Anxiety and the Mind

If you are one of the 8 million adults who live with an anxiety disorder, it can be hard to know what's actually happening to you when you experience and symptom of anxiety - especially when feeling overwhelmed and rather uncomfortable! All we know is that it doesn't feel good, and we're likely to look for any way to stop it. This might end up with us attempting to ignore the anxious feelings or thoughts, or steer clear of the situations that make us anxious in the first place!

It can be useful when we first start exploring anxiety, to try and understand what's going on at a neurological level (i.e. your brain). With this knowledge we can begin to understand the different methods to which we can try and change our relationship to anxiety and lessen the power we allow it.

Your Brain

The brain is a complex organ, but to make things simpler, we're just going to focus on three different parts: the thalamus, the cortex and the amygdala.

Thalamus: this part detects sensory information - what we see, hear, smell, feel.

Cortex: this part is about thinking - it will create thoughts about the sensory information it receives.

Amygdala: the brains emotional computer. It evaluates sensory information it receives and looks for emotional significance or potential threats - and sends out a response.

This could be an anxiety response, like fight, flight, freeze or fawn.

To make this easier to understand, here's an example of how these different parts communicate:

Imagine you walk into your house, the lights are off and you see a dark coat hanging on a door.

The dark coat is seen by our thalamus, which sends this information to both the cortex and the amygdala. (Crucially, the amygdala receives the information before the cortex).

• The amygdala is activated. Trying to protect us, it assumes the dark coat is a scary monster and sends the signal to feel fear.

• The cortex thinks about this information, and realises that it's just your coat you left there earlier. The cortex sends this new information to the amygdala, saying that we are safe.

• The amygdala receives the new information to stand down. However, it processed the sensory information first, so we have to wait a little time for the fear response to subside.

This is a simple example of how our amygdala, whilst trying to protect us, can send out incorrect signals to our body that we are in danger. It's trying it's best, but it acts quickly and can make mistakes. These signals can result in all the symptoms of anxiety we experience: shallow breathing, tight chest, sweating, blushing, tingling, brain fog - and many more.

This is an incredibly useful response to have when we are in real danger - you would want your brain to act quickly if you were about to be eaten by a sabre-tooth tiger! However, it's not so useful when you are doing a much less dangerous task, like speaking, driving or attending a party.

It can be helpful to remember this simple question when our amygdala is activated:

"Is this danger or discomfort?"

This is a simple act of noticing what we're experience (the anxiety symptom) and to note whether the signal is incorrect or not. Danger requires immediate action to get to safety. Discomfort is exactly that - uncomfortable, but doesn't require safety measures and will dissipate on it's own.

Learning and Re-Learning

Our amygdala is great at learning things. Through experiences in our lives, the amygdala will attach emotions to objects, images and situations - like post-it notes! What's great about this is that the amygdala can also re-learn - it can attach a different emotional post-it note to something. Here's an example:

A child is stroking a cat, the cat then scratches him and runs away. Through this experience the amygdala learns that cats = danger.

"I might get scratched", the amygdala thinks. "Better avoid all cats from now on".

Now the child has an emotional response of fear to cats. Imagine how powerful this may be if he continued to have many scary experiences with cats! To try and be safe, the child attempts to avoid cats at all costs. Although this behaviour appears to be keeping him safe, it is just re-enforcing the unhelpful idea that all cats are dangerous - when actually it was just one cat.

One day, the child is at his friends house and their cat comes over to him. The child's amygdala immediately activates, making him feel very afraid. The cat then jumps on his lap and licks him - eventually the child manages to stroke the cat and it begins purring. The child's fear begins to subside as he realises he is not in danger.

Success! The amygdala has re-learned something about cats - that perhaps they don't mean danger after all. As much as many people tried to tell the child that cats weren't dangerous - it was the experience of being afraid, and then realising he is not in danger that allowed his amygdala to re-learn. It learns through experience!

Although this is a simple example, it shows that our brain is wired to learn and re-learn things all the time. With continued experiences that allow for a positive result, rather than a negative one, we can re-train our brains not to jump to so many conclusions. Thanks brain!

Humanistic and Cognitive Therapy - Can They Work Together?

The humanist model of Person-centred counselling was developed by Carl Rogers. A non-directive approach, this model encompasses the idea that we all have the drive within ourselves to live more fulfilling lives. Through a safe therapeutic environment, clients can explore themselves and move towards greater self-understanding. Rogers’ spoke of three core conditions; empathy - allowing the client to feel heard, unconditional positive regard - acceptance of the client (which they are aware of), and congruence - being your real self.

Dr Aaron Beck

In contrast, Beck’s model of cognitive therapy is more structured; a formulation-based practice which is focused on the client's thoughts (cognitions). A main element of Beck’s approach is the idea that how we think and our fundamental beliefs affect how we feel and behave. If these thoughts are negative and unhelpful, cognitive therapy aims to focus on them, providing techniques to challenge and alter unwanted thoughts and therefore behaviours. As an educative approach, cognitive therapy often provides homework and goals, with the client learning skills and essentially becoming their own therapist.

Within person-centred therapy, the explicit roles of client and counsellor are less specific. The therapist's role is to be their equal, providing absolute safety, positive regard and wearing their expertise as an invisible garment. Rogers believed that, when given the right environment and support, individuals strive towards fulfilment. Through this positive experience people will develop a good valuing process - an innate way in which people can trust themselves to determine what is good or bad for them, and for society. Those individuals who do not get the support they need may have a distorted valuing process, creating a conflict within themselves. 

