I made sure that my tone at all times was to be calm and relaxed and confident given that Tom’s presenting symptom was anxiety.
Session One of Three.
Tom arrived on time and was smartly dressed in a shirt and trousers with clean black polished shoes. He immediately made an excuse that he had come straight from work and seemed quite embarrassed and shy. I welcomed him in and we sat down.
Tom is 45, single and a train driver. Under issues that he would like to resolve he had written ‘stop panic attacks at work – ok when I’m driving the train’ and under what outcome was he looking for he had written ‘same.’ Under what stops you achieving this on your own he had written ‘ I don’t know what to do - I thought I was having a heart attack but Doctor said it’s anxiety.’ He had ticked that he truly desired change in his life.
Tom was not taking any medication and had written that he felt anxious, was having problems sleeping and that he did not feel confident at times in his new job. He was an only child and did not wear contact lenses or glasses ( something I needed to know if I was going to ask him to close his eyes for hypnosis ). His interests included walking his dog, DIY and travel. We discussed his answers and I discovered that he had recently had a promotion at work which he was proud of and he enjoyed the new responsibility however his shift pattern had changed and he was having problems sleeping. He also had to attend management meetings which he did not enjoy that he had not had to attend previously and worrying about them was affecting his sleep. He said that his father had died suddenly four months ago of a heart attack which had also affected him – his mother was still alive.
I explained that one of the reasons for the client intake form was to try and understand what had brought Tom to my office today ie. the causes of his concern as opposed to the symptom itself. We agreed that the loss of his father suddenly at around the same time as he became aware of his anxiety could certainly be an influencing cause as could his new promotion which also happened at around the same time. I wanted to focus Tom’s attention ‘into’ my office as opposed to any ‘outside’ thoughts ( shopping list etc etc ) so added that it may be interesting to complete a simple form that may further decipher causes of his symptom which Tom was happy to do – I said he didn’t have to do anything just answer 30 questions yes or no, which again he was happy to do.
I read out the Holmes and Rahe stress inventory questions and made sure that he could see clearly what I was reading from and the marks that I was making on the page.
Tom answered yes to
death of a close family member,
change in financial status,
change in responsibilities in job,
outstanding personal achievement,
trouble with boss,
change in work hours or conditions,
change in sleeping habits,
change in eating habits and
Christmas which gave him a total score of 243.
We discussed his answers which provided me with additional information – he had received a pay rise as a result of his promotion, he was now the driver of the train and responsible for it ( which he was very proud of and enjoyed ), he felt that he had reached outstanding personal achievement as he had ‘worked up from the bottom having left school at 16’, he was experiencing problems with his boss because whilst Tom was an excellent practical man he did not like filling in forms and found meetings very difficult.
The change in shift pattern had affected his sleep and his routine of walking his dog every lunchtime ( his mother now walked the dog when he was at work ), his eating habits had changed because of his shifts and sometimes he missed meals and Christmas had been almost impossible because of the loss of his father.
I explained that someone with a similar score to Tom could be expected to be showing signs of moderate stress in their lives and there would be a 50% chance of illness or a change in health so the fact that Tom had himself had a change in health was not surprising. He admitted that he knew he was not as well as he had been in the past as he had had colds and coughs recently that he could not ‘shake off.’ He never usually suffered from colds or coughs. I clicked on my computer to show a picture of the brain and said that the oldest part of the brain was where the problem lay :
It is linked to and controls miles and miles of highly sensitive nerves that are protected by running deep within our bodies to all our internal organs – it keeps us alive and it generates our emotions and our feelings. It is responsible for releasing stress hormones eg adrenalin and also the release of endorphins that mop up any excess adrenalin. It keeps us safe by responding in a very primitive way – the flight or fight response - which is very useful if a train is coming towards you on a level crossing however it can be compared to the mentality of an 8 year old child. So often it takes you from perceived danger to perceived safety ( from the point of view of a child ).
