CHAPTER 1: WHEN LIFE FEELS
OUT OF CONTROL

Quick Calming Techniques

It is during our darkest moments that we must focus to see the light.

ATTRIBUTED TO ARISTOTLE

IT WAS 6:30 IN THE MORNING in the busy emergency room at the Walter Reed Army Medical Center in Washington, DC. I was just putting on my white lab coat as I walked through the doors to the unit. It was my third day as an intern, and the emergency room would be my home for the next month. Down the hall from me, a woman was screaming. Curious, I went to see what was going on.

Beth, a 40-year-old patient, was lying on a gurney with a swollen right leg. She was in obvious pain and screamed whenever anyone touched her leg. Bruce, a brand-new psychiatry intern like me, and Wendy, the internal medicine chief resident, were trying to start an IV in Beth’s foot. She was anxious, scared, uncooperative, and hyperventilating. A blood clot in her calf was causing this tremendous swelling. The IV was necessary so Beth could be sent to the X-ray department for a scan that would show exactly where the clot was, allowing surgeons to operate and remove it. With each stick of the IV needle to her swollen foot, Beth’s screams became louder. There was a lot of tension in the room.

“Wendy, can I try to start the IV?” I asked softly.

Exasperated, she handed me the IV set. I walked around the gurney to Beth’s head, established eye contact with her, and gave her a gentle smile.

“Hi, Beth, I’m Dr. Amen. I need you to slow down your breathing. When you breathe too quickly, all of the blood vessels constrict, making it impossible for us to find a vein. Breathe with me.” I slowed my own breathing.

“Do you mind if I help you relax?” I asked. “I know some tricks.”

“Okay,” Beth said nervously.

“Look at that spot on the ceiling,” I said, pointing to a spot overhead. “I want you to focus on it and ignore everything else in the room . . . I’m going to count to 10, and as I do, let your eyes feel very heavy. Only focus on the spot and the sound of my voice. 1 . . . 2 . . . 3 . . . let your eyes feel very heavy . . . 4 . . . 5 . . . let your eyes feel heavier still . . . 6 . . . 7 . . . 8 . . . your eyes are feeling very heavy and want to close . . . 9 . . . 10 . . . let your eyes close and keep them closed.

“Very good,” I said as Beth closed her eyes. “I want you to breathe very slowly, very deeply, and only pay attention to the sound of my voice. Let your whole body relax, from the top of your head all the way down to the bottoms of your feet. Let your whole body feel warm, heavy, and very relaxed. Now I want you to forget about the hospital and imagine yourself in the most beautiful park you can imagine. See the park—the grass, the hillside, a gentle brook, the beautiful trees. Hear the sounds in the park—the brook flowing, the birds singing, a light breeze rustling the leaves in the trees. Smell and taste the freshness in the air. Feel the sensations in the park—the light breeze on your skin, the warmth of the sun.”

All the tension in the room evaporated.

“Now I want you to imagine a beautiful pool in the middle of the park,” I continued. “It is filled with special, warm healing water. In your mind, sit on the edge of the pool and dangle your feet in it. Feel the warm water surround your feet. You are doing really great.”

Beth had gone into a deep trance. I went on.

“Now I know this might sound strange, but many people can actually make their blood vessels pop up if they direct their attention to them. With your feet in the pool, allow the blood vessels in your feet to pop up so that I can put an IV in one and you can get the help you need, still allowing your mind to stay in the park and feel very relaxed.”

To my great surprise, the moment I made the suggestion, a vein clearly appeared on top of Beth’s swollen foot. I gently slipped the needle into the vein and attached it to the bag of IV fluid.

“Beth,” I said softly, “you can stay in this deep relaxed state as long as you need. You can go back to the park anytime you want.”

And with that, we wheeled a now tranquil and relaxed Beth into X-ray.

When Your Brain Works Right, You Work Right

Virtually all of us have felt anxious at some point in our lives, and that’s perfectly normal. How we respond during these difficult times, however, can make all the difference in the world when it comes to our overall health and well-being.

Unfortunately, many people self-medicate with alcohol, drugs, overeating, or wasting time on social media. Although these things may give us temporary relief from feeling bad, they usually only prolong and often exacerbate the problems.

