behavioral therapy

By: Luna Loves good science

I am a firm believer in the power of our minds to not only cope with (most) mental diseases, but also to eliminate them. I say this as a future physician, scientist, and someone who has spent much of my life dealing with severe debilitating anxiety and depression. These days, most people I know would describe me as fairly confident and optimistic, but growing up, most people, including myself, doubted I could ever be a normal part of society. However, through various techniques, culminating most recently in mindfulness, I was able to overcome my limitations. This is why I want to share my journey through mental health treatment, because I truly believe that if I could accomplish this much, anyone can.

The first major sign that my anxiety was abnormally high even as a young child was when I had an existential crisis at the age of 5. When my great-aunt died and I realized death was permanent, I began to believe that I was going to die and everything would kill me. I developed a specific ritualistic prayer that I had to say every night in exactly the same way. If I got it wrong I would have to repeat it until I said it correctly at least 5 times or else I knew that I or someone I cared about would die. This prayer ritual continued all the way through high school. In elementary school, my anxiety manifested as selective mutism. The first time most of my teachers and classmates heard my voice was when I prerecorded presentations on a tape recorder at home to play in class because I physically could not speak in school. My parents, scared for my future, brought me to the National Institutes of Health (NIH) for evaluation. They were told that this was not normal child shyness and without treatment, it might never resolve. They wanted to enroll me in a study to test the effectiveness of antidepressants combined with therapy on my condition. If you are curious about this condition and these NIH studies, check out this article, which pretty much describes my childhood and the doctor who did these studies.

Ultimately, my parents were scared to put such a young child on drugs, and so my experiences with different techniques of therapy began, including psychoanalysis, cognitive therapy, and behavioral therapy. To treat the selective mutism, my parents started with behavioral exposure therapy, which uses desensitization techniques to reduce specific phobias that cause anxieties. The first experiment was to try to talk to one of my teachers on the phone from the comfort of my own home, a place I was able to speak normally. My third-grade teacher would call me over and over again, but for the longest time any words I tried to say to him came out as random grunts. Then one day I got one word out. I think it was “Hi.” I’m pretty sure as soon as I realized I had spoken I cowered in horror thinking the universe would end, but nothing bad happened. Over time I was able to speak with my teacher more and more over the phone. I never was able to talk in his class at school, but I had made a first step. The next year, with the help of one of my best friends who transferred to my school, I was able to start talking in class, and even occasionally raising my hand to answer questions. I was still a pretty anxious kid, and when my best friend moved away, this manifested again in silence, withdrawal, depression, and the creation of vivid fantasy worlds to escape into. Psychotherapy couldn’t help me much, because I couldn’t analyze something that seemed like it had always been a part of me. My anxiety and obsessive behavior continued through high school, where I became incredibly isolated and developed anorexia and severe depression.

At the beginning of college I made a decision that I would not maintain these habits, and I continued my own exposure therapy, talking to strangers as much as I could. I was incredibly awkward, talking so quietly that people couldn’t hear me or forgetting to tell people my name. I would look at the ground and not make eye contact, but at least I was talking to people. It was a huge step, and because of it I had a lot of success developing a healthy social circle. I was still frequently plagued by bouts of anxiety and depression that I couldn’t seem to escape, despite continuing therapy.

Even through the anxiety and depression, my dream was always to be a doctor and a scientist, saving the world by researching cures for deadly diseases and using this research to directly improve the lives of patients. However, my anxiety culminated in the inability to get into an MD/PhD program because when I interviewed, I struggled to talk and would frequently burst into tears. I took two years off after college to do research and to work on my mental health. I continued with psychotherapy and behavioral cognitive therapy and eventually began taking selective serotonin reuptake inhibitors (SSRIs) for my anxiety and depression. During this time I discovered the field of Positive Psychology, which was developed by Dr. Martin Seligman, an academic psychology researcher at the University of Pennsylvania. I read his book, “Learned Optimism,” which describes his approaches, focusing on positive emotions (content with the past, happy in the present, hopeful for the future), positive individual traits (establishing your own strengths and virtues), and positive institutions (creating positive supportive communities for yourself). As the title suggests, the book describes how you can learn to be optimistic, rewiring your brain to become something new. The idea that you could change your brain and personality was fascinating to me, and I began realizing how much more control we have over ourselves than anxiety would let us believe. Ironically, around this time my therapist told me she was not very optimistic about my chances to get into MD/PhD programs due to my anxiety, and she cautioned me to prepare myself for the worst. But, inspired by the field of positive psychology (which she didn’t practice), I decided that I could be different and that anxiety didn’t have to stop me from achieving my goals. I went on my interviews and got into many MD/PhD programs. I wish I could say this was the end of anxiety ruling my life, but I still had a long way to go.