It is also important to remember that it is operating using information that you provide it with. For example if you are in a car and someone cuts in front of you but you happen to be listening to some nice music and not in any hurry then you may think to yourself casually ‘ they must be in a hurry’ and not be affected by it at all. However if they cut in front of you and you shout out of the window and shake your fist then the old part of your brain inside has no idea what is going on, hears the tone of your voice and it’s knee jerk reaction is to produce adrenalin ready for the ‘fight or flight ’ that it perceives is to follow. Your heart starts to beat faster to increase the blood flow to muscles and vital organs in preparation for the flight / flight and then nothing happens because you have neither had to run nor fight.
And if the old part of your brain keeps receiving signals from you and reacting over time it gets tired and cries out for a rest so that it can recharge. And when it calls out for a rest and if you ignore it often it finds your weakest point and attacks it to get your attention. For example someone gets a new job that means a lot of travel which is causing them stress and anxiety - eventually the old part of their brain finds their weak spot ( not enjoying the travel ) and it may be that they have a panic attack on the motorway. The old part of the brain believes that if it can stop the travelling then the person will finally listen to it, stop for a while, and rest and recharge themselves.
Tom interrupted and said that his panic attacks had only started now he had to attend meetings and we agreed that perhaps this was his weak point ( his fuse ) that his old brain had pinpointed. Tom was actually quite full up with dealing with the stress of losing his father, shift changes, not sleeping or eating properly and saw it’s best opportunity (Tom’s weakest link ) to stop Tom in his tracks by sabotaging his meetings.
Tom looked quite relieved by the simplicity of the explanation and grasped it effectively however he was concerned that he could not avoid the meetings – he was already having trouble with his boss about his contribution in them. I shared with Tom the idea of a locus of control in that some people have a more external locus of control and others a more internal one. I hoped he would find the concept of control easy to understand and connect with since he had a lot of control when he was driving his train.
We discussed that people with an external locus of control tended to rely on others for their opinions, believe things are out of their control, believe in fate and that other people play a big part in how their life unfolds. These people tend to be much more vulnerable to anxiety, poor health etc whereas people with an internal locus of control believe they are responsible for their own lives and any consequences of their actions – these people are often calmer, more positive, bounce back after difficult events in their lives etc…….. I suggested that if we could find a way to make sure that Tom’s ‘ old part of his brain ’ started to feel less stressed and began to recharge then not only would it stop attacking him in meetings but it would be more able to help him help himself ( internal locus ) as necessary in his daily life in a more healthy way as opposed to looking outwards and relying on others opinions ( external locus ).
Tom added that recently he had started to feel stressed at the thought of going to the local supermarket so had opted for the smaller local shop although it had not felt like a panic attack. We discussed that maybe his ‘ old brain ’ had noticed another weak link – in the same way that Tom did not like the way he felt his new colleagues in the meetings at work were looking at him, he may now be associating all strangers with looking at him – so he was now choosing the easier, safer and more familiar option of the local shop. We discussed that panic attacks took on many different formats and as such it was important to notice the symptoms and understand the causes to reassure Tom what was happening, that it would subside and that moreover he would be learning a way of controlling them.
I shared with Tom that release of adrenalin as a direct response to perceived danger causes muscles to tense however if the body then tenses up as a response to the ‘felt’ tension then more adrenaline will be released/ controlled by the ‘old brain ’ which feels the secondary warning and this causes more tension – so tensing up because we have tensed up makes things much worse. The key is to not tense up or at least to understand what is going on and stop the cycle / to relax and let the tension subside. When adrenaline is released into the bloodstream it is in response to one of our most primitive instincts – the fight or flight response. The adrenaline immediately affects the muscles of our heart getting it to pump faster to get blood to the parts of the body that will help us ‘ fight or flight.’
The fast beating of your heart / hearing it sometimes in your ear makes people fear a stroke or heart attack, which in turn releases more adrenaline.
Sometimes the chest muscles tighten and breathing is constricted because of the adrenaline – which causes more fear which releases more adrenalin. During an anxious episode people breathe very quickly and more oxygen enters the body and too much carbon-dioxide leaves which upsets the delicate balance required to facilitate efficient gaseous exchange ( which is why breathing into a paper bag works as carbon-dioxide gets re-circulated into the bloodstream ).
