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     FROM FEAR TO TRUST WITH STRESS MGMT . .Ch. 5

Chapter 5
 From FEARING to   TRUSTING
and Stress Management

Outline of Chapter

Session 5-1   ABNORMAL TO NORMAL RANGE OF FEAR
     Fear as irrational or abnormal
     Fear as instinctual and learned
     Phobia as out-of-control fear response
                   SOURCES OF EXCESSIVE FEARING
     Traumatic experiences
     Natural catastrophes
     Suppression/repression
     Trait anxiety
     Displacement
     Pathogenic beliefs
     Lack of Positive Strokes
     Poor value choices
Session 5-2   ERIKSON'S FEAR--TRUST MODEL
     His place in history
     Psychosocial development
     Stages of development
     Stage-Step model
     Outcome of favorable ratios
Session 5-3   REGAINING CONTROL OF FEAR
     Psychoneuroimmunology (Selye, Ader)
     Autonomic nervous system and stress
     Multiple  combined strategies
     Regaining one's rationality (Ellis)
     Relaxation  for fear and anxiety(Benson)
          Jacobson Relaxation Exercises
          Schultz's Autogenic Training
     Use of biofeedback (Green)
          EKG, GSR, EMG, Dermal,     
     Systematic desensitization (Wolpe)
     In Vivo Desensitization (Kazdin)
Session 5-4  STRATEGIES FOR FEAR REDUCTION (Research)
     Counteraction the bio-chemistry of fear
          Sleep, exercise, success,
          aggression, alcohol, cocaine,
          love, social support, medicines,
Session 5-5REBUILDING TRUST
     Group processes
     Self-disclosure (Jourard)
     Sharing feelings

Fearing to trusting and stress management
    Excessive anxiety and fear are factors in some emotional and physical illnesses. The classic outline of Erik Erikson's Developmental Stages in this chapter helps people determine how to “trust” so they can grow emotionally.  This growth helps prevent some of the possible illnesses. While the first part of the chapter deals with the types of fears and the sources of their origins, the later part of the chapter describes current stress management ideas and skills.  Hans Selye, Ph.D. was strongly influential in showing how excessive and unrelenting stress (anxiety, fear, irritation) affects the immune system, producing disease and even death. Jacobson’s relaxation exercises are featured in this chapter.  Biofeedback work by Elmer and Alyce Green is featured. Autogenic Training by Johannes Schultz is featured. Joseph Wolpe’s systematic desensitization is featured. Alan Kazdin’s counter-conditioning is featured. Sidney Jourard’s self-disclosure is featured. Credit to Herbert Benson is given for his Relaxation Response.

Overview: Living between fear and trust

     Psychology has some guidelines for helping people conquer certain anxieties and fears, and improve their ability to trust.  It would be nice if people simply trusted each other. It would be marvelous if all parents raised children in such a way that every child would have emotional trust. Human nature does not always work that way. In certain instances human nature is cruel, not always intentionally. Each person suffers from another's unkindness and/or ignorance. This can produce an excessive amount of fear and mistrust.  Each person can suffer from someone else's excess greed and selfishness, but each person can also suffer from lack of knowing how to built or regain trust. Survivors have hope and zeal to fight their way out of excessive fears and establish a reasonable amount of trust.  Survivors may perhaps never wipe out all fears, but they seem to learn some skills for dealing with fear and mistrust.  Eliminating all fear would make most of us a victim of every crook and swindler.  Living by total trust might take away one's wariness of competitors.  Total trust might discourage us from pursuits in research and in one's search for the truth. No one can live without some healthy fear and healthy trust. People exist in the middle, sometimes more on the side of fear, sometimes more on the side of trust. Life is a constant system of escaping the grabbing hands of fear, and fleeing into the safer harbor of trust. This chapter will show you some of the guidelines.

Session 1  ABNORMAL TO NORMAL RANGE OF FEAR

                   “A good scare is worth more to a person than good advice.”
                                           Edgar Watson Howe, Country Town Sayings, 1911

Fear is our friend, when it is controlled. Fear keeps us from falling. Fear defends us from being cheated.  Fear of retaliation makes us treat others decently.  Fear of sickness and disease drives us to healthier life-styles that do not bring disease. Fear protects people from harmful experiences, pain and suffering. Without fear some persons would be reckless drivers, obnoxious insulters and permiscuous syphilis victims. Fear of the consequences of one's behavior is a deterrent to problem behavior, as well as a motivation for avoiding what is troublesome. Fear turns on aggression when necessary. Fear activates the “fight-flight” stress reduction procedures. People need a healthy fear sensor to survive well.

Fear as irrational or abnormal

Fear is also a foe, an enemy. Excessive and unending fear is a powerful crippler of bodies, minds and spirits. Uncontrolled fear undermines and eventually destroys our ability to cope with the stressors of living. Fear without some relief undermines self-esteem. Real and imaginary fear slows the mental processes during examinations. Fear sharpens our view of threats to our survival. Unconscious fears block our emotions from falling in love. Catastrophe-produced fears paralyze people from action. Exaggerated fear shrivels up people's social life.  Anxiety-producing fear turns people to tranquilizing agents, some prescribed, some illegal. Unresolved fears can grow into phobic reactions that need to be treated. At times fear can be very destructive.

Fearing as instinctual and learned

 Fear is quickly learned, if not instinctual. Fear is survival equipment, which we share with other species (Figure 5-1). The infant child tenses body muscles quite automatically when the child is lowered into a bed more swiftly than average. A child appears to have a  natural fear-response without being learned. The fear of falling may be natural. Beyond this there is little to counteract the notion that fear is learned. Humans differ from other species. It is generally known that, for humans, fear is one of the primary factors in certain emotional disorders. Fear is emotionally disturbing, mainly when fearing has become a habit and is secretly harbored. Fear can start out small or be started by something very painful. Being bit by a dog at age 3 may make one fearful of dogs the remainder of one's life, even though a child doesn't usually remember things that happened at that age.  Experiencing being yelled at can initiate fear of authority figures.  Experiencing harsh discipline can make a person emotionally unavailable in childhood and continue later with a marriage partner.

 Imagine that you are in a fearful situation.  Your eyes are big. Your head is pulled back. Your brain is whirring about what to do. You are thinking about fight or flight.  Your heart is beating at double its normal rate. The palms of your hands are sweaty. Your blood pressure is high.  The neuro-transmitters of your body are racing at space-flight speed. You can't really decide what course of action.   You only sense that it is up to you to survive.

   Your emotional being is tied up in a very narcissistic process of survival.   Recall the information in Chapter  No. 1 about narcissism.  This is when the ego is  turned back on the self, in a set of processes  which feed the self, for the sake of emotional survival.   

   In the anxiety-fear response the person's emotional processes are characteristically narcissistic for the purpose of survival.  In such cases the narcissistic instinct is acceptable and normal.   

   In cases like hemotophobia (fear of blood), where the fear response is learned or triggered, out of control and quite irrational, narcissism is still functioning, but functioning irrationally for the sake of an imagined need for survival.

   This chapter describes the skills of stress management for dealing with anxieties and fears.  Other chapters describe skills that deal with irrational ideas and beliefs (like hematophobia) which are causing problems like anxiety and fear. Try to hang onto the idea that certain problems need to be treated with multiple skills at the same time.

     A person may harbor harsh memories in the unconscious.  These harsh or terrifying memories are like cassette tapes in the brain. Current experiences cue the tape to replay the old emotion. It can all happen at an unconscious level. When the old fear is aroused by a new cue (a current threat), the old emotions erupt and replay. That can be emotionally disturbing. As long as the old bad experience of fear is tucked away in the unconscious, it can continue to replay every time it is cued by a current behavior similar to the past.  This puts people into a personal bondage to the past fear-generating experience. That is perplexing. It can even be maddening to the person. Sometimes it takes months of counseling to uncover such past fear-generating experiences and learn the fear-generating cues. Early ventilation, early use of “self-talk” to stop the cycle, and early fear-control methods help prevent the possibility of long-term fear problems. It helps to expose them by talking about them to someone such as a counselor, or to a private friend who will hold your struggles in confidence. Beyond this kind of confession, people benefit from adding “self-talk” to reduce “irrational” ideas that generate fears (Albert Ellis). People also use some desensitization skills, and a strong mind-over-matter attitude to conquer their fears.

