parabola Books 1999. Merton, Thomas, The Way of Chuang Tzu, Shamhala Press, 2004 (originally published in 1965) and No Man is an Island, Harcourte Brace, 1955. Beck, Charlotte Joko, Everyday Zen: Love and Work, Harper & Row, 1989 and Nothing Special: Living Zen, Harper/Collins, 1993. Dalai Lama, The Art of Happiness: A Handbook for Living, Riverhead Books, 1998 Chodron, Pema, Start Where You Are: A Guide to Compassionate Living; Shambala, 1994 and When Things Fall Apart: Heart Advice for Difficult Times, Shambala, 1997. Chittick, William, The Sufi Path of Love: The Spiritual Teachings of Rumi, State University of NY Press, 1983. May, Gerald, G. The Awakened Heart: Opening Yourself to the Love You Need, Harper Collins, 1991.

24. 24 Sources (cont.): King, Martin Luther Jr., Strength to Love, Fortress Press 1981. Maritain, Jacque, The Person and the Common Good, C. Scribner Sons, 1947. Mandela, Nelson, Long Walk to Freedom, Little Brown & Co., 1994. Tutu, Desmond, God Has A Dream: A Vision of Hope for Our Time, Doubleday, 2004. D’Agular, Fred, Feeding the Ghosts: A Novel, Ecco Press, 1997. Rawicz, Slovormir, The Long Walk: The True Story of a Trek to Freedom, Lyons Press, 1956. Keenan, Brian, An Evil Cradling, Random House, 1992. Nuernberger, Phil, Freedom From Stress: A Holistic Approach, Himalayan Institute Press, 1981. Lowen, Alexander, Depression and the Body, Pelican Books, 1972