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Thoughts on Anxiety (including Dan From Virginia's technique)

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Unfortunately it seems like communication with Dan From Virginia (his original comments are at the bottom) has broken down. I guess I'll provide my own thoughts on his technique and why I think it's a novel approach.

First, a few preliminary thoughts.

1. Cognitive Behavioral Therapy--the most effective standardized treatment for anxiety--is beset with a slew of problems. One is that CBT's aim is to reduce anxiety, not help you overcome anxiety. While graduated exposure is the only way one can desensitize oneself, it is not entirely clear how to be systematically exposed to certain elusive fears. For instance, if you have a low tolerance of uncertainty, how do you expose yourself to uncertainty in a systematic and graduated manner that thoroughly desensitizes you to it?

No doubt, CBT has ways to increase tolerance of uncertainty (exposures, cognitive restructuring, etc.). And if you are simply looking for reduction of anxiety, then I would advise you to go seek out a professional CBT psychotherapist (make sure they were specifically trained in CBT and are not simply incorporating CBT with a bunch of hogwash).

CBT is even more effective for phobias. Unlike generalized anxiety, phobias are specific fears, which means it's easier to outline an exposure hierarchy in order to extinguish the fear. Here's part of the problem: exposures for phobias are difficult to endure. And if you suffer from phobias, there's a high probability that you also suffer from mild to extreme generalized anxiety (or at least have GAD tendencies like myself). If so, this issue will most likely surface and interfere with your treatment of the phobia.

Once again, you may be cured of your phobia, but there's a distinct possibility that you may only reduce the intensity of phobia.

2. Mindfulness-Based Cognitive Therapy (MBCT) is a treatment that essentially tries to insert the technique of Mindfulness into Cognitive (-Behavioral) Therapy.

This has advantages and drawbacks.

The advantages are that Mindfulness appears to be effective for addressing more abstract fears, like fear of uncertainty, fear of failure, etc. A lot of this is likely due to downregulation of the aymgdala function and positive changes to neurology. Mindfulness is also a handy tool for enduring exposures. So it may facilitate progress along your exposure hierarchy.

A drawback of MBCT is that there's some ambiguity as to when one treats thought as thought (i.e., employ mindfulness) or when one challenges thought (i.e., CBT technique of replacing irrational thought with rational one). These are two distinct options that don't necessarily compliment each other.

Another drawback is that most MBCT psychotherapists are not themselves expert meditators, or at the very least, not expert meditation instructors.

A problem for both CBT and MBCT is that many people struggle with fight-or-flight activation (my problem). Psychotherapists will suggest to perform exposures that induce some fear, but not an overwhelming amount of fear (i.e., avoid intense fight-or-flight). However, if fight-or-flight is your issue, then using the techniques like challenging one's thoughts, using meditation to focus away from the anxiety, or only exposing yourself to a moderate amount of fear are in some ways tantamount to avoidance and safety strategies (i.e., the very things that fuel anxiety).

3. Regular meditation doesn't target anxiety and most instructors are not psychotherapists. I would expect any long-term meditator to be less anxious than he/she was when he/she started (due to the changes in the brain that I've already alluded to), but as we've seen, some still struggle with anxiety after years of meditation. In fact, one may come to accept one's struggles with anxiety. I won't comment on whether this is a more rewarding effort, but viewed strictly from the lens of someone that wants to overcome anxiety, this is not success.

4. This brings me to Dan's technique. It essentially appears to be the flip side of MBCT; he's inserting a CBT technique into Mindfulness. Namely, using the idea of exposures as a guide for one's attention toward thought.

Here's some advantages to it.
  1. It targets anxiety.
  2. It employs exposure in order to extinguish fear.
  3. The technique generalizes to every fear.
  4. It is mindfulness. So it assumes the neurological benefits that any meditative practice holds.
  5. It is the absolute opposite of avoidance/safety behavior. Unlike using cognitive tricks or mindfulness to mitigate fear during exposure, you are exposed to fear itself.


