Mind and Emotions (20 page)

Before turning your awareness to your emotions, begin with a few minutes of mindful breathing. Just close your eyes and notice your breath as you learned to do in chapter 5. Either count your breaths or say, “In… Out…,” to help you keep your focus on your breath. If a thought intrudes, notice or label the thought and then let it go.

Once you’re more centered after a few minutes of mindful breathing, let your attention expand to include other physical sensations. If you want, you can briefly scan yourself from head to toe and note physical sensations in each part of your body.

When you’ve observed your physical experience, expand your awareness to your emotions. Watch what’s happening in your emotional life
right now
. If descriptive words or labels come to mind, that’s fine. But if you start analyzing or judging your feelings, notice and let go of these thoughts. Just stay with your feelings and observe how they evolve and change over the span of a few minutes. Notice if you’re experiencing more than one feeling or a blend of emotions.

Bring a sense of compassionate acceptance to everything you observe. These are the emotions of a human being who struggles yet is trying to carry on and survive. Breathe into the emotion, wherever in your body it seems to originate, and accept it for what it is: a feeling that comes with being alive. Don’t try to fix, change, or suppress the feeling. Relax into it, even if it hurts.

After you’ve observed your emotions for a while (five to fifteen minutes, depending on how much practice you’ve had), come back to mindful breathing. Let yourself focus on the calm, steady sense of each breath.

During this week, try to set time aside each day for mindful awareness of your emotions. If you do, your feelings will gradually seem less frightening or overwhelming. Instead, they’ll become like passing weather: something to notice, accept, and observe as they change and evolve.

Practicing Imagery-Based Emotion Exposure

Now that you’ve fine-tuned your emotional awareness, you’re ready to start using imagery to induce target emotions that you want to work on. Whatever your target emotion might be—anxiety, anger, sadness, grief, or shame—select a recent event where you felt it strongly and then visualize the scene. Where were you? Try to see every detail of the environment, and also notice who was there, what they were wearing, and so on. Now try to hear what was said—not just the words, but tone of voice. Were there other sounds in the scene, perhaps in the background? Now notice any tactile experience. Were you holding or touching anything, did you feel hot or cold, or were there sensations inside your body?

As you watch the scene unfold, focusing on the details and listening to any dialogue, become aware of any emotions you might feel. Let them grow as you key into the most evocative aspects of the scene. Once you’ve experienced the scene fully, you’re ready to practice emotion exposure, first briefly, and then for a more prolonged time.

Brief Exposure

In brief exposure, you let the painful feeling build to a moderate level, then shut the scene off. Rate the intensity of the emotion on a scale of 0 to 10, where 10 represents the emotion at its most intense and painful and 0 represents a complete state of comfort and lack of any painful feelings. Once you’ve brought the scene to mind in detail, keep observing it as the negative feelings rise and reach a level of 5 or 6, then stop visualizing and just watch the emotional wave, noticing how it intensifies, crests, and then diminishes or gives way to a different emotion. Throughout, verbalize an ongoing description of everything that happens.

Here are detailed instructions. If you wish, you can record the instructions, pausing after each paragraph so you have time to observe and describe your experience. In the beginning, you can do these brief exposures for five minutes, or even less. That’s enough time to get a bit used to the emotion or feel it begin to fade.

Find a quiet place to practice where you won’t be disturbed. Visualize the scene you’ve chosen in detail and watch the difficult emotion arise. Notice the feeling and keep your attention on it until a word or phrase comes to mind that labels the emotion. Just say to yourself, “Right now I’m feeling _______________.” Now notice how strong the emotion is. Say this out loud or to yourself. Rate it on a scale of 0 to 10. Also notice whether the emotion is growing or diminishing. At what point in the wave is the feeling—ascending, cresting, or diminishing? Find words for all of this.

