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Most of us with anxiety or panic find this idea so overwhelming that we will never get started, however. If we do get into a situation in which we need to "face the fear" directly - especially if the experience has been forced on us - we are traumatized by the experience and feel powerless. Cognitive behavioral therapy, by contrast, is not about forcing you to do anything you don't want to do. It is about guiding you slowly through the process of your own self-discovery, as you realize you are able to do the things you used to fear - indeed, that these things are not actually dangerous and that you are perfectly safe while interacting with them. Far from making you feel powerless, this process actually increases your sense of personal control, independence, and autonomy. To return to our example of the person who is afraid of snakes, a cognitive behavior therapist will not ask them to hold one, but they might ask if they'd be willing to go see an exhibit about earthworms at the zoo. If the patient finds this a slightly scary or uncomfortable idea, because earthworms are shaped similarly to snakes, but not an "impossible" idea, this means it is in the sweet spot for cognitive behavioral methods. It is a challenge, but not such a hard challenge that it is overwhelming. To borrow terminology from educational theory, this challenge is in the patient's proximal zone of development, meaning it is difficult and new enough for them that it causes them to learn, but not so difficult that they are forced to give up. Much to my own dismay, there were times, albeit rare ones, when no matter how difficult the task--I not only did it, but surprised myself at my ability to deal with unappealing tasks that I had put off for great lengths of time. This often happened with regard to housecleaning. The rule concerning these all-out clean-ups was that they were permitted when, and only when, they were due to external forces. Their cause was usually for one of the following reasons: Friends were coming over to visit. Relatives were coming over to visit. A girlfriend was coming over to visit, especially when it was a new girlfriend. The landlord was coming over to visit. The building's super, plumber, a cable television installer, or some other type of handy person was coming over to do work in my apartment. As far as I was concerned, doing a concerted "clean-up" under these circumstances just didn't count, even if my place looked nicer for the effort. After all, the only reason I accomplished the task in the first place was because I worried, "If they see how I live, they'll think, `He must be a nut,'" or, "If the plumber tells my landlord what condition my apartment is in, he might try to have my lease revoked." Of course, once the special event passed, it was back to business as usual, with me playing the hapless, helpless, and, essentially, hopeless procrastinator. However, even if it was just for a short while, my apartment looked like it belonged to the person that I yearned deep inside to be.

In the span of time between when I began to clean up and when the last guests left, I saw that I really hadn't lost my ability to make my place presentable. Instead, it seemed more that I had simply abdicated myself from that responsibility. You will never avoid problems, stress, and obstacles. You will never avoid the dark. All you can do is learn how to move with purpose, precision, and focus through it. There's no reason to let it stop you and keep you from placing one foot in front of the other. When it gets dark and everyone else around you is letting it stop them, keep moving. Get down and crawl. Stick your hands out and feel around. By the time you can see light again, you will be miles ahead of everyone else and miles closer to your goals. "Problems" aren't as bad as we "think" and "feel" they are. They're more imaginary than real. We take simple problems, add emotion to them, and allow them to grow out of control. Hamlet says, "There is nothing either good or bad, but thinking makes it so. To me, it is a prison." Do you develop emotion when you see a rock? Do you see it as a problem? Does a rock make you angry and upset? Does it make you extremely happy? I hope not. It's just a rock.

