Autism from the Inside Part 11 — Anxiety
Everyone experiences anxiety. It is born out of fear. Fear of rejection, fear of abandonment, fear of vulnerability, fear of fear. Buddhists use the word Dukkha to describe that unease or instability. Fear of fear is what they call double dukkha. Anxiety about anxiety.
It is part of the fight, flight, fawn response to perceived dangers in our environment.
Autistic people experience anxiety quite frequently and I guess the reasons for that are past trauma or cPTSD. We try fail, try and fail, try and fail and in the process build increased emotional empathy and compassion. But we do so at a cost to ourselves. We stand up for other people and become traumatised, then stand up for other people and become traumatised, to the point we need more time to isolate ourselves from society. With each attempt internalising our failures. The manager of the local Buddhist meditation centre here in Reading said to me “I have heard of people going around the karmic cycle in the wrong direction, but never met someone”. She is describing this self-sacrificial cPTSD cycle. The fast-paced world takes its toll on our nervous systems so we experience shutdowns and meltdowns.
I have been diagnosed with a Generalised Anxiety Disorder many times during my life. For the most part I self-medicated with alcohol to numb the pain, then prescription SSRIs, then CBT, then psychodynamic therapy. Last year I started a new job (I told Occ Health about my anxiety before taking up the post), but was put into a fast-paced chaotic environment that rapidly pushed my anxiety beyond my control. There was too much disorder for me to calm down. I went on sick leave with the NHS, which made my anxiety even worse, because I could not compute what to do whilst being on ‘sick leave with the NHS with anxiety’.
I used every possible online resource I could find to try to regulate my nervous system and here’s what I learnt.
“Generalised Anxiety Disorder” is a medical label, one we can choose to associate ourselves with or not. I went around saying “I have an anxiety disorder”, “I have an anxiety disorder!”, “I have an anxiety disorder!!” very quickly “I have a panic disorder!”, “I have a panic disorder!!” and it was game over. I became a tortured ball of panic for months, having panic attacks from the moment I opened my eyes in the morning, and 2 or 3 myoclonic seizures during the day.
I was a workaholic, so my blueprint is to do rather than be. I need to do something to make this stop, what can I do? What can I do?!
We need to stop doing and deploy our parachute. The para-sympathetic nervous system. The rest and digest response that tells our nervous system to stop.
Here’s how:
- Yawn. Yawning invokes a primitive pack animal response when there are no threats. It tells individuals within the herd that they are safe. You are safe. Yawning is contagious and calming.
- Valsalva Manoeuvre: The manoeuvre divers use to clear the nasopharyngeal airway, activates the vagus nerve, which regulates heart rate and therefore blood pressure. Whilst doing that manoeuvre also bear down as if having a bowel movement for about 10 to 15 seconds, then exhale. This causes a forced rise and then relaxing decrease in blood pressure as you exhale.
- Self Havening. This is used with combat veterans and nurses alike, and others who experience traumatic situations.
- Side-hugging. Self havening mimics being hugged. There is a lack of hugging in healthcare due to safeguarding and the perceived sexualisation of the act. But I learnt about side-hugging whilst working with traumatised children (an approved method written into the school behaviour management policy). Side hugging helps co-regulate someone's nervous system. I see no reason why it can’t be done more in the NHS. A lack of compassion is a common criticism of staff in the mental health services, and side-hugging really isn’t difficult.
- Encourage the panic. The more we try to stop the anxiety the stronger it becomes. So instead try to invite anxiety. This is counter-intuitive but telling the panic attack to “bring it on!” actually calms down the physiological response.
- Breath. Use an app like Breathly or Relief, to count and control your breathing. There are lots of different breathing exercises you can learn.
- Educate yourself on what a panic attack is. It is a physiological response from an over-active amygdala. Like a toaster placed underneath a smoke alarm. The alarm goes very easily. Learn about the vagus nerve and dorsal-vagal theory and practice these techniques.
- Cognitive Re-framing. Describe the thing you fear is happening or will happen, and re-frame the situation. This is not always possible if you are in a genuinely life-threatening situation, but it can slow spiralling thoughts.
- Cognitive Defusion. Learn to look at your thoughts rather from them. I mentioned that I found labelling and focusing on the word “anxiety” amplified the response into panic. It easily gets out of control. Cognitive defusion is at the heart of mindfulness based stress reduction, which has roots in Eastern meditation, in which you learn to become the mindful observer — my body is doing this thing, but it is not me. These thoughts are entering my mind, but they are just thoughts, they are not me. “I probably worry too much”, “I’ll choose not to worry”, “It is what it is”.
- Cognitive Behaviour Therapy teach us to insert spaces between stimulus, thought and response. Space to choose each outcome. If like me you are in a chaotic environment where everything is happening all at once, it is very hard to insert spaces. But removing yourself from the environment, or away from the trigger allows you to catch your breath, stand back and then take a more rational approach on whether you want to intervene or how you want to respond.
For those interested in Autism I recommend watching the film “Incredibly loud and extremely close” because in the context of autism chaotic environments can be just that — incredibly loud and extremely close.
Having said that you may assume that autistic people are useless balls of anxiety when placed in difficult situations, but far from it. Anxiety is linked to our expectations. When I worked with violent children I expected to be attacked. When I worked in A&E I expected to face difficult situations. We can often be a very calming presence when the situation demands.
I learnt a valuable lesson whilst working with vulnerable people in schools and in the NHS. Particularly as an A&E porter — vulnerable people and those without capacity don’t need squeamish people who fold up. You are the calm influence, you are the rock of stability, no matter what is going on around you.
This has been useful outside the workplace for me. A few years ago a man was shouting and crying in my local supermarket, everyone was keeping their distance trying to avoid the drama. I put my basket down, walked over to him, helped him to the floor, saw he had burns on his legs, so instructed the staff to call an ambulance, and sat with him. By the time the ambulance crew arrived the aisle was closed and he was laying calmly in the recovery position with me.
Whilst working in a Prison I found myself in the middle of a riot, with tables and bedframes flying around me on the wing. My role was to look after a visitor (who seemed frightened). I recognised I wasn’t responsible for quelling the riot. I called it in on the radio, allowed the chaos to happen over me, and calmly walked the contractor out of the block to safety.
I have similarly disarmed a man in the street with a gun and a few people with knives at my throat in the course of my life, by not engaging with what they wanted to do, but by focusing our minds on the clear sunshine that exists behind every cloud.
If you see someone is anxious co-regulation is also a wonderful way of helping them re-regulate their nervous system, by standing next to them in silence you can share your calmness, demonstrating that person is safe. Demonstrating that the perceived danger is just that. Perceived. Someone did this with me last year and I don’t think she knows how big an influence it had and how much I appreciated it.
This is by no means a comprehensive article about everything related to anxiety, because we all experience it in different ways. But please share this and comment, because we are often bombarded with crises and fears, and I hope these tips can help others find peace and calm control.