Phobias as an out-of-control fear responses

On a practical level fear exists when you know the cause, and anxiety exists when you do not know the cause. A  phobia is a specific fear which is an outcome of a general anxiety, displaced on the feared object. In a phobia the fear attaches itself somewhat irrationally to something slightly removed or loosely connected, generally by a process of association.  Certain overly anxious and/or fear-habituated persons can become overly fearful of heights, snakes, mice and/or flying in airplanes.  The psyche does this for almost no reason other than the psyche's desire to unload some anxiety or make some inner sense out of anxiety-producing confusion.  Essentially a phobic reaction is a normal reaction which has gotten out of a person's sense of control.
      Agoraphobia is a specific phobic reaction. “Agora” is the Greek word for “market.” Certain anxiety-overloaded persons suddenly panic while shopping. Anxiety levels get out of control. Heart beat rate increases. Breathing increases. Phobics sometimes feel they might die from their anxiety. Agoraphobics leave grocery carts half full and go outside, or home. They panic half way between home and town, fearful they will lose control before returning home, or before getting to the nearest hospital.  In phobic reactions there are certain cues that begin to trigger the backlog of unresolved anxieties.  Anxiety attacks repeat so that the person cannot believe it can be brought under control unless the person leaves.

                                The anxiety / illness connection in 116 Harvard college students after 35 years.

                                 “The emotion of severe anxiety. . .was a reliable marker
                                 for increased susceptibility not only to coronary heart
                                 disease but also to overall future illness.”
                                                     Russek, King, Russek & Russek, Psychosomatic Medicine, May-June, 1990

     A phobic reaction is a psychological displacement. The anxiety is displaced on specific objects or situations which act as cues for the triggering the response. Some psychologists have believed that fear and anxiety were similar (Izard & Tomkins, 1966). Other psychologists believe that anxiety is a more powerfully destructive emotion than fear (Epstein, 1972). A phobic reaction can reach obsessive levels. A phobic reaction which occurs frequently, becomes almost locked in at a biological level, because the fear is hard to shake off.  People develop fears of leaving doors unlocked at night or leaving the electric cooking stove on. Such persons may get up dozens of times day or night to check whether the doors are locked or the stove off or on.  Phobic reactions are compulsions. The phobia is no longer just emotional, but appears to be a change in brain biology.
     Many phobias like  claustrophobia (fear of closed-in places) have no known cause, except in cases where someone was traumatically held against their will. In such cases a painful experience burns a message so deeply it affects a person until they find psychological treatment. This would by a phobic reaction which came from “conditioning” by a specific event, that happened catastrophically or repeatedly. Claustrophobia occurs quite naturally to almost anyone who may be confined to smaller living or sleeping space than usual.
     Some phobic reactions are “learned,” like  hematophobia (fear of blood), perhaps after watching mother or some significant other person who showed signs of fear at the sight of blood. There are scores of phobic reactions such as the few mentioned here. Some phobias are internal displacements of unresolved inner anxiety upon animals, things or situations. Some phobias are learned by watching our model's fears.  Some phobias develop after catastrophes put a deep imprint on our memory.  Some phobias result from abuse by others, and the internal sense of shame makes the abused person fearful of dirt and germs. Phobias generally do not go away unless we admit them, own them, confess them, talk about them, self-talk their irrationality into oblivion, learn desensitization processes, learn more faith and trust-improving processes.

Fears from suppression/ repression

Symptoms of free-floating anxiety
1. irritability
2. anxious expectation
3. pangs of conscience
4. episodes of panic
5. hypersensitive to
    sights and sounds
6. startle reactions
7. cardiac palpitation
8. breathlessness
10. giddiness
11. nausea
12. dryness of mouth
13. diarrhea
14. compulsive eating
15. urinary frequency
16. sexual emissions
17. blurring of vision
18. physical weakness
19. (other)       Louis Lin, M.D., Comprehensive Textbook of Psychiatry-II,  1975.

While violent and vile things like those in the lists above, happen to many people, certain persons are adversely affected for a while or a long time, but others remain unaffected and/or rebound more quickly. Very early Freud believed that anxiety was traceable to repression of feelings and memories of those violating experiences. In repression persons unconsciously stored painful images in the unconscious memory.  Later, in Freud's Inhibitions, Symptoms and Anxiety (1926) he enlarged his views. The enlarged understanding included the fear which resulted from inner violations, done sometimes by oneself. If a person stole something, which was basically against his values, the guilt which might result from that violation might be a negative charge, generating anxiety in the emotional system.  If someone valued a friendship, but cheated the friend, the guilt could become an inner conflict, creating a free-floating anxiety. Such behaviors as sexual infidelity could produce a severe inner conflict if it was continued by a male or female who claimed great religious commitments. Sometimes a sexual indiscretion might be indulged by someone who becomes neurotically guilty and then becomes excessively and neurotically religious to neutralize past inner guilt. When a person violates his own personal value system, personal anger at self and personal guilt about one's behavior has the power of generating large amounts of free-floating anxiety, which is always ready to attach itself to something and become a  phobia.  Phobias drive persons to compulsively wash germs off hands, compulsively open doors with handkerchiefs to avoid germs,  compulsively wear a glove, compulsively check to see if the back door is locked or the gas cooking stove is on, avoid airplanes, avoid elevators, avoid shopping centers, walk around ladders, etc.  
Developing inner trait anxiety

Psychology has recognized that certain kinds of anxiety are not a problem, but other kinds and larger amounts are deeply disturbing. A distinction is often made between state anxiety and trait anxiety. Driving through fog or in a snowstorm can produce a great amount of state anxiety. The financial investor who watches the stock market fall for a few days has state anxiety. Mothers watch their toddlers try to walk. That is being called state anxiety because it occurs in response to something specific, a state of existence at that moment. However, some persons feel anxious nearly all the time, or phobic in specific stances. Such persons have a larger amount of trait anxiety.  They bring their anxiety with them. They are anxious about birds hitting their car, planes falling out of the sky, children running into the street, and thousands of other similar incidents. Trait anxiety is deeper. Trait anxiety may develop from more traumatic and harsher experiences, but trait anxiety also develops from excessive suppression and repression of negative experiences.

Fear from displacement

 Displacement is a tool the unconscious system uses to deal with an accumulation of unresolved negative feelings such as, shame, guilt, anger, disappointment, etc.,  all of which arise from  external catastrophe, abuse, violence, etc. Displacement is the next logical step from suppression (conscious) and repression (unconscious) of negative feelings. For example, the person who has been sexually abused, and who never blows the whistle on the abuser, will suppress or repress the feelings of shame, which get displaced on some other object, such as germs, dirtiness, or any other nearby idea or object.  The anger, hurt, irrational shame and guilt become displaced, because the feelings are not ventilated in some sensible way.
     Daughters can develop anxiety reactions when they grow up with overly-demanding, guilt-inducing, mothers.  The desire to please comes out of an excessive amount of irrationally induced guilt in the daughter. The inability to please mother often enough generates the guilt that displaces into trait anxiety.  Displacement of hurtness in one's emotional system, onto some free-floating  anxiety is quite common.  Tracing the anxiety back to the source and speaking up about it, generally neutralizes the effect of the displacement.  

Fear from pathogenic beliefs

                                 The Anxiety/illness connection in 116 Harvard college students after 35 years.

                                “The emotion of severe anxiety. . .was a reliable marker for increased
                                 susceptibility not only to coronary heart disease but also to overall future illness.”
                                          Russek, King, Russek & Russek, Psychosomatic Medicine, May-June, 1990


Children will often spread false ideas that can produce anxiety, fear, and even phobic reactions. Remember this one? “Step on a crack, break your mother's back.” Most of us didn't believe this one, but some children feared the crack in the sidewalk for years. Anxiety arises when pathogenic (illness-producing)  beliefs are promoted by misguided persons.  If you were taught that “Silence is golden” and practiced repressing feelings, after years it could set up an inner emotional neurosis, a phobia, or an obsession of some kind. Silence is not always golden. That notion is irrational when carried to extreme. Many people have anxieties because they believed something which has no basis in fact. “Because of pathogenic beliefs patients develop fear, anxiety, guilt, or remorse; institute repressions; and develop symptoms, inhibitions, and faulty object relations. In therapy, patients work to disconfirm pathogenic beliefs” (Weiss, 1990, Abstract).