As a psychiatrist, a brain imaging specialist, and the founder of Amen Clinics, which has one of the highest published success rates in treating people with complex and treatment-resistant mental health issues, I can assure you that the secret to overcoming anxiety, both now and for the rest of your life, is to work on optimizing the physical functioning of your brain.

Why? Because simply put, when your brain works right, you work right—in every area of your life. And as your brain becomes healthier, your ability to respond to everyday stressors, problems, and challenges increases exponentially, leading to fewer bouts of anxiety and better overall physical, mental, and spiritual health.

Later, I’ll give you some strategies that will help you better care for your brain over the long haul (chapter 4), but first I want to walk you through some techniques (like the ones I used with Beth) to help you calm yourself down when you are in the midst of an anxiety attack or other emotional or physical crisis.

Let’s start by taking a closer look at how your brain and body function in a crisis. In the psychiatric profession, we call this the fight-or-flight response.

The Fight-or-Flight Stress Response

The fight-or-flight response is hardwired into our bodies to help us survive. It is mobilized into action whenever a stressor appears, such as what happened to Beth in the emergency room. Harvard physiology professor Walter Cannon first described the fight-or-flight response in 1915. He said it was the body’s reaction to an acute stress, harmful event, or threat to survival, such as experiencing an earthquake or being robbed at gunpoint.

Acute stress activates the sympathetic nervous system, which prepares you to either put up a fight or flee a dangerous situation. The fight-or-flight response is triggered by the amygdala, an almond-shaped structure in the temporal lobes that is part of the limbic or emotional brain. When you become stressed, the amygdala sends a signal to the hypothalamus and pituitary gland to secrete adrenocorticotropic hormone (ACTH). This, in turn, signals the adrenal glands, on the top of the kidneys, to flood the body with cortisol, adrenaline, and other chemicals to rocket you into action.

The graphic on pages 12 and 13 illustrates what happens in our bodies when this response is set off.

The fight-or-flight response is part of a larger system in the body called the autonomic nervous system (ANS). It is called “autonomic” because its processes are largely automatic, unconscious, and out of our control, unless we train it otherwise (more on that coming up). It contains two branches that counterbalance each other: the sympathetic and parasympathetic nervous systems. Both regulate heart rate, digestion, breathing rate, pupil response, muscle tension, urination, and sexual arousal. The sympathetic nervous system (SNS) is involved in activating the fight-or-flight response, while the parasympathetic nervous system (PNS) helps to reset and calm our bodies.

Our very survival depends upon the fight-or-flight response, as it helps move us to action when there is a threat. But when stress becomes chronic, such as if you live in a war zone, grow up in an unpredictable alcoholic home, are sexually molested over time, or wake up every morning in a panic, your sympathetic nervous system becomes overactive. When that happens, you are more likely to suffer from anxiety, depression, panic attacks, headaches, cold hands and feet, breathing difficulties, high blood sugar, high blood pressure, digestive problems, immune system issues, and problems with attention and focus.

In his groundbreaking book Why Zebras Don’t Get Ulcers, Stanford University biologist Robert Sapolsky pointed out that for animals such as zebras, stress is generally episodic (e.g., running away from a lion) and their nervous systems evolved to rapidly reset. By contrast, for humans, stress is often chronic (e.g., daily traffic, a difficult marriage, job or money worries). Sapolsky argued that many wild animals are less susceptible than humans to chronic stress-related illnesses, such as ulcers, hypertension, depression, and memory problems.[1] He did write, however, that chronic stress occurs in some primates (Dr. Sapolsky studies baboons), specifically individuals on the lower end of the social dominance hierarchy.

