Be Seen. Be heard. Be you.
Elyce Kiperman-Gordon, MS, LCMHC, NCC
The Patient: Chris, a 38-year-old male, came to me with the intention of reducing his stress at work. He recently received a promotion and now works in a high-pressure environment with many new challenges. Since he took on the role, he has been constantly stressed, having panic attacks, and unable to concentrate or focus. He is a high achiever and a hard worker, and the new role makes him question his abilities. He has been anxious and frustrated at times and quickly “flips out” and “checks out” by scrolling on his phone or computer to distract himself and isolate. Usually, he enjoys being with others, but lately he wants to be alone, and it has been affecting his relationship with his wife. His primary objective was to find a way to deal with stress and anxiety better.
Chris was able to express to me how much he enjoys his new job and recognizes that it is an extremely competitive environment. Chris wants to remain in the role. He is exceptionally proud of the fact that he is the youngest person to ever be at this level with the company. He is driven, strives for perfection, and intends to advance in his career. Ordinarily easy-going, this new role is much more stressful, which he is then bringing home with him. He realized his new position was creating reactions that were not healthy and he didn’t feel he was being himself.
Growing up, Chris had parents that were very supportive of his ambitions and encouraged him to succeed at everything he attempted. As an adult, his tendency is still towards perfectionism in all his pursuits. Hard work and winning motivate him to do even more. The more he works, the more he gets the raise, the bonus, and the promotion. However, he is feeling overwhelmed with the pressure and is isolating himself more and more to cope with the outside stressors. He knows his behaviors are impacting his health.
During our conversations, Chris noted his frustration levels would easily go from 0-60 in a minute. He stated that the most important thing to him was being successful both at work and at home. High achievers can frequently overwork themselves and are unaware of the impact it has on their mental and physical health. Chris wasn’t listening to the physical and mental symptoms he was experiencing, like digestion issues, racing heart, tightness in the chest, lack of focus, and now bursts of frustration and most recently panic attacks.
When a person is stressed, the part of the brain often called the emotional brain sends signals to alert the sympathetic nervous system to respond to the perceived threat. This is the part of the autonomic nervous system that is designed to prepare you to respond quickly, known as the “fight or flight or stress response”. Chris’s nervous system was affected by the acute stress-related symptoms, keeping him in an aroused state of being and affecting the way he was responding. If there is no threat, the other part of the autonomic nervous system, the parasympathetic nervous system, slows down the stress response to a relaxed state of being. When one of these systems is working harder than the other, not allowing the other one to counteract it, the nervous system can become dysregulated.
Chris was stressed, worried, and panicked. When someone presents with high stress and anxiety levels, I incorporate a clinical application of the polyvagal theory to address the nervous system regulation first. Polyvagal theory helps to identify three shifts in the nervous system that produce three states of being; rest and digest (social and safe), fight or flight (mobilization), and freeze (immobilization).
Despite the fact that Chris was not in a life-threatening situation, his sympathetic nervous system perceived his stress and anxiety reactions as dangerous and threatening and remained on a heightened alert. If you are constantly in fight-flight, you won’t be able to recognize or detect safety any longer. You will continue to find more ways to protect yourself, like becoming anxious, panicking, or becoming angry and frustrated. Consequently, you shut down, and then you can’t concentrate or focus. That is what was happening to Chris as he approached his work, he would shift into the fight or flight response, and he would become stressed, frustrated, anxious, and panicked, causing him to shift into the flight or flight response. Additionally, his thoughts about failing contributed to the activation of his nervous system going into shutdown, explaining why he was “checking out” and wanted to be alone or hide away his phone and computer.
The goal was to use polyvagal techniques to establish a baseline for Chris to remember how it feels to not be so anxious. Many people who are stressed or dealing with anxiety lose sight of their own normal, calm, and safe state.
We started him with breathing exercises that work on the vagus nerve, which helps regulate stress, to reconnect him to his natural resting state and allow him to become aware of his calm state. Recognizing the physical sensations in our bodies aids in the mapping of our nervous system and the development of new neural pathways for safety and connection in relationships. Chris learned to listen to his body and become more aware of the state of being he was in at the time. This allowed him to build the capacity to regulate his system and prevent such potential risks in the future.
When we were able to Chris back into a safe state, he was able to access higher cortical functions, bring his body back out of the shutdown phase, and refocus his cognitive abilities. As he gained more skills around his nervous system, we then moved into cognitive behavioral therapy (CBT) techniques. CBT engages specific techniques to target unhelpful thoughts, feelings, and behaviors that are known to trigger and produce high levels of anxiety.
Chris had some underlying beliefs that were driving his anxiety and stress symptoms. “I am a failure when I can’t do things perfectly,” for example. This belief may then lead to feelings and behaviors that result in negative outcomes, reinforcing a negative cycle. He was able to challenge his unhelpful patterns of thought and behavior and facilitate him in creating new, more helpful patterns of thinking and behaving.
Chris and I had many sessions together. It didn’t take long for him to develop the ability to recognize his triggers, address the situation immediately, and use the calming techniques before they manifested physically. He found ways to take ownership of what was happening to his body so he could regulate his emotions and responses to stress. He found he was much more resilient at work to the daily challenges, and he stayed grounded without having to dissociate from his surroundings to feel relief. Once Chris was able to manage his bodily responses, his panic attacks subsided, he wasn’t getting bursts of anger, and he was calm when he arrived home. He was reconnecting with his wife and feeling safe connecting with her. From there, we were able to progress to the next stages of working with him on his perfectionism traits and his core beliefs around success. These blended approaches helped him to connect and socialize more with others while also deepening and expanding his connection to himself in ways he never knew existed.