Fear from lack of Positive Strokes

When a child is given sufficient Positive Strokes and Warm Fuzzies (libidinal nourishment) traumatic experiences are cushioned. The impact of traumatic experiences is probably the same, but the nourishment which preceded and follows the trauma has a cleansing power; a neutralizing power.  Alcoholics Anonymous and most self-help group processes function by giving positive emotional support for sobriety. First, the groups are places to own feelings, confess them, share them and ventilate them. Secondly, the group generates support. The group helps to replace the craving for alcohol by their emotional acceptance and emotional disclosing. The cleansing power of positive emotional experiences can transform anxiety-ridden neurotics and phobics into calmer people. So the formula for tolerating an overwhelming anxiety should include a disclosure and sharing process with another human being. Heightened fear is neutralized by increased love.  Exaggerated anxiety is calmed by caring human beings, who demonstrate and teach their skills for increasing trust.

Fear from choice of false and unproductive values

Anxiety about food and shelter may drive one person to find a job and drive another person to steal. Stealing tends to create anxiety and fear.  A job tends to increase self-worth, dignity and trust. A person's values may determine the choice. Someone's values about intimate relationship may drive one person to say, “I'm sorry.” and another person may have a high value on an extra marital affair. The person who says s/he is sorry, values reconciliation. The person who runs after an extra marital affair to resolve conflict, obviously values the titilation of passion more than the work of reconciliation.  Someone believes in communication and settles job stress.  Another was never taught to believe in problem-solving communication, and suffers from ulcers due to suppressed anger.  Certain values help eliminate anxiety, while other values increase anxiety. Being thrown in jail for stealing, being divorced for an extra marital affair, and having an ulcer because one hates his job, are the results of value choices.
     Some persons have no choice because they have not seen their parents say, “I'm sorry!” Their parents did not value, or believe in the importance of reconciliation, and the rebuilding of trust. Some persons only ever saw their parents passionately infatuated, and divorcing after they ran off with a new lover.  Such a person may not have a choice of values because this person never learned the importance of fidelity. Likewise, the angry employee may or may not have learned alternatives, so may or may not have the possibility of choice.
     The figure of Ego Joe used in this chapter (Figure 5-13) and textbook, continually shows that a person has a value/belief system. Some values and  beliefs are more helpful than others. Ignorance of the optimum values sometimes produces unfavorable choices and outcomes. Good models and training improves choice responses. Whether one has increasing fears or increasing trust may depend both on education and modeling.

Session 5-2   ERIKSON'S FEAR/TRUST MODEL

After almost a generation of learning from Freud, Alfred Adler and Carl Jung, it was Erik  Erikson (1902-1970) who set forth the classic  “8 Stages of Psychosocial Development” (Erikson, 1950). With the now-famous stage-step chart counselors could help persons identify blockages to emotional growth. Erikson believed the fundamental blockage to maturation was “mistrust” which made people fearful of again risking and venturing in the growing process.  Erikson's “stages” helped people examine what painful experiences in their past slowed emotional growth.  Erikson enabled psychology to become existential and progressive after quite a long time of Freudian thinking which was heavily influenced by regressive and reductionistic tracing everything to the past. With Erikson's stage-step chart a person can more easily identify a deficiency at one step which prevents development at another step.

Erikson's place in history

     Erik H. Erikson was born in Frankfort, Germany of Danish parents. Prior to becoming a psychoanalyst, He was an art teacher in a private school, having graduated from Montessori method training program. He took his training from Sigmund Freud's daughter, Anna, and completed it in 1933. He immigrated into the United States, practiced as a child's psychologist, and held positions at Yale University, Harvard University and the University of California at Berkeley. Erikson is one of a number of “neo-Freudians” who reformulated Freud's concepts, giving more emphasis to the autonomy of the ego. These persons include Alfred Adler, Karen Horney, Harry Stack Sullivan, David Rappaport and Heinz Hartmann.  They downplayed the role of instincts and Freud's psychosexual development. Hence, they are often referred to as Ego Psychologists. These Ego Psychologists strongly advocate both the independence of the ego and therefore, the responsibility of the ego (the person). They focused on reality testing more than the Freudian  free-association talking about past painful experiences.  Like Adler, they emphasized the persons total “life style.”

   "In settings of family disorientation and in the absence of dependable sources of love and safety, the person grows up with an attitude of basic distrust, in which case he tends to be rigidly hostile, suspicious, cynical, and pessimistic toward everyone, even when others attempt to relate to him [her] in a positive way, as in a classroom.”
     Erik Erikson


Erikson's psychosocial development

Erikson and other the neo-Freudians helped bring a balance to Freud's writings. The neo-Freudians did not attack Freud, only increased the significance of social-cultural dimension on human behavior, saying that the social environment was as important as the biological development. Freud had set forth a developmental process which was heavily oriented to the sexual nature of persons. Freud had understood people's development in terms of 5 stages: 1. Oral (dependency; birth to age 1), 2. Anal (child lets it all out; age 1-2 or 3), 3. Phallic (early boy/girl playfulness; ages 3-5 or 6), 4. Latency (prepuberty; ages 6 to puberty), 5. Genital (full sexual development; puberty to death).  
     Trained Freudian analysts used words like oral to describe any personality type which was basically self-serving, narcissistic, withdrawing and/or addicted. They used the term anal to refer to a personality who vented their emotions so that what came out harmed others. Various combinations produced terms like anal-retentive which was a person who had a lot of anger inside but held it there.  An oral-obsessive was a person who indulged excessively in one or many pleasures. Such terminology amused and intrigued psychoanalysts, but angered clients, students and the public in general. The anal-retentive is now labeled as a passive-aggressive, and the oral-obsessive is now simply labeled a phobic, a substance abuser or an addict. Erikson's 8 Stages became extremely helpful in bringing a balance. Now biology is wedded with sociology and psychology becomes more accepted.  

Erikson's Stages of Development

In Erikson's model each stage prepares a person for the next stage. If a person develops well in one stage, that leads to a better development in the next stage.  If a person fails to develop adequately in one stage it may lead to poor development in the next stage. The worst problem is to miss the first step, insufficient trust. The infant

Erikson's Stages of Development

In Erikson's model each stage prepares a person for the next stage. If a person develops well in one stage, that leads to a better development in the next stage.  If a person fails to develop adequately in one stage it may lead to poor development in the next stage. The worst problem is to miss the first step, insufficient trust.  

People need to learn to trust (see lower left arrow). If trust functions in the psyche are damaged by experiencing excessive mistrust (from excessive criticism or absence of love) that person tends to have difficulty developing and moving up the various levels.
Traumatic experiences of excessive hurt, abuse, criticism, guilt and other negative occurances from people tend to lower the person's ability to trust. That begins a downward cycle of more deficiencies in trust and consequent behaviors.


Stage-Step model for Luther and Ghandi

 Erikson demonstrated this developmental process in his biographies of Luther (1959) and Ghandi (1969) as well as in a major classic, Identity, Youth and Crisis (1968). He saw “crisis” in every developmental step, the biggest crisis occurring in adolescence. In this stage young persons become emancipated. They scan their world of education and experience. They decide who will be their heros. They chart courses for the future.  Those adolescents who have lived with more trust, been given more autonomy, taken more initiative, acted more industriously, will probably understand their identity better, find intimacy with a lover sooner, and go on to generativity faster.


The  8  Stage-Step model

Unfortunately, some children are treated very badly by their parents. Hurt, hate and hostility burst from these parents so excessively that the ego of the infant senses it at a very early age. The ego of the infant learns that it cannot trust. The infant learns to fear not being fed by Positive Strokes and Warm Fuzzies (libido). That turns a child into a slightly fearful, inhibited and/or shy person. The child begins to suffer from fear. In this kind of an environment the ego fails to trust adequately. Now the ego is inhibited. It begins to withdraw. Laboring with an insufficient supply of good will the child sees himself or herself not functioning like others and soon the child functions with some form of guilt, some form of “Oh, dumb me.” This kind of response is not based on the facts, but on a perception of the self. It is the beginning of inferiority or low self-esteem. Later, at the very crucial time of adolescent decision making, the person is partly inhibited, partly fearful, partly anxious and partly dysfunctional. Who am I?  What am I worth?  What can or should I do?  The person's identity can be foggy, and the results may be confusion, disturbance, or problem behavior.
     The stage-step chart also functions across all ages. At any moment in time, something traumatic can undermine someone's trust level and the person can fall back down to the bottom step.  At any moment in time there can be an excessive amount of guilt (real or neurotic) which inhibits passage to generativity. The adolescent's emotional system cries out for intimacy but can't achieve it adequately if the person has not yet achieved an adequate amount of initiative and industry. You can begin to see the profoundness of the stage-step chart and it practical use for our personal understanding of ourselves.