Dizziness is caused by the effects of gravity and sudden channelling of the blood to major large muscle groups in preparation for flight or fight.
Tension across the scalp or a stress headache is also caused by adrenaline as it constricts the many muscles in the scalp – the longer or more intense the anxiety the greater chance of the muscles beginning to ache.
Some people experience blurred vision because adrenaline causes the tiny delicate muscles at the back of the eyes used for focussing to repeatedly contract and relax.
The unconscious nervous system has many feeder lines that run to your stomach and these gently release adrenalin during times of anxiety onto the structure of the stomach causing continuous and random contractions that feel like your stomach is churning. As anxiety grows the drops become a flow and the muscles stay contracted hence the ‘knot in my stomach’ sensation. The stomach ache that follows when the attack has passed is a result of aching and tired muscles.
The unconscious nervous system is also attached to your saliva glands and when adrenalin is released digestion is put on hold ( since it is not required in the flight or fight process ) so your mouth feels dry.
Our bowels can also be subjected to the same agitation caused by adrenalin and this can cause bloating, wind and diarrhoea. The bladder may also feel as though it needs emptying when in fact it is only half full – this is because the body is trying to ‘off load’ excess fluid for flight or fight.
The adrenalin also causes shaking as the muscles are continually contracted and relaxed and any adrenalin left for example at the end of the day tends to get deposited around the neck area – hence tension in the neck. Endorphins released mop up any excess adrenaline which is why exercise is so important.
Sweating and clammy hands is a result of the body trying to pre-cool before the ‘flight/fight’.
Blushing is caused by blood vessels in your neck and face expanding again to release heat in preparation for flight/fight.
Tiredness – emotional tiredness is very different from physical tiredness and eventhough you may feel physically tired it is your emotional energy banks that are low.
( Symptoms and definitions taken from John Glanvill Therapy and Self Awareness – Work Book 2 Anxiety 2011 www.johnglanvill.com Anxiety Hypnotherapy Specialist )
The body also releases Noradrenaline which stimulates the liver to release fats and sugars as energy ready for the ‘flight or fight’ which is why we often crave sugary products after stressful situations.
The body releases Cortizol which thickens the blood ‘ in anticipation that we may be injured in the flight or fight ’ so that it will clot more easily however whilst this is undoubtably useful if we are indeed injured it may not be useful if we are not – blood clotting can lead to Strokes and Heart Attacks.
If we can stop and think in a situation as opposed to reacting instinctively many of the above symptoms can be alleviated.
Tom recognised many of these symptoms and realised that his anxiety had been affecting him for much longer than he had thought ‘ but at least he knew he wasn’t dying now.’ I shared with him one of my favourite quotes that we consider ourselves as ‘ thinking creatures that feel, whereas infact we are actually feeling creatures that think’ ( Jill Bolte-Taylor – My Stroke of Insight ) and once we understand this we realise that we cannot trust our instinctive response ( not all the time anyway ). If we can just pause and think rationally for a few seconds at least then we could slow down or even prevent the sudden release of adrenalin and all the unnecessary chaos it causes. Jill Bolte-Taylor also adds that ‘ responsibility ’ should be written ‘ response-ability ’ in that as humans we can begin to realise that we have a choice/ ability to respond ( or not ) to situations. Tom added that he enjoyed the responsibility of driving the train.
So in summary anxiety and stress is not something we want too much of.
The good news for Tom was that he now understood what was causing his symptoms namely ‘ adrenaline in the hands of a very ‘young’ old brain ’ – Tom was amused by this.
I was aware of time and that we had actually done a lot of work so said to Tom that he had two options – we could relax now and provide him with a technique that would help him if he felt any hint of anxiety coming on in the future however this technique meant he may experience some of the symptoms to a level he would be completely in control of turning them up and down at his will, or we could work specifically on confidence building for meetings. Tom said that now he knew he was not dying he would like to try the control technique. I reassured him he could open his eyes at any time.
