Cognitive behavioral therapy (CBT) is a widely used approach to treat symptoms of general anxiety disorder (GAD). The goal of CBT is to help an individual be more tolerant of their worrying behaviors, thus decreasing the negative psychological and physical symptoms of GAD. Applied relaxation (AR) is an alternative approach that is used for various mental health problems, including GAD. It focuses on the somatic symptoms of tension and physical discomfort associated with anxiety, with the goal of reducing worry. Both CBT and AR have been shown to be effective at diminishing the symptoms of GAD in individuals who struggle with emotional and somatic symptoms. However, few studies have compared the dynamics that cause the symptom reduction in each of these treatment approaches.

Eleanor Donegan of the Department of Psychology at Concordia University in Montreal sought to identify the mechanisms by which AR and CBT worked and also to determine if one was more effective than the other at maintaining long-term symptom reduction. For her study, Donegan evaluated 57 individuals who underwent either AR or CBT over a period of 12 weeks. She found that for both groups, the amount of time they spent worrying each day decreased from approximately 36% of the time to 20%. Additionally, both AR and CBT reduced the amount of daily anxiety by nearly 50%.

Donegan noted that even though the participants were much less anxious as a result of their treatment, they still had significantly higher levels of worry and anxiety than non–clinically anxious individuals. When Donegan looked at how the effects were achieved, she found similarities and differences. Specifically, even though both AR and CBT decreased somatic anxiety, the effect on worry was more significant in the individuals who underwent CBT. However, Donegan believes that both of these techniques could be useful to address GAD. She added, “Change in worry occurs in part because of change in somatic anxiety, and vice versa, in both CBT and AR.”

Reference:
Donegan, E., Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0028132

All of life, all of learning and growth, all of healing follows a spiral path. We return over and over to a place of pain or suffering in order to master the lessons held therein. Each revolution of the spiral brings us more experience and perspective and skill, so that our path is smoothed and we become increasingly resilient and expansive. This sounds good, but in practice it can be quite difficult.

When we find ourselves repeating old patterns we thought we had gotten rid of, dealing with the same difficult people repeatedly, or turning into a teenager again after spending 15 minutes with certain family members, we may feel discouraged. When we are trying to change our behavior from something we dislike to something we like, or to something more functional from something less functional, it is hard to find ourselves in that familiar, rotten territory—all our hard-won awareness shines a blinding light on our foibles, while our bag of well-earned tools hangs loosely at our side, for all intents and purposes utterly empty. But these are actually opportunities for change, and so we can welcome them.

It isn’t easy to change how we do things. The older we get, the more years of habit we have keeping us in the familiar groove, whether or not it serves us. Those grooves were laid down very early on, when we were soft and spongy. Those tracks can be very difficult to obliterate or alter. But not impossible.

Fear not, and do not dismay. These seeming setbacks are natural, normal, and in fact necessary to the process of living our lives, healing our suffering, and moving along our life paths. If we can accept that we have certain lessons we need to learn, it becomes less onerous when they pop up repeatedly. Comprehending the spiral nature of self-healing and understanding the stages of change can help us recognize our successes and appreciate our own hard work.

Awareness
First, we develop awareness. We notice that something isn’t right. We aren’t happy in our relationships or we aren’t satisfied with the quality of our lives. We may search for understanding, in counseling or through contemplation or self-study, or simply wake up to what we are doing. This can be a very painful part of the process of change, but it is necessary. If we don’t know what we are doing, we can’t change anything. But at this stage, we can’t usually act differently.

If we cultivate a nonjudgmental observer’s point of view, a friendly curiosity about ourselves, we can gather a lot of information. This kind, detached attitude also helps us avoid triggering the old patterns, most of which evolved out of self-protection. Refraining from attacking ourselves when we see these patterns means we won’t aggravate them further. No salt in the wound.

Alternative
Once we understand how we get ourselves in trouble, we can choose an alternative, the next stage in the process of change. The general rule here is, “just do something different.” We are talking about change, not perfection. Doing something different is a success, even if it is not pretty or smooth. Learning to excuse ourselves to go to the bathroom instead of engaging in a habitual conflict is not the only strategy we will ever employ, but just breaking the momentum of a negative habit is a powerful experience.

Practice
The practice is up to us. This is the third stage. We have identified the problem, the alternative to it, and now we have to actually walk the path. We will not do it perfectly or have fabulous results every time. We will be clumsy and mess up. If we use our friendly awareness skills, we will notice that just practicing—whether it is meditating, thought-replacing, or lifting weights—is a reward in itself.

Practicing anything intentionally engages us with our lives. The more we practice the new action or thought, the less room we have for the old one. We realize that our work is paying off. We find ourselves automatically saying the new words, pausing where we might previously have rushed in, or stepping forward with confidence where once we might have hidden. We start to see that our work in one area spills over into other areas. Just as lifting heavy weights in the gym translates to ease in lifting grocery bags, children, furniture, and other previously immoveable objects, working consistently with our minds eventually brings more peace, more happiness, and less suffering to ourselves and those around us.