Once the emotion reaches an intensity of 5 or 6, drop the image and shift your focus to noticing sensations in your body: feelings of tension, pain, pressure, heat, or cold. Describe these physical sensations in words. And once again notice any changes in the emotion itself. Does it shift in intensity or quality? Is it deepening, softening, or beginning to evolve into some other emotion? Find words for all of this.

Notice any desire to mute, numb, or push away the emotion and put that desire into words.

Find other ways to characterize the emotion. How big is it now? As big as a house, a bus, a bush, or a pebble? Say what size it is. What color would you say it is? What texture does it have? Smooth as silk or gunmetal? Is it lumpy, sharp, or rough as sandpaper or granite? How heavy is it? Find words for each of these metaphorical descriptions.

Again, notice any changes in your feeling. Is the emotion starting to give way to new emotions? Are there new or changing sensations in your body? Where are you on the wave? Find words for all of this.

If you feel an impulse to act on the emotion, notice it and observe what it’s like to
not
do anything. Describe the experience of feeling this urge without acting on it.

If thoughts arise, particularly judgments, just say to yourself, “Now I’m having (angry, sad, or anxious) thoughts” or “Now I’m having judgments (about myself or my emotion).” Just label the thought in the same way you’ve been labeling everything else you notice, and then let it go.

Keep watching and finding words for your emotion until it begins to soften and diminish, or until you’re ready to stop. Then you can return to mindful breathing as a way to ground yourself again.

Try doing brief exposure with your target emotion once a day for a week. You can switch to other scenes if the original image loses its ability to evoke much feeling. After a week, when you’ve had practice with multiple brief exposures, you can move on to longer sessions.

Prolonged Exposure

Brief exposure is a stepping-stone to longer exposure sessions. As you get more accustomed to observing and staying with your feelings, you can move to this prolonged exposure practice. Three things will change:

• You’ll continue to focus on the emotionally provocative image throughout the entire exposure, not just in the initial phase.
  
• You won’t describe the emotion. Instead, all your attention will be on inducing the emotion by remembering everything that was done and said in the scene you’re visualizing.
  
• You’ll extend the duration of exposures, staying with the visualization until you experience a significant reduction in emotional distress. This indicates that desensitization, or habituation, is occurring.
  

In prolonged exposure, the object is to keep focusing on the visualized scene until your emotional distress has fallen to half or close to half of the highest level in that exposure session. Here’s a summary of the prolonged exposure process:

1. Induce the emotion by visualizing an emotionally provocative scene in detail.
   
2. As the emotion gathers strength, evaluate its intensity using a scale of 0 to 10.
   
3. Notice sensations in your body and any changes in the quality or intensity of these feelings.
   
4. Keep visualizing the scene, noticing what was done and said.
   
5. Notice any impulse to act on your emotion and notice how it feels to not act on your urge.
   
6. Keep visualizing the scene and notice any thoughts that come up.
   
7. Periodically evaluate the intensity of the emotion on a scale of 0 to 10. When it drops to half or close to half of its highest level, stop visualizing the scene.
   
8. Breathe mindfully for several minutes.
   

Repeat this entire process until the visualization no longer triggers significant distress. Then come up with another distressing visualization that provokes the same emotion. It’s best to use prolonged exposure daily until you’ve achieved some acceptance of the target emotion and find it significantly less upsetting. Remember, the purpose of exposure is to reach a point where you’re no longer avoiding your feelings, and therefore no longer paying a high emotional price for habitual avoidance.

Try not to distract yourself in any way during exposure exercises. For brief exposure, stay focused on the emotion. For prolonged exposure, keep your attention on the upsetting scene. Don’t let your mind drift, and don’t seek reassurance or try to look on the bright side, especially when working with anxiety. This focus is necessary to achieve habituation.

Applications

Imagery-based emotion exposure is appropriate, indeed necessary, for developing acceptance of any of the negative emotions associated with emotional disorders. Each painful emotion is triggered by different types of thoughts, images, or situations, and of course we all have our individual triggers. To maximize the effectiveness of your exposure practices, find the triggers that set off the most intense feelings of anxiety, depression, anger, shame, or guilt for you.

