1. Accessing the Internal Voice"Now I know from what you have told me that up until this point you have experienced this intense feeling on a number of occasions. I'd like you to bring one of these times to mind now, and let me know what you are either thinking or saying to yourself at these times, just beforethe feeling occurs. You can do this either with your eyes open or closed. Most people find it easier with their eyes closed"
Notice that this language is more immediate and associated than, "Think of a time when — " which is more ambiguous, and could result in them thinking of an experience by seeing themselves in it, rather than being in the experience and re–experiencing what they feel when that happens. Or they might run through a listing process, scanning across different examples, but without stepping into any of them. Either of these alternatives would make it more difficult to hear what they are saying to themselves.
Usually they are able to tell me immediately what they are saying to themselves, but sometimes they may have some difficulty. If they don't know what they are saying to themselves, they may be too separated from the experience at the moment, and this is often visible in their nonverbal behavior — their body is relatively motionless, and they don't look anxious. When this is the case, there are several choices.
One choice is to use my language to help them re–associate into the experience.
"When you are in that experience, what do you feel in your body? If you are sitting down, can you feel the shape, texture, and temperature ofthat particular chair, and your posture as you sit in it? If you are standing, can you feel how your feet contact the floor, and the position of your feet? Do you feel tense or relaxed, balanced or off balance?" Usually that will enable them to really be in that experience, making it easy to notice what they are saying to themselves.
However sometimes it is easier to accept and utilize their separation from the problem experience by asking them to imagine that they could see an image of themselves in the problem context. "IfI were to draw a picture ofyou in one of these experiences, as in a comic book, where the artist draws thought bubbles above each character's head, what should I put in the bubble over your head to indicate what is being thought at that precise moment?"
Or you can use some version of the "as if" frame: "If you did know what you are saying to yourself in that situation, what might it be?" or simply, "That's OK, just make up something" Since I will be adjusting the tempo, not the content, the exact content of what the voice says is really not that important. It is only important that they come up with something that fits well for them in that situation.
Once they know what they are saying to themselves, I ask them to think of other situations in which they have their anxiety, and ask what they are saying to themselves in those. Typically it is either the same sentence, or one that is fundamentally similar, or has the same kind of presuppositions or implications — that they are about to die, or are in some kind of very difficult situation that they can't handle, or that has very unpleasant consequences. By doing this, I am helping them to create a larger category of experiences in which they have the same feeling of anxiety. Then when I help them change the feeling in one of these, the change is much more likely to generalize to all the experiences in the category.
2. Noticing the Tempo"So the sentence you have said to yourself is, 'The plane is going to crash into the sea' When you have said this to yourself, do you say it in your normal conversational speaking voice, or do you say this at a faster tempo?"
Here I am offering the client just two options; most will immediately confirm that they are using a faster tempo of speaking. If they say it's otherwise, I ask them to check; to date out of the more than 900 clients I have done this with, every one has been able to notice a much faster tempo.
3. Baseline Tempo"OK, now I am going to ask you to do three things. The first is to say or think this sentence exactly as you have done to date and notice how you feel in response to doing this " …
4. Slowing Tempo by One Third"OK, now I am going to say your sentence, slowed down by about one third. After I have said it, I want you to say or think this sentence to yourself at this slowed–down speed and notice what's different" …
Then I say their sentence out loud and slowed down, and then pause while they say it internally in the same tempo. In order to slow down the tempo they have to change their physiology — slow their breathing, relax the tension in their vocal cords and chest, how they shape their words, etc.
5. Even Slower Tempo"OK, now I am going to say the same sentence even slower, and when I am done I want you to do the same, and let me know when you have done so "
I then say the sentence out loud, and slow down the tempo dramatically, to demonstrate exactly what I want them to do. I allow at least two seconds between each pair of words, matching each word to their breathing out, so that each word is paired with the relaxation that naturally occurs when breathing out.
I watch them carefully to observe their increased tension as they anticipate when they will hear the next word, so that I can say the next word somewhat later than they expect. I pause even longer between the last two words of the sentence — at least double the length of the previous pauses. Then I pause to give them time to say the sentence in this slowed down tempo, and wait for them to tell me when they are done… .
6. Testing"OK, now when you try to think of this as you used to, what are you noticing that is different?" Usually their feeling of anxiety will be entirely gone; sometimes it will be greatly reduced. The tempo shift deconstructs the meaning of the old sentence, and changes their response. Very rarely it may not change much — or at all — and I follow with the visual variation below.
Another way to do the same exercise is to ask them to see the sentence in front of them as they say it to themselves, translating it from the auditory to the visual.
"Now I want you to see that sentence out in front of you, as if it's on a small billboard, and notice what the sentence looks like in detail Tell me how far away from you it is, what size the letters are, whether they in boldface, italics, or regular type, etc"…
"Now I want you to begin to stretch the sentence apart, creating longer spaces in between the words, first noticing the new locations of the words, and then to attending to the spaces in betweenthe words, rather than the words themselves." …
This is a figure/ground shift of attention. If I don't see a dramatic shift in their breathing and posture, sometimes I ask them to put space between the letters as well as the words. "Now I want you to separate the letters in each word. Put spaces between the letters, and then pay attention to the spaces between the letters, rather than to the letters." This further changes the meaning of the sentence, and is also a demonstration that they can voluntarily change their feeling response.
If the sentence has a negation in it, like "I can't — " I have sometimes suggested that they, "Remove the apostrophe and the t in the second word of the sentence" being very careful not to say the word that I am referring to. This reverses the meaning of the sentence entirely, and they find themselves able to do what they previously thought, "I can't." I often delete any other word that causes a problem, for instance, "And now take the fourth word and do the same thing. Start to fade it out a little bit more, a little bit more. And then there's a certain point where — pfff — white it out. So it's not there. You know it's not there, because when you look now, it s not there." When doing this it is important to not say the word, but only refer to it indirectly by its position in the sentence.
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