Teaching notes for a 5-minute sequence to reduce anxiety or prevent a panic attack

Afterthoughts Counselling and Training Ltd ©

Teaching sequence demonstrated on Youtube AfterthoughtsNi

https://www.youtube.com/channel/UCseclWmHyeY8QQLb7Rz4Oeg

I have a slide presentation for this too. if anyone wants it please contact me via facebook. (it has pictures)

Because I have met so many people who have no tools to manage extraordinary symptoms when I meet them first, I offer this sequence to you. It is important to have something to do when anxiety or panic or sadness (among many other post-birth trauma symptoms) come to visit. I recommend this sequence having taught it for many years in one version or another. Those who use it immediately and practice it in advance of needing it, have a very effective technique which reduces symptoms and restores a sense of safety, balance, and control. Things you want to feel in labour and birth, but at any time in life too.

Begin differently for Panic attacks. I use this sequence to help clients restore control when they are having a panic attack. I add a grounding technique at the very beginning.

Grounding is bringing the person back into the room and helping them to orientate in time and space.  Fear responses or anxiety can be helped in this way too but are not always necessary.

  • Begin with breathing and tapping
  • Direct the person to feel their feet on the ground.
  • Direct the person to see three things in their environment that are the same colour.
  • Ask them to count back from 18 in 3s, and thenstart the ten-second squeeze sequence.

This allows a few minutes for the symptoms to reduce. Eye contact. A smile. Reassurance that they are safe, this will pass soon. ‘This will pass more quickly if you do these things’

The ten-second squeeze

 

The idea of squeezing all the body muscles in sequence and holding all these muscles tight is to enable the system to reduce the adrenaline rush that initiated this response. It also helps to be doing something and keeping the mind distracted. Complete the squeeze with a shake. I saw this first on Youtube a long time ago. A young man used it to give him courage in the moment and it seemed to work. I’ve used it ever since. I did try but can’t find that now to credit him with this.

  • Toes to head, name all the muscle groups. Progressively squeeze, then hold for 10 seconds. Shake it out.

The hormone adrenaline floods into your bloodstream, putting your body on high alert. Your heartbeat quickens, which sends more blood to your muscles. … But the physical effects are real: During a panic attack, the adrenaline levels in the body can spike by 2.5 times or more.  https://www.webmd.com/anxiety-panic/panic-attack-happening#1

 

Then, the 2-minute sequence. This should with practice, have three separate elements.

 

Tapping

First. Regular tapping. An ordinary pace. Anywhere really as long as the taps take place on both sides of the body. Tapping is used in EFT and EMDR among many other named therapeutic approaches.  It is also used naturally when you are restless, tapping toes or drumming fingers. Below (b) in this image is after tapping. (Google images, research.gate). I suggest spending a little time on Google Scholar to see how broadly researched this is. It takes time, generally about 4 minutes for the neurological changes to take place. With a very restless client, I will shorten the sequence to one minute, follow with a 10-second squeeze and then initiate the full 2-minute sequence. It’s about helping a person to feel they are in control. Gain insight too from Jim Donovan’s TED talk on tapping. He goes so far as to say tapping saved his life.

 

Breathing. A lot of exercises with breathing involve numbers. There is no need to count the breath in or out. In fact, this is unhelpful to this sequence. A short but deep breath in, a long breath out. When breathing out encourage this person to push their breath out in a downward motion. This pushes down on the Vagus nerve. It just makes a logical kind of sense. In an anxiety state a series of events have stimulated adrenal glands and blood flow, carrying an adrenaline stimulation to muscles and organs. Imagining this effect being restricted by that downward push on the breath will help settle the mind too.

 

Occupy the brain with a simple task. This can be numbers or the alphabet or a nursery rhyme. If I say to a person having a panic attack, that they are safe, everything in their body is saying otherwise. Placing a sequence in their minds, that they have known all their lives, is very settling. This prevents escalation and begins to enable the other 2 processes to work their benefits. These balloons are an example of an exercise that might work. Look at the picture. Remember all the balloons with numbers. See how number one is highlighted in a yellow ring. Move the ring in your mind to number two’s balloon, then 3,4, etc. (or just count), (or say the alphabet). This is not done out loud, which requires some concentration at the beginning.

Closing your eyes is not recommended. In therapy, if your client closes their eyes you have lost them if panic escalates. In fear, there is an attachment orientation and desire to meet the eyes of another for reassurance. Reflecting confidence and being a safe person to another involves eye contact.

