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  • Yaniv Gafner

Alleviating Anxiety - A Body Psychotherapy Approach



Search not elsewhere,

It is too far from self.

Look on one’s own

And it is everywhere.

It is I but I am not it,

This is the way to truth.

Untitled / Liangjia


Introduction

It’s almost too simple, I thought to myself. Could it be that by guiding my patients to reconnect to themselves, I’d be helping them alleviate their anxiety? Could it be that the answer to dealing with anxiety is self-connection?


If scholars, psychiatrists, and researchers are hard searching for the complex reasons, sources, and solutions to various Anxiety Disorders, I may be off track. Still, the evidence in my clinic shows time and time again — reconnecting with oneself alleviates anxiety.


Now, what does reconnecting with oneself actually mean? It means different things to different people. The academic term for self-connection may be intrapersonal, which is defined as “occurring within the individual mind or self,” and I would add within the body. In Neuroscience research it is often referred to as interoceptive — the part of our brain that allows us to observe ourself.


For some, it may mean dedicating time for oneself or doing a pleasurable activity alone. Writing, exercise, and meditation are common practices for increasing one’s intrapersonal relationship, but their effects may be temporary. Others cannot tolerate being alone and constantly seek company or activities to keep them busy and distracted, which often result in increased anxiety. Even going to therapy may serve as a distraction if it focuses solely on behavioral symptoms and interpersonal aspects.


There are patients I’ve seen for whom reconnecting to themselves sounded like a silly idea. “I am myself,” or an empty agreeable gesture were common reactions. For others, the idea invokes fear and anxiety. And, there are those who find the connection to themselves or to their body to be vague or ambivalent.


When I ask, “How are you feeling right now?” or “How do you experience yourself?” Those patients often respond with “I don’t know,” or “I don’t feel anything.” It is exactly this disconnection that prevents them from feeling present, grounded, secure, confident, in their place, in themselves. They are left feeling anxious, lost, or confused with headaches and other somatic symptoms.


Searching online for “Anxiety treatment” yields about 255,000,000 results! From Cognitive Behavioral Therapy, Psychiatric medication, Focusing, Mindfulness, psychotherapy and all the way to natural remedies. Every modality has its own specific approach, but most seem to focus on reducing symptoms and changing behavior.


As a Biosynthesis Psychotherapist, I don’t focus on symptoms or behavior, rather I help my patients contain them. I don’t try to “change” my patients, rather I accept them as they are and encourage them to accept themselves just the way they are. This self acceptance may be the cornerstone for reestablishing the intrapersonal relationship in a person suffering from anxiety, or any person really. And often times, this then, enables the change they long for.


A crucial component in reestablishing and deepening the intrapersonal connection occurs on the energetic level. There are several ways to do that, but the fundamentals are breathing and grounding. These are also important keys to alleviating anxiety. I will elaborate on all of that later on.


In this paper I shall explore the history and evolution of body-psychotherapeutic approaches to anxiety through the works of Wilhelm Reich, father of body-psychotherapy, and two of his leading disciples, Alexander Lowen and David Boadella. And, using case studies from the clinic, I offer my approach as a Biosynthesis Psychotherapist in helping those struggling with various forms of anxiety, including general anxiety and sexual anxiety.


In a 2013 interview, David Boadella, founder of Biosynthesis, defined the main goal of therapy as “[helping] a client move from his problems to his resources… so that he can lead his life in a way that is satisfying and become his own therapist.”


For me, above all, this means helping a client reconnect to himself. It’s true that we can have external resources, but our most powerful ones exist inside of us. The deeper we know ourselves — cognitively, physically, spiritually — the more we are true to ourselves, to our being, to our essence. And in turn, anxiety is reduced, we accept, sense, and feel ourselves, which helps us express ourselves, act, reach out, and connect with others in a way that is true to our way, pace, wants, and needs. This is what connecting to oneself means, and this is what enables oneself to “become his own therapist.”


Part I

Putting a shirt over my three months old son, I could recognize his anxious reaction. With his face covered, even for a moment, his eyes cannot see and his breathing is constricted. He immediately begins to pant and move his hands and legs rapidly, attempting to change the situation and restore the harmony of his fragile existence. And indeed, the very moment I pull down the shirt, his breathing slows down and his whole body relaxes. This is a simple example of the evolutionary, natural reaction of the body to a situation that is experienced as dangerous, or in a word — anxiety.


The most basic definition of Anxiety is “apprehensive uneasiness or nervousness usually over an impending or anticipated ill”, meaning, worrying about what might happen. Anxiety is inherent in all living organisms thus every living creature experiences anxiety. It is an important and useful function of life. However, as with every other natural process, the problems begin when disturbances occur that prevent its completion.