The Fight-or-Flight Response. Threat: an attack, harmful event, or threat to survival. Brain: processes the signals, beginning first in the amygdala and then in the hypothalamus. ACTH: pituitary gland secretes adrenocorticotropic hormone. Cortisol released and adrenaline released.
Physical effects of cortisol and adrenaline release: Heart beats faster and harder; Bladder relaxes; Pupils dilate for better tunnel vision, but there is a loss of peripheral vision; Erections are inhibited (other things to think about); Air passages open and rapid shallow breathing increases; Blood pressure increases; Production of tears and saliva decreases; Digestion slows; Hearing diminishes; Muscles become tense; trembling may occur. Muscles around hair follicles constrict, causing goose bumps; Blood vessels shunt blood to upper arms and upper legs (fight or flee) and away from hands and feet, which get colder; Veins in skin constrict (colder hands and feet) to send more blood to major muscle groups (to fight or flee), causing the “chill” sometimes associated with fear; Blood sugar level increases for energy; Brain has trouble focusing on small tasks; it’s thinking only of dealing with the threat; Immune system shuts down

In humans, one big stress (such as being robbed, physically attacked, or trapped in a fire) or multiple smaller stressors (such as fighting with your spouse or children on a regular basis) can turn on a chronic fight-or-flight state in the body, leading to mental stress and physical illness.

But by using the following techniques, you can learn to quiet your SNS and activate the PNS, which will lead you to feel calmer, happier, and less stressed.

Technique #1: Use hypnosis, guided imagery, and progressive muscle relaxation to enter a deep relaxed state.

Many people associate hypnosis with loss of control or stage tricks. But doctors know it to be a serious science, revealing the brain’s ability to heal medical and psychiatric conditions.

“Hypnosis is the oldest Western form of psychotherapy, but it’s been tarred with the brush of dangling watches and purple capes,” said psychiatrist David Spiegel, MD, the son of a famous hypnotist and associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine. “In fact, it’s a very powerful means of changing the way we use our minds to control perception and our bodies. . . . The power of hypnosis to immediately change your brain is real.”[2]

Using hypnosis, guided imagery, or progressive muscle relaxation (PMR) increases parasympathetic tone and can quickly decrease the fight-or-flight response in a wide variety of conditions, as it did for Beth. These techniques have been found to have many benefits, including lowering anxiety, sadness, and tension in parents of children with cancer;[3] pain and fatigue in those receiving chemotherapy;[4] stress in those with multiple sclerosis;[5] anxiety and depression;[6] migraine frequency;[7] tension headaches;[8] craving and withdrawal symptoms in people quitting smoking;[9] post-stroke anxiety (a result of listening to a PMR CD five times a week);[10] and phantom limb pain.[11] They can also improve quality of life in the elderly[12] and dialysis patients,[13] fatigue in the elderly, and sexual function in postmenopausal women.[14]

Learning hypnosis, guided imagery, and progressive muscle relaxation is simple; there are many online audios that can guide you. We have several on our Brain Fit Life site (www.mybrainfitlife.com). You can certainly do it yourself. Below are the instructions I give my patients to help them go into a deep relaxed state. The skill builds over time, so it is important to practice this exercise to gain mastery. Set aside two 15-minute periods a day and go through the following five steps:

  1. Sit in a comfortable chair with your feet on the floor and your hands in your lap. Pick a spot on the opposite wall that is a little bit above your eye level. Stare at the spot. As you do, slowly count to 20. Notice that your eyelids soon begin to feel heavy, as if they want to close. Let them. In fact, even if they don’t feel as if they want to close, slowly lower them as you get to 20.
  2. Take a deep breath, as deep as you can, and very slowly exhale. Repeat the deep breath and slow exhale three times. With each in-breath, imagine taking in peace and calmness, and with each out-breath, blow out all the tension—all the things getting in the way of your relaxing. By this time, you’ll notice a calm come over you.
  3. Squeeze the muscles in your eyelids, closing your eyes as tightly as you can. Then slowly let the muscles in your eyelids relax. Imagine that relaxation slowly spreading, like a warm, penetrating oil, from the muscles in your eyelids to the muscles in your face—down your neck, into your shoulders and arms, into your chest, and throughout the rest of your body. The muscles will take the cue from your eyelids and relax progressively all the way down to the bottoms of your feet.
  4. When all the tension has left your body, imagine yourself at the top of an escalator. Step on the escalator and ride down, counting backward from 10. By the time you reach the bottom, you’ll be very relaxed.
  5. Enjoy the tranquility for several moments. Then get back on the escalator riding up, counting to 10 as you go. When you get to 10, open your eyes, feeling relaxed, refreshed, and wide-awake.

