When the Trigger Is Your Mother

“We broke up,” I spout. 

A tense silence. My eyes cling to the lettuce cups. Seconds take an eternity to pass. Anxious for her reply, I peek up. Her eyes twinkle with welling tears. She was my best friend growing up, and though we’ve had it rough since puberty, my aching loneliness craves her support, so I push on. “I, mom—I—I like…guys…I—I thought it was a phase, as Dad told me, or something, but it’s not going away and—and…yeah, we broke up.”

The window for a quick positive response closes. The approaching waiter retreats. Steps away before speaking. He knows a breakup when he sees one. “Do you have AIDS?” she says with a sudden urgency.

“What?” Not that question. “No.”

Her ignorance flings her so far from where I need her to be, yanking my hope away so fast that it leaves me breathless. 

“What about grandkids?” she panics. 

I claw at anger to stay afloat. “What? I don’t know. It can still happen, I guess.”

This was a terrible idea.

She scoops a lettuce wrap, tears falling down her face as she piles the chicken on top. “Well, of course, we love you and accept you…but just, you know, not the lifestyle,” she says, crunching into a bite.

“Lifestyle” is the Mormon codeword for sex with other men, even though if asked, they’d say “lifestyle” means all the partying “they” do. 

I sink into the booth, disgusted with the families of mall shoppers around me shoveling mounds of fried rice into their mouths. We cut into our dynamite shrimp in silence. 

It’s clear, my mother won’t turn on the Mormons. Should’ve kept my mouth shut.

My mother asks for the check. Escape.

*******

I was nineteen when I came out to my mother; forced to tell her after a failed suicide attempt. I hadn’t known it would be the beginning of my end. 

My story was horrific: after being a closeted, gay Mormon in the 90s, I found relief as a tweaker. I drove a car under an eighteen-wheeler and walked away, was arrested for possession and distribution then pushed through the Washington D.C. judicial system, became an informant for the federal government, watched friends OD, and evaded threats to my life…basically, all the “that would never happen to me” consequences times ten. 

But I walked away, alive, having never “ratted” and with my case dismissed. I don’t know how other than I was one lucky SOB. Thankfully, since then, recovery has stuck. 

But it meant I had to deal with life on life’s terms. 

In 2008, the journey with my mother took a significant hit after the Mormons funded the California vote in favor of Prop 8 to ban gay marriage. Even in sobriety, despite those early recovery years feeling closer to her than I ever had, I was still clinging to the hope that she would one day renounce her beliefs. 

But that was a pipe dream.

The years that followed were met with more disappointments. And the more my esteem grew in recovery, the more painful the disappointments became. 

I had to accept that she would never change. 

I had to protect and save my little boy self.

I needed to let go of the mother I expected her to be and let her be the mother she was, which wasn’t enough.

So I made the impossible choice to never speak to her again. 

To grieve her as if I lost her.

And I thought getting sober off methamphetamines would be the hardest thing I’d ever have to do...

But there is a happy ending. 

When my now husband met my mother for the first time, it was one of the first few interactions I had with her after years apart. She was unavoidable at life-marking events in my siblings' lives, and gradually, the waters were tested until I felt confidently free from emotional reactions toward her (aka being triggered). But, I was very wrong. She made an innocent comment that set me off. 

Later, in our hotel room, my fiancé casually remarked, “Why don’t you just forgive her?” 

“Forgive her? Do you have any idea what she’s done to me?”

“Yeah, but, like you said, you’re not that person anymore.”

I scoffed - as if forgiveness were that easy. 

“She should be asking for my forgiveness!”

He laughed. “Don’t laugh at me!” I snapped. 

“Sorry, but you did all that work to stay away, yet you still hold resentment. What was the point?”

I scoffed again. My mouth dropped. I thought I had moved on. I thought I was healed. Was I still expecting her to change?

Damn. 

I needed a new approach.

That’s when I realized forgiveness is an active verb.

Sean and his mother, years later, at his wedding.

I was going to experiment and see what would happen if, in my mind, I wholeheartedly repeated “I forgive you” toward my mother when in her presence for the rest of the trip. She would have no idea. 

We’d share a meal.

“I forgive you.” 

A walk.

 “I forgive you.”

A drive.

 “I forgive you.”

On and on I would experiment. Hoping to be free. 

Until the last day, my mother asked to speak with me alone. That was unusual but good because I could use the opportunity to say “I forgive you” out loud. Perhaps-

“I don’t know why, but I had an idea for something I wanted to try, and I’m hoping you’ll let me,” She said. 

I nodded, confused. 

“M’kay,” she said, sitting me down on the love seat, “this may sound strange, but lie down and put your head on my lap.” 

It’s too much intimacy that I am not prepared for, but still, I awkwardly scrunched my entire 6’4, 220-pound frame on the love seat, resting my head on her lap. 

I flinched when I suddenly felt her hand stroking my hair. What is going on?

I can’t look up because I think she’s already crying. “I just wanted to speak to that child inside of you. To that four-year-old. I wanted him to know - I am so, so, so sorry. He is right to be upset. His childhood was not fair. And I wish it had gone better for him. I hope one day he can forgive me.”

She continued stroking my hair. I swallowed the most enormous lump in my throat. “I see him still in so much pain,” she said, “and I just want him to know he’s loved. And I love him. And I wish it were different. But it’s not. And I’m so, so sorry because of that.” 

It’s as if I were the four-year-old who received that which he had sought after his entire life.

I was so moved that I vowed to forgive her entirely. But how? Internally, repeating “I forgive you” was giving space between her words/behavior and my reactions but that wasn’t enough. Within that interstice my growing awareness could see that I as the adult was fine; it was the child in me still emotional even after hearing this from my mother. But why? He wasn’t alone anymore. He wasn’t abandoned. He had love, and understanding. So, then why? 

Could it be that my triggers were now only habit? The mechanics of the brain. After years and years of reacting to her, it made sense that I was trained to respond this way. So forgiveness was not only an active verb but a practice in breaking a habitual way of thinking! 

If I simply observed the emotional trigger coursing through my body and repeated to myself - it’s nothing more than an emotional reaction based on my past and that is perfectly okay, nothing is wrong - I could separate enough from the emotion to give myself a chance to choose to act differently. And most of the time that looked like not responding at all. It would be like turning around the Titanic at first, but would become progressively easier, until over time, the habit would die. And replaced by something new - like love. 

Which is exactly what happened. 

Unbeknownst to me, my mother had her own evolution in our time apart. Despite still being Mormon, she internalized her relationship with her God into a more take-what-you-can-and-leave-the-rest brand, which left her less in a place of judgement and more in a place of acceptance and love. 

She even cheekily told me, she loved my soon-to-be husband more than me and that I better not screw it up because he’s a good one - and she meant it! 

And when I asked my mother to walk me down the aisle, she didn’t hesitate. 

So, on the day, in her best dress, tears streamed down her face - as mine - for we now shared a love we knew not possible. 

I know how hard forgiveness truly is because of my path with my mom…for people who are struggling, here’s a reminder that finding the space beyond the emotion is the best place to start. 

---

Sean Hemeon is an award-winning actor (9-1-1, Criminal Minds, CW’s Husbands), screenwriter, and abstract expressionist painter. His debut memoir, The Good Little Druglord, chronicles his extraordinary journey from a former Mormon drug dealer to a federal informant, exploring themes of mental health, addiction, redemption, and identity. He resides in Los Angeles with his husband and their two Boston Terriers. Follow him on insta @sean_hemeon or www.seanhemeon.com for all updates. 

What is Polyvagal Theory?

Polyvagal theory often uses the metaphor of a ladder to describe the autonomic nervous system. This photo is by  Xin.

Despite the fact that it floated around me for years, I never paid attention to the word “polyvagal.” My (incorrect) assumption was that if polyvagal theory really worked, I’d hear about it via word of mouth. That changeI’ve begrudgingly accepted that I am that word of mouth.

As this Wikipedia entry on polyvagal theory shows, this is a new and emerging field of science. Wiki editors are adding new links to impassioned scholarly articles on all sides of the debate as we speak. Instead of hand-wringing about this, I’m focusing on how polyvagal theory helps me understand which actions to take depending on the state my nervous system is in. I’ve needed this for a long time.

Polyvagal is a new understanding of how the autonomic nervous system regulates behavior to keep us safe pioneered by Stephen Porges in 1994. In the same way that critical somatics helped me establish a daily foundational practice for nervous system regulation, polyvagal theory has given me in-the-moment techniques that help me regulate. It also provides me a framework for understanding how my nervous system works and what it needs to function properly.

Rundown of the nervous system “states” as described by Stephen Porges

Polyvagal theory has helped me understand how my nervous system tries to protect me by changing states in response to what’s happening. I can now recognize what being stuck in a hyper- or hypo-aroused state feels like (again, if you don’t know what this means, you were me before learning about this theory). I’ve learned which polyvagal tools to use to build my tolerance for inevitable daily stressors. And since polyvagal emphasizes the importance of co-regulation, or how people interact with each other to manage emotions, it’s led me to invest more in personal relationships as an important path to improvement.

Learn more

• Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism

• Using Polyvagal Theory to Balance the Nervous System

• All About the Vagus Nerve

Where Did Weighted Blankets Come From, Anyway?

Keith Zivalich with Pugsly, the Beanie Baby that led him to his “aha” moment in 1997.

Bevoya: Can you tell us about your background -- where did you grow up? where do you live now? What do you do for a living? And a little about your own mental health journey, if you have a journey to share?

Keith: I grew up in Los Angeles.  Now I live with my family in Valencia, CA, a suburb outside of LA.  Since, 2015, my primary source of income is through running a small family e-commerce business making and selling The Magic Weighted Blanket. I don’t really have much of a mental health journey other than recently self-diagnosing myself as a highly sensitive person, which is not a disorder but more of a personality trait.  Not sure it had anything to do with me inventing the weighted blanket, but I do know I instantly felt a calming sensation the first time my daughter placed her Beanie Baby on my shoulder, which was the inspiration for the weighted blanket.

Bevoya: How did you start exploring weighted blankets? What was happening in the world at that time and what led to your insights?

An early prototype of the “bean blanket.”