During my early years in school, I continued psychotherapy, behavioral cognitive therapy, and medications to manage my anxiety, but the stresses of medical school and graduate school frequently overwhelmed me. In the clinics, sometimes it felt like selective mutism hit me again as I struggled to present patients to intimidating doctors. While other students would just stumble a little under the pressure, I would burst into tears and start hyperventilating when I couldn’t get words out. When I started doing PhD work, I would sometimes get so anxious about experiments and expectations I would stop showing up to lab to avoid facing everything I was failing at. The ultimate blow that threw me into my deepest depression yet was breaking my ankle. I required surgery and was immobilized for 2 months. I had so much time alone with my thoughts of failure and disappointment, and I physically struggled with the pain and inability to take care of myself. I took a leave of absence, and as a last ditch attempt before giving up on everything, I began exploring a different field of mental health treatment, mindfulness.

I discovered mindfulness through my dad, who sent me books about it while I was sitting at home depressed with my broken ankle. One of these books discussed mindfulness in the context of Qigong, a Chinese art that uses movement for meditation and healing. When I searched more about it, I found that there was a Shaolin temple near my home in Houston with a 31^st generation Shaolin monk who practiced healing qigong. On a whim, I reached out to Grandmaster Shi De Shan and started private sessions hoping to help heal both my ankle and my mental illness. He taught me how to meditate and practice mindfulness.

All the techniques I have discussed above focus on endlessly analyzing thoughts and emotions, identifying them as a part of who we are. In these methods, we can learn to live with anxiety and depression by understanding and acknowledging these parts of ourselves. Mindfulness differs by identifying thoughts and emotions as what we experience. We are not our depression or anxiety. Instead, they come from habits we have built up over time to cope with the environment around us. And because they are not who we are, we should be able to observe our thoughts and associated body sensations in an objective, non-judgmental way. Rather than analyzing our thoughts, we simply meditate and watch them float through our heads, realizing how fleeting they are. Then we let them go, floating back out of our head the way they came in, without evaluating, judging, or adding to them.

To many people this sounds like a bunch of new age-y nonsense, but there is a significant amount of evidence that techniques based on mindfulness are very successful. Regular users of mindfulness meditation have less brain activity in their limbic system, the part of the brain associated with aggression, anxiety, anger, and development of posttraumatic stress disorder. When measuring physiological and emotional response to stressors, mindfulness meditators have a much faster recovery than nonmeditators. Mindfulness may be more effective than behavioral or cognitive therapy in changing the fear response to phobias as well as general anxiety by rewiring the brain to sever the connection between the fear inducer and the fear reaction. Interestingly, certain types of mindfulness training can diminish the disproportionate fight-or-flight response associated with high anxiety states.

In the last year since I began training in mindfulness, my life has changed completely. I have been off my antidepressant medications for over 6 months. I no longer let anxiety control every action I take. I’m slowly releasing every fear that has been holding me back, and I’m watching the magic of life unfold. I’ve found things I’m truly passionate about and I don’t let anxiety stop me from pursuing them. And best of all, I am following my dreams to help as many people as I can and do my part to change the world. When my mind was filled with fear and anxiety all the time, I couldn’t really get enough outside myself to help others. Sure, I still get overwhelmed or anxious sometimes. I have built up a lot of bad anxious habits since I was 5 years old. But overall…everything is awesome! I hope my story inspires you, and together we can use the power of our minds to release our mental illnesses.

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Tag Archives: behavioral therapy

My Journey to Mindfulness: Letting Go of Anxiety and Depression

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