    To make these steps easy to remember, think of the following words:

    • Focus (focus on the spot)
    • Breathe (slow, deep breaths)
    • Relax (progressive muscle relaxation)
    • Down (ride down the escalator)
    • Up (ride up the escalator and open your eyes)

If you have trouble remembering these steps, you may want to record them as you read them aloud and then do the exercise as you listen to the audio.

Allow yourself plenty of time to do this. Some people become so relaxed that they fall asleep for several minutes. If that happens, don’t worry. It’s a good sign—you’re really relaxed!

Once you’ve practiced this technique a few times, add the following steps:

  1. Choose a haven—a place where you feel comfortable and that you can imagine with all your senses. I usually “go” to the beach. I can see the ocean, feel the sand between my toes and the warm sun and breeze on my skin, smell the salt air and taste it faintly on my tongue, and hear the seagulls, the waves, and children playing. Your haven can be any real or imaginary place where you’d like to spend time.
  2. After you reach the bottom of the escalator, use all your senses to imagine yourself in your special haven. Stay for several minutes. This is where the fun starts and where your mind becomes ripe for change.
  3. Begin to experience yourself—not as you currently are, but as you want to be. Plan on spending at least 20 minutes a day on this refueling, life-changing exercise. You’ll be amazed at the results.

Technique #2: Master diaphragmatic breathing.

In the chapter’s opening story, the first thing I did with Beth was help her to slow her breathing so she could get more oxygen to her brain. Diaphragmatic breathing is a core biofeedback technique to help you feel better fast. It is simple to teach and, once practiced, simple to implement and maintain.

Like brain activity, breathing is essential to life and involved in everything you do. Breathing delivers oxygen from the atmosphere into your lungs, where your bloodstream picks it up and takes it to all of the cells in your body so that they can function properly. Breathing also allows you to eliminate waste products, such as carbon dioxide, which can cause feelings of disorientation and panic. Brain cells are particularly sensitive to oxygen; within four minutes of being deprived of it, they start to die. Slight changes in oxygen content in the brain can alter the way you feel and behave.

BREATHING ANATOMY

Inhalation: Diaphragm pulls downward, helping lungs expand with oxygen. Exhalation: Diaphragm returns upward, forcing lungs to expel carbon dioxide.

The diaphragm, a bell-shaped muscle, separates the chest cavity from the abdomen. Many people never flatten the diaphragm when they inhale, and thus with each breath they have less access to their own lung capacity and have to work harder. By moving your belly out when you inhale, you flatten the diaphragm, significantly increase lung capacity, and calm all body systems.

When someone gets angry or anxious, their breathing becomes shallow and fast (see the “Breathing Anatomy” diagram). This causes the oxygen in an angry person’s blood to decrease, while toxic carbon dioxide increases. Subsequently, the oxygen/carbon dioxide balance is upset, causing irritability, impulsiveness, confusion, and bad decision-making.

Learning how to direct and control your breathing has several immediate benefits. It calms the amygdala (part of the emotional brain), counteracts the fight-or-flight response, relaxes muscles, warms hands, and regulates the heart’s rhythms. I often teach patients to become experts at breathing slowly, deeply, and from their bellies. If you watch babies or puppies, you will notice that they breathe almost solely with their bellies—the most efficient way to breathe.

Expanding your belly when you inhale flattens the diaphragm, pulling the lungs downward and increasing the amount of air available to your lungs and body. Pulling your belly in when you exhale causes the diaphragm to push the air out of your lungs, allowing for a more fully exhaled breath, which once again encourages deep breathing. In biofeedback, patients are taught to breathe with their bellies by watching their breathing pattern on the computer screen. In 20 to 30 minutes, most people can learn how to change their breathing patterns, which relaxes them and gives them better control over how they feel and behave.

BREATHING DURING ANGER

Two waves plotted on a chart. The left side of the chart is titled Feeling Relaxed and shows two wave cycles with high amplitudes. The right side is titled Feeling Angry and shows the waves diminishing to almost straight lines.

