On Labor Day, I sprained my ankle trail running which required me to be on crutches for several days and in a brace with limited mobility for three weeks. During that time, I noticed something. I felt significantly calmer. I felt grounded. I felt a sense of inner peace at a time when things around me were anything but peaceful. Once the brace came off and my mobility improved I noticed an increase in stress and anxiety. As I reflected on this shift, the only thing different was that while I was injured I was unable to multitask; I had to focus on one thing at a time so as to not re-injure myself and well, to stay upright. My lesson? Multitasking doesn’t work for me. As a therapist, I have known for years that our brains don’t actually multitask and that attempting to do so leads to lower productivity and higher stress. And yet as someone who is still working on saying “no” more often (i.e., someone who takes on too much), multitasking was my way of getting it all done - or so I thought.
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 The process of therapy is just that - a process. In a time of incredibly jam-packed schedules, so many of us want our healing (and really, most things in life) to go quickly or have a magic pill. The thing is, often times the problems and/or challenges that motivate us to enter treatment in the first place have taken years and sometimes a lifetime to develop. Thus, healing from life’s challenges and shifting directions is a process that takes time. Given this, I thought I would share ways to make the most of your time in therapy. Do you have to do these things? Absolutely not. However, the more you take your therapeutic work outside of the therapy office and do work between sessions, the more quickly you will likely heal (versus if you don’t do those things). These aren’t really short cuts to therapy; change takes time. But they can help reduce in-office work or the length of time in therapy.
 While the strategies in the previous post are ways to regulate in-the-moment when we pop into anxiety and the fight or flight response (sympathetic nervous system), in order to prevent these situations from continuing to happen we can make larger shifts in our lives. Whenever making changes to our lives, it is important to take small steps changing one thing at a time so as not to overwhelm ourselves and inadvertently sabotage our efforts. By shifting things slowly over time we can build on our successes. You may or may not being doing some or all of these things already. Perhaps consider adding one or part of one slowly over time.
 We all have experienced anxiety at one time or another, whether preparing for a test, prior to a presentation at work, or on our first day of a new experience. We may feel a keyed up sensation in our body, our heart may race, our breathing may be short, and our thoughts may run quickly through our minds. When we experience anxiety, our autonomic nervous system has most likely picked up on a potentially dangerous situation and is letting off of the vagal brake (see previous two blog posts for details on what this means) to prepare us to fight or flee if necessary. Thus, inherently, anxiety is not a bad thing; it is our body and brain’s way of alerting us to pay attention. Anxiety becomes pathological, in other words a diagnosable condition, when it becomes a regular occurrence, interferes with our functioning, and we meet certain other symptom criteria. Essentially, when our anxiety is out of control and is no longer helping us it can be helpful to try some skills to address it.
In helping people with their anxiety, I see two main ways to target it: (1) Short term distress tolerance strategies to help with anxiety in the moment (what some experience as anxiety attacks and others as panic attacks), (2) Shifting ones lifestyle to create more safe-enough spaces for regulation and health. Perhaps with a greater sense of how our autonomic system works (see previous blog post) we can shift towards understanding how to help ourselves regulate. As before, it is important to understand that our autonomic nervous system uses a process called neuroception to interpret our experience within our environment and then determines which of the three autonomic states is needed. What I find so essential about this is that it happens outside of our conscious awareness. That is, we do not choose our state so there is no shame in what our brain and body choose to do; it just happens based on our experience (i.e., our perceptions of it) and how our brain interprets it.
This is an exciting time in the fields of mental health and neuroscience. We are beginning to better understand how the brain and the body work with greater refinement as technology evolves. Through Stephen Porges’ work with the vagus nerve, we have a greater understanding of how our bodies respond to our world automatically, outside of conscious awareness - that is, from our autonomic nervous system which involves the sympathetic and parasympathetic nervous systems. The Vagus Nerve - A Brief Overview The vagus nerve is the tenth cranial nerve and is responsible for a number functions in the body. In terms of how we interact with our world, the vagus nerve controls the parasympathetic nervous system, sometimes referred to as “the relaxation response”. We now know that there are actually two parts to the parasympathetic nervous system. One helps us engage socially in a relaxed manner and the other shuts down our system to protect us in the event of perceived life threatening danger.  Relevant Connections of the Vagus Nerve I love that so many are trying to be positive and connect with the positive these days. And I would like to encourage us to authentically feel our feelings. To not skip over or suppress them because they are uncomfortable. The grief, despair, fear, anger, sadness, and/or whatever else we may be feeling (including positive emotions) is real. It is through sitting with and working with these feelings that we will be able to come out strong on the other side. It is through our work that we will resolve our feelings so that they don't later seep into our lives seemingly without our control or even understanding. It is okay to feel what you feel now, whatever that is, knowing that the discomfort is temporary and necessary for life, love, and change. Give yourself permission to do what you need to do when you are ready.  We can't save everybody. When we try, we fail. Once we know that, we begin to say "no" more and set boundaries so that we can focus our efforts on those close to us (priorities) and those we choose to help (in my case, my clients and agencies to which I donate money and sometimes time). Sometimes this pisses people off because they aren't used to hearing "no" or expect us to say "yes" for whatever reason. And, none of this has to do with us. Yes, we are all connected. And yes, it is important to support each other. And of course, there are many sad stories out there. But it is equally important to allow people to have their own journey and to not enable them so that they do not have to experience pain or discomfort because without that pain or discomfort, life lessons are missed. That is, each time we enable we take away someone's learning opportunity. And this too, pisses people off because it's uncomfortable and not what some want. It makes people be responsible and accountable and take a deep look at themselves. This doesn't mean we don't care or don't have compassion, it actually means we do... That we allow people to experience their own life in a way they can grow. We can still be there for them, but not by taking away the discomfort or pain, but by holding space for their journey, by loving them unconditionally, by listening, and if we know them well enough, by gently planting the seeds of change as they are ready for them. To me, this is what it is to be a helper, to care, to love, and to hope.
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