There is of course the problem that it shares with MBCT; when do we engage into content and when do we not? If you engage in content, then you're simply worrying, freaking out, panicking, etc. And this becomes an unproductive exercise.

If you don't engage in content, you can't follow the trail of hot thoughts.

So it is unclear how one does both.

Dan from Virginia:
Using largely plain descriptive language here to support a repeatable practice...what I would do is literally do a reverse of "avoid the spiral of escalating thoughts/sensations". I head straight for "the spiral". If you remember the "hotter/colder" game we played as children, as variant of concentration practice, play hotter colder with the *escalating sensations*. Essentially as you keep working towards the "spiral" you are getting "hotter" and there are signs that will let you know you are getting to the right place
  1. first, the "radio player" voice of the mind, will let you know by *escalating thoughts*
  2. for me, a deeper sign the heart will palpitate with an atrial fibrillation
  3. for me, a even deeper sign is a slight to moderate convulsive movement in the gut
In particular, I note these signs as progress towards "hotter" because the mind may be telling/yelling and possibly screaming at you to "stop". That is a good sign you're going in precisely the right direction, ie your attention and concentration are fixed on sensations and thoughts that are "hotter". Keep your concentration focused and when one *sensation and/or thought pair* begin to hit upon an even *hotter sensation or thought pair*, allow attention to go to the "hotter" one, in other words - allow attention to make a gentle switch to trade up. :-)

Existing insight (seeing through content to context) in this can be helpful, for obvious reasons, but isn't necessary. I'll also note this can lead to insight. If you have good insight practice already, but seeing through content it isn't yet an instant reflex, then use practice to bring yourself to context first. Then allow yourself to get lost in the content. Yes, that's right. You have to let go and allow yourself to become what you behold (context becomes content again). If being context is a reflex, no worries as it'll co-pilot of its own accord. If being context (insight to see through content) isn't in the repertoire, no worries; essentially by simply holding attention towards the energetic center, the pocket of your consciousness that's giving you the anxiety can come to the surface - given enough time in concentration in the "hottest spot" found in the "hotter colder" game. And simply by holding concentration long enough, the center (aka "spiral" as you said) will flicker and fade like a candle at the end of its wick. With that fading, don't stop; keep concentration for a while (at least minutes) into the quiet. Content is silently dropping (attachment withering) leaving only context even if you can't see this for a while.

It is always best to do this when the anxiety is freshest, that is when it is naturally arising, but do this practice in private until you're confident you can handle it in more public places. If you can't get somewhere private, note/write down the thoughts arising around the sensation and use them for sitting. Tears, sobbing, and many other phenomenologies will occur. Just note them (don't resist them, but don't act on their content - this is not a good time to get up and tell someone off even if every fiber of your being says so...that's just the content talking and right now you're giving yourself to something not to act on, rather something to unfetter.)

You may think you've got it, just to see it pop up again. You may note that the anxiety is greatly weakened and/or that there's a second trigger to the anxiety...rinse and repeat. After a while, you can do this anywhere and your ability to see through such content becomes an unshakable reflex.

Finally, the clearest sign we realize the anxiety is truly gone, is usually when you begin to worry what will happen to you without the anxiety to 'shepherd/push' you (believe it or not). And this belies another phenom in this that to fully resolve one thing, such as a defense mechanism, can then reveal yet another wound it was covering. And in this sense, things can seem better having traversed a "layer" and then worse for a while as we dismantle ourselves.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/14/13 8:58 PM as a reply to Chris Dipster.
So how has Dan's technique worked for you thus far?

Also, I wonder if this works for small/persistent worries in addition to acute fear. My take on what he is saying is that you just continually move your attention to the most intense sensations that are present as they move around and take different forms?

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4/16/13 1:27 PM as a reply to Elijah Smith.
I have been applying the technique for the past two days. It seems to have real promise, so far moreso than any other mindfulness technique I have applied, though there is always a chance it is placebo. When I have worries the problem with awareness is often that while focusing on one area, a stronger feeling in another area pops up that is subconsciously resisted. This technique brings to the surface all of these subtle feelings. It just seems to completely turn off the mechanism that pushes these feelings down, i.e. the mechanism that keeps them stuck. I will keep testing it over the next few weeks.

