In the relatively safe space of the consulting room, two-thirds of my adult patients are learning to regulate fear. Fear—ranging from chronic generalized anxiety to a state of chronic fearful hypervigilance, often verging on panic—that they have been living with every day since early childhood. All are high-functioning, productive, and living in relatively safe surroundings. All consulted me with somatic pain symptoms. Many were surprised to discover that they had been living in fear since childhood.
Here are some of their concerns: What if my wife develops a cardiac condition? What if my partner, unpredictable in his verbal attacks on me and others, is verbally abusive toward me in front of our dinner guests? What will happen if I let my in-laws know about my mother’s alcoholism, after they’ve known me for ten years? What if that debilitating shoulder pain returns after my baby is born? What if I don’t do my job perfectly every time, even though my performance has been rated Excellent for more than five years in a row? What if my husband yells at our children when he’s alone with them and I’m not there to protect them? What if my son, already on academic probation, continues to drink and is thrown out of college?
These peoples’ concerns are unrelenting, often requiring immediate intervention before they can think clearly enough to understand, or mentalize, the sources of the fear and trouble-shoot how to negotiate the intrapsychic and interpersonal demands of their lives. Feeling seen, safe, and supported are fundaments of a secure attachment, which facilitates the development of emotional regulation that underlies the experience of bodily well-being.
To facilitate self-regulation, I have developed the E-G-O “tool” that incorporates three simple awareness exercises learned from trauma training in Somatic Experiencing® and years of personal meditation and breathing practices. I teach this when we discover that anxiety and fear are too intense to think clearly. I recommend that patients use it between sessions whenever they need it. I have demonstrated this technique to groups of colleagues and I wrote about the E-G-O in keynote lecture for the 22nd John Bowlby Memorial Conference which will be published in the forthcoming monograph Unlocking Pain: Disrupted Attachment and Chronic Physical Pain (L. Hamilton, Ed.; Karnac 2017).
There are three elements and you can begin with any of the three: E for Exhale, G for Grounding, or O for Orienting to the external environment. Each element is effective in directing your awareness to what is happening right now, in this moment, in this space. Mindful directing of awareness has been incorporated by contemporary teachers and researchers such as Jon Kabat-Zinn and Daniel Siegel, to name only two. Depending on the level of anxiety or fear, we may spend more or less time with each element. When the patient is as safe and settled as possible, they gain benefit from exploration of their presenting issue.
I invite my patient to start by noticing their breath without changing it. Here I ask if they have had any trouble with breathing in their medical history. If no, I invite them to exhale slowly through their mouth, without effort, letting all of the breath flow out and then wait for their body to inhale. The extended exhalation activates the parasympathetic “brakes” on the fight-flight-freeze activation mediated by the sympathetic nervous system. (If the patient has had breathing problems, we save work on fear about breathing for a later time.)
Then I move to G for Grounding, inviting the patient to “receive the support of the seat and floor under your feet,” an element learned from one of my Somatic Experiencing® teachers, Nancy Napier, LMFT, SEP.
The O for Orienting is used to help the patient put additional braking on sympathetic activation that is the source of anxiety, fear, and panic. I invite the patient to let their eyes take them slowly around the room in both directions, noticing what their eyes are drawn to explore. This element can be extended for as long as it is helpful to the patient in settling. I check in with the patient throughout, as I’m doing the exercise with them.
Here are some reports from patients who have felt the benefits of using the E-G-O tool in and out of the session:
“So many times since last session, I felt panicky and I remembered to slow down and Orient. Just looking around the room helped reduce my anxiety so much.”
“I used the E-G-O tools on that business trip when I was terrified that the pain in my legs would be so intense that I couldn’t participate in any of the business functions. I was fine!”
“I found myself using it between business meetings. It helps me decompress and be more alert for the next meeting.”
“I hadn’t realized how afraid I am until you were teaching me the E-G-O process. I look forward to coming to sessions for you to help me practice, again and again. It clears my head, and I’ve been able to notice more easily all of my reactions to my family members. And I’m responding to them with more confidence.”
While Frances Sommer Anderson, PhD, SEP was an advanced psychoanalytic candidate at the NYU Postdoctoral Program in Psychoanalysis and Psychotherapy, program director Dr. Lewis Aron invited her to co-edit Relational Perspectives on the Body (1998), a groundbreaking volume bringing the body back into the psychoanalytic consulting room. In Bodies in Treatment: The Unspoken Dimension (2008), Anderson wrote about a 30-year period of being an analysand who was simultaneously experiencing bodywork adjunctively. In 2013, she co-authored Pathways to Pain Relief, with Eric Sherman, Psy.D. Anderson was certified in 2011 as a Somatic Experiencing® Practitioner. She was invited to give the Keynote Address at the 22nd John Bowlby Memorial Conference in April 2015. Her lecture, “’It Wasn’t Safe to Feel Angry’: Disrupted Early Attachment Bonds and the Development of Chronic Pain,” will be published in the forthcoming monograph Unlocking Pain: Disrupted Attachment and Chronic Physical Pain (L. Hamilton, Ed.; Karnac 2017). She was an invited panelist to the American Psychosomatic Society “Neuroscience of Pain” mid-year meeting, with a presentation entitled “Growing Up Afraid: Early Attachment Disruption, Emotion Regulation and Somatic Pain.” Anderson is on the teaching and consulting Faculty of the Manhattan Institute for Psychoanalysis Trauma Program.