Stage  No. 1 -- Trust versus Mistrust


In the first year of life the infant learns to relate to the emotional climate of the parenting environment. It is believed that the child fashions the degree of emotional closeness or bonding to the parent in this year. This influences the degree of basic trust which the child uses for much of the future.  The more consistent the parental love and care the greater the amount of basic trust in the infant.  The more emotional inhibited or hostile the parent is, the more mistrust is generated, which slows emotional growth. All through life people need love and caring. When the supply is inadequate emotional growth is slowed and emotional deterioration begins to set in. Losing a loved one is extremely depressing. It can drop one into Erikson's Stage 8 level of despair very quickly. The solution to this problem is to return to Stage 1 level of social relationships in which emotional nurture puts oneself back on the upward stairway to regained ego identity.



Stage No. 2 -- Autonomy vs. Shame/Doubt



During the second and third years children explore and challenge the limits which are being set. They walk; they talk; they obey and they refuse. Autonomy is self-rule. Children are not granted 100% of it, but learn some autonomy/responsibility. In this stage parents need to allow some childhood self-rule. Overanxious and overprotective parents communicate anxiety and thereby generate unnecessary shame and doubt. That blocks adequate preparation for initiative in Stage No. 3.  Persons who feel they have been victimized by childhood deficiencies in autonomy can find growth renewed by going back to classes offered in Community Education courses. Such persons need to risk and claim some fun and success to re-instill trust into their weakened ego.

Stage No. 3 -- Initiative vs. Guilt


Preschool children take a great amount of initiative in finding their own Positive Strokes and Warm Fuzzies. They need to be affirmed in what they do well. Without positive affirmation of what they do well, the negative criticism they sometimes deserve grows into a larger and larger amount of unrealistic  guilt (Oh, dumb me!). Without counterbalancing affirmation of positives, the negatives take over. Adult guilt, real or imaginary, can send a person into the depths of despair very quickly. The route back out of despair for an adult requires the rebuilding of the basic trust. Basic trust is often rebuilt by communication of feelings, saying you're sorry (confession), and being forgiven.



Stage No. 4 -- Industry vs. Inferiority


Latency, ages 6-11, is a time when success and failures add up to industry or  inferiority, or some percentages in either direction of success or failure. Children in this age are naturally inclined to create, build, fix and change things to their tastes. That is industry. As with all previous stages the “crisis” is one of getting over the hump into industriousness and not sliding into feelings of inferiority.  The road back out of inferiority almost always involves regaining basic trust. To accomplish that may require putting trust in a counselor, putting trust into a job locating agency, putting trust in friends to help find a job, putting trust in a group therapy process,  putting trust in “the higher power” (like Alcoholics Anonymous), or putting trust in trustable people. The chances of regaining one's industry without recreating basic trust are somewhat small. By luck or good fortune, some personal mentoring support the ego is fed with sufficient successes /strokes that the person moves up the 8 stages.

Stage No. 5 -- Identity vs. Confusion


Adolescence is the time of greatest identity  confusion. Yet, confusion can exist in persons of every age.  Erikson understands correctly, that adolescence is a crucial time of life. Friends, jobs and values are primarily selected during this time of life. If an adolescent's mother is overanxious, the adolescent will probably react negatively. If the adolescent's father or mother is harsh and critical, the adolescent may become rebellious and join other adolescents whose fathers are harsh and critical. Erikson identified identity in the “sexual area,” the “vocational area” and the “social area.”  Fixing this identity likely requires some feedback from trusted persons. The confused adolescent needs to have a friend, a teacher, a counselor, anyone, to give him or her some truth about how they feel and see the situation.  The road back requires the person to put trust in someone.

Stage No. 6 -- Intimacy vs. Isolation


Young adults, emerging from the identity crisis of adolescence, are looking for intimacy. The underlying theme of the Erikson 8-stage model is that a failure to be somewhat successful and be comfortable with any one stage inhibited the person from successful completion of the next stage. In this case, failure to be happy with oneself, one's job, one's friends, means that one's undeveloped identity will inhibit meaningful intimacy. Men are more prone to stay in  isolation until they feel secure in their job or profession. Large amounts of hostility at the level of basic trust can make a person (male or female) inhibited, meaning their ego is too hurt and cautious to form the basic trust that is part of intimacy. Basic trust is found in groups; hunting groups, hobby groups, school classroom groups, social groups, religious groups, therapy groups, etc. Joining a group of like-minded persons helps generate some degree of close relations. Relationships are important for a person’s well-being. Higher illness and mortality rates are frequently shown to exist with persons not cultivating more social relations, more intimacy.
Stage No. 7 -- Generativity vs. Stagnation

    

Generativity functions to generate ideas, generate income or generate professional stature. Generativity can actually start at any age. Erikson's stages are not necessarily fixed to age levels. Erikson would not conclude that certain persons are doomed to travel the descending stages or steps, while others are always privileged to take the escalator upward toward generativity. Whether people reach generativity or stagnation is often a result of choices. A choice to keep guilt alive by not confessing one's abortion, one's theft, one's hate, etc., can keep oneself on the stage-steps going downward. A choice to hold on to inferiority by not attending community college or community education simply greases the skids for the person to slide down into despair. Probably nothing will happen unless the person decides to invest in discovering basic trust.  Sometimes this is an exercise of trust, believing against one's own unbelief.

Stage No. 8 -- Integrity vs. Despair


Integrity comes with negotiating the rapids of life's seven previous stages sufficiently well. It may not happen until an older age, but it generally won't happen without battling the current in the previous stages. Personality is not fixed by biological dimensions at an early age. Personality unfolds until it vanishes. Integrity is “the ego's accrued assurance of its proclivity (inclination) for order and meaning. (Integrity is) an acceptance of the fact that one's life is one's own responsibility.  The lack or loss of this accrued ego integration is signified by fear of death.” (Erikson). Despair is afraid of death. Integrity is what people look up to, lean upon and trust. That makes the cycle complete. Each generation looks to those persons who have somewhat successfully chosen the high road.

Outcome of “favorable ratios”

Each stage, completed adequately enough to move on to the next stage, generates a “favorable ratio” of by products, according to Erikson. He called them “virtues.” “Without them and their re-emergence from generation to generation, all other and more changeable systems of human values lost their spirit and their relevance” (Erikson, 1950, p. 274). Ultimately, people live by what they value. It is understandable that when a small infant learns to trust his feet to carry him while walking, that gives him more “drive and hope” for conquering the next stage. The same would be true for each of the stages. Here is Erikson's list.


     Drive and Hope emerge from a favorable ratio (f-r) of basic trust.
     Self-control and Willpower emerge from a (f-r) of autonomy.
     Direction and Purpose emerge from a (f-r) of initiative.
     Method and Competence emerge from a (f-r) of industry.
     Devotion and Fidelity emerge from a (f-r) of identity.
     Affiliation and Love emerge from a (f-r) of intimacy.
     Production and Care emerge from a (f-r) of generativity.
     Renunciation and Wisdom emerge from a (f-r) ego integrity.


“In this scheme, Erikson's key idea that each stage integrates previous stages, is preserved . . . Basic trust belongs to the core theme of wholeness.”
     Richard Logan, 1986 University of Wisconsin

     The “virtues” (or optimum values), according to Erikson are Hope, Willpower, Purpose, Competence, Fidelity, Love, Care and Wisdom. You may have observed that Erikson understands virtues to be a product of living.  There are many persons who feel that virtues or ideals in one's mind and heart help propel the person in the direction that is generally considered better.  People do live by what they value. They make it their virtue and ideal.

Session 5-3 REGAINING CONTROL OF FEAR

We have always known that emotions affect health. However, research and scientific evidence for emotion-induced illnesses is quite new. It is now being discussed under the concept of  psycho-neuro-immunology. (Psyche generates neurological changes which affect a person's immune response.) We now have evidence that psychological emotions generate bio-chemical substances that either break down the immune system or build it up. The first psychological understanding of this came out in the early 1940's when the University of Minnesota created the Minnesota Multiphasic Personality Inventory (MMPI).  This 566 question test was designed to identify a number of things, one of which was  hypochondriasis, which was the tendency of a person to have a variety of pains and problems, but none of them traceable to a medical problem. Persons diagnosed as hypochondriacs had excessive amounts of emotional anxiety which converted into biological muscle tension. Anxiety-activated muscles become painful. So hypochondriasis was the psycho-physiological illness. People often mistakenly said the pains were “in the patient's head.” No. The pain was real, but the pain did not come from a bacteria or virus. It came from the psyche's emotional overload, converting into nervous and muscle tension and exhaustion.