 

10-second squeeze sequence

Start with a 10 second squeeze and shake that out gently

A 2-minute sequence with Tapping, Breathing, and Numbers. Then the 10-second squeeze

A 2-minute sequence with Tapping, Breathing, and Numbers. Finish with a last 10 seconds and relax

 

Alternative uses, a few examples

  • I use it in therapy to teach clients to stop a panic attack themselves
  • Use frequently over weeks to re-train anxious neural networks to become less anxious (let me know when you find this works for you)
  • Use it after the flight or fight response has been activated in labour
  • Use it to relax a stressed system before or while breastfeeding
  • When you have had a tiff with your darling
  • Use it when you wake with a nightmare or having felt afraid in your sleep
  • When sleep is elusive even though you are tired
  • Try with a restless baby and let me know if it helps
  • Before a presentation, you are nervous about giving

Each part can be used alone. Tapping on its own helps you get to sleep. Breathing to relax at the first sign of a stress response. Numbers sequence to quieten your mind when you are studying. You can do this at work or on a bus.

Choose one element eg tapping under a desk. Take 5 and do the whole sequence in the loo. 2 parts are enough to distract a habitual system.

It won’t work if you don’t use it. Get your system to know these things so well there is immediate recognition and response to starting the sequence.

And lastly. It’s taught by you doing it with your friend/ colleague/ patient/ client! Don’t leave them out there on their own trying to become comfortable with something that doesn’t make any sense to them yet. You doing it too, will make them confident of its value.

Which helps them get it in their system. Which gives you a small opportunity to get the benefits too. Enjoy!

 

 

preparing for a traumatic birth

I am putting together some teaching materials on this subject. Part one of 4 will give you some information on reducing anxiety responses in the moment. Not everyone has a traumatic birth experience. Most births thankfully are conducted in a manner that means you are informed about decisions and process at the time and feel confident and contained throughout.

What we do know about birth, though, is that it can be an unpredictable journey. A small number of parents are adversely affected in terms of their mental health. 18% of women will describe their birth as having been traumatic. Often this is due to smaller and some larger escalations in anxiety or fear during labour and birth.

I suppose the logic of preparing for being afraid means that if this happens you can intervene at the moment, or shortly afterward, to reduce the chances of longer-term effects. A bit like having a towel in your car in case a spontaneous rupture of membranes happens when you go shopping, definitely not something you could predict. If you learn after the event that 15% of women have a spontaneous rupture of membranes prior to labour, you might feel more miffed that the car seat got soaked.

Preparing for trauma in labour might feel contra-intuitive. However, some very ordinary strategies and a basic understanding of how and why this happens can help you settle things quickly.

More here very shortly.

Searching in therapy for the positive

Happiness. Did you know there is score for your Countries level of happiness? Finland is the routinely the happiest country. Ireland was 14th on the world’s list; USA 18th and the Uk 19th in 2018. It might be surprising to consider that the levels replicate year on year. It leads to more questions than answers really. What makes a country happy? What influences those levels?
Dfarhud et al (2014), reviewed various studies and concluded that results of studies on genetic factors for happiness indicated an average effectiveness of genetics at about 35 -50 percent on happiness. So at least part of the capacity to be happy is influenced by our genes.
Research in the field of positive psychology and happiness often define a happy person as someone who experiences frequent positive emotions, such as joy, interest, and pride, and infrequent (though not absent) negative emotions, such as sadness, anxiety and anger (Lyubomirsky et al., 2005) The conclusions of this study demonstrated that what precedes numerous successful outcomes, influences the human behaviours which correlate with success, and describes the positive effects of happiness as the hallmark of well-being.
I have followed Michel Odent with interest as my midwifery journey has transitioned. He turns the argument regarding the capacity of stress hormones in pregnancy to affect a developing fetus on it’s head by questioning the lack of interest in research on the influences of positive hormones in pregnancy. In his article ‘The Function of Joy in Pregnancy (Odent 2006). While recognising the enormous growth in positive psychology research it is important too to be practical.

