Tuesday, July 28, 2015

"Overcoming Anxiety" by David Berndt

Overcoming Anxiety:
Self-Help Anxiety Relief
by David Berndt, Ph.D.

Author and psychologist David Berndt, Ph.D., is celebrating the release of Overcoming Anxiety, the first of in his new Psychology Knowledge Mental Health Series.
The author joins me today to share a special guest post and an excerpt from the book. You can also read my review. Make sure you follow the author's blog tour, featuring many more reviews, guest posts, and interviews.

Psychologist David Berndt, Ph.D., in Overcoming Anxiety, outlines several self-help methods for relief from anxiety and worry. In clear language and a conversational style, Dr. Berndt talks intimately with the reader like he would in a therapy session, and he shares what he learned from his peers and clients about how to make techniques for anxiety management more effective and helpful.
You will learn:
·       A Self-hypnosis grounding technique in the Ericksonian tradition.
·   Box Breathing, Seven Eleven and similar breathing techniques for anxiety relief.
·       How to stop or interrupt toxic thoughts that keep you locked in anxiety.
·       How to harness and utilize your worries, so they work for you.
·       Relief from anxiety through desensitization and exposure therapy.
Designed to be used alone as self-help or in conjunction with professional treatment Dr. Berndt draws upon his experience as a clinician and academic researcher to give accessible help to the reader who wants to understand and manage their anxiety.

I wanted to start off by teaching you a technique, sometimes known as the 54321 Technique, you can begin to use right way. I learned a version of this initially from another psychologist, Yvonne Dolan, who is one of the bright stars of the Solution Focused brief therapy approach. Perhaps because of her training under master therapist Milton Erickson, she learned the value of being especially creative and innovative. When I noticed early in my career that my skill set needed some bolstering, I sought training from Ms. Dolan, among others. She taught an earlier version of this technique in a seminar that I attended on treatment approaches to Post-Traumatic Stress Disorder.
The information she shared is presented in her 2000 book, One Small Step, Moving Beyond Trauma and Therapy to a Life of Joy and she indicated that the technique in its original version should be credited to Betty Erickson, the wife of hypnotherapist Milton Erickson. This particular method, as it has evolved in the way I use it, is now one of my "go to" tools whenever I want to help my clients to feel more grounded. Yvonne Dolan originally taught me the approach as a tool for dealing with flashbacks, so it is a fairly strong remedy, but my patients and I have discovered that it can be useful with many types of emotional storms.
Ms. Dolan encouraged those of us who were in that PTSD training seminar to continue to develop what I will call the "54321 Technique," and to modify it. I have, over the years, had the privilege - with significant input from many of my clients - to change, improve upon, and modify some components of this procedure. I now use the tool clinically as I present it here, to teach my clients how to manage anxiety and other strong feelings.
Custom Designed
The way I am presenting this technique is easy to teach, and in order to present it to the reader I have similarly made it as accessible as possible, and in so doing, by necessity I am making it rather generic. I leave it up to you the reader to shape it, change it, and enrich it in ways that are tailored to your own unique needs and style. As you become more skilled at the basic procedure (and others presented in later chapters), you will find ways to improve the technique by making it more interesting to you, more simpatico, and thereby more powerful.
In its simplest form this 54321 skill can be quite helpful, without any changes. However, by changing the technique and making it yours, you will more confidently rely on it for managing severe anxiety and for relief during other peak moments of stress. Combined with other strategies in the later chapters, you will get more adept at developing an emotionally intelligent skillset, from which you can pick and choose your best option for handling an emotional problem.

Praise for the Dr. David J. Berndt's Work
About the Multiscore Depression Inventory:
"A textbook example of how to create a psychological test." ~ Oscar Burrows, Mental Measurement Yearbook
"Dr. Berndt is a creative and forward-thinking psychologist who has contributed to advancing psychology both with his research and clinical practice. He has helped countless patients with their depression and anxiety, and his conversational and accessible style of writing makes Overcoming Anxiety a book you would want for your top shelf." ~ Charles Kaiser, Ph.D. Professor Emeritus of Psychology at the College of Charleston

My Review

By Lynda Dickson
The author shares numerous techniques for overcoming anxiety and related disorders: the 54321 technique, breathing exercises, scheduling worry time, desensitization to overcome fears and phobias, cognitive behavior therapy to tackle negative thoughts, dealing with thoughts that can lead to depression. These are all described in a simple, step-by-step manner, making it easy for readers to employ them on their own or with the assistance of a trained psychologist. The author also describes the physiological reasons for panic attacks. Includes a full reference list at the end.
It's hard to believe so much information can be packed into such a small volume (188 pages). Full of handy self-help tips from a trained psychologist, this book is the cheapest form of therapy you are likely to get.