I would like to elaborate on the physiological and psychological causes and effects of anxiety by going back to the beginning:


“In his first publication on anxiety neurosis Freud based his thinking on the fact that “anxiety neurosis is accompanied, in whole series of cases, by a most significant reduction of sexual libido psychic desire,” and he concluded that “the mechanism of anxiety neurosis… is to be sought in diversion of the somatic sexual excitation from the psychic, which process then causes the abnormal utilization of this excitement.” This “diversion from the psychic” can be brought about only through repression of perception of genital sensations. Somatically this means nothing other than prevention of the shift from the vegetative to the sensory-motor system.”


This excerpt from Wilhelm Reich’s book Genitality in the Theory and Therapy of Neurosis, quotes his teacher, Sigmund Freud and makes specific references to the libido, which Reich later coined as Orgone energy, and the Chinese call Qi. What this simply means is that when the natural process of anxiety is incomplete, it interrupts the natural flow of life energy between the autonomic nervous system, which is largely unconscious and in charge of the flight or fight response, and the sensory-motor system, which is in charge of the ability to take sensory information and use it to make useful motor actions.


To put it simply, if anxiety becomes chronic (neurotic), its energy is accumulated in the body and disrupts the otherwise natural reactions of the person in response to a perceived threat. Alexander Lowen, M.D., the prominent American psychotherapist, student of Reich, and my personal therapist from 2001 to 2002, explains this correlation distinctly: When “the level of discharge is inadequate, the first result is the production of anxiety.”


Here I would like to bring an example from a patient of mine. Joseph, a 35 years old man who reported about suffering from premature ejaculation and severe pain in his groin during intercourse, particularly in more aggressive positions and situations. As soon as he changed positions or ended the sexual act, the pain subsided. His natural impulse in response to sexual excitement was met by performance anxiety, which in turn blocked the flow in his body and produced the pain. The greater the excitement, the greater the anxiety, and the greater the pain Joseph experienced.


This is an example for the anxiety neurosis and the disruption of the natural flow of energy, or communication between the autonomic nervous system and the sensory-motor system that Reich wrote about. Further, Reich wrote: “we observe in analysis that anxiety increases as soon as even the perception of genital excitation is repressed, and abates when the perception is tolerated.” Under healthy circumstances, the accumulation of energy in the form of excitement and anxiety in Joseph’s body, would have been discharged in the sexual act and result in pleasure rather than pain.


According to Reich: “If orgastic motor satisfaction does not occur (sexual discharge), and if the sexual excitation does not become bound up in psychoneurotic symptoms (Joseph’s inability to contain his sexual excitement, leading to premature ejaculation), a renewed blocking of genital sensibility usually occurs (Joseph’s groin pain), and the anxiety, including all the vasomotor phenomena, sets in once again. Of course, this anxiety is no longer pure stasis anxiety in that it now also expresses the ego’s “fear” of its own sexual needs” (Joseph’s performance anxiety.)


In contrast, when Joseph started a long-distance relationship with a woman, he would get sexually aroused while talking to her, but wouldn’t masturbate or ejaculate. He delayed and avoided ejaculation for months until he was able to unite with the woman. This energy built up in his body and created a stasis that again, produced pain in his groin. During that same period, and in direct correlation, Joseph’s anxiety was markedly increased and affected him both personally and professionally.


Both instances — the premature ejaculation and the delayed ejaculation — were accompanied by anxiety, and reflect the body-mind split in Joseph. He was either too anxious to contain the excitement or too anxious to release the excitement. In both these contrasting instances, the flow of energy was blocked, it accumulated in Joseph, and left him feeling anxious most of the time.


In his summary of the four aspects of energy metabolism that can be taken as crucial for growth and development — Energy flow, Energy level, Energy direction, and Energy containment — David Boadella, one of the pioneers of body psychotherapy, founder of Biosynthesis, and my inspirational teacher, wrote that Energy flow is concerned with “the circulation of energy from centre to periphery in streaming pathways," with the basic pulsatory polarity of “expansive reaching out to the world (in pleasure), and contracted shrinking in from the world (in unpleasure and anxiety).” Energy level simply means how much energy one has - that depends on breathing and eating. The less you breathe, the less energy you have. Energy direction has to do with grounding (discharge through the legs and genitals/recharge through the feet) and sounding (discharging through self expression/recharging by the intake of air and nourishment.) And finally, Energy containment involves the ability of the person to contain and release impulses (by tensing up or relaxing the musculature.)