Keith: In 1997, our family had just moved back home from Boise, Idaho where I was working for an ad agency. One day, my daughter placed a Beanie Baby on my shoulder and I noticed how it hugged me. My first thought was to imagine a blanket filled with these little beans.  It would be “the blanket that hugs you back,” which is now our registered trademark.  I asked my wife to make a child size prototype to show around to our neighbors with kids.  No one liked it.  It was too heavy.  I remembered a friend of ours who is a special needs teacher telling me that she used to hug the kids with autism and sensory processing disorder in her class to calm them down.  I gave her the prototype to try out.  She came back the next day saying she needed more.  From that moment on, I knew weighted blankets were going to be huge.  I found a manufacturer here in Los Angeles and started making them. We called our new business The Original Beanie Blanket Company but Ty Corporation, the maker of the Beanie Babies, sent us a Cease and Desist letter, so we called it the Original Bean Blanket Company.  That’s our legal name to this day. We sold our first blanket in 1998 to a friend we made in Boise, Idaho.

Bevoya: In the past decade or so weighted blankets have become incredibly popular. As someone who has watched the marketing cycle unfold, what has surprised you about the popularity of weighted blankets?

Keith: Honestly, I was not surprised by their popularity.  What did surprise me was that it took so long.  Knowing that we had a market within the autism and sensory processing disorder communities, we started marketing our weighted blankets to OTs in 1998.  Around that time, I had applied for a patent on my own for the design of a weighted blanket, but it was denied. By the early 2000s, as OTs started to get the word out about weighted blankets, there were a couple of moms with special needs kids who also started making and selling them.  Slowly, over the next decade, weighted blankets remained a cottage industry, but there was growing awareness.  By around 2014, the mass media started catching on.  We were featured in Forbes, Cosmopolitan, Dr. Oz, Wall Street Journal, USA Today and others.  It was around that time, I was able to quit my regular job and focus on the family business.  Then, in 2017, we were interviewed by Time Magazine for their 2017 invention of the year award.  After hearing about our journey from inventing a new product and becoming a leader in a niche community, we were sure we would be featured.  But alas, no.  The award went to the Gravity Weighted Blanket which had broken the record on Kickstarter for raising the most money for a start up.  By that time, we had been in business for almost 20 years.  With the award, they acknowledged that Gravity did not invent the weighted blanket, but that they brought it to the mass market.  From 2017 on, weighted blankets exploded, as did our business.  But with that media attention came an outpouring of competition, now obtaining their weighted blankets from China, like Gravity did, and the prices for weighted blankets dropped to a level that has made it very hard for a US manufacturer like us to compete.  So now, instead of just trying to sell The Magic Weighted Blanket, I am trying to sell the one person who has been there all along, The Weighted Blanket Guy.

Keith: It wasn't like one day I woke up and thought, "Hey, I should be the weighted blanket guy."  It has been something people have been calling me for many, many years.  From day one, when we started a niche company and all the way through the explosion of weighted blanket's popularity, I have always answered customer phone calls and emails, and when I introduce myself, I very often heard people say with shocked surprise, "You're the weighted blanket guy."  And one of the things about being a small family business, you pretty much have to do it all, and that includes building your brand.  I've spent 26 years building the Magic Blanket brand and thought it was time to put myself out there as the guy who started the weighted blanket phenomenon.  And although I don't like him, it has worked wonders for The Pillow Guy.  The goal is not to necessarily promote my brand, but to promote me, my story and the knowledge I have gained by being consumed with all things weighted blankets so I can help bring a little calm and comfort into people's lives.

Bevoya: What do you wish more people knew about weighted blankets? What do you think companies get wrong when they try to sell them?

Keith: I wish people knew that weighted blankets have been bringing calm and comfort to people for a long time and that it is not because of the media hype.  That media hype has turned weighted blankets into a get rich quick scheme by many start ups.  They buy cheaply made and priced blankets from outside the US, make a lot of money, sell the company and look for the next media darling.  In the meantime, we have loyal customers who have found a holistic remedy to their anxiety and sleeplessness and then tell their friends and we eke out an existence.  Weighted blankets work. There is science behind it with a long legacy of helping people.  That is the story the media giants should be telling. So the Weighted Blanket Guy is telling it.

What these companies get wrong based on customer feedback is that these companies are selling one size for both men and women – a 48x72. Most of the factories in China mass produce these as a standard size. There are two drawbacks to this size. 1) 48 inches is often too wide for most women. It spreads the weight out too much so the person is actually under less of the compressive weight, which is where the magic happens. 2) 72 inches is too short for most men.  All blankets have a tendency to pull up. A 72 inch blanket is going to pull up over a taller person’s feet.

Keith with his family in the early years

Bevoya: Do you have a favorite type of weighted blanket? What should consumers look out for when trying to choose one?

Keith: I have been sleeping with same Charcoal Grey Chenille 20 pound blanket for going on 10 years.  Chenille is our most popular because it is super soft and durable. There are several things consumers should look for:

• Get the blanket to fit the body, not the bed.  I get calls all the time from people asking for a queen or king size blanket.  A blanket that large weighs over 30 pounds and needs to be taken to a Laundromat with industrial size machines.

• A removable duvet cover is a bad choice.  You have to unzip the cover.  Untie the inner liner.  Machine was and dry the cover.  Hand wash and hang dry the inner liner.  Re-tie. Then re-zip. I get many calls from consumers who have learned this the hard way and now want something that can go right in the washer, right in the dryer and then right on the bed.

• Is there a warranty that guarantees quality?  Because most of the weighted blankets on the market today are made cheaply overseas, there is little or no assurance of quality.  We have a lifetime warranty and I can count on one hand the number of blankets that have been returned faulty to us.

• All weighted blankets retain some degree of body heat.  When weighted blankets exploded on the market in 2017, one of the biggest complaints from the general market was that they were hot.  So manufacturers started coming up with alternative covers that were “cooler.”  Yes, they will be “cooler” for one simple reason, they are more breathable.  Cotton and cotton flannel are “cooler” fabrics because they are more breathable.  Heat can more easily pass through than a chenille or minky or fleece.  But many manufacturers want prospective customers to think that they will be cool under one of these blankets.  But the truth is a weighted blanket presses down on the body and traps body heat.  It is going to be 98 degrees.  With cotton or another type of cooling fabric it will technically be cooler but most people will not feel a great amount of difference.  I always tell people to give their bodies a couple of weeks to get used to the blanket, including used to the added heat.

• Paying a little more for our professionally American made weighted blanket is worth it.  Our blankets last a long time.

 Bevoya: Is there anything else I've neglected to ask you that you want to share?

Photo of the Charcoal Grey Chenille ($ 171.00)

Keith: No, I think this covers a lot.  But I do hope the one takeaway will be that after the mass media hype about weighted blanket fades, the fact that weighted blankets have been bringing calm and comfort for over 26 years means they aren’t just another fad, like the Snuggie.  Remember those?  When I first came up with the weighted blanket idea, there was a similar product called the Slanket. It was a blanket with sleeves invented by a college kid and his mom made the first prototype.  He and I both started our businesses around the same time, 1998.  Then years later, a competitor came out with the Snuggie and it exploded on the market.  But is was a gimmick and a fad, and Snuggies aren’t really around anymore.  My hope is that weighted blankets bring calm and comfort to everyone for many more years to come.

Your Comprehensive Guide to Kids and Anxiety

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Early support and treatment really does make a difference

Anxiety in children has been diagnosed an at increasingly higher rate in the past few years. Here’s some information from the CDC:

• 7.1 percent of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety

• For children aged 3-17 years with anxiety, more than 1 in 3 also have behavior problems (37.9%) and about 1 in 3 also have depression (32.3%)

• Among children living below 100% of the federal poverty level, more than 1 in 5 (22%) had a mental, behavioral, or developmental disorder.

• Age and poverty level affected the likelihood of children receiving treatment for anxiety, depression, or behavior problems.

Children who receive support and treatment early—as soon as possible after symptoms start—will have a better chance of successfully managing their anxiety. That’s why it is so important that parents (as well as teachers and other adults who interact with children) know the signs, and what to do to help a child who may have anxiety. 

More pressure means more anxiety

Dr Patti Ashley

The increase in anxiety among children likely can be attributed at least in part to the high-pressure environment kids live in today, along with the desire to make their parents proud—which may be a challenge for kids who set unrealistically high expectations for themselves. “Kids want to please their parents and don’t feel like they’re enough,” says Dr. Patti Ashley, psychotherapist, author, and creator of a psychotherapy approach called Authenticity Architecture. “This causes lots of anxiety.” 

Not surprisingly, social media and the tendency to be plugged in 24/7 also plays a role. Everyone else’s life looks so perfect and exciting, and there’s the persistent pressure to compete. Kids are constantly comparing themselves to everyone else.  “There’s so much more to live up to, with the pressure of social media. Higher expectations,” Ashley says. “Then there’s also chronic fear because of mass shootings, especially in schools. The nervous system thinks it is in chronic trauma.” 

How anxiety is different in children than in adults 

There are some basic characteristics in anxiety that are generally consistent across the board. But there are some elements that make anxiety especially challenging for the children who have it—and the people who care about them and are trying to understand how to help them. 

“Anxiety is a sign of personal distress and suffering, whether it be an adult or a child. The difference is usually an adult has more awareness and an ability to articulate what they are experiencing due to a more expansive ‘feeling vocabulary,’” says Linda Snell MSW, LCSW at New Method Wellness. 

“Children experience anxiety in three ways,” Snell says. “It is experienced in the thoughts a child has, such as a fear of objects and/or worrying about events or people. Secondly, it is experienced in the body, such as stomachaches, headaches, vomiting, diarrhea, and tiredness. Lastly, it manifests in a child’s behavior. A child may freeze, cling, shake, fidget, and cry. In both children and adult’s anxiety will result in avoidance. Anxiety can cause a marked interference in one’s life affecting the adult’s work performance and the child’s school performance, disrupts both the adult and child’s relationships, and decreases self-esteem to name a few effects. In a child it can exacerbate a child’s feeling of dependency where for an adult it can increase isolation.

