Instruction Manual 2: Is this going to eat me or not?

The instinct that drives anxiety is the Fight or Flight response.  I would differ with Walter Cannon here and call it the Fight or Flight REACTION, but he is unavailable for comment at the moment, as he named this phenomenon in the 1920’s.  Since then, it has in fact been suggested that the name is not quite descriptive enough, and most recently it has been called “Freeze, Flight, Fight, Fright, Faint” by Bracha and his gang.  To-maaa-to, To-mah-to. 

The major players in the fight or flight instinct are shown here.  There are actually two (ok probably more, but I’m a therapist not a neurologist) process happening simultaneously.  One of these is totally and completely unconscious.  We want it that way.  We don’t want to have to THINK about whether or not it’s a good idea to move our hand if we accidently touch a hot stove.  (“Hmmm . . . what’s that smell?  And it kinda hurts . . . sizzling sound . . . probably should move my hand. . . ready set go!”) The reactive part of our brain takes over there, and we have a reflex reaction to jerk our hand back.  This is a good thing.  Information comes in through our 5 senses, and runs through the command center for survival, our mighty amygdala.  Though tiny, this structure has a lot of power and primarily answers the question is “IS THIS GOING TO EAT ME OR NOT???”  If the answer is no, the information flows smoothly through to be processed by our highly developed cerebral cortex.  We think about it . . . we decide what to do with the information.  If your amygdala decides that whatever it is evaluating poses some sort of a threat, it hits the big red panic button and triggers a complex chemical chain reaction throughout your body with the activation of the HPA (Hypothalmic, Pituitary, Adrenal) axis.  Rapid fire, your body responds to the threat.  We all know this feeling.  Your heart races, your muscles tense, you breathe faster.  Every single thing that happens in your body is oriented toward responding to that threat.  We need to either get the heck out of there or be ready to defend ourselves.   At the same time, the incoming information is also being analyzed by other brain structures.  The hippocampus is in charge of more rational responses, and can settle the amygdala down a bit.  Here’s the interesting part.  The amygdala response happens TEN TIMES faster than processing through the hippocampus.

The super in my office building gives me frequent opportunity to demonstrate this principle.  I swear he wears crepe-soled shoes to sneak down the hallway for the sole purpose of watching me jump out of my skin when he says “BOO” or something similar.  That’s the amygdala response.  There is no recognition of WHO spoke, or that this is the same guy who regularly lets me in to my office when I forget my keys, simply a chemical reaction to an unexpected event.  It doesn’t take long, of course for my hippocampus to put Charlie in context and realize that my life is not in immediate danger.  As my heart rate returns to normal, we laugh about how easily startled I am, and get on about the business of living ... which is at that moment usually about me NOT resisting the urge to get a Diet Coke out of the vending machine.  Oh that stuff is so bad for me. 

What makes this problematic in today’s world is that the amygdala is a light switch.  It’s off, or it’s on.  There’s no in-between.  From a survival perspective, it makes a heck of a lot more sense to overreact to a rustle in the bushes that turns out to be a bunny than to underreact to a rustle in the bushes that turns out to be a wolf.  In our amygdala, there is only YES this is an immediate, life-threatening danger to which I must react or NO, it’s not.  There is no maybe.  Maybe is a yes, which explains why we experience the physiological fight or flight reaction in the face of things we clearly know are NOT life-threatening.  We have a shortage of true, life-threatening dangers in today's world.  When's the last time you ran into a lion in the elevator at work?  Gee … it’s kind of like our Amygdala just takes over … and our brain is temporarily HIJACKED …..

Instruction Manual 1: Design Features





First of all, let’s look at how your brain is designed.  I am of the opinion that we are a well-designed, efficient, functional unit – even though we don’t come with a manual or schematics.  I think that our bodies WORK.  Perfectly.  Until we get in our own way. 

Years ago, I attended a lecture in which the presenter … who had my full attention because I was about 5 minutes out of graduate school and eating ramen and he was presiding over a catered drug-company sponsored luncheon.  Read:  FREE REALLY GOOD FOOD.  I would have gone to a lecture on watching paint dry… Ahem – so this presenter talked about a study out of Auburn University (and if anyone has a reference to this study I would LOVE to have it.  I’ve lost the paper) in which it was discovered that a decrease in serotonin levels was associated with the human immune response.  So much so, in fact that some physicians had begun getting an antidepressant on board PRIOR to major surgical procedures (like open heart surgery) to combat the post-surgical depression that created problems.  I thought that was SO COOL!!!  So let me get this straight . . . when we are trying fight off illness, our bodies respond chemically with depression.  “Depression” tells us to get under the covers and stay there.  That’s just good thinking when we’re trying to heal.  Pull back, lay low.  We don’t do it, of course.  We just keep going . . . and going . . . and going . . . 