happiness is life experience marked by a preponderance of positive emotion. Feelings of happiness and thoughts of satisfaction with life are two prime components of subjective well-being. TWEET
The counselling assessments which we use to provide measurements predict a preponderance to symptoms of anxiety of depression or risk. We look for the worst that a person has been feeling. Measurements for happiness are not in any way a routine construct of establishing wellness levels. The Epigenetic Institute recognises that numbers of studies indicate that the question of happiness is multidimensional, and demonstrate that much has to do with expectations and beliefs alongside relationships and values.
Mayers, (2007) in his concluding comments on DNA and happiness genes remarks that managing the mind is very effective and can rapidly improve well-being.
TWEET
While Dr Mayers is primarily referring here to the practice of meditation the principal is the same. We all have a baseline for contentment or joy or happiness. A level almost that remains fairly stable throughout the day. The quantity of happiness being influenced by life’s seasons and events. Seasons may come and go but those levels, day by day may stay the same.
It is hard if the life a person leads or is influenced by factors based in biology or circumstances has not provided a baseline sense of every day contentment. If you are depressed or severely anxious and afraid it may seem unfair to believe a greater degree of happiness is possible in the routine of life for many around you. Clients who have baby’s in the midst of life turmoil may even describe this sense of happiness, co-habiting with the emotional turmoil of their birth experiences as jarring and uncomfortable. It can seem crass to recommend that pregnant women or new parents ought to seek out the way of joy, when life circumstances draw the heart inwards or down.
So much can be done. Often simple acts of kindness from you to you can change expectation. Expectation igniting hope and some (potentially fulfilling) hard work can begin to change that chemistry. This is what the research says. It provides encouragement to those who feel able, to start to seek the more content road whatever the circumstances. Realistic truth, honest connections and some hard work might germinate the seeds of hope for a richer happier life in the future.

Resources below.
https://www.wikihow.com/Be-Happy This is a very practical look at growing happiness
https://psychcentral.com/lib/15-ways-to-increase-your-happiness/
Suggestions for a happier life: http://www.davidmyers.org/Brix?pageID=46

http://www.drjamesdbaird.com/

holarpedia is supported by Brain Corporation
Psychology of happiness
David Myers (2007), Scholarpedia, 2(8):3149. doi:10.4249/scholarpedia.3149
revision #37099 [link to/cite this article]

Post-publication activity

Curator: David Myers
• David Myers, Hope College, Holland, MI

Trauma: It does not occur in isolation to the community of a traumatised individual

Looking at trauma evolving in the context of local community influences

In 1992, Judith Lewis Herman published her book Trauma and Recovery. “The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.” 1

I live in Northern Ireland, born in the South. In 1998, I was in Stormont, waiting with family and friends for the signing of The Belfast Agreement (also known as the Good Friday Agreement because it was reached on Good Friday, 10 April 1998) and I remember my 3-year-old daughter escaping under the barrier to greet the politicians. There were stark predictions, by academics after the agreement was signed, of concern for the mental health of the next generation in Northern Ireland. In 2016, The Mental Health Foundation reported that Northern Ireland had a 25% higher overall prevalence of mental health problems than England. Previous to this, in 2014/15, according to the Northern Ireland Health Survey, 19% of individuals showed signs of a possible mental health problem. More women (20%) than men (16%) reported signs of mental health problems.2

Also in 1998, the ACE study (Adverse Childhood Experiences Study) was yet to be published in America. This was a study of 17,337 people of which 75% had attended college and all had access to good health care. The results were astonishing, and have influenced the basis of much of mental health planning globally. Clear links between adverse childhood events, life-time illness and early death were established.3

This information formed the basis of many initiatives in health and education. I sometimes work with teachers who are able to describe programs which equip little children to self-regulate. Setting a foundation for life in terms of being able to recognise symptoms of stress and developing a core belief that small interventions can bring relief in the moment.

The Atlantic Philanthropies, invested over 8 billion dollars in promising programs. They invested in people and places where they saw the chance to create opportunity and promoted greater fairness and equity. They have invested in 8 areas of the world, and spent a great deal in sponsoring community and peace initiatives in Ireland, North and South. 4

Chuck Feeney, founder and entrepreneur and this organisation, remained anonymous for many years in their investments in Northern Ireland which began in the early 90’s. Their stated ethos is ‘a belief in addressing deeply rooted problems sooner rather than later,’ giving grants to “big bets” designed to produce lasting results. The Atlantic Philanthropies founded Giving While Living and has inspired many individuals and companies to give a portion of their profits away to research-based projects in their own lifetime. (ATNI following suit at training programmes. More later.)