Hans Selye's fear arousal/control model

Hans  Selye, M.D., former professor at the University of Montreal, experimented with animals and produced physical illnesses in them by stressing them. Partly, he stressed animals by depriving them of their needs. He increased anxiety by not allowing them to make a normal coping response. Selye stressed animals with excess noise, stimulation, temperatures and irritations. When the animals became diseased with a variety of illnesses, he knew it was from stress.  He published The Stress of Life (McGraw-Hill, 1956) in which he described his procedures and his results. Excessive stress was statistically accountable for physical illness. His popular version Stress Without Distress (Signet, 1974) added strength to the growing movement of stress reduction.  Immunologists became interested. They reviewed their past research and started new research. The result was an extremely large and comprehensive publication entitled Psychoneuroimmunology (Ed. Ader, 1981). In this publication Cunningham (1981) identifies connections between the “mind, body and immune response.”  Solomon (1981), in the same publication, discusses “emotional and personality factors in the onset and course of autoimmune disease, particularly rheumatoid arthritis.” The verdict is in. The evidence is strong. Emotions affect health.  Anxiety is an emotion. Some is necessary. Too much affects one's health adversely. Other emotions like happiness are more relaxing and have a more positive effect on the body.

Regaining control of autonomic nerves

Hans Selye's lifetime studies pursued the link between stress, the anxiety created by it and the final breakdown of body tissue.  He formalized his understanding with the “ General Adaptation Syndrome.” The General Adaptation Syndrome is a three stage model: 1. Alarm, 2. Resistance, 3. Exhaustion.  It works like this. Suppose you went to visit your friend and you were met by a vicious barking dog. Instantly your alarm system would be activated. Your sympathetic nervous system responds and several things happen. (A) Your blood pressure increases. (B) Your respiration rate increases. © Your pulse rate increases. © You perspire more. (E) Your pupils dilate and (F) your senses are keenly awakened. But your friend calls the dog inside and locks it in another room. The alarm shuts off and your anxiety disappears. Now change the scene. Suppose you are fired from your job. The alarm will sound and anxiety will motivate you to get up and go job hunting. The alarm is on all the time you are job hunting and the sympathetic nervous system is working more, possibly day and night. Imagine that this continues for weeks, and you can't find a job. Selye believed the body enters a stage of resistance when the alarm isn't removed. The body becomes slightly tense and resists change. The body memory says, “Be Prepared” (the Boy Scout motto). In this stage all the activities of the sympathetic nervous system continue at the higher level, anticipating the continuing anxiety. This continued higher level of activity of the sympathetic nervous system requires energy and resources. Without sufficient relief they move to the final stage which is the stage of exhaustion where one or more body organs become diseased from overwork and insufficient nurture. (Figure 5-15)
     The model in Figure 5-15 pictures how the person is able to rise to certain tasks, using the mental, emotional and bio-chemical resources that are available. The model acknowledges that a person is able to withstand  anxiety-producing stimuli (problems) for a long time, due to the resistant properties in all the components that make up a person. Resources, however, are ultimately limited and people become ill when the biological system is unable find more relief or more resources.

Regaining control via multiple strategies

Dealing with the anxiety/fear system when it has exceeded tolerable limits may require a multiple approach. Studies of people in combat and other dangerous situations suggest that two of the factors  which reduce  fear are learning what to expect and learning exactly what to do about it (Miller, 1959).  Rats that learned to turn a small wheel in order to avoid an electrical shock or escape an electrical shock had less anxiety, as determined by the fact that they had shorter or smaller lesions (ulcers) in their stomachs after a period of experimentation. This experiment (Weiss, 1971) demonstrated the principle that learning is important in the elimination prevention and elimination of fears. For humans, learning by way of education and skill-training has proven to reduce anxiety and fears.  
Regaining control of one's rationality

People need to deal with different anxieties and fears in different ways. Suppose a person feels anxious and fearful around his boss.  First, if one's anxiety is more state (specific object) than trait (non-specific) then the person  needs to face up to the aggravation and decide to neutralize its power or go somewhere else.  Job anxiety is state anxiety, and this anxiety will probably not leave unless we resolve it or leave. Secondly, a person needs to deal with whatever possible traumatic experience one had in the past.  That may require dialogue, confrontation, mediation, contracting, going somewhere else, etc.  Thirdly, there are times when the anxiety or the phobia needs to be treated using systematic desensitization. This desensitization is achieved through combinations of relaxation, psychiatric or social support, and the willingness to think rationally. Ultimately, this is the treatment of choice, and you can do this by yourself with the instructions that follow.

Regaining control via relaxation

Relaxation therapy has been around a long time. Ancient witch doctors used ceremonies and incantations of the gods, which probably diverted the attention of the anxious person enough to make them relax and heal. The immune defense system is suppressed during anxiety. The diversion and relaxation allowed their immune system to rebound from the anxiety of the illness. The practice of  Yoga,  Transcendental Meditation and certain ceremonies in all religions contribute to one's ability to relax the sympathetic nervous system.

     To understand why relaxation helps prevent illness and heal nerve tissue, muscle tissue and biological functions, it must be understood that during times of stress the body slows down or even shuts off the  immune system. We are primarily indebted to Hans Selye, M.D. (1982) for the research behind the diagram he produced.

HANS SELYE:   “Through the first mediator ( stress coming through any one of the senses) the agent or situation disruptive of homeostasis eventually excites the  hypothalamus, a complex bundle of nerve cells and fibers that acts as a bridge between the brain and the endocrine system.  The resulting nervous signals reach certain neuroendocrine cells in the median eminence of the hypothalamus, where they are transformed into CRF (corticotropic hormone releasing factor), a chemical messenger that has not yet been isolated in pure form but is probably a polypeptide. In this way, a message is relayed to the  pituitary, causing a discharge into the general circulation of  ACTH (adrenocorticotropic hormone).   ACTH, reaching the adrenal cortex, triggers the secretion of corticoids, mainly glucocorticoids such as cortisol or corticosterone. Through glucogenesis these compounds supply a ready available source of energy for the adaptive reactions necessary to meet the demands made by the agent (stressor). . . Simultaneously, hormones and  catecholamines are liberated to activate mechanisms of general usefulness for adaptation.” (Selye, 1982)




Hans Selye simplified by an outline (Figure 5-16)

     A. Stress triggers hypothalamic decisions to fight or flee.
     B. Hypothalamus activates the pituitary.
     C. Pituitary releases ACTH (adrenocorticotropic hormone)
     D. ACTH activates the adrenal glands to start glucogenesis
          (Glucogenesis is the liver converting fat to sugars.)
     E.  Adrenal cortex suppresses thymus (immune defenses)
           (The body can’t fight stress and disease at the same time.)
     F. Blood circulation to stomach is shut down.
          (All blood is directed to muscles for survival.)
     G. Blood vessels in the skin constrict so skin is cooler.
          (Blood is being driven to muscles for survival.)
     H.  Respiration rate and heart beat rate increases.
     I.  Perspiration helps cool and eliminate water.
(When blood glucose combines with oxygen the output
is carbon dioxide and water.)
     J. Pupils dilate and senses become keener.

     These are activities of the  autonomic nervous system, which is both electrical and hormonal, and is partly subdivided into the sympathetic nervous system (BP, heart rate, respiration rate, perspiration, pupils, senses) and the parasympathetic nervous system (digestion stops and mouth gets dry).  Its name, autonomic, is no longer quite appropriate since relaxation exercises, accompanied with biofeedback, have been able to alter what was previously considered automatic.

Regaining control via biofeedback

          National   
     Best       
     Seller     
   The
   Relaxation
   Response

Herbert Benson, M.D.
Harvard Medical School
 with Miriam Z. Klipper
A major step forward in the control of run-away anxieties has been the combining of relaxation exercises with biofeedback. If you count your pulse that is biofeedback. If you take your own blood pressure, that is biofeedback. When you have an electrocardiogram (EKG) done on your heart that is biofeedback, providing that the polygraph tracings are immediately available to you, and especially if the polygraph write-out is available on line and immediately visible on a screen. Your body has messages that your can read to understand yourself. We also have electronic technology that measures additional biological responses. The electroencephalograph (EEG) detects  brain wave frequencies. Delta, by definition, is the slowest frequency (0.5 to 3  cycles per second). It is usually present during sleep. Theta (approximately 3.5 to 6.5  cycles per second) is the frequency that is found just before sleep, and also occurs during moments of creativity or moments of sudden insight. Alpha (in the range of 8 to 13 cycles per second) is a state of relaxed wakefulness.  Beta (13 up to 40 cycles per second) is associated with solving practical problems like balancing your checkbook. Beta frequencies are also associated with anxiety and apprehension, like when the IRS inquires about your tax forms.  