Check this out.  What are the things we just simply can’t do without?  Heart rate, respiration, blinking, sweating, digestion – things we never consciously think about, but without which we would not last long.  Where are these things located in your brain?  In the very absolute center.  Far away from the outside where it can be bonked and damaged by a blow to the head.  Now that’s good design!  This red part of the diagram is called our reptilian brain.  We share these basic functions with just about every other living creature.  It is the most primitive and least developed part of the brain.  If this part of your brain is damaged, you’re pretty much toast. 

The next layer of the onion is the limbic system.  Here lies the heart of our fight or flight response.  Notice, still VERY WELL PROTECTED, which tells me that the engineers thought these functions were worth protecting.  Here lies reaction, not response.  On the outside is where higher order thinking happens.  We can live for a long time without speech, the ability to distinguish colors, or without logic and reasoning . . . not so much without breathing.  So if we’re going to get whacked in the noggin, this is the part that takes a licking and we keep on ticking.  (Someday perhaps I’ll write about the humiliation of the fact that only time I’ve been knocked out in a horse accident I was riding a PONY.  Insert helmet safety lecture here.  Without protective headgear, I wouldn’t be writing this blog).   

If our bodies are designed so perfectly, and are working correctly, how come I have a job?  How come people are flocking to their doctors and psychiatrists and therapists struggling with the debilitating impact of anxiety and depression?  For my money, it’s because we don’t know how to work the equipment.  We haven’t read the manual.  Ever tried to put together “ready to assemble” furniture without the directions?  Good luck!  Once we understand how our brains work, we can stop feeling like we are at the mercy of our emotions and reactions, and start making progress. 

Next up:  Is this going to eat me or not?

Have You Checked the Instruction Manual?

I looked it up.  There are close to one million “How To” titles on Amazon.com.  There’s an instruction manual for everything. When you buy a new electronic device or ready-to-assemble furniture, it’s right there in the box, printed in at least 2 languages with diagrams.  Ever marvel at the fact that there are instructions on just about everything?  Step A:  remove contents from package.  Really?  I needed THAT much direction? 

Wouldn’t it be GREAT to have an detailed instruction manual to ourselves?  By and large, people know very little about the functioning of these amazing bodies and even less about the care and feeding of a brain.  There’s a lot of focus on nutrition and physical health these days, but that’s about WHAT to do, rather than WHY to do it, and you get 47 different opinions.  Eat carbs, don’t eat carbs, eggs are poison, eggs are fine . . . who can keep up?  Exercise, eat right, get enough rest – but don’t forget to work a 60 hour week, take the kids to soccerdanceandgirlscouts, and for goodness sake join a book club so your brain doesn’t turn to mush.  Do all these things and no doubt you'll be happy and successful just like the model on the billboard. 

The first step in our instruction manual might be to realize that our brains were designed an awfully long time ago.  Think about civilization, say 1000 years ago.  Life was simple.  Bob, the Medieval stereotype, got up when the sun came up.  When the sun went down, he rested.  He worked hard all day long because if he didn’t, he starved or otherwise succumbed.  No one had to tell Bob to pull his own weight because everyone knew that they had to work together or they would find themselves in the unenviable predicament of doing without.  And I'm not talking about doing without TASTY food and COMFORTABLE shelter, I'm talking about doing without FOOD and SHELTER.  Period.  Simple:  Work hard all summer to stock up enough for the winter, or punch some extra holes in your belt and hope you make it to spring.  There was real danger:  fire, flood, famine, plague, predators . . . a medieval wonderland.  Lions and tigers and bears were what came in and ate the livestock and occasionally a small family member.  Bob had 14 kids because only half of them were expected to make it to adulthood to have little Bobs of their own, who would then take care of Bob if by some miracle he lived past 40.  Bob accepted things because he had no choice.  I don’t recall seeing a “Black Plague” scene as I cruised through “It’s a Small World” at Disneyland.  There was family, and community, and life, and death.  It wasn’t pretty.  It wasn’t safe.  It wasn’t a greeting card, but it was simple. 

Think about how much civilization has changed in the last 1000 years.  We’ve doubled our life expectancy, had miraculous advances in science and technology, pretty much insulated ourselves against imminent disaster, and then there’s the miracle of Facebook.  Things are different.  Way different.  There’s 24 hour everything, a zillion channels on TV and more to do in a day than can possibly be done.  There's traffic and bosses and "protocol."  Politics have risen (or rather sunk) to a new level.  Cell Phones and I-Pads and Kindle and ... and ... and ...  