Monroe, a fifty-one-year-old librarian, provides a good example of the entire imagery-based emotion exposure process from start to finish. He experiences significant shame regarding a wine-colored birthmark on his neck and lower cheek and also believes that he’s a boring person who can’t find interesting things to say. Whenever he notices someone looking at him closely, he imagines that the person is disgusted by his appearance, and he feels ashamed as a result. Conversation is another trigger for his shame, and the longer the conversation lasts, the more intense Monroe’s shame grows as he struggles to say something interesting. Cognitive triggers include thoughts such as “I’m ugly” and recalling “stupid” things he’s said. Monroe has a wide variety of strategies for avoiding his feelings of shame:

• Getting angry at people for looking at him or trying to talk to him, which briefly masks the shame
  
• Constantly watching TV, listening to the radio, surfing the Internet, or compulsively taking pictures so he won’t have to feel bad about how ugly and boring he is
  
• Trying to shut down emotionally
  
• Drinking wine in the evening until he feels numb
  
• Avoiding people, conversations, and phone calls
  
• Avoiding mirrors
  
• Ruminating about recent encounters, hoping to remember one redeeming thing he said or trying to recall any positive response in the other person but finding only “idiocy”
  

Trying to mask or get rid of the shame hasn’t worked. The shame persists and strengthens because Monroe has never accepted it or desensitized to it. So now, on top of shame, he’s also struggling with loneliness, depression, a bit of a drinking problem, and a deep feeling that he’s wasting his life (and he’s become ashamed about this too).

Monroe decided to do brief emotion exposure, initially focusing on his birthmark. He used an image of someone staring at his face and maintained the image until the shame was moderately strong. Then he began describing the feeling internally, including details of his physical experience, thoughts, and any changes in the emotion. Monroe tried not to use his typical emotion avoidance strategies, but he noticed that he occasionally began to shut down or think about TV shows and photography. As soon as he observed this, he returned to describing the shame. When the emotion diminished or evolved into a new feeling, he stopped the exposure.

After a half dozen exposures, Monroe noticed a substantial reduction in shame related to his appearance, so he shifted to prolonged exposures. After about a week the distress associated with this long-standing trigger was substantially reduced and hovered around 1 to 2. At that point, Monroe shifted to imagery-based exposure practices targeting his shame about his conversational abilities, visualizing a scene where he was grasping for things to say.

Duration

Mindfully observing your emotions, along with whatever else you experience during meditation, is a key skill in emotion regulation. Make this a part of your daily self-care rituals. Continue practicing imagery-based emotion exposure until the target emotion is less distressing and you are no longer using emotion avoidance strategies with that emotion. This might take anywhere from several days to several weeks, depending on how frequently and effectively you practice.

When you’ve mastered imagery-based emotion exposure, you can move on to the next two chapters: Interoceptive Emotion Exposure and Situational Emotion Exposure.

Chapter 12

Interoceptive Emotion Exposure

What Is It?

Interoceptive emotion exposure is a desensitization process in which you re-create, in a safe and controlled way, the physical feelings associated with distressing emotions. You do exercises that raise your heart rate and respiration rate and make you feel warmer, dizzy, shaky, and so on. This allows you to become habituated to the sensations so that you no longer fear them.

Interoceptive emotion exposure was originally developed by cognitive behavioral therapists to treat panic disorder (Craske and Barlow 2008). People with panic disorder are fearful of the internal physical states associated with panic: rapid heartbeat, dizziness, and feeling out of breath, weak, or hot. David Barlow and his research associates later extended interoceptive emotion exposure to the treatment of all distressing emotions (Moses and Barlow 2006). The rationale is that each problematic emotion has a physical signature—internal sensations associated with that emotion that become distressing in their own right. Part of learning to accept emotions and be less distressed by them is learning to accept the sensations that go with them.