Joseph experienced disturbances in all four of these aspects. For biographical reasons I won’t go into here, he remained contracted more than he was able to expand, even in pleasurable situations. His breathing was flat, his pelvis rigid, he was ungrounded and unable to contain high charge, or he contained too much charge depending on the situation. He suffered from what may be regarded to as pleasure-anxiety.


Reich wrote about this extensively, but the basic idea is that “the individual brought up in an atmosphere which negates life and sex acquires a pleasure-anxiety (fear of pleasurable excitation) which is represented physiologically in chronic muscular spasms… It is a bio-physiological anxiety and constitutes the central problem of psychosomatic research.” What this means is that anxiety is a physiological phenomenon and not just a psychological one, which occurs on the body level and leads to somatic and cognitive symptoms.


In my sessions with Joseph, we spoke a lot about the history of his life as well as about and his dreams and aspirations, but I also wanted to connect him to the present. There are several ways to do that, but I found that for him, working directly with the body was most effective.


The doctors Joseph went to see found no pathology that could explain his persisting pain so it became clear to me that it may be the result of chronic muscular tension and the subsequent anxiety. I invited Joseph to try several exercises aimed at releasing muscular tension and relaxing the groin and pelvic area.


For example, using this simple Bioenergetic exercise was highly effective: Joseph laid on the mattress on his back, placing his feet flat on the floor about shoulder’s width. I invited him to move his knees slowly apart without moving his feet in a slow effortless movement. I encouraged him to stretch his knees as far apart as they would go and then slowly bring them back together and so on. All the while I asked Joseph to breathe continuously and easily.


At first, his movements were mechanical and quite fast. But with time, Joseph was able to relax into the exercise and sync the movements to his own rhythm. That’s when he was able to breathe more deeply and to allow the involuntary vibrations in his legs to occur more freely, which he first experienced as weird or as a sign of weakness. Later, he was able to give in to the involuntary movements and accept them as the way of his body to release tension, and in a way represent the life of his body. This showed Joseph the pain he carried was unnecessary and that change was possible for him.


Following our sessions Joseph saw significant changes immediately when his pelvic area felt more relaxed and the pain in his groin disappeared. And over time, Joseph was able to feel more confident and less anxious about his relationship with the woman and his life in general.


Of course, it was not a stand-alone exercise that changed Joseph. This was all done as part of a year-long therapeutic process in the context of his life. The exercises helped him reestablish his intrapersonal relationship through his body and to discharge some of the pent up energy, which in turn enabled him to feel less anxious and more present, grounded, and confident. To feel more himself.


Part II

We are now nearly a century after Freud and Reich studied anxiety neurosis and the phenomenon has become increasingly widespread. Today, in 2017, anxiety is considered so common that a recent article in The New York times, was entitled “Prozac Nation is now the United States of Xanax.” This of course, is a reference to the all too common use of the anti-anxiety drug, which has now surpassed the antidepressant drug.


If Reich was concerned with the physiological aspects of anxiety, the following definition from Mosby's Dictionary of Medicine, Nursing, and Health Professions, provides a glimpse into the symptoms people face when suffering from anxiety: “anxiety is the anticipation of impending danger and dread accompanied by restlessness, tension, rapid heartbeat, and rapid breathing that may or may not be associated with a certain event or situation.”


This general definition adds to natural anxiety the question of whether the reaction is associated with an actual event or not. When it does, the anxiety passes when the threat passes, just as it did for my son. When it doesn’t, it may persist, in which case, it turns into a chronic condition, or worse, it becomes a disorder. It interrupts a person’s daily function and quality of life, often in the form of physical symptoms as well as in episodes of paralyzing anxiety or panic attacks.


It’s interesting to note that “Anxiety Disorders were only recognized in 1980 by the American Psychiatric Association. Before this recognition people experiencing one of these Disorders usually received a generic diagnosis of 'stress' or ‘nerves’.” Is there anyone in this world who doesn’t experience stress or nerves? We all do.


In this globalized, hyper-technological, high-paced age, this phenomenon is not exclusive to the U.S. People all over the world are dealing with anxiety. Here in Israel, a country battered with external and internal conflicts, anxiety is rampant. Every single patient that came into my clinic suffered from anxiety one way or another. From social anxiety, to exam anxiety, performance anxiety, and all the way to existential anxiety. Even highly functional individuals carry in them unnecessary anxiety by trying to keep up with whatever it is they think they are supposed to do and be.


As a therapist, I can see in my anxious patients the personal and cultural effects of anxiety and its fluidity from a natural reaction to a threat, to a chronic condition in which the threat is perceived as constant, and all the way to panic attacks, in which the threat is perceived as imminent even when it is not.


Dissecting anxiety furt