GSR, EMG, DERMAL  

The  GSR (galvanic skin response) uses a measuring device which detects moisture in the finger-tips as a result of stress, anxiety or arousal.  This monitoring device enables a person both to detect higher levels of anxiety, but the buzzer tones on the measuring device will get lower and subside as the person uses relaxation exercises.  The  EMG (electromyographic) monitor uses sensors to detect electrical neurons activating muscle fibers. In a highly anxious mood the neurons will be firing the muscles at a higher rate than when relaxed.  When people use relaxation exercises the EMG buzzer will become lower in tone as the anxiety is brought under control.  The EMG measurement is more accurate and is used to compare persons in the same environment.  The  DERMAL monitor is simply a thermometer. It can be an electronic monitor with tone and buzzer, but a simple house thermometer will work.

Pioneers Elmer and Alyce Green

Drs. Elmer and Alyce Green, working at the Menninger Foundation in Topeka, Kansas, initiated clinical biofeedback training in 1967.  They also studied the physiological prowess of Jack Schwartz of the Aletheia Foundation in Oregon. He demonstrated in their laboratory that, at will, he could either bleed or not bleed, when sailmaker’s needles were pushed all the way through his biceps, and withdrawn. Also he showed that he could prevent, at will, the burning of his skin with lighted cigarettes. Later, the Greens studied 17 yogis in India with a portable psychophysiology lab, and made a video record of the research. As a group, the yogis demonstrated self regulation of the autonomic nervous system, controlling metabolic rates, blood flow, heart beat, and brain waves. The experiments of the Greens helped spread the scientific  news of the power of the mind over biological processes.

Pioneer relaxation teacher Edmond Jacobson  

Dr. Edmond Jacobson (1938) developed tensing and relaxing exercises which helped improve his wife's health. He used Luigi Galvani's discovery of electrical impulses. He applied the idea to the electrical impulses of the brain to the body muscles. He was the first to measure impulses with an electromyographic device (myo means muscle). The Jacobson Relaxation Exercises have been wedded with biofeedback and can now produce a good understanding of what is happening when the anxious person is successfully using this approach.

Jacobson Relaxation Exercises:

Here is the script which you may use for the Jacobson Relaxation Exercises. Find a tape recorder and read this script into it. Read slowly and appropriately enough to follow it when you actually do the exercises. Pause long enough to allow time to do the activity suggested.


Make your own relaxation tape
and practice the skill of mental
self- control over anxiety.

Let's begin. I am sitting in a comfortable position or lying on the floor. My goal is not to go to sleep but to get into a deep state of relaxation. I am dressed in comfortable clothing and I have taken precautions not to be distracted. I am ready to begin.

Make a tight fist with both of your hands by clenching your fingers together. Hold it to the count of three......  one...  two... three...  Reeeelaaaxxxx.... Again, make a tight fist with both hands....  tighter....  Hold it....  one....  two...  three...   Reeeelaaaxxx....     Third time, make a tight fist with both of your hands... Hold it.... one... two... three... Reeeelaaaxxx.....

Clench both fists and bring them up to your shoulders to tense your biceps....  tense them tightly...  one... two... three...  Reeeelaaaxxx...    Again, clench both fists and bring them up to your shoulders... hold them tight...  one... two... three...  Reeelaaaxxx...  Once more, clench your fists and bring them to your shoulders... hold tight... one...  two... three...   Reeelaaaxxx...

This time, tighten the muscles in your forehead and scalp by wrinkling up your forehead and raising your eyebrows at the same time.... hold it.... one... two... three...  Reeelaaaxxx...  Again, tighten those forehead muscles.... hold it... one... two... three...  Reeelaaaxxx...  Third time, wrinkle and stretch those forehead muscles.... hold it.... one... two... three...   Reeelaaaxxx...

     (Repeat each of the following phrases 3 times.)

Pucker up your lips. Wrinkle your nose and squint.... hold it... one... two... three... Reeelaaaxxx...

Push your head as far back as it will go... hold it... one... two... three... Reeelaaaxxx...

Bend your head forward touching your chin on your chest... hold it.... one... two... three... Reeeelaaaxxx...
Take a deep breath and fill your lungs to capacity... hold it... one... two... three... Reeelaaaxxx...
Tighten your stomach muscles and make the stomach rigid.... hold it... one... two... three... Reeelaaaxxx...
Lift your shoulders as high as you can up toward your ears... hold it... one... two... three... Relaaxxx...
Tighten your thigh muscles by lifting your feet a few inches off the floor ... hold it... one... two... three... Reelax.
Tighten your shin muscles by pointing your toes toward your chin.. hold it.. one.. two... three... Reeelaaxx...
Tighten your calf muscles by pointing your toes toward the wall... hold it... one... two... three... Reeelaaxx..

Arch your back by making your stomach stick out... hold it... one... two... three... Reeelaaaxxx...

Take a deep breath and fill your lungs to capacity... hold it... one... two... three... Reeelaaxx...

     (Repeat this daily during one month of treatment. Use a thermometer to measure fingertip temperature before and after. Keep a daily log and prove to your body that your mind has control over the anxiety which grows to higher-than-necessary levels. Fingertip temperature readings in the low to mid 80's (fahrenheit) is a strong indication of increased anxiety. Fingertip thermometer readings should be above 90 to show relaxation levels in almost everyone but persons diagnosed with Reynauds Disease, which is a malfunction of the temperature control system)


Autogenic Training for relaxation:  

Johannes H.  Schultz, a Berlin psychiatrist, found that he could produce the  relaxation response by simply getting people to tell their body to become warmer, thereby releasing anxiety which was constricting the blood vessels in the skin. His book, Autogenic Training, was written in 1932. “Auto” means self, and “genic” means to create. He circumvented the exercise part, and involved the mind to disengage the autonomic and sympathetic nervous systems from their problematic stress responses. Sometime when you are extremely stressed while studying, take a thermometer and check your fingertip temperature. If it is in the 80 degree range, repeat each of the following lines three times. Repeat the exercise until your fingertip temperature elevates into the 90 degree range.
     My right arm is heavy and warm.
     My left arm is heavy and warm.
     Both of my arms are heavy and warm.
     My right leg is heavy and warm.
     My left leg is heavy and warm.
     Both of my legs are warm and heavy.
     My arms and legs are heavy and warm.
     My stomach is warm and calm.
     My breathing is calm and regular.
     My forehead is cool.

     This is much like self-hypnosis, without all the ideas which the word “hypnosis” creates for so many people. There is a wider application for the concept. People have not exhausted the concept of telling yourself what you want to become and chances are that if you repeat it and work at it enough, that is what you will become.  Go ahead, use a thermometer to prove it to yourself.  Go to an electronics store and buy a GSR (Galvanic Skin Response) monitoring device. Reduce your run-away anxiety without great cost to yourself. Tapes are available using Autogenic Training styles, to assist in  weight reduction, smoking cessation, and dozens of self-improvement programs.

Control by systematic desensitization

Wolpe (1958) originated the concept that generating images of anxiety and fear, while using the mine-over-matter relaxation skills, would help to extinguish the anxious response. If used in therapy, the patient and the therapist develop a number of scenes which create the  anxiety in the patient. Then while the patient is using the relaxation forms, the therapist introduces the anxiety-producing scenes, allowing the patient to practice controlling anxiety when faced with the imagery. The scenes are depicted repeatedly until the person has demonstrated to himself or herself that s/he is able to maintain control.   A series of treatments like this might take up to 15 sessions.  
     When practicing this by oneself, simply practice systematic relaxation exercises, using a biofeedback thermometer, so that confidence in anxiety-reduction is quite assured.  Then approach the anxiety-producing situation slowly. When anxiety increases slightly, simply stop and practice the relaxation exercises.  Then move again slowly toward the anxiety-producing situation until internal anxiety begins to increase. Stop and practice the relaxation exercises. Move ahead or back off as needed. After a small gain is made, stop and enjoy the success.  Practice again tomorrow.