Dr. Dana Dorfman, PhD, psychotherapist and co-host of the podcast “2 Moms on the Couch,” echoes the connection between inability to express their situation and an array of physical symptoms. “Because children do not have the vocabulary, life experience, and developmental capacities to identify and verbalize their feelings, they may be less likely to do so,” Dorfman says. “Thus, anxiety may manifest in behaviors that may be easily misinterpreted. Some examples include tantrums, difficulty sleeping, difficulty separating from parents, nightmares, regression from previously acquired skills like toilet training and sleeping through the night, rigidity (being inflexible or highly demanding), irritable mood, changes in eating behavior, and excessive clinginess. Children may also exhibit tension or anxiety by nail biting, lip biting, tics. Anxiety in children can also manifest physically:  such as stomachaches, headaches, and sensory sensitivity (hypersensitivity to noise, light, and touch).” 

This tendency to produce confusing symptoms can make it difficult for adults to accurately detect anxiety in children, at least at first. “Children are rarely able to identify and verbalize feelings, particularly anxiety,” says Dorfman. “As a result, they exhibit it in behaviors which may be "misleading,” misunderstood, or misinterpreted by adults around them. For example, frequent stomach aches could be attributable to factors like diet or illness, rather than anxiety.”   

Types of anxiety 

As with adults, anxiety in children can have several different forms. Dorfman says, “There are several categories of anxiety disorders- the emergence of which frequently corresponds with developmental stages and can last far longer than developmentally appropriate.” Dorfman listed some examples of common types of anxiety:   

• In younger children: Separation anxiety

• In early adolescence: Social anxiety

• During school years and beyond: Obsessive - Compulsive Disorder 

• Adolescence and beyond: Panic Disorder

• Generalized Anxiety Disorder (any age) 

• Posttraumatic stress disorder 

“All of the above-mentioned disorders may be catalyzed by an event or experience,” Dorfman says. “They are likely to persist, often require treatment and may or may not recur throughout lifespan. If one experiences one or more of the disorders, there is a greater likelihood of recurrence or additional anxiety disorder to emerge at a later stage.” 

What causes anxiety in kids? 

There is no single definitive cause that has been identified as the root of anxiety conditions. However, Snell says an individual is more than likely to develop an anxiety disorder if:

• he/she has experienced trauma

• he/she has a physical condition that is linked to anxiety

• he/she has biological relatives diagnosed with anxiety disorders or other mental illnesses.

“There is agreement that anxiety disorders can be both genetic and caused by environmental factors,” Snell says. “Studies do indicate that an anxious parent does pass on a predisposition for an anxious child to be more emotionally sensitive than the average child. On a positive note. an anxious child is more likely to be kind and compassionate.” 

Does it run in families? 

It often seems like some families have clusters of people (of all ages) who have anxiety, and experts say that’s no coincidence. “Yes, there are significant genetic factors which contribute to anxiety,” Dorfman says. “If a family member—particularly a parent—has anxiety, a child may be more likely to inherit this trait. Additionally, parents who demonstrate significant anxious behavior are likely to engender anxiety in children. Children who experience trauma such as loss of a parent, natural disasters, or are exposed to chronically stressful circumstances are more prone to anxiety.”   

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Signs that a child may have anxiety 

Dr Takesha Cooper

It’s important for adults to be alert for possible signs of anxiety, so they can help children get treatment and support as soon as possible. Specific symptoms or anxiety-related behaviors can vary by the individual, but there are some things that can often be red flags.  “Symptoms of anxiety include avoiding the situation that triggers anxiety,” says Dr. Takesha Cooper, assistant clinical professor of psychiatry at the University of California Riverside School of Medicine and a child and adolescent psychiatrist at the Riverside County Department of Mental Health's Lake Elsinore Family Mental Health Services. “For example, if a child is anxious about being away from a caregiver as in Separation Anxiety Disorder, that child will avoid scenarios in which they have to be apart from their caregiver. They might follow the caregiver through the house, express extreme anxiety or have a tantrum if the caregiver needs to leave.”

Dorfman advises parents to watch out for any significant changes in daily functioning, particularly related to eating, sleeping and general mood. “Parents should be aware of regressions. For example, a child who has been fully toilet trained for over a year suddenly begins having frequent accidents or a child who did not have difficulty with parents' departure at school drop off, may suddenly resist separations.” 

It’s common for anxiety in children to manifest itself in ways that mimic behavior issues or anger management problems. “Children with anxiety often worry about ‘what might happen’ so they might verbalize these worries out loud,” says Cooper. “Some children when anxious can even become agitated and aggressive. This is their fight-or-flight that kicks in and can easily be mistaken for a disruptive behavior disorder, such as oppositional defiant disorder, or a mood disorder, such as bipolar disorder. This is why it’s important to have the child undergo a thorough assessment to understand their triggers and to talk to the child to better understand what is going through their mind before and during these episodes, because it gives us a clue into why they behave the way they do.” 

What should you do if your child has anxiety? 

“First, take a deep breath and know that anxiety in children is fairly common,” says Snell. “One in ten children are diagnosed with anxiety disorders. Getting your child help will require time, patience, commitment, and collaboration. I strongly suggest you and your child see a qualified mental health professional who is trained to assess your child and partner with you in addressing your child’s anxiety. A professional can help you and your child learn effective tools to decrease your child’s distress, apply the tools, and troubleshoot any issues as well as keep both you and your child motivated while monitoring progress.”

Don’t make them stifle their feelings. “I tell them all feelings are okay but all behavior isn’t,” says Dr. Ashley. “It’s okay to feel whatever they feel. Our culture has created this ideal that in order to be successful we must overcome these feelings.” 

Parents need support, too

While the primary concern is the child with anxiety, family members—especially parents—can also benefit from helpful resources. “Parents greatly benefit from education about anxiety and treatment approaches,” says Dorfman. “Parents may contact pediatrician who is likely to be well versed in emotional issues of childhood and can refer the family to a mental health professional. Ideally, the professional will work with parents in addition to the child to educate, provide strategies and resources so that parents may support child with compassion and understanding. Parents may also confer with teachers and may reach out to school social worker or psychologist for resources, support and referrals.”  

Treatment options

The traditional approach to treating anxiety was a two-pronged strategy: a combination of medication and therapy.  “The two most common forms of treatment are Cognitive Behavioral Therapy (CBT) and Psychodynamic Psychotherapy,” says Dorfman. “Medications which are commonly prescribed are SSRI (selective serotonin reuptake inhibitor) and/or anti-anxiety and sedative medications.” 

That’s still the basic foundation recommended by many mental health professionals. However, these days, more medical and mental health practitioners are also incorporating other strategies into their recommended treatment plan, as we’ll describe later.

Therapy 

Dorfman says, “The most commonly used treatment approaches for children with anxiety are play therapy, for children under 12 or so; talk therapy; psycho-education (learning about anxiety); cognitive behavioral therapy; and parent guidance. Psychopharmacology—meaning medications like SSRI and anti-anxiety medications—are also effective, particularly when paired with therapy.” 

Medication 

“Medications can be effective and beneficial,” says Dorfman. “The introduction of medication is largely contingent upon the degree of impairment and the degree to which the anxiety interferes with daily functioning. Often, patients are assessed and engage therapy before medication is introduced, though patients and situations vary significantly. “

“Medication can be an important treatment for anxiety disorders, even in children,” says Cooper. “We consider medication when the anxiety interferes significantly in a child’s ability to function. For example, if a child has severe generalized anxiety disorder and has been unable to attend school for weeks due to the anxiety, it would be helpful to consider adding medication to the treatment plan which should already include psychotherapy. Or a child with Panic Disorder who has intense fear of future panic attacks such that she is unable to leave her home would benefit from a trial of medication to see if it helps her. “ 

“While these scenarios are severe, children with moderate anxiety can still be good candidates for medication, particularly if they are already receiving therapy but still are symptomatic,” says Cooper. “Oftentimes we see the medication can help children better utilize therapy because they are less anxious and more willing to discuss their anxiety or try anxiety reduction techniques the provider suggests such as exposures which are proven to help reduce anxiety. For mild childhood anxiety, medications should generally not be chosen, given that good cognitive-based therapy by a trained clinician alone is often effective in reducing symptoms.” 

Alternative or complementary treatment options

Alternative or complementary treatment options are no longer viewed with the type of skepticism as they were in the past. Even better, these days there is such a wide range of creative (and fun!) alternative treatments that there’s something to fit everyone. 

“In the past decade or so, patients have increasingly used various forms of meditation and mindfulness practice,” says Dorfman. “Patients are encouraged to exercise regularly, journal and breathing techniques.” 

“I like to find what kids are interested in,” says Ashley. “Getting out in nature, doing art. Take a hike. You have to be in the experience of feeling joy and laughter. That gives the body a message that I am safe and okay. Talk therapy is important and helpful, so I like to combine several forms of therapy. I like to find something they enjoy doing that’s more right-brained, because that’s where the imprint happens. Try to make it as personal and customized as I can.”

Examples of alternative/complementary treatments 

Many people are surprised to discover the impressive—and interesting—range of treatment options available to help those with anxiety. Here are just a few examples of therapy types that can be used to treat anxiety. 

Surf therapy: the ocean waves have a soothing effect, and the water provides a serene environment that promotes bonding with family members. 

Equine therapy: horses can have a calming effect, and caring and guiding the horses gives anxious kids an outlet to focus their energy, providing a positive distraction. 

Dolphin therapy: while used primarily for children with autism, some experts say this can also be a good form of therapy for those with anxiety or depression. 

Wilderness therapy: spending time outdoors in an “adventure program” can help kids gain confidence and develop problem-solving skills. 

Yoga therapy: yoga is all about focusing your body and mind in a positive way, and the emphasis on finding your center and controlling your breathing can help alleviate the symptoms of anxiety. 

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What about you? Have you found an anxiety treatment that works well for your family? Share in the comments below!

From Living with OCD to Helping Others

The author Natalia Aniela Aíza

My journey as an OCD therapist (and what I have yet to learn).

Compulsions are some of my earliest childhood memories. I was the only daughter of a single mother, a political refugee from Poland, and a Mexican father that I didn’t know. I locked and relocked the front door, then picked up the landline to make sure there was a dial tone, then looked out the back window to see if there was a car in the alley. I was six years old when I started spending every afternoon, and many weekends alone on the top floor of a duplex in downtown Milwaukee. 

