also wanted to introduce the idea that physical symptoms can indicate emotional stress and inner turmoil. Anne seemed unaware of this connection and saw her high blood pressure as a strictly medical problem. I told her, “Sometimes bringing up the past, or even thinking about the past, uncovers long-buried feelings that result in anxiety symptoms. It’s normal to feel tense or scared when you delve into a painful past. Anxiety is the body’s natural response to danger, real or imagined, current or past. My guess is that our last conversation about your sister brought up a traumatic and difficult memory that ignited your panic attack.”
When anxiety becomes extreme or constant, it can take a significant toll on health and well-being. Sometimes, as in Anne’s case, severe anxiety or panic mimics a heart attack. Typically, medication is used to alleviate the initial symptoms associated with a panic attack, such as a racing heartbeat, weakness, faintness or dizziness, sense of terror or impending doom, sweating, chills, chest pains, breathing difficulties, and feeling a loss of control. Psychotherapy, cognitive behavioral therapy (CBT), relaxation, and meditation techniques have been shown to be highly effective and preferable over the long term in helping patients control or overcome these symptoms. These methods also enable patients to replace irrational, maladaptive, and self-defeating thoughts with more positive, realistic ones.
I now understood more about Anne’s difficult childhood, yet kept wondering what else she was not revealing as she maintained the family code of silence. I decided to bide my time and focus on teaching Anne skills that would help her to control the physical and emotional symptoms that had brought her to the emergency room. I told her, “Learning skills and strategies for improving your resilience and mindfulness will help you calm down and take control before the anxiety becomes overwhelming. You will be better able to prevent future anxiety attacks and minimize the impact of the ones that might break through. Perhaps, after you learn some skills, you will also feel able to speak more openly about your past.”
Although recollecting a difficult past may exacerbate emotions initially, when we share our stories with someone we trust, over time it is possible to feel calmer and more at peace. Everyone faces anxiety and intensified emotions at times, but it is important to remember that even the most powerful feelings reach a peak and then subside, like an arc or a wave. We need to learn to “ride the wave” of our emotions, with the understanding that they will eventually level off. Consciously deepening one’s breathing when emotions run high fosters the ability to tolerate strong feelings.
Learning to “Tolerate the Affect”
Learning to tolerate the affect means learning to bear and manage intense emotions as they arise. Another way of thinking about this is to cultivate the ability to feel strong emotions or sensations as they present themselves—as we experience them. To do so, begin to observe your feelings without doing anything about them. Try not to judge them or react. Simply notice and perhaps become curious about each feeling state as it comes and goes. As you become aware of your emotions, practice naming each feeling, such as “joy,” “anger,” or “frustration,” in a steady and relaxed way. Then deepen your breath and notice what happens. Perhaps you will sense your emotions building, peaking, or easing and the wave becoming less pronounced. Paying attention to your feelings, rather than simply reacting to them, can reveal much about your inner world and liberate you from the potential storms of emotion and physical sensation.
In contrast, avoiding your feelings delays the process of moving through them successfully. For example, when you numb yourself to the pain of loss or hurt, the associated feelings cannot successfully resolve in your conscious or unconscious mind. Painful feelings, when examined, can become magnified before they quiet down. However, when people allow themselves to observe, feel, and move through their pain, the intensity of their emotions subsides and they gain a greater sense of personal empowerment and resilience.
My goal was to help Anne develop the internal resources needed to allow her complicated and uncomfortable feelings to surface and to learn to tolerate her pain. In this way, she could eventually move beyond the old demons. I knew that if she were able to do this, she would find greater inner peace. Therefore, teaching her a basic approach to use to practice observing and being present with her difficult feelings was an important place to continue our work.
Strategy for Tolerating Painful Feelings
Notice the feeling as it arises in your mind and body.
Give it a name, such as anger, sadness, shame, or remorse.
Take a few deep breaths.
Observe how the feeling moves through you.
Remind yourself that you can handle this feeling and that it will subside.
Pay attention as the feeling begins to pass through and quiet down.
Mindfulness
I explained to Anne that the above technique was not only a way to control her anxiety but also a way to become more mindful, and that increased mindfulness would help her in all facets of her life.
Mindfulness means deliberately paying attention to, and seeing clearly, what is happening in our lives in the present moment, without judgment. It does not eliminate life’s stressors, but it can help us respond to them in a calmer manner that also benefits the heart, mind, and body. It helps us to recognize and step away from habitual patterns of behavior, which are often unconscious emotional and physical reactions to everyday events. For example, being mindful helps us make more thoughtful decisions about food, exercise, rest, and perhaps even our relationships.
Our minds have a tendency to wander through all kinds of thoughts and emotions. Some of these are positive, while others may include feelings of unexpressed anger, anxiety, cravings, guilt, and shame. When we indulge ourselves in these negative thoughts, we make them stronger. We do not want to stop thoughts and emotions from entering our minds, as they deepen self-awareness and guide future life choices. Instead, the idea is to notice and observe our feeling states without embellishing them in our minds. It is important to understand that whatever we focus on in our minds becomes stronger. As a result, it behooves us to focus on thoughts that are positive and support our best intentions.
When we pay attention in the present, we are not dwelling in the past or the future. We are anchoring ourselves in the moment, creating a space where peace and contentment can grow and flourish.
Mindfulness also means being consciously nonjudgmental. This gives us a chance to be kinder and more compassionate with ourselves and in our relationships with others. Rather than being judgmental, we can perhaps become more curious about our own behaviors and those of others. We can be aware that an experience, interaction, or feeling is either pleasant or unpleasant, but when we are mindful, we learn to observe rather than judge.
For example, Anne could bring herself into the present moment and be curious about the dynamics with Justin and within herself rather than be critical. This would help her to be more open-minded and positive. Mindfulness is not about creating balance and happiness, although these are often residual benefits. It is about being awake to our lives and finding peace within.
Mindfulness improves our physical and psychological well-being. It heightens our capacity for creativity, intuition, and wisdom. We can train our brains to be more present and less judgmental, to better care for ourselves, to create healthier relationships, and to make better life choices.
The most basic vehicle to mindfulness is the conscious focus on and deepening of the