The Early Intervention Transformation Programme (EITP) is a Delivering Social Change (DSC)/Atlantic Philanthropies Signature Programme which is funded jointly by five government departments (DoH, DE, DoJ, DfC and DfE), DSC and Atlantic Philanthropies. This evidence-based programme starts early in a child’s life by initiating interventions for parents to use when baby is still In Utero. 5

There are 4 workstreams within EITP:

  • EITP Workstream 1 aims to equip all parents with the skills needed to give their child the best start in life and will focus on key parenting stages through the Getting Ready for Baby, Getting Ready for Toddler, Getting Ready to Learn; and Play Matters projects.
  • EITP Workstream 2 aims to support families when problems arise before they need statutory involvement and will focus on the delivery of an integrated regional model of early intervention for these families through the Early Intervention Support Service.
  • EITP Workstream 3 aims to positively address the impact of adversity on children through a range of projects including Home on Time, Edges, Building Better Futures, Raising the Educational Outcomes of Looked After Children, Early Intervention Child Care (Thrive), Children of Imprisoned Prisoned Parents, and the Family Drug and Alcohol Court (FDAC).
  • EITP Workstream 4 consists of a Professional Development Project which aims to strengthen the culture of inter-professional working practice, with a particular focus on Adverse Childhood Experiences by supporting professionals to train together as well as embedding commonality in prevention and early intervention approaches.

In 2018, Belfast had its first trauma summit. It was organised by Action Trauma that was founded by Clive Corry in memory of his late wife, Gillian. Clive’s vision is to spread the word and make Belfast a trauma information hub, driving research, improving understanding and disseminating information on every aspect of trauma. This was the ethos behind the investment in the International Trauma Recovery Summitheld in Belfast last year. It was a not-for-profit event, held in the Waterfront Hall and was full to the doors each day. Therapists were able to meet international leaders in trauma psychiatry, psychology and psychotherapy. More importantly, a one size does not fit all strategy for trauma was apparent in the variety of ways of working. 6

The world of knowledge is changing faster than policy can be developed to guide process. Dr Dan Siegel’s forward to Robin Shapiro’s book ‘The Trauma Treatment Handbook’ reflects this new dimension. Dr Siegel identifies that not all approaches are scientifically proven. He balances this in recognising that the range of interventions described in this book enable a diversity in ‘ways of working’ with individual experiences of symptoms. 7

Therapists will have a list of tools they can use in a variety of different scenarios. All will be able to define the way they work to enable a new client to understand what the journey they are embarking on might look like.

If I say I am a Person-Centred Trauma Focused Therapist and use a variety of tools drawn from many other disciplines, a client might hear ‘you will be looking at me as an individual and will be happy to structure this counselling process to my own personal needs’. If I explain that I am also a midwife, clients will feel able to share a birth-story in the knowledge that I will understand the complexities of that journey. If a therapist defined their therapeutic approach only in those terms a client who needs to work with relationship issues or grief perhaps might look elsewhere.

The National Counselling Society and the British Association of Counselling and Psychotherapy (see resources below) give a profile of therapists who give the public a very clear list of subjects that they are happy to work with. This makes it easier for members of the public to source a therapist to suit their own needs.

Whatever the approach or discipline practiced by a therapist, the needs of the client for understanding the complexities of their issues in regard to their current state of mental health are paramount. Processing and travelling through this journey will depend on the therapeutic approach of the therapist. It is worth considering travelling a little distance to see the therapist that might best meet what a person feels instinctively would help them on their own personal journey.

Therapists normally have, what we fondly refer to as, a tool bag. If a client presents with panic or anxiety or depression, our way of working will be altered. Specific helping tools might be adapted to individual needs. A principal in trauma care is to hand back, or develop, control in the client. Being able to manage symptoms, work directly with PTSD as a result of birth or life’s experiences, and resolve and restore equilibrium is the ideal. Clients should leave a therapist with some tools to access later and feel a stronger sense of autonomy in their own capacity to relieve symptoms themselves in the future.

The profile presented here, is of a ‘community narrative’ peculiar to Northern Ireland. The unspoken whyand the precise reasoning for the need in this new generation for particular consideration is reflected in the local community narrative that you belong to. Growth, wellness, personal pain, and the wounds of the new generations are found in whatever the community looks like where you, the reader, live. Knife crime at one end, loneliness and isolation at another, integration and community identity, in another. This is where families are born and babies are made. Women and men carry their own story and growth and pain to the conception and birth journey. A simple trauma in a birth trauma response is embedded in this rich history. This capacity to open a door, to the paths that led to this moment in therapy, is created in a place of holding. Appreciation of how the journey made the difference might be lost in a counselling journey that seeks only to work with symptoms.

 

References

  1. Herman J.L. 1992, Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror
  2. Mental Health in Northern Ireland: Fundamental Facts 2016
  3. Adverse Childhood Experiences Study (ACE Study)
  4. The Atlantic Philanthropies (Northern Ireland Region)
  5. The Early Intervention Transformation Programme
  6. Action Trauma
  7. Shapiro, R. 2010, The Trauma Treatment Handbook: Protocols Across the Spectrum. W.W. Norton and Company, New York-London

 

A growing list of other support, weekly:

The National Counselling Society

British Association for Counselling and Psychotherapy

 

Part 7 → Birth Trauma: Part 3 of 3

Blog series on Perinatal mental health and psychological birth trauma

For every year of births, the estimate long term cost to society of Perinatal Mental Health in the UK is 8.1 billion pounds (Bauer, 2014). 1 This estimate is based on the costs of mental health care of women through pregnancy and beyond, and it follows the trajectory of the cost of health-related ‘quality of life losses’ over the lifetime of mothers and their children’.