In late elementary, I started feeling the urge to cut my arm. It was pre-internet, and I had no idea that anyone else did this too. I always cut in the same spot on the same arm, and then spent the next week compulsively dousing the wound with rubbing alcohol. The skin would bubble and puss, and I would focus all my anxiety on that searing pain. I distinctly remember that queasy feeling of being both powerful and powerless – what I now understand to be the dichotomy of having a control disorder that is out of control. I literally could not stop hurting myself. 

By middle school, my compulsive cutting had morphed into stealing. I was easily the best student in my classes, but was pathologically quiet. When other students went to recess, I would sneak back into the teacher’s supply room and take folders and binders. I never used any of these items, but I created a little collection in my bedroom that felt sacred to me. 6th grade summer, I began to slip single sleeves of stickers into my pants at the local Kohl’s grocery store (a staple of 1990s Wisconsin). My OCD version of shoplifting – the same item from the same store at the same time of day, every day – obviously got me caught. I actually got handcuffed as a 75 pound little girl, taken to the police station, and fingerprinted. 

My stealing abruptly stopped after this scared straight moment, and my OCD morphed once again into the place where it happily stayed for the coming decades: perfectionism. 

Of course some part of me is grateful that my compulsivity settled into a safer landing spot than self-harm or theft, but now that I am a therapist, I appreciate how much harder it is to heal from perfectionism OCD. Pushing myself to achieve that “just right” feeling, and overachieving until I literally cannot keep my eyes open anymore, has propelled most aspects of my life. It has brought pride and achievement, but also loss and disconnection. I anchor myself so loyally to perfection, I am not sure who Natalia is outside of it. 

Natalia with her team at Kairos Wellness Collective.

I realize the irony of trying to compose this very essay. My center is thriving, my life is full: and yet I wake up early Sunday morning to search for the consummate words to describe perfectionism. I am no longer that frightened and lonely little girl in Wisconsin, but somehow I am still driven by an intangible sense of danger. Being less-than feels unsafe.

If I put my therapist hat on, I am able to identify my current OCD as “ego-syntonic.” This means that my core self and my OCD are in line. Even if I recognize how my happiness is limited by my need for excellence, I will still willingly make this trade. 

As a mental health practitioner, I have a belief (perhaps superstitious) that the universe pairs you with the clients that you need to fully see yourself.  I began my career with two jobs: as an expat therapist in a ritzy neighborhood of Shanghai and as a child therapist at a local orphanage.  I spent the year toggling back and forth between these very different workplaces, struggling with the duality of working with children with abandonment wounds and over-achieving adults. It was only in retrospect that I started connecting these two client bases as aspects of my own self. 

From a very early age, I accepted that I wasn’t good enough to keep my father. I knew nothing of the circumstances of my parent’s rupture, but I formed a core belief that I was not worthy of love.  My attachment style, unsurprisingly, has been anxious for my whole life. I fear that love will crumble if it is imperfect, and I am hypervigilant of my partner’s reactions to me.  My anxious brain can ruminate on something as benign as a sour look in my direction. 

In Cognitive Behavioral Therapy, we teach our clients that most negative perceptions can be traced back to one of three core beliefs: I am unworthy, I am unsafe, and I am unloved.  My perfectionism has been so treatment-resistant because it was my salve for all three of these fundamental fears. 

Perfectionism is my brain’s effort to give me a sense of control; if I am measured, perhaps I will be safe. If I am tireless, perhaps I will be worthy. If I am flawless, then perhaps I will be loved. 

However, as an OCD specialist, I know that we have to let go of the compulsion in order to heal the obsession. Consistently meeting your own outsized standards reinforces that you must always do so, no matter what. I will never feel loved, worthy, and safe, until I am truly able to lean into the discomfort of imperfection.

Even as I sit here trying to type out my “perfectionism story,” overthinking and judgment lingers around this very text.  My perception of my business is warped by self-criticism.  Every piece of negative feedback fully eclipses all the positives.  Sometimes I even feel nostalgia for the self-destructive little girl that I once was. This adult version of me must continuously self-construct. If I slow down, or do just good enough, I do so with a chorus of intrusive thoughts that I might fail. 

I long to break step with this pattern. I have been marching forward for so long that I don’t know how to dance. I see the harm of perfectionism in my clients, but also how dearly they cling to it. I have to be honest with them – this compulsion still shadows me now.  Committing these words to the page signifies a pact with myself to finally, completely let go of perfectionism. 

I tell my clients: let’s try this new dance together.

Natalia Aniela Aíza, LPC, is the founder of Kairos Wellness Collective, an OCD clinic in Boulder, Colorado.  Her maladaptive perfectionism drove her out of a difficult childhood to Harvard College, then Harvard Law, before she found her true calling as a mother and an OCD specialist. She is passionate about mental health advocacy, and honesty from healers about our own (ongoing) struggles. You can follow her center on Instagram.

When You’re the One Who’s Sick

Photo by Łukasz Rawa

You’re a burden.

Let’s be clear here. I’m talking about chronic illness or illnesses. My husband lives with and has to accommodate a chronically ill wife—except during those rare breaks when symptoms ebb and I appear energetically normal.

It’s not at all the way is seems in the old British mysteries I love to read, where the wife, delicately clad in a ruffled bed cap and a soft blue bed jacket, is a shadowy figure confined to her room. Often, she is made out to be “enjoying poor health.” Actually, we’re sorry we’ve brought our conditions on our partners and our friends and we are ashamed that we have to excuse ourselves to those who want us to join them for quiet cup of coffee in the newly opened café in our town or an interesting outdoor expedition in the countryside. 

When you’re the one who’s sick . . . you’re expensive.

In one recent week alone, standing before the cashier’s windows at medical facilities, I dug into my purse to shell out copays of a hundred dollars each for two different CT scans on two different parts of my body. One scan viewed my dangerous aneurysms—little deadly balloons that have stretched areas in my arteries; the other was performed in preparation for my upcoming knee surgery. The mention of the upcoming knee surgery has made me remember to include all the costs associated with that. The nose swab, the six plastic bottles of special concentrated shower soap, and the exorbitant parking fees for all the specialists’ visits. We have surely spent at least $250 on parking alone so far.

I’ve got the routine copays for doc’s visits and prescriptions (gabapentin for my persistent hot flashes, a statin for an occasionally jumpy heartbeat and maybe for clogged old lady arteries, I’m not completely sure, and Tramadol for my chronic body pain. My friend Howard’s mother sums it up as, “it’s always pain or copays,” which is true) and a host of over-the-counter meds, and appurtenances (e.g., ibuprofen, acetaminophen, eye drops, wrist and knee braces, shoe orthotics—not the four hundred sixty-dollar custom ones for the shoes I wear most often). In the first three months of last year, my husband and I saved $300 at CVS alone, not including prescriptions.

When you’re the one who’s sick . . .you feel guilty.

And remorseful that you have brought these problems on those dear to you. My husband has to take time off from work to ferry me to doctors’ appointments now that I’ve had the knee replacement and haven’t yet been cleared to drive. Also, all my life I’ve been afraid to ride in elevators alone so he accompanies me to my PT appointments on the fourth floor when no friend can come with.

When you’re the one who’s sick . . . you’re seen as a failure.

As if you’ve done something to bring on these illnesses, although most probably it was something that was done to you. Growing up, I was a victim of unrelenting criticism for behaviors a young child couldn’t avoid. I was the child of parents who abused alcohol, my mild-mannered, depressed father to the point where he became a hopeless drunk, my mother, who could drink herself into a two-day stupor, but return to her part-time job on Monday without so much as a headache, denying that she had been anything but “tired” over the weekend.

Given my upbringing, research says I’m at risk for a number of medical conditions such as chronic pain. Although I don’t recall being in pain as an athletic young person, I do recall my mother referring to my “aches and pains.” Were they the portents of my pervasive body pain later in my life?

Anyway, our illnesses aren’t our fault, and some few people realize that. When I went to the Emergency Room on Thanksgiving Day, just before dinner, because of excruciating pain like a wire, vivid in its red-hot intensity, encircling my lower stomach, a CT scan revealed that I was suffering the pangs of diverticulitis.

A large ER doctor who looked like a kinder version of the genie in the old Thief of Bagdad movie smilingly asked, “Do you know why you got this?”

“No.”

“Bad luck,” he said. “That’s all.”

I was not being held responsible for causing my sick situation.

When you’re the one who’s sick . . .

your condition(s) fluster your friends and family members.

And you wonder about the social discomfort and pity faced by those who use wheelchairs. A man I know displayed wide-wide alarm when he witnessed my husband helping me up from a low antique chair at a low heirloom table at my sister-in-law’s home. My knees were terribly painful that day. When I was getting out of the chair after lunch, he looked on, horror stamped on is face, as if he was peering at the remnants of a grisly accident.

When you’re the one who’s sick . . .you do not use illness to elicit sympathy from others.

Quite the contrary. It’s like being the only one in the family of accomplished cooks that likes loud festive meals but who can’t cook to save her life. The assignments they give you get easier and easier so as not to tax your non-existent culinary skills, and you still overcook the eggs that were to grace the top of an elegant shrimp dish, and you spill hot water on the dog that was underfoot (but not seeming to get in the way of the other cooks at the stove), necessitating a trip to the vet before everyone could sit down to the gourmet meal (minus the overcooked eggs). Or, when you can barely hoist yourself up from a chair, your knees ache so badly, and everyone else, all of them over 65, is performing what to you are extraordinary physical feats: Kneeling on hardwood floors bare of carpeting without any covering or cushioning for their knees, walking a couple of miles a day on cement pavement (my bête noire) for fun, loading the trunk of a car for an outing when you can only carry your purse (not even your book-filled public television tote) to the car, where you sink down into the passenger seat with a groan you try desperately to muffle out of earshot of the others.

You long to be like everyone else who at least seemingly are hale and hearty, with no need for care from others.