I asked if he was happy to proceed and if he had any questions which he didn’t. I said that I was going to talk him through a very simple process, he did not have to say anything just sit back and relax and I asked him which hand he wrote with ( right ).
I knew Tom was a little apprehensive so decided to avoid the traditional induction and start conversationally first then move into the more conventional methods once he was relaxed and focussed. I said he was welcome to close his eyes if it made him feel more comfortable and that I was simply going to talk through the technique and help him relax.
I reassured Tom that he was welcome to open his eyes at any time if he so wished.
I utilized personal information unique to Tom in the hypnosis - the fact that Tom enjoyed driving his train and that he knew his hands were important to him and the element of control they gave him and also the fact that he enjoyed the control and responsibility ( most of the time ) of his new job. I gave him/ taught him an anchoring technique that he could use at any time in the future when he may feel anxious or stressed in any way.
I have given a few extracts from the script below :
‘ ……..Tom I am going to talk you through a technique that you can use whenever you need to that has helped many of my clients who have suffered with anxiety in the past……anxiety and stress often occur when you feel that the resources you have are being overwhelmed by the demands that are being made upon them…..’
‘……..and I know because you have told me that you are the driver of a train……….and your hands are so important to you………..to turn levers and dials……….to grasp firmly …….to pull…..and to give signals…..a wave maybe…..to punch in numbers and settings so that everything is just right………’
‘………a safe place where you can relax……and go deeper……….and whilst you are resting here I would like your unconscious mind to search through your memories and find a time when you felt calm and happy……..confident…….accepted and strong…….just allow your inner mind to find a time when you felt calm and confident, no matter how brief that time may have been or how long ago……’
‘………….and now as you feel these feelings I’d like you to close your right hand into a tight fist and as you do so those positive feelings become even stronger…..that’s right….just close your right hand into a tight fist as a sign and symbol of confidence and determination……hands are such important things…..you know that……’
‘………….Your unconscious mind has memorized these feelings, these experiences and they will remain just beneath the surface as inner resources. ………..And because of this they will be readily available whenever you need them….all that you’ll need to do is clench your right hand into a fist as these memories and positive feelings wash back over you…..’
‘……..you may not always be able to keep unpleasant feelings from appearing in your mind or body but you’ll be able to transfer them into your left fist where you can control them……..and when it feels as though all those unpleasant feelings are collected in that fist …..….’
‘……….and as you sit there resting listening to my voice you don’t need to try and remember everything that I have said to you whilst you are relaxing or whilst we have been talking because your mind is a wonderful and powerful thing…..a wonderful resource……it’s like shaking up one of those snowstorm ornaments you may have seen as a child…..some of the things we have discussed today will connect with you immediately…..some will drift down later ….and some in a week or so……so trust your mind……everything is there………….and I’d like you to spend a few moments with those good feelings……..confidence and an easy calm…………’
[ Extracts of the script only ]
Tom re-orientated well and I noticed that his right hand was still clenched tightly closed which embarrassed and amused him – he immediately stretched out his fingers.
He said that he had very much enjoyed the anchoring exercise and felt much more reassured. He was amused by the fact that some of the most important hormones in his body were in the control of a very young ‘ old’ brain which was trying to help him in the best way it could but was relying on basic instinctive information. This had the potential to cause a certain amount of internal chaos and it was up to him as the adult to calm things down a bit, take control of the situation and bring about order.
Task Setting and Homework – I suggested that Tom continue using the clenched fist anchoring technique between now and our next session not only because it was a new ‘ tool ’ ( Tom listed DIY as one of his interests on his intake form ) that he could chose to learn more about and practise using but also because the technique benefitted from ‘re-charging ’ – it became more powerful with use – and to sit down if necessary if he felt he was becoming anxious for any reason until he felt his body start to soften and rest.
I also suggested that as endorphins mop up left over adrenalin and given that exercise releases endorphins Tom walk a little more quickly with his dog or took longer walks – which Tom very much liked the idea of. I gave him a copy of the cd that I give all clients which included support material and asked that he take a few moments to listen to it in the week. We had covered a lot of material in the session and I said he was welcome to call me at any time if he had any queries.