I must qualify: I haven't used it on intense/acute anxiety yet, only worry and rumination.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/16/13 4:47 PM as a reply to Elijah Smith.


RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/16/13 6:42 PM as a reply to Chris Dipster.
It sounds to me like the basic mechanism in Dan's technique to subvert resistance to whatever thoughts and feelings are happening, by reversing one's attitude towards them (searching them out instead of recoiling from them)...and this allows a genuine exposure to the anxious experience, rather than the clouded anxiety / resistance / dissociation complex that one is normally exposed to, to happen. Which is to say, the technique sounds like plain-old mindfulness (increasing awareness of one's experience), albeit mindfulness done really well, arrived at by skillful means.

I think looking at it this way provides a starting point for trying to figure out when one is engaging in content productively (= when resistance is lessened, when one experiences some primitive drive in a more direct-seeming way) and when one is engaging in content unproductively (= when not).

Whatever the case, it sounds good to me!

As for CBT and phobias, surely someone has studied CBT + beta blockers, which might mitigate the "unendurability" problem, no?

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/16/13 11:07 PM as a reply to End in Sight.
End in Sight:
It sounds to me like the basic mechanism in Dan's technique to subvert resistance to whatever thoughts and feelings are happening, by reversing one's attitude towards them (searching them out instead of recoiling from them)...and this allows a genuine exposure to the anxious experience, rather than the clouded anxiety / resistance / dissociation complex that one is normally exposed to, to happen. Which is to say, the technique sounds like plain-old mindfulness (increasing awareness of one's experience), albeit mindfulness done really well, arrived at by skillful means.


That is a good description I think. Would you agree that my description of the technique as continually moving awareness to the feelings/emotions/thoughts of greatest intensity?

Also to the OP: Where did you see MBCT using both cognitive restructuring and mindfulness? I was under the impression that there wasn't really any cognitive restructuring going on (it's not mentioned in The Mindful Way through Depression) but that it is still called cognitive therapy because the term includes anything that includes working with thoughts directly. I definitely could be wrong though.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/17/13 5:55 AM as a reply to Elijah Smith.
Elijah Smith:
Would you agree that my description of the technique as continually moving awareness to the feelings/emotions/thoughts of greatest intensity?


Sounds like it...but, with the qualification that, as you move to the highest intensity stuff, even higher intensity stuff starts to be generated (because you're not defending yourself from your own anxiety as much anymore), which you then pay attention to.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/17/13 10:55 PM as a reply to Chris Dipster.
I tried using Dan's technique just now. The unpleasant feelings in my gut, in my head, on my skin, etc. began to grow quickly, but since I was going head first into it, I kept zeroing in on the unpleasantness (possibly the nana of 3 C's). All those sensations grew in intensity and spread over my body, and I got a lot of intense sensations around my forehead (seems like the transition to A&P). Also, I had an interesting experience with the sense of body becoming very vague, with there being a speck around my forehead where I had the most noticeable physical feeling. Quite rapturous, yet slightly scary in a way that I've never known it to be. Maybe it has something to do with how stages can present themselves differently when you focus on one particular characteristic.

Sorry that this doesn't exactly address the issue of dealing with anxiety, but, uh... I suppose it can be temporarily dealt with by crossing the A&P while intently focusing on the growing intensity caused by the unpleasant sensations. I feel that after the A&P, itches, distracting thoughts, anxiety, worry, all fade out, like Dan says. I think a good move from there is 3rd jhana.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/18/13 5:38 PM as a reply to Mind over easy.
I haven't found it to get that intense yet, I guess perhaps because I have been using it on typical worries less so than flat out anxiety. It seems little harder to use on the subtle feelings if they don't manifest more strongly when you put attention on them.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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4/22/13 10:15 AM as a reply to Elijah Smith.
Elijah Smith:

Also to the OP: Where did you see MBCT using both cognitive restructuring and mindfulness? I was under the impression that there wasn't really any cognitive restructuring going on (it's not mentioned in The Mindful Way through Depression) but that it is still called cognitive therapy because the term includes anything that includes working with thoughts directly. I definitely could be wrong though.