I try not to complain. But I prefer to tell my husband how I am feeling so he will understand why I’m not doing certain things on a particular day, why I can’t walk very far on the hard tile floors inside Target without having to sit down on a conveniently empty shelf in the table linens section, why I long to get back to the car before we’ve covered the distance we planned to go on our nature walk, why I don’t even want to get out of the car in the first place, why it’s taking me even longer on a particular morning to go down the beautiful pine stairs in our two-story apartment by grasping the banister with two hands and taking the stairs as a toddler would. No need to discuss the timing of meals; he already knows that I have to eat little bits of food at frequent intervals to prevent my stomach from hurting the following day.

When you’re the one who’s sick . . .you’re not allowed to talk about your illnesses.

Or even refer to your limitations, except to fellow sufferers. (Even here in these pages I’m afraid readers’ eyes are cast upward, as if they’re appealing to heaven to spare them from this boring recital that is also in bad taste.) To others, you must always chirp that you’re fine, fine, fine. That’s difficult because when you’re chronically sick, that’s about the only thing you are. Sick. Much of the time you aren’t doing much else besides being sick and what’s now referred to as advocating for your health: managing your illness(es) and your doctors and their assistants and your medications and pharmacists, and making, canceling, and rescheduling doctors’ visits, tests and unpleasant procedures.

I have recently asked my HMO to assign me someone who can work with me on prescription management. That is, what scripts I need when, how to order refills in time to get them when I need them, so I’m not constantly running out, bearing in mind that the pharmacist doesn’t fill my pescription the moment they get it. I might have to wait two or three days to actually get the meds. The personnel at my HMO—both medical and non-medical—don’t seem aware of the pharmacologist shown on their website as on the HMO staff.

I have a close longtime friend who lives with a chronically sick husband. He has more conditions than I do and his are more serious than most of mine. He did know in advance that some of his current conditions would result after he had cancer radiation treatments early in his adulthood. My friend is burdened, not only caring for her husband, but by his complaints about his health.

The rehab room the author lived in after her knee surgery.

My friend’s husband is rightfully depressed and feels hopeless, so he’s resistant to new therapies or other activities like socializing more. He’s not convinced these lifestyle modifications will help him. I know the feeling, but I am always willing to try new remedies for my conditions, the latest being dry needling for the severe pains in my upper hamstrings and the sides of my calves. (They worked.) My friend’s husband doesn’t want to exercise. I exercise a lot. Her husband is suicidal. I’m not. At least, not often. But I understand his despair all too well. My friend is only 62, so she doesn’t realize how the swift descent into aging can catch us off guard with its vicious incurable illnesses and bring us down like the point of a sharp weapon into soft flesh. My husband is 67, but has no problems, except arthritis in his hands; he only understands the limitations that that particular condition brings. Still, his condition doesn’t restrict him; he’s a landscaper, using his hands all the time, and he’s handy with tools.

I don’t tell this friend much about my daily attacks, many of them making their first, but not always last, appearance. She already has to listen to her husband’s quotidian laments. And has to do all she can to keep from falling into depression herself.

I also have a friend who lives far away but whose emails back and forth with me consist of seventy-five percent bemoaning or analyzing our medical conditions. One thing that’s shocking is that we seem to give one another our illnesses. Recently, she’s been hurting a great deal from sciatic pain. Three days ago, I started waking up with sciatic pain so intense my husband had to let me lean on him as he escorted me to and from the bathroom at 5:00 o’clock in the morning. The orthopedist diagnosed me with bursitis in my hip and gave me a cortisone injection that didn’t help. After a month of the early morning agony, my friend’s pains began to subside and so did mine. The strangest thing is when my sciatic ache began, I was unaware that my friend was experiencing that same pain. And when mine began to subside, I didn’t know hers had started to disappear as well.

An aside: Two months after I wrote the above, mine has returned in force.

When you’re the one who’s sick . . . you couldn’t have anticipated this sustained misery:

The tumor, the stomach aches, the chronic pains, the dry left eye, the fractured ankle with lasting intermittent pain and a new fear of falling, the strong, but arthritis-inflamed knees, the groin pain, quad pain, hamstring pain, butt pain. Not one of us sufferers, when we were in our forties or fifties, looked down the road to ten or twenty years in the blurry future and imagined we would be so sick. None of us thought: I’m going to have numerous clinical conditions targeting me, baffling me, costing me, overwhelming me, and overcoming me—seemingly out of nowhere.

When you’re the one who’s sick . . . some new and unexpected ailment is always cropping up.

And like the second law of thermodynamics, which in effect states that throughout the universe, which includes you, left on their own, things always get worse. So, whatever suddenly surfaces in your body is never a cure or even an improvement in any of your conditions. It’s always startlingly bad, baffling, and without a traceable cause.

In the passenger seat of the car just the other day, I yelped and grabbed my right knee. My husband asked what was wrong.

“The side of my knee feels as if an ice pick is being pushed into it,” I told him while gently massaging the area. Even though I knew the pain would go away, and probably never return I was glad I wasn’t teaching a class or undergoing a delicate dental procedure at the time. Although various pains in my knees have returned, that one hasn’t. My husband paraphrased the caption of a New Yorker cartoon in which god, looking down from on high, muses, “Let’s see. What pain should I give Lynette today?”

When you’re the one who’s sick . . . doctors are as baffled by your chronic illness(es) as you are.

Diagnoses are often dicey approximations, outright cures elusive. Tests performed in the world-class medical facilities in Greater Boston, where I live, fail to coax their causes out of hiding. The doctors, wearing white nametags with lettering too small to read, stare at their computer screens and mumble to themselves. They frown and lean away from me, as if afraid they might contract my condition from me. They are careful not to acknowledge the psychological and emotion toll your maladies take on you. As if being ill, having intractable conditions, have no impact on your feelings. Although I have to express my gratitude that when I was diagnosed with breast cancer, the radiologist, the oncologists, the physicians’ assistants—not one single medical professional ever uttered the words tumor, malignant, or cancer. I appreciate enormously that display of sensitivity. It was as if they did have an inkling of what I was going through, of my mental state. As if they did know this was all foreign and fear-making. As if they knew I had feelings beyond just the medical aspects of cancer that they each dealt with.

I’ve recently been diagnosed with fibromyalgia, although the only symptom of that condition that I have is widespread body pain. No headaches, inability to concentrate, insomnia, numbness or tingling in my extremities, depression, or fatigue, thank heavens. The pain itself is enough to bear. I suspect that doctors had to slap that label on me so my health insurance company would acknowledge my symptoms of chronic pain and pay for treatments and medication.

The rehab room the author lived in after her knee surgery.

Speaking of treatments, although my HMO is actively, one might say aggressively, limiting the use of opioids by its patients, it is sorely lacking in any new approaches besides the usual skimpy medication, acupuncture, and physical therapy solutions. All of the most recent progress in the link between the brain, gut, and body has somehow slipped by them. My HMO doesn’t have a psychologist specializing in helping patients learn to manage their minds and therefore their troublesome symptoms.

Doctors are always surprised at how old I am, and think I am decades younger than I am. I know I look young but my body knows the truth. I was always in stunningly good health: weight, blood pressure, cholesterol level (except for that time my blood was taken while I was eating lunch, when it was slightly raised). My HMO patient portal is evidence of my past good health. However, I now understand that, in my case, that great health was largely due to my age. And of course, genes.

In a Balance and Strength course, sponsored by my HMO, I was able to perform all the exercises easily. When the class was directed to do forward heel-to-toe walking exercises, I was told I didn’t need them. But I did them anyway—backwards. I was the next to the youngest in the class, but the youngest was recovering from a broken leg so her abilities were on a par with those of the participants in their eighties. Then I hit the age of seventy and got sick. A nurse (in her seventies) said she and her sister had decided, “You’re well when you get older—until you’re not.” It’s as simple as that. In the past two years I have been diagnosed not only with breast cancer, but aneurysms, anemia, low white blood cell count, and the clogged artery I mentioned earlier.  

When you’re the one who’s sick . . .your caregiver has to make endless allowances and accommodations.

My persistent and enervating hot flashes prevent me from going out when the temperature is above 75 degrees, the humidity above 50 percent. Even winter dampness triggers sticky hot flashes. I aim a fan on myself at night, off and on, as the hot flashes come and go. I have a fan affixed to my desk; I carry a battery-operated one in my purse. My husband’s comfortable heat range is broad so my antics with the fans (and the temperature gauge in the car) don’t bother him.

I can’t perform a lot of errands because in the third parking lot, an ache somewhere in my body catches up with me. So, my husband does the lion’s share of the grocery shopping (which I dislike anyway). He holds the car door open wide so I can drag my swollen knees inside. Both pains there and in my groin prevent me from entering or leaving a car gracefully. Only heaven could help me the times I was able to do an errand or two on my own and someone parked close to my driver’s side door and I couldn’t open it wide enough to get my knees back in the car after leaving my destination. I finally got a handicap sticker so I can park in wider designated spots, which give me more room to open my car door.

When you are the one who’s sick . . . you realize that most of your conditions won’t go away.

They won’t even improve. That’s the biggest blow. Between a quarter and half of US adults endure chronic pain. Johns Hopkins University Hospital states that chronic pain (mostly back pain) costs more than $635 billion annually—more than the yearly costs for cancer, heart disease, and diabetes.

It's very hard, no, it’s impossible to make anyone understand what we chronically sick people are enduring unless they are in the same position. Even doctors don’t understand. Their only advice for those with chronic pain is to exercise more. I often wonder if they do. My previous PCP once told me she got stuck with other physicians in the elevator at my HMO.

“Aren’t you supposed to be using the stairs as you tell your patients to do?” I asked.

“Yep,” she answered, “but we don’t.”

A tall sports medicine doctor who was heavily padded with soft fat, laughingly told me he’d never used a treadmill or any exercise equipment at all.

When you’re the one who’s sick . . .you undergo frightening, uncomfortable tests and procedures, ordered by doctors you don’t know.

I’m jabbed and pressed, made to lay my bare skin on icy rigid x-ray tables, and told that I’m even sicker than I thought because I have other conditions I wasn’t aware of. I remind myself of what a friend told me: that everyone, even the youngest, is walking around with conditions they haven’t yet been made aware of, negative conditions that will reveal themselves in their own good time.

Despite what numerous legitimate medical websites and magazines insist on, even if you look young (I do) and people can’t believe you’ve lived seven decades (I have) and doctors take a look at your chart and exclaim, “I can’t believe your age” (they can’t) our deteriorating body’s parts are staging a revolt with the last of their strength. More and more of them will need propping up with complex procedures and a battery of pills.