Flooding and counter-conditioning  

This procedure prevents the person or client from making an avoidance response.  Flooding (Kazdin, 1978) takes place with sufficient cues and images to arouse the anxiety, which the patient allows to run its course, after the stimuli are removed. The success of the procedure depends on counter-conditioning, where a new emotional response is taught to correspond to a milder form of the previous stimuli. If a person is persistent enough, the anxiety response will lessen and/ore extinguish. The cliche, “Face the fear,” may be saying the same thing.
In Vivo Desensitization  

After practicing with imagery, the person might go into real life (in vivo) try-out.  Suppose a person wanted to conquer fear of flying (Figure 5-17). That person might practice relaxation training using Dermal, GSR and/or EMG biofeedback, along with Jacobson, Autogenic or Reelaaaxxx exercises.  When the person feels in control, the person (possibly with the therapist) might go to an airport, first just to watch and relax. Later they might enter the airport and practice relaxation.  Next step might be to go to the pre-flight lounge, practicing relaxation all the time.  Possibly the person could visit the inside of the plane a time or two or more. This in vivo (real life) practice has a lot of benefit for anxious/fearful people.


Session 5-3 STRATEGIES FOR FEAR REDUCTION

Constant anxiety/fearfulness eventually reduces the levels of norepinephrine in the brain (Weiss, 1970). Norepinephrine and  dopamine are both neurotransmitters (like electrical impulses sending voice messages). These chemicals are present in the synapses (spaces filled with chemical transmitters) between nerve segments in the brain and in the body. If the concentration of these bio-chemicals is high, brain signals and sensory signals pass quickly through nerve segments to brain cells (von Euler, 1956). High levels of  norepinephrine also exist when people are happy, and higher levels exist when people are euphoric. Experiments were conducted with rats (Weiss, et al., 1970.) which revealed that norepinephrine levels were above average for those rats which were given the opportunity to learn how to prevent and/or escape the shock.  Those rats which were not allowed to learn how to prevent and/or escape the electric shocks had lowered levels of norepinephrine.     Considering the fact that norepinephrine levels are also low during  depression (Schildkraut & Kety, 1967) it is not difficult to see that anxiety/fear becomes a major source of emotional and physical problems. The research evidence for the connection between fearing and low norepinephrine levels is quite extensive and convincing even though there isn't enough place here to show it all.

Counteracting fear's bio-chemistry

If we know what body chemical is lowered by fear, then part of the answer to eliminating the fear is finding what activity will elevate the dysfunctioning body chemistry. Research has already shown some direct behaviors which raise norepinephrine levels.  Sleep raises norepinephrine levels (Hartman, 1973), so the next time someone tells you they get by on 5-6 hours, stay away from this norepinephrine depleting behavior. S/he may be more anxious and fearful, and therefore harder to deal with.  Exercise (Davis, 1973: Howley, 1976) raises norepinephrine levels by up to four and one-half times (450%), so it is not surprising that people use exercise to elevate norepinephrine levels after an anxiety-producing and fear-producing day of activities.  Success from meeting challenges builds norepinephrine levels (Frankenhaeuser & Johansson, 1983), so picking small goals and succeeding removes fears and builds trust.  Aggression raises norepinephrine. In the fight-flight stress response, norepinephrine increases (Benson 1975), counteracting the effect of fear. Fearful persons need to become angry-aggressive (properly directed) to counteract the energy-consuming power of fear. They need to hitch their angry passion to prove something with their lives rather than sit and do “Poor me!.

      Love raises norepinephrine levels and lack of love lowers norepinephrine levels. Six male rhesus monkeys were deprived of maternal interaction and peer interaction for the first 22 months of their lives. Researchers (Kraemer, Ebert, Schmidt & McKinney, 1989) from the University of Wisconsin examined cerebrospinal fluid (CSF) every month and evaluated the level of norepinephrine (NE), dopamine and serotonin. “Mother-deprived infants (rhesus monkeys) had lower levels of CSF NE than 12 mother-reared infants.”

      Social support raises norepinephrine levels. Insufficient personal interaction lowers norepinephrine levels. Social scientists often obtain their first information from animal experiments.  Psychologists (Pappas, Saari, Smythe & Murtha, et al., 1987)  used newborn male rats to test the notion that later psychological functioning was enhanced by social contact. The forepart of the brains of the rats were depleted of their supply of norepinephrine by another substance.  Some rats were reared in isolation and others in a social setting with other rats. Then the rats were run through a maze. “Isolated rearing impaired Lashley maze performance . . . and they made more errors . . .” (Abstract). Socializing activities improve performance. In another study (Kraemer, Ebert, Lake & McKinney, 1984), 16 rhesus monkeys were used to study the norepinephrine levels during depressive states induced by isolation. They wanted to determine the impact of social isolation. They determined that “Low CSF NE (cerebrospinal fluid, norepinephrine), whether drug-induced or naturally occurring, was associated with a more severe depressive response to separation” (Abstract). Even the latest research repeats the same conclusion (Cornwell-Jones, Palfai, Young & Desai, et al., 1990), from Syracuse University, conclude that biological functions are impaired by “norepinephrine depletions” and “an abnormal social environment.” So why not practice love and social relations as optimum lifestyle factors. Women already socialize naturally more than men. Men more frequently choose to raise their norepinephrine  with stimulants rather than relationships. Men often pay prices for this.

      Medicines which counteract anxiety disorders raise norepinephrine levels. Persons who have exaggerated fears and anxieties sometimes need medicine to raise their norepinephrine levels, after having driven norepinephrine levels down by not resolving fears (by therapy, by conflict resolution, by positive thinking, by assertive behavior, etc.). Certain medications are helpful. A person needs a prescription for them. Some of the more recent medications for anxiety and panic disorders are Buspirone, Fluoxetine, Sertraline, Paroxetine and Citalopram. Older medications are  antidepressants: (Tofranil, Elavil, Sinequan, Norpramine) They help bring people out of the depletion of their norepinephrine.  Narpan, Nardil, Parnate  are part of another group of medications, called monoamine oxidase inhibitors (MAOI).  These medications inhibit the formation of certain body chemicals which enables norepinephrine levels to rise, thus easing the effects of certain anxieties, fears and guilt (a major inner fear).  While on the topic of medication, it is necessary to realize that medicines for other illnesses may be lowering norepinephrine levels, compounding the fear cycle. Antihypertensive agents (Reserpine, Methyldopa, etc.) do their calming effect by lowering the level of catecholamines, dopamine and norepinephrine. This information is here to help you become informed about the medical side of reducing out-or-control anxieties and fears.
     Studying  and memorization.  While in school there is nothing like studying to decrease the amount of anxiety and fear. Failure to study can burn more anxiety and fear energy than studying.  Here is how the nervous system works.  If you wiggle your finger, you know that it takes a thought to start it, but the thought gets translated into a chemical reaction which travels through your nerves. First of all it takes a sufficient amount of sodium, calcium, potassium and chlorine to make that neuron go from your brain to your finger.  Along the way it passes through nerve segments and the spark must jump through the gap (synapse) from one segment to another by way of chemical transmission.  To go through the synapse the nervous system provides acetylcholine, dopamine, norepinephrine and epinephrine. To make the finger wiggle once will require X-amount of all these chemicals. To make the finger wiggle 10 times will require 10X-amount of the same chemicals.  Now, suppose you are anxiously studying for an exam and you tap your finger on your desk for hours while you are studying. That burns up a larger amount of sodium, calcium, potassium and chlorine, acetylcholine, dopamine, norepinephrine and epinephrine. Next, recall that you are anxious and every muscle group in your body is slightly tense. Your back is tense. Your stomach is tense. Your brain is processing information about 20-100 times faster than when you are sun-tanning. How much reserve of sodium, calcium, potassium, chlorine, acetylcholine, dopamine, norepinephrine and epinephrine do you have?  Is it unlimited? Obviously not. You leave your study desk and get a coke for relief. Then you get hooked on watching a TV program.  Now the anxiety and guilt is burning up norepinephrine (plus other chemicals) even faster.
     Now, however, add the ingredient of fear of your father. He's paying for your education. Now add the ingredient of your mother who is a professional lawyer. Now add the ingredient that all your brothers and sisters are professionals.  Your fears of failure, rejection, and economic embarrassment raise your levels of anxiety and fear.  You study and push yourself until the supply of sodium, calcium, potassium, chlorine, acetylcholine, dopamine, norepinephrine and epinephrine are depleted.  There is good strategy and bad strategy for restoring your supplies of neuro-transmitters. Be careful what choice you make to restore the norepinephrine and all the other goodies you lost from your guilt-ridden attempt to escape the original anxiety. There are choices, some ignorant one, and some educated ones.  Probably studying isn't such a bad way after all to decrease the depletion of one's neuro-chemicals.