NHS England defines perinatal mental health problems as occurring during pregnancy and in the first year following the birth of a child. This NHS definition embraces a wide range of mental health conditions and it is estimated that 1:5 women will be affected.

A wealth of research recognises that if women who are having babies suffer from conditions such as anxiety or depression when they are pregnant or after their baby is born, that their children may need additional help as they too develop. There is a push to help parents understand the very real benefits of healthy attachment behaviours, which facilitate the growth of neural pathways, benefiting baby’s development.

This is hard news if you are a mum or dad who finds themselves in this position. Knowledge initiates opportunity for change. There is also wonderful research on the benefits of interventions. Power to enable growth and stimulate a secure base in little ones is in the hands of mums and dads, the wonder of siblings and the extended family. See – 4 Ways to Promote Healthy Attachment in Infants 2

The action of looking forward and considering the cost to infants beyond the labour ward creates the opportunity for voices and agents of change in the story of birth and mental health recovery to be heard. The report in 2014 mentioned above led to an increase in active caring services throughout the NHS for women whose mental health is discussed on booking, or diagnosed at a later stage. Perinatal mental health took on a higher profile with streamlining of services. New support and treatment pathways exist now as a result, provided within many UK and Irish maternity services to women with mental health concerns during pregnancy.

The Birth Trauma Association, a charity which supports women with trauma symptoms post birth, estimates that 30,000 women in the UK experience symptoms annually. The Birth Trauma Association define Birth Trauma as a shorthand phrase for post-traumatic stress disorder (PTSD) after childbirth. This is also used for women who have some symptoms of PTSD, but not enough for a full diagnosis. Follow to their website for further information. Link below. 3

Almost 3.5% of women are estimated to already have PTSD when they are pregnant, 4% to have PTSD after childbirth (Yildiz, 2017). 4 Women are individuals, with complicated life histories. As therapists, it is important to see the whole person when we consider working with the various presentations of both trauma and other psychological responses; before, during pregnancy and beyond.

In each of the following weeks various aspects of perinatal mental health conditions will be explored.

Opinions expressed here are my own.

 

We don’t have to do all of it alone. We were never meant to. – Brené Brown

 

References

  1. Bauer et al. (2014). Costs of perinatal mental health problems. London School of Economics and Political Science, London, UK
  2. 4 Ways to Promote Healthy Attachment in Infants (The Urban Child Institute)
  3. What is birth trauma? (The Birth Trauma Association)
  4. Yildiz et al. (2017). The prevalence of post traumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Journal of Affect Disorders. (source; PUBMED 2019)

A growing list of other support, weekly:

NCT – 1st 1,000 Days New Parent Support 

Nurture Health – Breaking the Silence of *Conception *Pregnancy *Childbirth

ATNI – Counselling and Training

 

Part 2 → Creating the Biology of Courage

Single and complex birth trauma

Birth Trauma is often mistakenly described as though single incidents explain the patterns of trauma presentations which occur in very different individuals.

Single incident birth trauma; a single emergency, even terrifying in the moments which follow, can be treated in a session or two. When multiple incidents of trauma have occurred in a woman’s past, a complex trauma response to birth is much more likely. While trauma and a life history of difficult events can be a force that strengthens character, it can equally create a vulnerable network of historical coping mechanisms that make a person more vulnerable in new situations.

Complex trauma is named aptly. Yet it has patterns that are detectable in therapy. The mind finds a way of managing very quickly when a person becomes afraid. It doesn’t search the whole bank of experience, but somehow pattern matches a part of this new fearful place with another.

A woman may not wish to disclose a whole world of pain in the mental health assessment which proceeds therapeutic interventions. Equally she may not know that bullying in primary school or a painful sexual experience or an almost drowning as a toddler could be relevant to the fear, depression, nightmares or anxious thoughts which form her psychological presentation after a traumatic birth experience.

Curiosity and faith are the therapists’ friends. If we are ‘still’ with our clients when the primary trauma experience has been worked through and settled, the complex pattern most often emerges spontaneously. Working safely here is paramount; knowing what is useful, where it is unwise to tread, or how to settle and quieten responses too complex for this season.

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