A case in point is my knees. They started going bad when I was in my early fifties. They had a right to. Youthful years playing games like handball on hard concrete courts. Dancing, lots of dancing: dance classes, dance performances, and social dancing in downtown clubs at night. My knees had been used. Had I been warned of possible consequences, warned that my knees would give out, would I have danced less? I doubt it.

I arranged to have one knee replaced, even though I had been alerted by the surgeon who would perform the surgery, that the pain was unimaginably intense. But I had no choice; I was told I wouldn’t be able to walk much longer on that knee.

When you’re the one who’s sick . . .you have a lot of work to do before surgery.

That is, since I belong to my particular HMO. Maybe because I’m old I have to have a lot of tests before being cleared for surgery. But no one told me that. I only found out when, upon ending my virtual appointment with my PCP for another of our benign discussions that do not relieve any of my anxieties or confusions about relief from my conditions, I was told to see a specialist because I had previously unnoticed anemia, and by the way, have you had this blood test or that stress test and the other pulmonary test, and what does the cardiologist think about your heart? When I called to make these appointments, the various offices didn’t know who I was or why I was calling.

When you’re the one who’s sick . . .your spouse fetches what you need.

My husband learned what equipment my condition would require after I returned home from knee surgery, barely able to walk. On colorless Saturday mornings in January, before the surgery, he drove to the Masonic Center twenty minutes away from our house to sit in line in his car to pick up free used items my post-surgery knee would require. When I came home with a wounded knee, a surgical knee, a fragile, complexly healing knee, painful from skin to bone marrow, with uncertain balance, overall lack of strength, and pain pain pain, he’d already gotten me two walkers, one for each floor in our house, a “bath transition bench” so I could wash my body with his patient help, a cane I refused to use, and a walker with a seat, should I care to go shopping and want to sit and rest between the aisles.

My husband helped me into and out of bed, notwithstanding the baby blue appliance I had bought for fifteen dollars to lift my legs with. He fixed my pillows and covers in ways I found I liked and even though I can now arrange my pillows and the covers the way I like, his tucking me in has turned into a nightly ritual.

When you’re the one who’s sick. . .your caregiver becomes a pharmacological expert.

My husband squinted over a chart the rehab center sent home with us

to sort out the morning and evening and meds and the ones I had to take in the middle of the night when I was groggy, and those I needed to swallow with or without food or before or after eating. The ones, like Eliquis, I was to stop taking two weeks after I left rehab, and the ones, like baby aspirin, I was to continue taking for an indefinite length of time.

When you’re the one who’s sick . . .your spouse puts his life on hold.

My husband goes to most of my medical appointments with me and there are many! My knee surgery was in February and I was recovering through March. As my husband is a landscaper, he was off until April when New England begins to toy with the idea of warming up.

He stayed by my side in a surprisingly new looking arm chair while I began my knee surgery recovery in rehab. In fact, he arrived at seven o’clock in the mornings and remained with me until seven pm, long after winter’s dark arrived, even though most of that time I was sleeping, sleeping so much that he became alarmed and tried to wake me when I was sleeping with dinner in my mouth, but I only woke slightly for a few seconds and at his urging, promised to swallow the food in my mouth. But seeing that I didn’t swallow, he made me spit it out and I went back to sleep for many more hours. For the few seconds I was awake, I was awed and grateful that I had so wonderful a caretaker. I tried to take care of him by sending him out twice a day for his cherished nature walks. When he returned, he brought me news of the loveliest aspects of the local world: the birds he saw and the rigid brown winter weeds and shrubs, and the thin perennials he identified—all awaiting spring to sing their songs or open their buds.

When you’re the one who’s sick, you are not your previously capable self.

I couldn’t imagine severe surgical pain. But after knee surgery and a lengthy stay in an unlovely rehab facility, I was not only in pain, but helpless. I would look at my foot and tell it to move and it would remain still. Twice fire fighters had to come to the third floor of my house to pick me up and set me on my feet after I had slid down to the floor.

When you’re the one who’s sick . . . you find out how much your friends and family love you.

It started with the bouquets that arrived in my hospital and rehab rooms as soon as I was out of surgery. The flowers seemed determined to stamp their bright colors onto the sullen grays and browns outside my windows. One longtime friend sent a spring bouquet in a white basket and drove more than 100 miles—three times, each way. First, to visit me in rehab, then to take care of me at home when my husband had to go back to work.

When you’re the one who’s sick . . . and you wake to a day when no joints or muscles or nerves hurt, there’s no stomach ache, nothing’s swollen, no new pain emerges as you get out of bed, you are filled with joy, wonder (you can’t account for why you feel so healthy) and exhilaration, loving your life and your circumstances for the first time in a long, long time.

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About the Author

Lynette Benton is a memoir, personal essay, family history, and creative writing instructor. Her work has appeared in numerous online and paper publications, such as Brevity; Women Writing Women’s Books; More Magazine Online, Skirt! Magazine, and local newspapers (the Arlington Advocate and the Lexington Minuteman).

She has guest posted on various literary web sites, and was a personal essay columnist for the Chronicle of Higher Education, and InsideHighered.org (the latter two under pseudonyms). An excerpt from her memoir was a finalist in a 2014 memoir-writing contest. Visit Lynette at Tools & Tactics for Writers and click on the word blog for tips on writing.

The Ultimate Stress Relief Cheat Sheet

If you can stop your nervous system from trying protect you, you can lessen your pain and quell your anxiety.

Hello reader! I’m Meredith Arthur. I work as a Chief of Staff for Pinterest’s product incubation studio and am the founder of Beautiful Voyager, a content and community site for overthinkers, people pleasers, and perfectionists.

I first started my journey into mental health research in 2015 when the neurologist treating my migraines diagnosed me with Generalized Anxiety Disorder. At the time, I found the Google results for “what is an anxiety disorder?” sorely lacking and I created Beautiful Voyager to fill the gap. My curiosity only deepened as I asked the same question over and over: Why didn’t I ever know that anxiety was contributing to the terrible physical symptoms (migraines, nausea, fainting, back pain, cramping) I was experiencing?

In 2016 I expanded my research by taking over the editor-in-chief role for Medium’s largest mental health publication, editing hundreds of personal mental health essays from people around the world. In 2020, just three months into the COVID pandemic, I published my first book on anxiety. That same year, I started working on the nonprofit How We Feel app with Ben Silbermann and Dr Marc Brackett. Since then, thanks to my partnership with the Pinterest social impact team, I’ve gotten to know the founders of many mental health nonprofits and stayed close to new trends in the space. It’s an ongoing journey that I find fascinating both on a personal level and a societal one.

Why a stress relief cheat sheet?

My understanding of anxiety has changed radically over the past nine years of curious investigation. I’ve explored many schools of thought and approaches to anxiety treatment. Take a look at how my answers to the questions “Why didn’t I know that I was suffering from anxiety?” and “Is anxiety connected to the terrible physical symptoms I’m experiencing?” have evolved over time:

• 2015: I don’t care why I didn’t know. I want to know why the therapists I saw didn’t know.

• 2017: Seems like, in the field of mental health, you need to know what’s wrong with you for people to be able to help you. At least I have Lexapro now.

• 2019: I guess I hid it so well that I unintentionally hid it from myself? I still have physical symptoms. I continue to be grateful for Lexapro, which helps me turn down the thermostat on my internal environment, especially on anxious mornings.

• 2021: I am still really sick—nausea, muscle aches, migraines, lightheadedness. Is anxiety connected to the physical pain I am in? I still don’t get it. COVID hasn’t helped.

• 2023: After a year spent in bed, something finally helped: I had a hysterectomy. I’m grateful to see a decrease in my physical symptoms, but I am still in pain. I don’t know what to do next. I suspect my nervous system plays a role here.

• 2024: I finally get it —I have spent a lifetime in a state of nervous system dysregulation. I believe I can improve my physical and mental health by regulating my nervous system. My pain is diminishing. It’s a daily practice, but I am healing.

I’m writing this cheat sheet to help you skip some of the steps I labored through over the years. Everything I share here is an honest recounting of what’s working for me based on personal experience.

Who you are

If you’re reading this, I’m assuming you’re a fellow voyager, a curious overthinker learning to navigate the choppy waters of stress and anxiety from other wayfaring overthinkers.

The philosophy behind this cheat sheet

If you can stop your nervous system from clumsily trying protect you, you can lessen your pain and quell your anxiety. Teaching yourself that you are safe is where this work begins. It’s as hard as it sounds. Your nervous system’s off switch is buried within a sea of internal confusion. (I’m simplifying the nervous system here — there’s no simple on and off switch. Your nervous system is more like fancy LED lights. The switch allows you to change the color and flashing patterns of the lights so that you can give yourself the right lights at the right time. No one needs fluorescent disco lights at 9 AM on a Monday morning. )

To become skillful at using the switch, you must find a path through the internal cacophony and learn which part of yourself to listen to when. A great place to start is with actionable nervous system regulation tactics.

Let’s get started.

Every technique I’m including has the same goal: to teach your body that you are safe. The best approach to all nervous system regulation is “little and often.” In other words, these are exercises that you can do in the moment to send messages of safety to your body (which, in turn, will send them to your mind and help you feel better overall).

Start with foundational, everyday practices.

If you start reading about nervous system regulation, it won’t be long until you start hearing about the “window of tolerance.” Your window of tolerance is, quite simply, your ability to tolerate the challenges of daily life. It’s your body’s ability to move from a hyper-aroused (fight or flight) or hypo-aroused (withdrawn, frozen) back to a more grounded self and place. If you’re interested in learning more about these three states, a great place to start is Stanley Rosenburg’s book on polyvagal theory. These daily practices build your window of tolerance so that you can recover more quickly and easily from nervous system arousal. (The nervous system exists to protect us. It is doing its job by going into an aroused state. The goal is to build a window of tolerance that lets you handle these inevitable daily stressors gracefully and intentionally, without your system being hijacked without you knowing it.)