             “The courageous man is the man who forces himself, in spite of
             his fear, to carry on. Discipline, pride, self-respect, self-confidence,
             and love of glory are attributes which will make a man courageous
             even when he is afraid.”
                                General George Patton, War As I Knew It, 1947


Session 5-4  REBUILDING TRUST

The concept of trust involves how you feel about yourself and the amount of nourishing feedback you are getting from others. The more Positive Strokes and Warm Fuzzies (libidinal nourishment for the ego) you get back from others the more trust you will probably have. Negative feedback hurts the ego and makes the person unsure-fearful. In between is the whole area of no feedback. No feedback is no one telling you how well you did or how poorly. No feedback is living without keeping in touch with reality. No feedback from friends makes you not know how you measure up. Without feedback people can begin to doubt themselves, unless they are anchored by some prior training. Even then, without adequate feedback people can begin to lose touch with reality. If someone goes to a lot of effort to find the right blouse or shirt, and then no one says anything about it, that leaves a person to be unsure about his or her decision. If a person knows that others like the blouse or shirt, then it can be worn again.  If they say they don't like it, the decision to throw it away is easy. Insecurity breeds and grows in an atmosphere of lack of feedback, almost more than in a negative environment of yelling and crabbing at each other. Anxious and fearing persons tend to withdraw socially. How does such a person turn that around?


                     “Self-disclosure, caring and trust are the intrinsic
                     rewards of friendship.”       Peggy Giordano, Stephen Cernkovich, M.D. Pugh
                                           Bowling Green University Ohio, 1986


Rebuilding trust in the group processes

Psychologists are convinced that one of the best mistrust-to-trust approaches involves a  group process. Lots of good things happen in groups. Friendships are created in groups. People trust themselves better among friends than among strangers. Trust grows as people know each other more intimately. The Alcoholics Anonymous movement and the many similar 12-step self-help support groups that have started since, find their therapeutic power comes from the experience of trusting within the group. The group is a place where members can become more aware of inner motivations. In groups people can try out new communication skills and not feel embarrassed. How do these groups produce trusting. Again, psychology is frequently asking the prior question. Its fine that trust is produced in a group process, but what happens in that group process to increase the trust?

                          “At a more personal level is the need to have a support
                          group with a high level of trust, where one's innermost
                          thoughts can be shared and discussed, and where a
                         process of social learning can be initiated.”
                              Maxwell Jones, Canadian Journal of Community Mental Health, Spring, 1988

Rebuilding trust through self-disclosure

 Self-disclosure seems to be at least one of the key ingredients to trust. Between friends, in marriages, at the office, on the job, wherever one relates to people, increased amounts of self-disclosure generate increased amounts of trust. Martin Fisher (1981) of Adelphi University sees self-disclosure as “shared experiences.” There is a therapeutic effect coming out of the practice of “shared experiences.”  Hiroaki Enomoto (1983) from Tokyo Metropolitan University, sees self-disclosure activities as having a “reciprocity effect,” meaning that if one shares his frustrations and struggles, it helps the other person to do the same.  Group leaders themselves, therefore, have often struggled with the very problems the group is struggling with.  In the process of sharing one's struggles the person needs to be open and the members of the group need to give honest and supportive feedback (Eckstein, 1984). Honesty and openness need to be coupled with a non-judgmental setting. That combination helps one know the truth about oneself. In the group process people experience a “caring community” (Eckstein, 1984). Caring is a Positive Stroking mechanism which nourishes the fearful emotions of the mistrusting person. Truth becomes one of the final processes and a goal of the self-disclosure process. Self-disclosure generates “closeness” (Bunch, Lund & Wiggins, 1983) and “ intimacy” (Fisher, 1981), which nourishes the emotional system Erik Erikson has described. Thus, the road through a group process of self-disclosure and shared experiences, done by honest, caring and non-judgmental persons, generates a warmth of closeness and intimacy which feeds ego processes with positive libidinal nourishment, making people function more appropriately. The psyche is the key. What feeds the psyche determines the outcome. It is always interesting that the word for psychology comes from the Greek word “pseuke,” “soul,” namely, the essence of being human. If the soul of a person is fed with what is high and noble, that soul rises from the strength of that nourishment. Erikson had 8 descending steps into despair; mistrust, shame and doubt, guilt, inferiority, confusion, isolation, stagnation and despair. If someone wants to dig out of the pit of Erikson's 8 descending stages they need to take self-disclosure seriously. They need to discard large amounts of their macho, their facade of strength, and share their weakness too. Trust can't grow if other persons are not permitted to see weaknesses and nurture them.  

     Sidney  Jourard of the University of Florida wrote The Transparent Self (1971) and became an early advocate of self-disclosure. He helped us understand the importance of friendship-generated openness and sharing. He called this kind of behavior “transparent.”

“If we want to be loved, we must disclose ourselves. If we want to love someone, he must permit us to know him. This would seem to be obvious. Yet most of us spend a great part of our lives thinking up ways to avoid becoming known.”

“Indeed, much of human life is best described as impersonation. We are role players, every one of us. We say that we feel things we do not feel. We say things we did not do. We say that we believe things we do not believe. We pretend that we are loving when we are full of hostility. We pretend that we are calm and indifferent when we are actually trembling with anxiety and fear.”

“Of course we cannot tell even the people we know and love everything we think or feel.  But our mistakes are nearly always in the other direction. Even in families -- good families -- people wear masks a great deal of the time.”

“Paradoxically, we fail to disclose ourselves to other people because we want so much to be loved. Because we feel that way we present ourselves as someone we think can be loved and accepted, and we conceal whatever would mar that image.”

“Another reason we hide is to protect ourselves from change. . . Still another reason we don't disclose ourselves is that we were never taught how. . . Personal ambitions and economic pressures also give us powerful reasons for concealing what we really are. . .  All of us hide behind the iron curtain of our public selves. . . Men hide what prevents them from seeming strong and masculine. . .”
“Disclosure is so important (because) without it we really cannot know ourselves. Or to put it another way, we learn to deceive ourselves while we are trying to deceive others. For example, if I never express my sorrow, my love, my joy, I'll smother those feelings in myself until I almost forget they were once part of me.”

     Non-disclosing persons are generally too quiet, too much of the time. Generally, persons who are not very communicative did not  see it in one or both parents. Such persons  often claim they have nothing to say. Our best advice to them is, “If you can't think of what to SAY, then ASK, don't SAY.  ASK others some questions about what they have been doing, where they have been, what their views are on current events.  Let other persons disclose first.  Prompt them by asking them something about themselves. Prime their pump. Hopefully, the other person is kind enough to return the favor and ask you something about yourself.  But AAHHhhaa! That's the hitch. People don't ASK and then they don't have to respond and risk self-disclosure.  A person's mask is then preserved, but such a person can stay in the pits of despair, stagnation, isolation, confusion, inferiority, guilt, shame, doubt and mistrust. The withdrawnness of the narcissistic (undernourished and withdrawn) psyche will defend itself in its safe position, even from health and happiness.

Rebuilding trust by sharing feelings


    “Perhaps the most important reason for self-disclosure is that without it we cannot truly love.”
     Sidney Jourard, Redbook, October, 1971

Group process isn't just group therapy. Learning to  trust isn't restricted to group therapy. Self-disclosure can take place with a friend, a marriage partner, another employee, anyone. The moment a person risks saying how s/he feels about something, s/he engages the feelings of someone else. If conversation continues, both will exchange views, which sharpen both perspectives.
     Here are some words which can trigger memories of past feelings. Practice recalling the experience which is triggered by the following words. Let the emotion-filled word stimulate the memory. Imagine you are telling this to a friend.

      Practice sharing feelings by letting these feeling-words trigger a memory.

     thankful                              resentful                 fantastic          
     upset                                  calm                        angry          
     happy                                 miserable                frustrated          
     fearful                               confident                sorry          
     fantastic                            blaaaa                     compassionate          
     embarrassed                    radiant                     tense          
  &nbs