If it didn't involve cognitive restructuring, then it would just be Mindfulness.

I had a nocturnal panic attack last night (this prompted me to revisit this board). I tried to apply Dan's technique, but found it difficult to get very far. My awareness definitely amplified what was already an intense attack and I experienced zero fear of the sensations themselves. The troubling thoughts of "What if this attack happens in a place other than my bedroom" was the only part of the experience that was distressing. So I tried to consciously bring this thought to the forefront and it made the sensations even more intense, but nothing really happened after that. I couldn't detect a hotter thought. This probably speaks more to my current level of skill than the technique itself, but it's curious that Dan disappeared from this board and shied away from e-mail correspondence. I question whether he has accomplished what he said he has.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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5/10/13 5:24 PM as a reply to Chris Dipster.
Chris Dipster:
Elijah Smith:

Also to the OP: Where did you see MBCT using both cognitive restructuring and mindfulness? I was under the impression that there wasn't really any cognitive restructuring going on (it's not mentioned in The Mindful Way through Depression) but that it is still called cognitive therapy because the term includes anything that includes working with thoughts directly. I definitely could be wrong though.


If it didn't involve cognitive restructuring, then it would just be Mindfulness.

I had a nocturnal panic attack last night (this prompted me to revisit this board). I tried to apply Dan's technique, but found it difficult to get very far. My awareness definitely amplified what was already an intense attack and I experienced zero fear of the sensations themselves. The troubling thoughts of "What if this attack happens in a place other than my bedroom" was the only part of the experience that was distressing. So I tried to consciously bring this thought to the forefront and it made the sensations even more intense, but nothing really happened after that. I couldn't detect a hotter thought. This probably speaks more to my current level of skill than the technique itself, but it's curious that Dan disappeared from this board and shied away from e-mail correspondence. I question whether he has accomplished what he said he has.


I actually looked into it and the founder of MCBT is actually quite against cognitive restructuring. Its called MCBT because it is mindfulness taught in a certain way designed to work as a method of therapy.

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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8/25/13 5:08 PM as a reply to Elijah Smith.
Interesting, I guess I've been away a while. It is so easy to lose track of time at this point - sometimes I feel like I look at my watch to see what season it is.

Anyhow, glad to hear what I wrote may have helped. I can tell you it has helped me and I was quite tickled to read that pet theory of why I hadn't been to this board in a while. It never occurred to me anyone would notice my absence.

If it is interesting to you, recently, stumbled on a translation of Sri Ramana Maharshi and started reading Be As You Are. I was tickled as well to see that he's been saying what I pointed towards just from another angle/emphasis - Self Enquiry. He talks about that hotter/colder game as the inner dog tracing his master's scent, aka going towards hotter...(I added the bold).

Maharshi:
Self-enquiry by following the clue of aham-vritti is just like the dog tracing his master by his scent. The master may be at some distant unknown place, but that does not stand in the way of the dog tracing him. The master’s scent is an infallible clue for the animal, and nothing else, such as the dress he wears, or his build and stature, etc., counts. To that scent the dog holds on undistractedly while searching for him, and finally it succeeds in tracing him.


Although tendencies towards sense-objects [vishaya vasanas], which have been recurring down the ages, rise in countless numbers like the waves of the ocean, they will all perish as meditation on one’s nature becomes more and more intense. Without giving room even to the doubting thought, ‘Is it possible to destroy all these tendencies and to remain as Self alone?’, one should persistently cling fast to self-attention.


So when you follow the 'hotter' as suggested, I'd offer this is another avenue to understand Maharshi...this is using tracing the self (as the metaphorical blood hound) to its root to the Self...only we're using extra strong scented bait, i.e. anxiety, fear, and terror. And what could be better...get to the root of those and not only have you learned to find the Self via the self, but we've rooted out some our most distracting/disconcerting pockets of self.