1. Somatics

I’ve come to think of my daily somatic practice as meditation with movement. Every morning I unroll my yoga mat and follow one of Sarah Warren’s online classes, usually first thing in the morning, in order to release muscle tension and teach my body what relaxed is supposed to feel like. I recommend starting with her level one course. It is a guided experience that builds upon itself every day, costs $45, and take two months to complete. It takes around 20-30 minutes a day.

2. Polyvagal exercises

I bundle the following three lateral eye-movement exercises with my morning practice. They are adapted from Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg. Critics will tell you that we don’t yet understand the mechanism that makes this kind of exercise work, warning you to sidestep the hype. While I support a healthy dose of skepticism in all wellness endeavors, it doesn’t hurt you to give them a try as they are easy and totally free. I’ve definitely found them helpful for releasing my trapezius muscle and easing my morning anxiety.

The Basic Exercise

• Sit tall wherever you are.

• Interlace your hands and clasp the back of your head between your ears, sending your amygdala a message of safety.

• With your EYES ONLY, look to the right and hold.

• Breathe, relax, and allow your body to soften.

• Hold 30-60 seconds until you yawn or feel an internal shift. It can take practice to learn to feel this shift, but the yawn is a dead giveaway that this is working.

• Repeat on the left side.

Seated Salamander Exercise

• I like to do this exercise on my heads and knees so that gravity helps me breath out with my belly. You can also do it sitting up. Whatever works for you to get the release.

• With your EYES ONLY, look to the right and hold.

• Allow your right ear to melt towards the right shoulder (not turning your head).

• Breathe, relax, allow your head to be heavy and you body to soften.

• Hold 30-60 seconds until you yawn or feel an internal shift. It can take practice to learn to feel this shift, but the yawn is a dead giveaway that this is working.

• Repeat on the left side.

Sphinx with Head Turn

• Lay on your belly and prop yourself up on your elbows with your chest and head facing forward.

• Anchor your pelvis by pressing down through the pubic bone.

• Draw your shoulders down out of your ears and extend your neck naturally (don’t look up too much).

• Turn your head to look over your right shoulder and hold for 1 minute. Again, ou are looking for that yawn or internal shift into ease.

• Repeat exercise looking over left shoulder.

3. Brecka breath

I do this practice every morning as part of my somatics/polyvagal routine. It was recommended by a somatic teacher who said, “It may look and feel a bit bro-y, but if you are oxygen-deprived due to stomach gripping or tension myositis syndrome, this kind of breathing can help you.”

What separates this practice from others, as far as I can tell, is the intentional pause you take between rounds of breath. In this special pause you relax and tune into the sounds of the world around you. Stay in that space for a few beats before slowly inhaling, exhaling, then returning to the next round. It took me a while to catch the hang of it, but now I really love that pause.

How to Brecka breathe

• When just getting started, do 3 rounds of 10 breaths.

• Inhale deeply as shown in the video. Exhale naturally. Do this breath 10 times in a row.

• Let your shoulders rise as you breathe in. Fill your chest and belly on the inhale. Allow the exhale to follow the inhale without overthinking it.

• Once you have finishes one round of 10 breaths, pause on the inhale. Do not exhale.

• Tune into the sounds around you and try not to tense up as you hold the breath. Relax into the feeling. Check out the video to see what this looks like.

• Once you’ve held that inhale as long as you can, slowly inhale and exhale, then get ready for round two.

• Do another round of 10 breaths, same as above, then pause again on the inhale.

• Repeat one last time.

• Over time, build to 3 rounds of 30 breaths.

4. Mindset/emotion check-in

Every day I set aside at least 10 minutes to “tidy” my mindset. Depending on the day, I do this by journaling or sitting quietly in the sun. The goal is the same — to create the internal space to understand what’s happening that day on a deeper emotional level.

I use Nicole Sachs’ approach to journaling. It’s called Journal Speak. When you sit down to Journal Speak, your goal is to speak directly from the emotion itself, unmediated by thought or analysis. This is radically different from the way I journaled throughout my 20s, which was filled with overthinking and self-analysis. Remember, many of us unintentionally suppress and avoid emotions we perceive as negative. When we give voice to unconscious negative emotions, we’re defanging them and soothing our nervous systems.

When I’m not in the right place to journal, I do this same practice without paper, sitting quietly in the sun to tune into the negative chatter in my head. I try to feel the emotions surfacing in my body. I allow myself to rest in uncomfortable emotional spaces. This is not easy but I know that it’s important: By teaching myself emotions aren’t as scary as they seem, I am regaining control of my nervous system’s master switch. Once I’ve done that enough, I send soothing mantras/phrases to the parts of my internal self that are complaining the loudest.

5. Afternoon gear shift

Nervous system regulation is best practiced in small and frequent ways. It’s important to learn to shift gears periodically throughout the work day — moving from the sympathetic part of the system (“flight or fight”) to the ventral (“safety and connection”).

Learning to relax in between tasks is another way of mastering your nervous system’s light switch.5 I do this by taking a quick moment in the middle of the day to connect with nature. This could be 5 minutes spent in my backyard, a small walk up and down the street examining tree leaves, or sitting and petting my dogs. I tell myself, “It’s OK to coast sometimes. I don’t always need to be in overdrive.”

I’m a broken record but will say one more time: the goal is to teach yourself that you are safe. If you are able to do that, your entire system can relax, your pain will be lessened, and your anxiety will plummet.

Exercises for difficult moments

Everyday practices are great, but what should you do when you’re facing something hard? Ground, Orient, Resource.

Ground yourself by becoming aware of your feet on the ground or the seat under you. Orient yourself by selecting five things in your immediate environment to focus on, spotting details like color, form, and texture. Resource yourself by finding a small action that tells your nervous system you are safe. If any of these exercises resonate with you, they can act as your resources when you need them.

1. In-the-moment mantra

Too often overthinkers want to fix everything at once, and while that is a nice idea, it’s not always realistic. Having a phrase or mantra you say to yourself is a way to shift your mindset in the moment when you need it.

What makes a good mantra

• It has to be a phrase you truly believe — your nervous system will know if you’re faking it

• It should be powerful enough to interrupt unproductive or negative thinking

• It should be connected to a topic that tends to cause you stress

Examples of mantras I currently use

• “I am allowed to have a vacation from [insert issue].”

• “I know that future me has [insert issue] covered, so I am going to let this go for now.”

• “If I keep thinking this way, I will only get sicker. Instead, I am going to imagine a future in which I’ve solved [insert issue]. I will envision this future in detail and allow that feeling of peace to wash over me.”

2. Belly breathing

If you are a stomach gripper, this is a crucial exercise for your nervous system. Most belly breathing exercises tell you to push your belly out when you inhale. That description never worked for me — I didn’t understand it mechanically. Instead, I have taught myself to visualize the diaphragm in order to understand the mechanics of the breath.

Your diaphragm is a muscle below your lungs, represented here with a dark red line.

Think of your diaphragm as an upside-down-bowl that turns into a plate as it contracts, sucking air into the lungs via the vacuum it creates as it pushes itself flat. Since this muscle pushes down on the top of your belly as air enters your lungs, your belly sticks out. After inhaling, you allow your diaphragm to relax back into its upside-down bowl and naturally exhale. Belly breathing is not about pushing your belly out. It’s about allowing your diaphragm to contract (inhale, think of the diaphragm as flat plate pushing down) then relax (exhale, the diaphragm returns to its upside-down bowl state).

How to belly breathe when faced with stressful situation

• Start by releasing all tension in your upper belly. Pop your belly out on purpose to loosen up. Do this in any position, wherever you are.

• Next, imagine your diaphragm turning into a flat plate as it pushes down on your belly and you inhale. Your belly now pushes out due to the inhale.

• Inhale for a count of 5 or 7. Your belly should feel big and free. Pause for a moment at the top of the inhale.

• Now allow your diaphragm-plate to return to its natural curved upside-down bowl state as you exhale. Your belly will go in. Hold on to the feeling of looseness even with the exhale.

3. The Basic Exercise

In addition to being a great foundational practice to build your window of tolerance, this polyvagal exercise is great in the moment when you’re feeling stress.

• Sit tall wherever you are.

• Interlace your hands and clasp the back of your head between your ears, sending your amygdala a message of safety.

• With your EYES ONLY, look to the right and hold.

• Breathe, relax, and allow your body to soften.

• Hold 30-60 seconds until you yawn or feel an internal shift. It can take practice to learn to feel this shift, but the yawn is a dead giveaway that this is working.

• Repeat on the left side.

4. Neck massage using oil

This one is simple — I take a few drops of this scented vagus nerve scented oil and rub my neck and ears with it. I spend a couple of minutes trying to release tension in the sides of my neck and follow the patterns recommended for my specific migraine pattern as illustrated in Stanley Rosenberg’s book.

Whew, that’s a lot!

If you’re still reading this, good work. This stuff is not easy. Whether you’re at the beginning of your journey or a seasoned mindbody traveler, I would love to hear from you. Write me in the comments and let’s help each other along the way.

Recommended Reading

• The Pain Relief Secret: How to Retrain Your Nervous System, Heal Your Body, and Overcome Chronic Pain by Sarah Warren

• Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism by Stanley Rosenberg

• The Mindbody Prescription by Dr John Sarno

Recommended Listening

• The Cure for Chronic Pain Podcast with Nicole Sachs

• SOMA: Releasing Muscle Tension and Reliving Chronic Pain with Clinical Somatics Podcast with Sarah Warren

• Using Polyvagal Theory to Balance the Nervous System on The Adult Chair Podcast with Michelle Chalfant

All About the Vagus Nerve

Photo by Basil James

In the past three months, my understanding of how to navigate my dysregulated nervous system has been super-charged through my learnings about polyvagal theory and the inner workings of the vagus nerve. I read Stanley Rosenberg’s step-by-step book on the topic and met regularly with an incredible somatic educator / coach, Amanda Joyce, who has helped me put the pieces together in a new way. Amanda shared a page of her own notes about the vagus nerve with me, and I organized them into the sections you see below. I encourage you to dig into this summary, but then go deeper with Rosenberg’s book if you have the bandwidth. It is pretty mind-blowing stuff. Even though we still don’t understand all of the mechanisms of the vagus nerve, we understand a lot more than we used to, and this information can be a gamechanger for overthinkers who learn to harness its healing power.