Guest Post by the Author
Anxiety Relief: Box Breathing and 7/11
by David Berndt, PhD clinical psychologist
The way I am going to introduce breathing techniques for the management of anxiety is very much the same way I introduce it to my clients. Breathing is a skill that most people never bother to learn, or, at least, they never learn well. Professional singers pay for voice lessons, in order to learn how to breathe deeply, using the diaphragm muscle at the bottom of the lungs to make their lungs into a bellows. They learn how to pump oxygen like a bagpipe over their reed-like vocal cords, so singers can hold and trill a note for a long time. Swimmers and gymnasts are trained at how to breathe deeply, and so are actors, who need to project to the back rows of a theater.
But, of all the groups who need to learn how to breathe deeply, there are few with more at stake than the person who is prone to anxiety. If you can learn to breathe deeply, and you can use that skill both tactically and strategically, then you will have a good chance at winning battles in your war with anxiety. 
Deep breathing techniques are helpful with management of the physical symptoms of anxiety, and they can also help to calm or still the mind, when your thoughts starts swirling. The reason deep breathing exercises play such an important role in anxiety management has to do with the impact of two different sets of physical equilibriums.  One of these is the role of the parasympathetic nervous system, and the other is the very specific role that breathing can play in warding off or reversing a panic attack.
Most anxious patients have learned at one time or another that breathing can help with anxiety, because taking several deep breaths can switch on the Parasympathetic nervous system. This finely tuned system’s cluster of physical functions (also known as the relaxation response) serves to counterbalance your survival reflex. Your Sympathetic nervous system, when your body senses threat - from a tiger, your boss, or the IRS, kicks into high survival gear. It pumps adrenaline, speeds up your heart rate and among other things, elicits a panting-like rapid shallow breathing, in order to rapidly take in as much oxygen as possible. Much of what we know as anxiety are the physical reactions that automatically switch on when the body needs to avoid harm. The parallel system (Parasympathetic) works in just the opposite manner, and it helps you unwind when the threat has ceased. Deep breathing is just one of many grounding techniques that can switch this relaxation system on; many of these grounding techniques typically operate by activating this Parasympathetic nervous system.
In order to breathe in a manner that switches on the Parasympathetic nervous system, you need to inhale deeply, like a deep sigh, expanding the lungs fully, assisted by your diaphragm muscle. You can practice this by putting one hand on the stomach and another on the chest. When breathing deeply the area near the stomach should expand more than the chest; that’s why deep breathing is often referred to as "belly breathing."
There are many different yardsticks to help you breathe deeply enough, and most of them involve counting. Think of the counting as scaffolding, it’s just a guideline and the actual numbers do not matter much. In fact, if there is a number that matters it is four. When you breathe in (to a count of four while doing so), you can begin to get the effect you are seeking. Three is not enough, and four is just barely enough – more than that is even better. Breathing in by a count of four and out by a count of four works, but it’s the smallest depth of breathing that actually helps with anxiety. Five is better, six is better still, etc.
However, when I teach breathing techniques, I want to make sure we are killing two birds with one stone. Breathing deeply (such as: in by four and out by four) will help switch the relaxation response on, but, as I said above, there is another system at play, and this one has to do with panic and severe anxiety attacks. Panic attacks can be warded off and/or reversed by adding a new wrinkle to your breathing strategy. There is not time to go into it in depth here, but I cover the physiology of this second component in my final chapter of Overcoming Anxiety (this mechanism has to do with a sensor in your body that maintains a balance between oxygen and carbon dioxide).
If you can take my word for it, all you really know is that you need to breathe not just deeply, but, in the process, also breath more out (or hold your breath) for an interval longer than the amount that you breathe in. 
Two widely used techniques illustrate simple ways to implement this, and both of them make use of both of these physiological systems. In Four Squared, you breathe in for a count of four, hold your breath for a second count of four, breathe out for four, and finally hold for another four, before starting around the rectangle a second time.  This method is also called "Box" breathing. Repeat it as long as needed but ideally at least four times. The other useful technique is called 7/11. You simply breathe in for a count of seven and out for a count of 11, and keep repeating this for several minutes.  Both of these techniques are constructed so that when you learn them, you are addressing both sets of problems.
These techniques can both seem to "take forever" to take effect, when you are very anxious, but often succeed after only a few minutes if you can hang in there. They can typically kick in a few minutes quicker than the benzodiazepines, and of course you do not develop a tolerance to it or an addiction like you likely would if you use the benzos in that manner. 
If you already have a breathing technique that you use, juts modify it to include the factors I mentioned above (more out than in, a count of four or greater). From a health perspective it does not matter whether you use your mouth or nostrils (whatever is easiest) or what other things you can combine with it such as visual imagery or muscle relaxation. While many of these other techniques can also be helpful, breathing alone is often enough to help bring your anxiety under control.
You probably want to develop a strategy about when and how to use breathing and how you practice to learn the habit of taking deep breaths. A therapist can be especially helpful in developing strategic and tactical applications. Whether or not you make use of a therapist, you will do best if you come up with a customized intervention that takes into account your strengths, interests, preferences, and past successes. Whatever method you use to practice breathing can also be an opportunity to combine breathing with a laser-like focus, or with one or more of the things you use already (listening to music?), so that the two can evoke each other.
Thanks for the opportunity to share this information with your readers. I hope that this can begin to give you a taste for all the techniques that are at your disposal when you decide to take the reins of your anxiety and learn to harness it.

About the Author
David J. Berndt, Ph.D. was a Clinical Associate Professor of Psychiatry at the University of Chicago, where he published or presented over 80 papers and articles, before establishing a private practice. Dr. Berndt currently lives in Charleston, S.C., where he also teaches in an adjunct capacity at the College of Charleston. He is best known for his psychological tests The Multiscore Depression Inventory, and the Multiscore Depression Inventory for Children, both from Western Psychological Services. He also contributes to several psychology websites including Psychology KnowledgeOvercoming Anxiety is the first in a series of books on dealing with psychological problems that Dr. Berndt plans to release in 2015-2017.