This idea of non-directive exploration differs when you look at the cognitive model. Based on the view that people’s thoughts and beliefs affect their feelings and behaviour. Beck calls these core beliefs ‘schemas’. Schemas can come from early negative experiences that distort our world view, such as neglectful care-givers. This could result in a schema that you are unlovable, which in turn creates a rule that you can only ever rely on yourself, because no one ever cared for you. When suffering from anxiety or depression, this distortion can become extreme.

The idea that every person is unique relates to the therapeutic relationship. As with all psychotherapy that involves (usually) two humans entering a relationship, both approaches emphasise this. Rogers’ core conditions aim to nurture the relationship, making the client feel safe. In the cognitive model, Beck believes the therapist's knowledge and expertise is also required. Where the client is the expert of themselves, the therapist is the expert on psychological problems and cognitive therapy does not shy away from this distinction. Does the rigid student/teacher relationship of a strictly cognitive approach hinder some people from truly opening up? From a person-centred outlook, maintaining an equal relationship may be difficult if the counsellor's expertise becomes a large part of the therapy.

How and why the client is feeling distressed is also worth exploring. Cognitive therapy understands that past trauma creates schemas and distortions This outlook draws similarities to the person-centred idea of an external locus of evaluation. The idea that whether people draw upon and trust their own values and instincts (operating from an internal locus of evaluation) or if they are influenced by the values of others (an external locus of evaluation). A person’s conditions of worth, which we mentioned before, are similar to a schema that creates negative rules. Unhelpful conditions of worth like ‘I must please everyone all the time to be accepted’, can be created from negative experiences where one might feel they can only be loved, or survive, if they strive desperately for the approval of an external value.

Whilst there are similarities regarding some of the causes of distress, there are many differences as well. One of the most clear differences is the structure of the counselling session itself. The cognitive model is formula based, goal driven and directive. Person-centred, on the other hand, believes that the client is the expert in their own lives, and allows them to drive the session, believing that they do have what they want inside of them, and with a secure relationship provided by the counsellor, they can gain greater self-understanding. 

Both models, in this sense, share this idea of a greater understanding of oneself to generate wellbeing - something that could be said of most talking therapy. What initially may seem like a difference, then, actually holds many similarities. It’s in the details that the differences arise. In a cognitive therapy session, the client and counsellor may logically focus on one problem and analyse. In a person-centred session, the client will gradually gain a greater understanding of themselves, including how they think and act in the world - creating greater self-awareness for the future and the rest of their lives. 

Although there are contrasts, I believe integration works, allowing the counsellor to draw upon what helps from both models. The idea of the five system formulation from cognitive therapy, which takes an issue the client is expressing and breaks it into five categories, may work well as a tool for the counsellor to use themselves when listening to the client. These categories are: environment (what is literally happening), thoughts (what am I thinking about it), emotion (what emotions am I experiencing), behaviours (how am I acting) and physiology (how do I physically feel). Instead of asking the client to essentially ‘fill out’ these categories, a counsellor may have this formulation in their head and use it to guide the client into looking at some of them, allowing them space to explore. This seems like a more natural way of looking at a problem, keeping the relationship equal and being less direct.

Each client is unique, and this is where the strength of integration really shows. There are strengths to both models, whether drawing from a formulation and applying it in a more natural way, or simply having the expertise and understanding that the cognitive approach brings, but applying it through a humanistic approach, I truly think that integration makes sense, to be adaptive and willing to utilise different techniques. One person may thrive in a formulaic environment, whereas for someone else that could be where they feel the least safe. Understanding our clients needs is fundamental to helping them gradually gain a greater understanding of themselves.

Relational Depth - What Is It?

Mick Cooper

After attending a training seminar held by Psychotherapist and Counsellor Mick Cooper, I decided to look further into his idea of relational depth, and what it means to both therapist and client. Cooper’s exploration offers insight into the power of a relational connection between people, looking at how and when client and therapist may experience relational depth.

Relational depth can be described as “a state of profound contact and engagement between people”. That statement may seem a little vague and, perhaps, so vast that it could incorporate a multitude of feelings between two people. However, you could see the simplicity and endless complexity of this statement as a metaphor for counselling and human relationships. Being human is, at times, beyond words. Simple interactions are surrounded by complex feelings and emotions.

This idea of relational depth has been described as magical and intense - a deep, connected feeling between client and therapist, where the client can feel that they are completely understood by the therapist, as they are there together, as two subjects connected within the clients world. Within this relationship clients may feel closer to themselves and find an awareness that allows them to forge more meaningful relationships in their own lives, having experienced relational depth in the safety of a counselling session.

Carl Rogers

Relational depth can be thought of as a moment where Carl Rogers' three core conditions of empathy, congruence and unconditional positive regard all work together as one - comparable to elements of the Person-Centered model. A way of being, as opposed to individual methods a therapist can draw upon, which can open the door to relational depth within the therapeutic space. Carl Rogers himself mentions that relationships with high degrees of empathy and regard, without conditions, have a good chance of becoming effective therapeutic relationships.

I believe that there are great joys to be had in expressing yourself absolutely to another human being. Some of our most meaningful relationships are those in which we feel understood and accepted by another, with no fear of judgement. Perhaps this is a moment of relational depth that we can all experience, even outside the therapy room.