The large waveform is a measurement of abdominal or belly breathing, by a strain gauge attached around the belly; the smaller waveform is a measurement of chest breathing, by a strain gauge attached around the upper chest. At rest, this person breathes mostly with his belly (a good pattern), but when he thinks about an angry situation his breathing pattern deteriorates, markedly decreasing the oxygen to his brain (common to anger outbursts). No wonder people who have anger outbursts often seem irrational!

Controlled diaphragmatic breathing has been shown to improve focus and lower anxiety, stress, negative feelings, and cortisol;[15] decrease depression[16] and asthma;[17] reduce obesity in children,[18] pain,[19] blood pressure,[20] motion sickness,[21] and seizure frequency;[22] and boost the quality of life in heart failure patients.[23]

Technique #3: Become expert at warming your hands with your mind.

Visualizing warmth, especially in your hands, is another tool to help you counteract the fight-or-flight response. I’ve found that teaching patients to warm their hands calms down their bodies and minds just as effectively as prescription drugs. Hand warming elicits an immediate relaxation response. We know this because biofeedback instruments allow us to measure hand temperature and then teach people how to warm their hands. Interestingly, children are better at this than adults because kids readily believe they have power over their bodies, whereas adults do not.

When my daughter Breanne was eight years old, she could increase her hand temperature by up to 20 degrees. She was so good at it, I brought her along with me when I did a biofeedback lecture to physicians at a Northern California hospital. In front of 30 physicians, I had her demonstrate her amazing skill. However, for the first three minutes her hands did nothing but get ice-cold because she felt such performance anxiety. In those few minutes I was horrified, feeling like a terrible father who was exploiting his daughter to be important in front of his colleagues. Then I whispered in her ear that she should close her eyes, take a deep breath, and imagine her hands in the warm sand at the beach (the image that worked best for her). Over the next seven minutes, her hands warmed 18 degrees. The doctors were amazed, she was so happy with herself, and I was relieved that I had not scarred her for life.

How can you warm your hands with your mind? You do it with diaphragmatic breathing and the visualization that works for you. For some, like Breanne, it’s imagining putting your hands in warm sand at the beach. For others, it’s thinking about holding a loved one’s hand or touching their warm skin. For still others, it’s visualizing holding a warm, furry kitten or puppy.

Let’s try it. Take a moment to focus on your hands, feeling their energy and temperature. Now close your eyes and hold out your hands, palms down, and visualize a campfire in front of you. Focus. Think heat. You can hear the fire crackle, smell the aroma of fresh-cut wood burning, see the sparks float up into the sky. Now feel the soothing heat as it penetrates the surface of your skin and goes deep to warm your hands. Picture this as you breathe deeply and count slowly to 20.

Did you feel an increase in warmth? Relaxation? Did you find you started to hold your hands closer as if there were actually a fire in front of you?

Practice this technique for a few minutes every day, and you’ll find you get to the relaxation response more easily and faster over time. Find the hand-warming images that work for you, and you will reset your nervous system to be more relaxed and counteract your stress response. You can buy temperature sensors online (under brand names Biodots, Stress Cards, and Stress Sheets) to get feedback on your progress.

Technique #4: Pray and/or practice meditation (especially Loving-Kindness Meditation).

Focusing on your breathing, a beautiful outdoor scene, or Scripture for just five to ten minutes a day is a simple yet powerful way not only to help quell anxious thoughts but also to improve your life overall. Prayer and meditation have been found to calm stress; improve focus, mood, and memory; and enhance prefrontal cortex function to help you make better decisions. What’s more, meditation benefits your heart and blood pressure, digestion, and immune system, as well as improves executive function and emotional control and reduces feelings of anxiety, depression, and irritability.[24]

There are many effective techniques, including reading, memorizing, or meditating on Scripture; writing out a personal prayer; reading classic spiritual writings; or focusing on gratitude. One of my personal favorite forms of meditation is called Loving-Kindness Meditation (LKM), which is intended to develop feelings of goodwill and warmth toward others. It has been found to quickly increase positive emotions and decrease negative ones,[25] decrease pain[26] and migraine headaches,[27] reduce symptoms of post-traumatic stress disorder[28] and social prejudice,[29] increase gray matter in the emotional processing areas of the brain,[30] and boost social connectedness.[31] Here’s how it works.