This and other remarks he's made tell me he is unequivocally on the same trail, but with other (very interesting emphasise) and lot of other interesting observations. And but of course, why not? We're all playing in the same field of Self with the same human tendencies.

Well, I had no idea the discussion had continued. If you're interested ask here if you have questions and I'll be happy to post or talking on the phone, let me know and I'd be happy to oblige. I'm not a teacher - much like David Carse, I have and embrace having a full time job - beside what could be better for churning the soil of the self.

I'll subscribe to this thread.

Dan

PS There's a whole universe of discovery that comes after this, though interestingly enough the basic techniques that become reflex remain useful in new ways and open locks for other discoveries. Enjoy yourselves! Dan

PPS my original intent on coming to the board was to encounter and see the interrelationships of any and all other traditions and practices present here. If someone here is master (has a solid intuitive understanding...please no emetics from the mind) of a path Daniel Ingram speaks about (or others), I'd be interested in chatting. Again, Enjoy! Dan

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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8/25/13 5:18 PM as a reply to fivebells ..
fivebells .:



Love this graphic...much like following the hotness of fear or anxiety, follow the hotter/colder trail of that which feels distracted by the thought of endlessness to its roots and hold fast well for a while past any inkling/sensation of it, in the hole formed by its absence. ...you'll know the result when you see (not how *you* have changed) but how the world/reality has changed.

Best.

Dan

RE: Thoughts on Anxiety (including Dan From Virginia's technique&
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8/25/13 7:09 PM as a reply to End in Sight.
End in Sight:
Elijah Smith:
Would you agree that my description of the technique as continually moving awareness to the feelings/emotions/thoughts of greatest intensity?


Sounds like it...but, with the qualification that, as you move to the highest intensity stuff, even higher intensity stuff starts to be generated (because you're not defending yourself from your own anxiety as much anymore), which you then pay attention to.


Interesting, your discussion is well said. On reaching "higher intensity stuff", I'd offer a little tidbit that might appear to be a "secret" if you haven't *seen* this for yourself yet, that said I'd offer would be helpful to know (even if just in the mind until you find out for yourself):

  • When a *hotspot with the paired thoughts* leads to another *hotspot/thought pair* appearing and you "gently trade up" (and here's the "secret"), it may appear to be happenstance, however, no matter how unrelated the two pairs may seem, don't have any concern letting go of the first less hot pair in order to trade up to the hotter spot and here's the why..
  • The two hotspots are related not by any thought content, but by the feeling content (the hotness). If you want an analogy to clarify, picture the first hot pair as being on very the tip end of a tree branch. Appropriate as it was your entry point.

  • As the feeling gets more energetic, that is more hot as you play the hotter/colder game, you are in analogy working your way from the tip of a branch towards the thicker older part of the branch and as a consequence towards the very trunk of the tree.

  • As you work down the branch and finally weaken or clear out a given hotspot after doing some "trading up", other hotspots that also branch down into that hotspot's branch (from other various outer branch tips on the outside edge of our tree) will also be weakened or cleared because their connection to the tree vis-a-vis the hotspot on the branch which was closer-to-the-trunk has been weakened or cleared. (When you clear something really, really deep, personally I've noted I'm acutely ready for a nap - which (some other advice here) prescriptively I take right then and there.)

So I'd offer never hesitate to *gently trade up to a hotter spot that presents itself*. Note that the mind goes for hotter spots just like it will more likely note a lion in a room before noting an equally sized couch. When a hotter spot appears, any thought to effort and try and hold onto a lesser hotspot/thought pair is actually just more self (ego if you will) getting activated and trying to get your attention.

Play the hotter/colder game pure and simple (focus on hotter). A day will come when a thought trying to get your attention away from a hotspot will itself become something to ferret out. In the meantime, perhaps remember (write on the scratch pad of the mind) that any non-hotter (distracting) thought may appear, but it is simply more mind incidentally getting triggered and as all thoughts do - trying to get your attention.

Best,

Dan

PS if you subscribe to this line and see my re-writes in emails, apologies - I was never much of a pre-post-editor as a post-post-editor. ;-) Dan