It just "is" what it is. It's not good. It's not bad. It's a very neutral thing. It's neutral because we, naturally, don't make analytical and emotional investments in it. The two sections of the brain marked V and N above, for the "ventral tegmental area" and the "nucleus accumbens," are instrumental to our experience of pleasure (which is necessary for the survival of the species--because pleasures, rewards, also include food, attachment, and sex). When the nerve cells in these areas receive a spike of dopamine, this is like an accelerator pedal. With addiction, that spike is from a drug, not everyday life, hence the idea of an addiction's hijacking our brain from its normal sources of pleasure or reward. (The term hijack for how addiction disrupts the brain has been promulgated by the director of the National Institute on Drug Abuse [NIDA], Dr. Nora Volkow.) Addiction also hijacks the brain in another notable way. Once dependent on a drug, people principally pursue the drug to relieve the misery of withdrawal. This has been called a negative (rather than a positive) reinforcer of behavior. (That is, an action taken to stop feeling bad.) Thus, people with an addiction have a hijacked brain in two ways: they seek both pleasure and relief from the discomforts of withdrawal, which are a powerful duo to contend with and try to manage. Let's return to the brain circuitry we are discussing. Another section, marked O, for the "orbital frontal cortex," serves to generate human drive and motivation. This region is also pumped up by the dopamine spike and gets us going, namely, wanting more of what makes us feel good or less of what makes us feel bad. It drives us humans (and animals) to repeat experiences, even if that means swallowing a handful of pain pills or sticking a needle in our arm. If for any reason you do not want to visit a mental health professional, or are worried about the expense of doing so, there are simple self-help practices you can use that have been proven effective for relieving anxiety in many cases. Apart from applying some of the principles of cognitive behavioral therapy (such as the gradual exposure method) through self-coaching, here are some other practices you might like to try: Meditation. Practiced by religious faiths around the world, meditation can have a spiritual dimension to it for some people.

For others, it is a purely secular activity. In any instance, however, meditation is essentially a process of focusing the mind's attention. Some practitioners refer to this as "emptying" the mind. Others refer to it as simply achieving a state of mental non-intervention, in which one allows thoughts to enter and exit one's mind without trying to arrest, cling to, or keep out any of the thoughts that come along. Developing these mental habits through meditation can be extremely helpful in managing anxiety and panic symptoms - especially in the moment of a panic attack - as we will see in the following chapter. One simple method that one can use to enter a meditative and focused state in any situation is as follows: simply try to count to ten. Whenever you get to ten, make sure you go no further, and return to one and start counting again. This sounds so simple as to be foolish, but it is actually a good way to keep one's mind in a state of focused awareness. You'd be surprised how easy it is for one's mind to just keep on counting to higher and higher numbers if you don't remember to pull it back down to one again each time. As a procrastinator, there were a few occasions when practically all sense of my personal responsibility to myself seemed to fly out the window. I may have showered, shaved, and wore clean clothes, but that me was the one I presented to the world--the other me was a disaster. Not only was my apartment a mess, but my bills went unpaid until I received a second or third notice. Delaying the bills left me feeling overwhelmed, and during periods when my bills were left unpaid, nervous confusion and stomach pains plagued me. While I knew that I should be paying bills, I couldn't bear dealing with them because just about every part of the process seemed to require too much effort. At the same time, the more I put off--the more I had to do. Seeking understanding, comfort, and a bit of insight into my condition, I talked to trusted friends, neighbors, and with professionals in the mental health field. To my chagrin, every once in a while someone would ask, "David, are you sure that you're not just being lazy?" All right, fair question--but my answer is a resounding "No." Why? Let's take a look at the following chart: Procrastination is a long-term condition. It can last for years and stay with a person into the future without end. Laziness comes and goes.

The lazy person has far more control over his condition than the procrastinator could ever dream of having. Relaxation. Relaxation, you say? If only! For many people with anxiety and panic, relaxing is the one thing they'd love to do more than anything, and the one thing they can't seem to do. How can anyone recommend it to them? The answer is, once again, that relaxation has both an internal emotional component and an external somatic, bodily component. And by influencing one's somatic response, one can alter one's internal emotional response as well. For instance, by consciously willing oneself to release the grip of each muscle, one can reduce one's feeling of anxious tension. Your perceived problems are no different than a dumb rock. That person, event, and thing you see as a "problem" isn't good and it isn't bad. It just "is what it is". It's neutral. It's nothing and you're turning it into something bigger and worse through your thinking, emotions, and perception of it. Assigning and labeling it as "good" and "bad" doesn't make it true. It doesn't make it fact. It's just your perception of what you think, feel, see, and believe when you look at that person, event, or thing. Very few things you label as "big problems" are actually real problems. Most of them are, literally, nothing. They're as unimportant as a rock.