I’ll never forget the time my client Jackie* came into session very excited. “I was in the car, and I started to get anxious” she exclaimed with a big smile on her face. “You seem happy about that,” I said, wondering why she was so positive about getting anxious. “Yes, when I started to get anxious I began to feel trapped as usual and then I stopped and asked myself what might be triggering my anxiety. And I figured it out! The sun was coming through the front windshield and I was getting hot! I pulled over to the side of the road and took my jacket off. I felt better right away!”
Jackie’s positive feeling about her experience was due to the fact that she figured out what specifically was triggering her anxiety, in this case being too warm. Once she identified the trigger she was able to do something about it, or what I like to say, “she un-trapped herself from the trigger.” By realizing that she was getting too warm and taking off her jacket, Jackie stopped her anxiety level from climbing higher. Had she not noticed her rising anxiety level and asked herself what it was about, Jackie’s anxiety might have continued to rise, even to the point of having a panic attack.
If you recall, most sources describe panic attacks as something that occurs “without warning” or “out of blue.” In my post last week, “Understanding the Vicious Cycle of Panic,” I asserted that panic almost always starts with a stimulus, or “trigger,” even if it is extremely subtle. I’m going to start to discuss those triggers today.
There’s a very popular show for small children called “Blue’s Clues.” Blue is an animated dog who lives with her “real” (non-animated) friend Joe. During each episode Blue likes to play a game called “Blue’s Clues” in order to answer a question posed by Joe, such as, “What would you like to do today Blue?” or “What was your dream about last night, Blue?”
Blue always leaves clues by making a paw print on the clue. Joe finds the clues and draws each clue in his “handy dandy notebook.” When he gets all three clues he sits down in his “thinking chair,” and “thinks, thinks, thinks” about each of the clues he has gathered. Once Joe looks and thinks about Blue’s three clues, he finds Blue’s answer to his question.
Trigger hunting is a lot like Blue’s Clues in that you have to actively look for the thing(s) that might be triggering your anxiety. Some of the triggers are subtle and not immediately obvious. Also, triggers are often connected to another and you may have to look at several triggers in order to understand how they work together to stimulate your anxiety. When you have all the clues, however, then the start and progression of your anxiety will make much more sense. Once you understand what pushes your anxiety level up, then you can take specific steps to lower it.
Two Categories of Triggers: External and Internal
There are two categories of triggers for anxiety, outside stimuli (external triggers) and internal stimuli (internal triggers). External triggers are those things that occur outside of ourselves and include things such as sights, sounds, smells, and even florescent lighting! Other external triggers include Over-stimulation, which is too much stimulation at one time and Under-stimulation, which is essentially boredom.
External triggers are common everyday events for all of us, such as a phone ringing, a song on the radio, or the smell of a barbeque. These events are intimately connected to internal responses such as thoughts, feelings, memories, images and body sensations. A thought in response to the smell of a barbeque may be positive such as, “I’m going to have a delicious steak!” That particular thought does not sound anxiety provoking. The thought in response to a phone ringing such as, “That’s a bill collector on the phone,” however, may be a very anxiety provoking thought. I’ll start to discuss internal triggers first in my next few Shareposts and then conclude this series by connecting internal triggers to possible external triggers.
Internal triggers occur inside of ourselves, that is, we experience them inside our minds and bodies. As stated above, internal triggers may follow external triggers. Internal triggers include:
Thoughts are an extremely powerful trigger for anxiety. Some people have the thought, “I am going to have a panic attack” as soon as they have any noticeable physical sensation. This thought in and of itself will increase anxiety. Why? Because the thought, “I’m going to have a panic attack” is scary! It sounds like there is no way out.
Again, if Jackie had that thought in response to being too warm, she could have been on her way to a panic attack. Instead, she thought, “I am getting hot.” In addition, she did something about being too hot in that she took off her jacket. There was a way out of her being too hot.
At this point you might be saying, “That sounds nice, but what about those times when there is no way out and I really am trapped…like if I’m on an airplane or getting an MRI?” My response is that you are never truly trapped. You can always free yourself from any situation using your thoughts.
Let’s take the example of getting MRI, which is scary for a lot of people because of the extremely small space and noisiness of the machine. Although there are lots of ideas about how to cope with getting an MRI, let’s just focus on how thoughts might “untrap” you from an MRI. Here are two ways in which one could “untrap” themselves using thoughts during an MRI.
Focus on others, not yourself
One friend of mine decided to pray for each member of his family during his MRI. He closed his eyes the entire time and focused on his love and concern for each member. He asked God to bless each person and brought up specific concerns. The key element here is that he was focused on his feeling for other people and not thoughts about what he was immediately doing.
Please note that you do not have to be religious to use this approach! If you do not pray, you could still bring each person to mind, think about them, and/or think what you would wish for them in their lives.
Mindfulness is a term to describe awareness and acceptance for what is occurring. In other words, if you can experience physical symptoms of anxiety without being scared of them, you can avoid panic. So thoughts like, “It feels very tight in here, but there is plenty of air for me to breathe,” will have a very different effect on your mood than, "Oh my, I can’t breathe, I’ve got to get out of here!!!"
In other words, nothing bad can happen to you while having an MRI except for feeling uncomfortable.
Images are pictures that we get in our mind. When I teach abdominal breathing and relaxation to my clients, I ask them to picture as clearly as they can a safe and relaxing place. Then I have them describe to me what they see: a beautiful, warm beach with gentle rolling waves, rocky cliffs, etc… Or perhaps it’s their backyard, with a hammock, a garden of flowers, a flowing fountain.
Sometimes we do not think in complete thoughts, but have fragmented thoughts or images as part of our thoughts. Some of these images can trigger anxiety.
A couple once came into a therapy session. The wife was highly anxious as the session started. The husband was feeling just fine. The therapist asked the wife why she was so anxious, and she did not know. The therapist traced the couple’s steps back through the day. It turns out that as the couple was leaving the house, the wife smelled gasoline. All the way to the therapist’s office the woman pictured their house catching fire with their three children in it and their children dying in the fire.�� No wonder she was anxious! These were incredibly vivid images! The therapist asked the husband if he smelled the gasoline. He indicated that he had. “What did you think?” “I thought that someone was filling their lawnmower with gas and spilled some.”
The different interpretations of the gas smell (which is an external trigger) triggered an extremely anxiety provoking image for the wife (house burning down) and an entirely neutral image for the husband (someone cutting the grass).
I’ll talk about Feelings, Memories, and Physical Sensations in my next post, but meanwhile, start to search for “clues” as to what your anxiety triggers are!
Dr. Jennifer Fee
*Client names and details are always changed to protect confidentiality.