Here’s the punch line:  How much have our brains changed in 1000 years?  That’s right, sports fans – not very darn much.  Certainly not at the rate that civilization has.  So essentially, our poor brains are trying to interpret this 4G world according to rules that were set in a time where perhaps the only G’s you had were goats to pull a cart, and 4G’s would have gotten you pretty far then, too.  Our brains are amazing in their ability to process and adapt.  But there’s a part of the brain that is still working off of instinct – and those instincts haven’t caught up with the times.  Working off our instincts (read: REACTION) in today’s complex world is like taking that 4G goat cart on the interstate.    

Much of my work with clients focuses on knowing HOW to work your brain.  If we understand the mechanism of the action, we can stop reacting to our reactions, and start responding to things.  You can learn to respond from your highly developed, logical and reasonable frontal cortex, and things that formerly were the source of anxiety, angst and consternation are now mild annoyances that barely register on the radar.   

Really.  You can.  J 

Mountain Lion vs. WalMart Bag

In my previous post, I mentioned that I participate in a sport no one has ever heard of.  Endurance Riding is like cross-country marathons for horses.  What that means is that my idea of a fun weekend is traveling to the middle of nowhere and riding (generally at a trot) my horse 25 or 50 miles a day for 1, 2, 3 (sometimes more) days on challenging trails in remote wilderness areas (one time I did a 100 mile race, but I would have to have a really good reason to do that again).  Yes, many people think endurance riders are crazy.  We are the butt of jokes about wearing brightly colored spandex instead of “refined” show clothing, our horses have the reputation of being wild and dangerous and too much to handle.  If this were a blog on a sport that is about the HORSE and not the RIDER, I could go on for pages about the wonderment of endurance.  Since it’s a blog on mental health issues, I’ll skip to the relevant part.  To be a serious competitor, a horse must be physically fit, which translates into lots and lots (and lots) of hours training on the trail, to the tune of 10-15 miles a day and 25 or so on the weekends.  (That was me BC – Before Children.  Lucky to get 10 miles in on a weekend these days . . . hence had to drop out of the ranks of “serious competitor.”  My horse doesn’t seem to mind.)  
  

Take a look at the attached picture.  In this moment I would CLEARLY identify the life threatening danger to be stepping off the trail and tumbling tail over teakettle into the vast nothingness below – not that I ever actually entertain those thoughts . . . of course not.  My horse Max, the poster child for the “fight or flight” instinct, has different thoughts.  Trail riders often joke about the fact that a horse will jump off a cliff to avoid having to walk by a Wal-Mart bag flapping on a bush … or a rabbit … or a stick … or nothing I can see … it’s a little bit of an exaggeration fortunately and the actual jumping off a cliff is rare, but you get the point.  My horse is a herd animal and a prey animal.  His survival for centuries has depended on his ability to flee from danger – but these days, most horses live in nice safe barns.  His instincts haven’t caught on to the shortage of actual physical danger however, and he is just SURE that that vicious hungry squirrel WILL, WITHOUT A DOUBT eat him.  Since I can’t stop being a therapist entirely when I ride, the parallels of this annoyance to how we deal with anxiety were not lost on me.  We so frequently go to extreme, and sometimes damaging lengths to avoid relatively harmless stressors.  In context, the fight or flight response is important, and vital to our survival. If I am hiking in the mountains and come upon a mountain lion, I definitely want my adrenaline pumping.  I want increased blood flow to my heart and lungs so I have the strength to either fight or run really fast.  However, in dealing with an angry spouse or cranky bank teller, that same fight or flight response isn’t very helpful!  (Although I do get a kick out of the image of running screaming out of the Holiday melee in ToysRUs when I go do my shopping.  Usually that's how I pass the time waiting in line.)  In that moment, I want to be working out of my cognitive, logical, mind and making decisions about how to handle that situation.
 

Clients often come into therapy with the goal to “be less stressed.”  I believe it is important to emphasize the difference between stress and anxiety.  Stress is inevitable.  It is a powerful, and often positive force.  Stress pushes us to do something different.  Learning to deal with stress without anxiety is the key.  Anxiety is driven by the meaning we make of a stressful situation, which is often based more on past experience and lack of coping skills than on the current event.  We experience an “Amygdala Hijack,” according to Daniel Goleman, and react with fear to a situation which poses no true physical danger.  Selye’s Appraisal Theory suggests that level of distress is determined by the interaction between our assessment of how bad a situation might be and our assessment of how equipped we are to handle it.  (More to come on these subjects – stay tuned!)    