Sit in a comfortable and relaxed position and close your eyes. Take two or three deep breaths, taking twice as long to exhale as inhale. Let any worries or concerns drift away, and feel your breath moving through the area around your heart. As you sit, quietly or silently repeat the following or similar phrases:

Let the intentions expressed in these phrases sink in as you repeat them. Allow the feelings to grow deeper.

After a few repetitions, direct the phrases to someone you feel grateful for or someone who has helped you:

Next visualize someone you feel neutral about. Choose among people you neither like nor dislike and repeat the phrases.

Now visualize someone you don’t like or with whom you are having a hard time and repeat the phrases with that person in mind. Kids who are being teased or bullied at school often feel quite empowered when they send love to the people who are making them miserable.

Finally, direct the phrases more broadly: May everyone be safe and secure.

You can do this for up to 30 minutes; it is up to you.

Technique #5: Create your emotional rescue playlist.

Music can soothe, inspire, improve your mood, and help you focus. It is important in every known culture on earth, with ancient roots extending back thousands of years.[32] After evaluating more than 800 people, researchers have found that people listen to music to regulate their energy and mood, to achieve self-awareness, and to improve social bonds. Music provides social cement—think of work and war songs, lullabies, and national anthems.[33] In his powerful book The Secret Language of the Heart, Barry Goldstein reviewed the neuroscientific properties of music. He suggested that music stimulates emotional circuits in the brain[34] and releases oxytocin, the “cuddle hormone,” which can enhance bonding, trust, and relationships.[35] He wrote, “Listening to music can create peak emotions, which increase the amount of dopamine, a specific neurotransmitter that is produced in the brain and helps control the brain’s reward and pleasure centers. . . . Music was used to assist patients with severe brain injuries in recalling personal memories. The music helped the patients to reconnect to memories they previously could not access.”[36] Be aware, however, that music you strongly like or dislike may impair your focus.[37]

Based on the concept of entrainment, which means your brain picks up the rhythm of your environment, you can manipulate your mind with the music you choose. In a fascinating study, research subjects rated Mozart’s Sonata for Two Pianos (K. 448) and Beethoven’s Moonlight Sonata as happy and sad, respectively.[38] Listening to happy music (Mozart’s piece) increased activity in the brain’s left hemisphere, associated with happiness and motivation, and decreased activity in the right hemisphere, often associated with anxiety and negativity. Beethoven’s piece did the opposite.

According to research published in the Journal of Positive Psychology, you can improve your mood and boost your overall happiness in just two weeks, simply by having the intention of being happier and by listening to specific mood-boosting music, such as Aaron Copland’s Rodeo, for 12 minutes a day.[39] Having only the intention to be happier was not as effective. Listening to happy instrumental music (versus music with lyrics) was more powerful in activating the limbic or emotional circuits of the brain.[40]

Create your own emotional rescue playlist to boost your mood quickly. Research shows it can be effective to start with musical pieces you love. If you’re not sure where to start, try some of these pieces, which have been shown through research to boost mood:

Without lyrics (words can be distracting[41]):

Add nature sounds (your own recordings or downloads of favorites) to boost mood and focus.[42]

With lyrics:[43]

Brain-enhancing music specifically composed by Barry Goldstein to enhance creativity, mood, memory, gratitude, energy, focus, motivation, and inspiration can be found at www.mybrainfitlife.com. Treat your brain and listen often.

Technique #6: Flood your five senses with positivity.

The brain senses the world. If you can change the inputs, you can often quickly change how you feel.

A fun way to put this all together to change your state of mind might be to take a sauna while listening to “Good Vibrations” and watching scenes of the ocean, all with the scent of lavender or rose oil in the air and while sipping on a cinnamon almond-milk cappuccino!

These six techniques are effective ways to help you feel better fast when you’re anxious or upset. Come back to them anytime you need to regain control over your mind and body.