WEEK 5: AVOIDANCE & IBD
We know that over a long history with a condition like IBD people can begin to avoid situations that cause fear and discomfort. Perhaps this includes a location where we felt vulnerable, or activities such as sex, exercise, travel, social events, new or unfamiliar activities or new foods. People sometimes find themselves avoiding distressing thoughts and feelings. Often people develop negative responses to aspects of the medical services and procedures that have become part of their lives. This can include: taking medication, even when people feel well; long waiting periods in their GP’s crowded surgery; being kept waiting in outpatient clinics, particularly during flare-ups; medical examinations, investigations, and procedures; needles and blood tests; as an inpatient, being reliant on hospital staff for your every need, and things not happening when and how you think they ought to; having to manage your diet all the time; having to plan for even the simplest activities; being unable to be reliable and always meet commitments; and so on.
Sometimes we may have an image of a terrible or distressing event that intrudes into our minds and triggers a fear response – the fight-or-flight response. This image can be one of physical threat, such as a motor vehicle accident, or a psychological threat – performing badly in an important work presentation, or having a fainting spell or a gastric problem in a public location.
Even just thinking of these issues can lead us to feel emotionally down, frustrated or annoyed, and can create a “don’t want to know” type of response.
Confronting Avoidance
Avoidance of things we dislike or that make us anxious or fearful is one of the most common of human responses. Avoidance can have hugely positive benefits, such as when it keeps us out of dark and dangerous locations at night, or we are averse to eating something that has made us unwell in the past. It has been said that the main function of the brain is to keep the body alive. The brain is therefore very sensitive to threat and is averse to risk. Often, people who have had serious motor vehicle accidents, can attest to how sensitive they are subsequently to traffic conditions which they had previously taken for granted.
The brain can be very effective at avoiding short-term risks and seeking short-term rewards. The longer term however is a different story. While avoidance of any individual task or event may be of minor importance, the aggregation of these over time can be significant. Sometimes we continue having quite significant issues, often for many years and with major personal cost, rather than face the difficulty, discomfort, or embarrassment, of seeking a remedy. People with a weight problem are often too embarrassed to begin an exercise programme, join a gym, or go to a public swimming pool. In effect, they are sacrificing their long-term health benefits for the comfort of avoiding short-term physical or emotional discomfort. Fears and phobias, be they social phobias, fears of driving or of using public transport, trauma related fears of particular locations, or fears of specific objects - spiders, moths, snakes – can have major distorting effects on people’s life options and their quality of life if unchallenged over a long period of time.
Conditioning
Conditioning is a term that reflects the learned association of a situation with consequences – I may begin to notice, and feel warmer towards red cars if someone I admire drives a red car – I may experience increased respiration, heart rate, sweating, and feelings of panic when driving past a location where I had a motor vehicle accident. Sometimes these responses can generalise, so I become sensitive to all road sites that remind me of the specific location, or to roads in general.
Usually there are several situations that trigger the responses, some to a greater degree than others. Even something as minor as the slight reluctance you experience in touching the car door on a hot dry day when you have previously received a small static electricity shock, is a conditioned response.
Overcoming our Conditioning
When the brain has learned that a situation is dangerous, embarrassing, or otherwise to be avoided, this learned response can become entrenched and affect us for many years.
When we use our rational thinking to realise that the feared situation is not a significant risk to our life or wellbeing, we can gain or regain our comfort with the situation or activity by a process called Systematic Desensitisation. Please click on the PDF file below to learn about how we can overcome conditioning and free ourselves of unhelpful avoidance.
Week 5 Exercises - Autogenic Training
Autogenic training is a systematic program to teach your body and mind to relax and maintain a balanced state. Autogenics involves mental repetition of verbal phrases involving heaviness and warmth, relaxed breathing, and a cool forehead, among other things.
Autogenic training has its origins in hypnosis where patients in deep relaxation experienced two sensations – warmth throughout the body and a sense of heaviness in the arms and legs. The autogenic program was developed to help people achieve deep relaxation through self-suggestion without the aid of hypnosis.
Autogenic training has been used to treat many medical disorders such as asthma, ulcers, high blood pressure and thyroid problems. It has also been useful in reducing the intensity of unpleasant emotional states such as anxiety and irritability.
In practising autogenic training it is important to maintain an attitude of passive concentration. The purpose is not to force yourself to feel heavy or warm, but rather to focus on the suggestive phrases while remaining indifferent to what actually happens. Passive concentration is not the same as daydreaming or falling asleep. You remain alert and aware of your experience without actively thinking about it or trying to change it.
However, we know that you will not be able to maintain passive concentration. Your mind will wander, which is to be expected. When you become aware of this wandering, just bring your focus back to the suggestive phrase.
You may also experience some unexpected sensations. For example, you may notice changes in your body temperature, tingling, or some feelings of anxiety or sadness. Whether you find the sensations pleasant or unpleasant, remember that they are not the purpose of autogenic training and will eventually pass as you continue to practice.
When you are beginning to learn autogenic training, it is helpful to eliminate whatever external stimuli you can. So try and practice where you won’t be disturbed or distracted. Once you have developed the skills you may be able to practise in more ordinary settings. Autogenics can even be practised for a few minutes at work. Instead of grabbing a cup of coffee or a snack, try to take some time to practice relaxation.
In the standard autogenic exercise, a verbal formula or suggestive phrase is introduced, you will repeat it to yourself four times as you try to maintain passive concentration. Each time you say a phrase, say it slowly and then pause for about three seconds.
Today’s practice will involve the themes of heaviness and warmth. Heaviness and warmth promote relaxation of the muscles and increase blood flow to your extremities. At the end of the exercise you will repeat to yourself four times: “When I open my eyes, I will feel refreshed and alert.” Then open your eyes, and take a few deep breaths as you stretch.