It is important to recognize that the physical process of anxiety is a normal and healthy part of being human, not something to fear or be ashamed of (if I put something in parenthesis here will you not notice that I ended a sentence with a preposition?).  There are truly not very many situations in today’s world where we legitimately need our fight or flight response.  However, there is an expectation that there is a straight line between stress and anxiety:  “Oh, I couldn’t handle it if that happened . . . “  “that would be horrible . . .”  Learning to identify that while we may not want to face a situation, and that facing it may be uncomfortable, in fact we HAVE faced difficulty, we CAN face difficulty, and we WILL get through it.  This decreases the chance of a fear-based REACTION and allows a considered, conscious RESPONSE.  Ta-DA!!!!  Isn't that what we're looking for? 

What sets me apart from my horse is that I have the cognitive skills to evaluate a situation and apply this knowledge, leading to a different, less anxious outcome.  Next time I am on the trail, however, I am certain I will have occasion to say to my horse “OH FOR PETE’S SAKE, MAX, IT’S A WAL-MART BAG!!!”

The Interesting Stuff

I am a therapist.  I carry a license … ok, so I don’t really carry it, but I do have one, and I’ll show it to you if you ask.  It’s in my office with a bunch of books, and a frightening amount of paperwork that just never seems to be “caught up.”  Such is the life of this therapist. 

Evidently, I am hilarious, and a hilarious therapist is a surprise to many.  The way of the world seems to be that hilarious people need an outlet for their hilarity, and thus began idea of THE BLOG.  A completely narcissistic endeavor, if you had asked me a few years ago.  A one-sided conversation with complete and total strangers – the epitome of “LOOK AT ME!!!!”  Well, then I read some blogs.  And I found them helpful, and comforting, and a refreshing break from the usual.  In some ways it was like a novel that never ended, but was delivered in small, manageable chunks. 

Clients often kind of look at me sideways and say things like “you’re not like other therapists …”  One client used the word “unorthodox.”  (One calls me "Yoda"  :-) )  While my “unorthodox” approach to therapy isn’t a good fit for everyone, it seems to work for most.  I like to LAUGH in session.  In fact sometimes my office mates knock on the door to ask us to keep it down a bit.  It’s not all fun and games in there, of course, but holy cow it’s not deadly serious either!  It’s life, folks.  Life is like “it’s a small world” at Disneyland.  Everyone goes through it once, it’s not very exciting most of the time, but there’s a lot to see and the scenery changes around every bend.  There are parts of it that you find interesting, and parts that you’d rather forget about.  The music might drive you a little crazy, but if you sit back and not fight it, you have a common experience to share with the rest of us.  (Do they still have that ride?  I haven’t been there since 1988).  We have ups, we have downs.  The hard times follow the joyous ones, and vice versa.  I figure you can pick whether you want to laugh or cry about it, but you just have to do it . . . like “it’s a small world.”  (Seriously – everyone gripes about it, but have you ever met anyone who has been there and didn’t go on it?)

But I digress – and I do that a lot.  Also, I am the queen of parenthetical commentary (my college roommate the professional writer may have suggestions for me there). 

So yes, I am a therapist.  But I’m also a person, and a mom, and a participant in a variety of relationships.  I am a lover of music, and red wine, and some kinds of art.  I ride horses, and participate in a sport called endurance riding that no one has ever heard of and when they do they think I’m crazy.  I am a proponent of religion as the practice of being a decent human being, not religion the exclusive cult.  I sing in my church choir and I listen to the sermon every week (which also surprises people because I’m not one of those people who just oozes religion out every pore.  It helps that the pastor of my church used to be a therapist, but beyond that, he is one of the smartest, most learned people I know.  Pretty sure that’s why I can stand him.  I’m sure I will have more on that at some point.  It’s a soapbox).  I go to work, and go home, and pay bills, and try to maintain a healthy lifestyle just like a lot of other people out there.  I overreact, have bad days, get distracted and forget things, lose my temper and holler at my kids from time to time (not that I’m proud of those things – just sayin’).  The point is, I’m just like my clients in most ways.  The one difference is that I have paid attention to the way minds, relationships, and emotions work for 15 years.  When you do that every day for a long time, you start to notice that you’ve been flying by the seat of your pants with little emotional plan, and that there are little (note the writer’s use of understatement) discrepancies between what you tell people to do and what you actually do.  Well, me anyway.  I know a number of therapists who behave completely differently than they advise others to and don’t seem to notice.  But that’s another soapbox.  So I’ve spent 15 years thinking about how to take this pie-in-the-sky therapy stuff where everyone hugs and holds hands at the end of the session and turn it into something useful in a really complicated (and frequently kind of crappy) world.  Unorthodox?  Perhaps.

Read On.