Please note that after the third stage—or any time, really—we circle back around to the first stage. There is no final stage where we win. The process never ends, but it gets easier with practice, so we might as well relax.

This month our Paramita, or practice on the path towards happiness, is patience. The practice of patience involves a shift in our perspective. Buddhist teacher Sylvia Boorstein says patience “…remains present as long as the mind remembers that things end…when their conditioning causes end…” Conditioning causes are the elements that are coming together in this particular place and time that are causing us stress. In other words, have patience, this too shall pass.

Stress could, in fact, be celebrated as the only opportunity we have to practice patience. Of course, our habitual tendency is to react against stress rather than greet it with enthusiasm, but that doesn’t mean it’s impossible to do so. Try it sometime.

We sometimes object to the idea of patience, as if it will make us passive patsies and “someone will get away with something” (oh, no!). Holding this attitude, we ignore the depth of harm we do in our impatience, and also misinterpret the actual practice of patience. Patience isn’t standing by while harm is done to us or to someone else. It is not about letting someone take advantage of us or abuse us. Patience is the capacity to calm the mind under stress so we can see our way clearly. In an abusive situation, for example, patience can lead us to make a plan for our safety, and come up with an exit strategy that will actually accomplish our freedom. Impatience can lead to running out of the house without clothes or money or any support at all, and where does that end up? Not in a good place, usually.

What Does Patience Have to Do with Happiness?

Patience is the antidote to anger. If we are irritated or angry or even feel violent impulses, we can actually learn to wait until the feelings pass, which they will. Anger can be difficult to work with, because it so strongly compels us to action. We often feel we will have no relief until we let it all out. In truth, we always do harm when we act out of anger, whether towards another being, a circumstance, or ourselves.

Patience comes from having confidence, born of awareness, practice, and experience that the storm will pass, and that if we ride it out, all will be well again. I recently heard a woman on the radio describing her radical approach to conflict in intimate relationships; instead of “Never go to bed angry” she suggested just going to bed, and seeing if you are still angry in the morning. Given the impermanent nature of all emotions, this approach makes sense. If there is something you can do about it, no need to get upset. If there is nothing you can do about it, there is no need to get upset.

[fat_widget_left] The therapist who changed my life in my mid-twenties used to tell me, “The reward of patience is patience.” I didn’t find that appealing in the least, and I told her so. I may have said, “So what?” or “What’s that got to do with me?” I was impatient and had no interest in slowing down. I could not conceive of any possible benefit to patience. If it was its own reward, that meant nothing to me. Twenty-five years later, I think I may have finally caught on a bit.

When I put some effort into practicing patience in one area, such as in traffic or with a person I might find irritating, then patience is more likely to arise spontaneously, without effort, when I need it most. I was on an airplane recently that had been delayed by weather. We were two hours late taking off, and most of us were going to miss our connections. The man sitting next to me was extremely fretful and frustrated and tense, and I found that I was actually quite relaxed. We chatted a bit, and I tried to cheer him up, but I could see how deeply attached he was to feeling upset. He told me he traveled a lot for business and it was just getting worse and worse. I agreed that air travel has grown pretty unpleasant for most of us, but I noted to myself that, above all, we have the experience we create for ourselves. That day I realized that my efforts to develop patience had paid off—I felt patient without even trying!

What does patience feel like? For me it is relaxing, energizing, with a clear tone, like a bell, and a view that goes on as far as the sky. Patience is the willingness to stop stirring the water of the pond we are trying to look into. Patience sets down the stick and waits for the natural clarity of the settled water to arise. (Of course, as a teacher of mine noted recently, then we can see all the junked tires, tin cans, and skeletons down there on the bottom!)

Patience is trusting our natural minds to know what to do when we stop disrupting and distorting what is actually happening in the here and now, and practice mindfulness.

Now, I eventually ended that plane trip in a miserable heap, having missed too many planes to reach my destination and having a respiratory illness that forced me to make a last-minute decision to just go home. So, patience is not the answer to everything, nor is it guaranteed to stick around all the time. What stands out in my mind is the contrast between myself and that fellow steeped in anxiety on the airplane, and the knowledge that it is possible to feel calm even when our impulses drive us strongly toward distress. The reward of patience is, in fact, patience!

Five Steps to Cultivate Patience:

• Meditate regularly, for 5, 10, or 15 minutes daily.
• Count ten breaths (yes, ten) when feeling stressed.
• Remind yourself that the other person is acting out of pain or ignorance and needs your compassion.
• Remember that this too shall pass.
• Give yourself 24 hours before you act.

What other ways can you find to practice patience?