What is the vagus nerve?

• The Latin meaning of vagus is “wanderer”

• Discovered in past two decades

• Allows for understanding of others' emotions

• Controls muscles for facial expression

• Displays emotions on faces and in voices

• Regulates basic functions like breathing, heartbeat, and eye dilation

• Plays role in sleep, mood, pain, stress, and hunger

• Largest organ in body’s autonomic nervous system

• Connects brain to large intestine

• Controls muscle movement in body

• Innervates trapezius and sternocleidomastoid muscles

• The vagal pathway bi-directional: 80% information from body to brain, 20% information from brain to body

• Communicates gut information to brain using neurotransmitters and hormones

• Responsible for receiving and spreading the message that you are safe, so it can restore regular functions, and you can relax. 

• The connection of your vagus nerve to your brainstem is different from being connected to your thinking brain. There is only one language the brainstem speaks: Am I safe, or am I unsafe?

• It receives fight, flee, or freeze messages from your brainstem (lizard brain) and help the rest of your body prepare to engage in a survival response.

• Through your brainstem, your vagus nerve — along with the cranial nerves responsible for senses like sight and hearing — scan both your internal and external environments for safety and danger.

• An important part of our body's control system is known as the "vagal brake" which is a system that helps regulate your heart rate and breathing. It's like the brakes on a bicycle that help you go faster or slower when needed and gives you the right amount of energy for each moment.

To understand polyvagal theory, you must first understand the relationship of the neck to the head

• The complicated coordination of tension and relaxation of the muscles that turn our heads requires precise muscle control. This is programmed into our nervous system in such a way that we do not have to think about the mechanics of it.

  • When something catches our attention, we automatically focus our eyes on it. The movement of our head follows the direction of our eyes, and then the movement of our body follows the movement of our head.

• Turning the head is one of the most important and complex movements of the body. As babies, it is one of the first movements we make. Control and coordination of the tensing and relaxation of these muscles depend on well-functioning cranial nerves.

  • Turning the head to either side should be an even, well-coordinated movement, without stops or jerks and without deviation from a smooth curve. Ideally, the head should be able to turn ninety degrees or slightly more.

• With chronic tension or flaccidness of these muscles, we obtain a forward head posture which reduces our breathing capacity which also means increasing anxiety, general fatigue, and low energy levels.

  • Forward head posture also puts pressure on the heart and crowds the blood vessels that go to and from the heart while compressing the vertebral arteries that carry blood up to the head, diminishing blood supply to the face, parts of the brain, and the brainstem.

What is polyvagal theory?

Presented by Stephen Porges in 1994, polyvagal theory is a model that describes the role the vagus nerve plays in regulating emotions, fear responses, and social connections. It identifies social engagement as a type of nervous system response.

• Social engagement is a playful mixture of activation and calming that operates out of unique nerve influence.

  • The social engagement system is a two-way interaction system (receptive and expressive) based mainly in the eyes, ears, larynx, and mouth but incorporating the entire face and the torso above the diaphragm. All twelve cranial nerves participate in the social and expressive functions. 

  • Social engagement is the human neurobiological network that is accessed when you feel safe, which facilitates connection/affiliation with others and your surrounding environment through eye contact, facial expressions, vocalization, and orienting of the body/face toward others.

• The social engagement system helps us navigate relationships. Social engagement forms the basis of social relationships by providing a sense of belonging, social identity, and fulfillment. Spending more time in the social engagement state of the nervous system is associated with positive health behaviors, and improved communication and social skills.

  • Social engagement is not a fixed or permanent state. If you have experienced an imbalance of time spent not in this state, then repeat balancing techniques should be done frequently or at least as needed. Since there is no such thing as a fixed state of balance, it is more useful to think of balance as an ongoing process.

• Societal expectations pressure you to feel as though you should appear calm and in control at all times. However, this is not how nervous systems work and does a disservice to honoring the importance and value of the other nervous system states and their many hybrids. 

  • Ventral vagal is safe and social (that is our connected state); you have the sympathetic, which is fight-or-flight; and the dorsal vaga- shut down or freeze. also have hybrid states

What the role of human connection to the nervous system?

• The human brain and our entire being (whether in children or adults) are designed for connection with a deep desire to be felt by others. We all need to be seen, valued, and met within our relationships. 

• Regulating your nervous system does not mean becoming calm; it means becoming connected. 

• Regulated or connected means having the ability to hold mindful awareness of whatever emotions you are experiencing while maintaining access to higher centers of the brain to remain grounded and connected in order to make decisions and respond.

• You can be angry and still connected to yourself.

• When we show up in relationships with the intent to be present with another person, it can sometimes look messy rather than calm in its presentation.

•  When “messy” is authentic and connected, and therefore regulated, even those moments can ultimately have the impact of repair, reconnection, and security. 

• The foundational trinity for connection is grounding, orienting, and resourcing. 

• GROUNDING is coming down to earth, feeling our bodies in relationship to the ground beneath us.  Feel feet on the floor, butt in chair, etc.

• ORIENTING is the process of becoming aware of our location in time and space- count colors, soft/loud sounds both ears, smells around room, taste in mouth, feelings touching your body

• RESOURCING refers to accessing our resources- could be sensations, emotions, colors, places, people, sounds, animals, types of music, places in nature, activities, animals, or people, symbols, words, concepts, archetypes, or figures— anything that shifts your state in a positive direction toward a sense of well-being, safety, gratitude, grounding, compassion, empowerment, or inspiration.

Building the “window of tolerance”

• A window of tolerance is the range of nervous system arousal you can tolerate without becoming overwhelmed and either hyper or hypo-aroused.

  • Stressors, both good and bad can still occur when you're within this window, but you are better able to tolerate the discomfort, and you're able to respond instead of simply reacting if you have good vagal tone

• It is neurobiologically and behaviorally possible to be highly aroused and still be regulated and contained within one’s window of tolerance. Discerning the difference between regulated activation of emotions as information and triggered states of emotional dysregulation that lie beneath awareness is a critical distinction. 

  • If you're feeling anxious and want to calm down, concentrate on your exhale. If you're feeling stuck and want to become more alert, focus on your inhale.

Emotional metabolism

• Here is what we know: what appears to arise from the mind might actually be being caused by the body, and looking after the body is, therefore, key to looking after the mind. 

• When your nervous system is overwhelmed, your neocortex goes offline, which means you can neither take care of yourself as you operate in real-time nor integrate any new skills. This is why when you are overwhelmed (reptilian brain running the show), you are not logical or rational (traits found in the neocortex).

• Pendulating is a term that describes the natural rhythm of contraction and expansion within our bodies. Think of it as the natural flow of breathing in and out.

• Understanding and experiencing this rhythm reminds us that even when we're going through tough times, there will be relief.

• Using pendulation has begun the deep work of getting to know your nervous system states and tracking your sensations, which will guide you to understanding what yes, no, and maybe feels like inside your body- connecting to your intuition. 

• This work will help you build resilience, choose clean pain, and train your nervous system to shift flexibly to different states as needed. Using your vagal brake, keeping your neocortex online, and metabolizing emotions will help you find freedom inside your body as well as your life. 

• And just like any muscle you are working to tone, it takes consistent training. Knowing the information and waiting until you are in desperate need of the tools will make it incredibly difficult to implement them.

• As you become more confident in your ability to stay grounded and in control, you can consciously adjust the balance towards calm when anxiety rises or towards heightened readiness when you need to take action.

• If you speak rationale to someone overwhelmed, you may as well be speaking another language. Think of that time you lost it (hyperarousal) only to later think, Okay, maybe I overreacted. Though at the time it absolutely did not feel like you were overreacting.

Exploring the Vagal Brake

• The vagal brake affects your breathing rhythm. It  slows down your heart rate to keep it within a healthy range (between 60 and 80 beats per minute). 

• When you breathe in, the brake eases up a bit and your heart beats a little faster. When you breathe out, the brake engages and your heart rate slows down again.

•  It's like gently squeezing and releasing the bicycle brakes. Focus on extending your exhale, which engages the brake slightly and helps calm your system.

• Picture yourself with one foot in a state of social engagement and the other foot in a mode of heightened readiness, like preparing to take action. Shift your weight between them, swaying slightly from one foot to the other. 

• Inhale as you lean towards the foot associated with heightened readiness, and then exhale as you shift your weight back to the foot associated with social engagement. Do this for a few breath cycles to feel the rhythm of your "vagal brake" releasing and re-engaging.

• As the vagal brake releases, you'll notice a range of responses becoming available. You may feel engaged, joyful, excited, passionate, playful, attentive, alert, and vigilant, all while remaining within the boundaries of safety and social connection provided by the ventral vagal system. 

• Without this vagal brake, we risk losing our sense of safety and connection and can easily slip into the protective states of fight-or-flight.

• Experiment with pushing the limits of this release. 

• Shift your weight in such a way that you're almost entirely leaning towards heightened readiness. Notice how your balance starts to shift and you might feel less steady. Then, return to a solid base by shifting your weight back to the foot anchored in social engagement. 

• Try the opposite too, with most of your weight on the foot connected to social engagement, and just a light touch on the other foot associated with heightened readiness. Observe the changes in your experience.

•  Experiment with how your vagal brake allows you to gather and mobilize energy and then helps you return to a state of calm.

• Recognize how the vagal brake serves as a boundary between the safety and regulation of social engagement and the survival response of heightened readiness.

• Once you've grasped the concept of your vagal brake, you can start playing with adjusting the balance between energy and calm deliberately.

• Practice maintaining your anchor in safety while experiencing mobilization. Alternate between periods of rest and taking action. 

• Explore the full range of experiences that emerge as you release and re-engage your vagal brake.

• Think about situations in your daily life where you either need to be energized or calm, and consider how you can use your vagal brake to help you navigate those moments effectively. 

• Recall a situation where you needed more energy and visualize yourself releasing the brake to meet that need. Then, bring to mind a moment when you wanted to feel more relaxed and re-engage your brake to achieve that sense of ease. You can use past experiences as a reference and play around with the idea of releasing and re-engaging your vagal brake to imagine how the right balance of energy might have changed those situations.

That’s it for the notes…for now. More coming soon, I’m sure.