Promoting Playfulness
In addition to curiosity, you can bring in playfulness as another defusion technique. For example, when encouraging Sarah to be curious about the pressure and weight she feels on her chest, you might ask her, “Does it feel like a tiny kitten sitting on your chest? Or is it more like a giant Garfield-like cartoon cat sitting there?” Sarah might be a bit taken aback, interrupting the process, but it leads her to pause and consider her experience.
We so often focus on labeling what we’re experiencing as panic, anxiety, “This is bad,” “I’m in danger”, that we don’t pause and understand what it is we’re actually feeling. This is one of the reasons why people hyperventilate in response to shortness of breath. They feel like they can’t breathe, so start sucking in a lot more air, which increases their CO2 levels, leading to hyperventilation, and potentially lightheadedness and fainting.
We can help Sarah to slow down by saying, “Okay, you feel like you can’t breathe, your mind is telling you that you can’t breathe. But you’re able to talk. You’ve been having this sensation for how many minutes? Four minutes. If it’s been four minutes and you couldn’t breathe, would you still be conscious? I can’t hold my breath for four minutes.” Examining it provides some distance from it.
We can help her to be curious about her experience by describing it. Let’s say she’s feeling flushed, hot, and sweaty throughout her body. We might ask her, with her eyes open or closed, to imagine her body as a heat map. What are the areas that feel most hot or flushed? Let’s make those dark red. And what about her fingertips, are they warm? Sarah might say, “No, I don’t even feel my fingertips.” So we can make those blue.
Doing this allows Sarah to come into contact with a scary sensation, but in such a way that she’s not overwhelmed or consumed, but can take a step back and look more closely at the experience she’s having. This creates some curiosity, some inquisitiveness. It also helps shift her attention away from the things causing distress to something like her fingertips, which aren’t in any way strange or different from her normal experience.
The Mind Avatar
Another common defusion exercise in ACT is to give a name to your mind. Let’s say that Sarah has named her mind Francine. When she’s feeling really anxious or scared about doing something, we might ask her what Francine is saying in that moment. Sarah might report that Francine is telling her this is a terrible idea, they’re going to have a panic attack, and it’s going to be horrible.
Naming the mind, giving it a separate character, allows us to get some space between our experience and what our mind is doing, so we can look at it from a greater distance. This is also why journaling can be really useful: it’s taking information out of your head where it gets jumbled and confused, and fixing it onto paper or into an app so you can pause, look at it, read it, and be able to think through and process your experience and thoughts.
By creating some separation between Sarah and Francine, she’s able to look at patterns, see them a bit more clearly, and realize that Francine is trying to help her, to keep her safe from an imagined threat. But also to see that Sarah doesn’t need Francine to protect her in that moment.
Sarah can talk back to Francine, not with the intention of getting rid of her, because the goal isn’t to completely eliminate anxiety. That’s not a workable goal. The goal is to help Sarah learn to say to Francine, “I see you, but this is not helpful right now. So you’re not going to be my focus. My values are going to be my focus instead.” Sarah can thereby pivot away from listening to what her mind is saying, and what the sensations in her body are saying, toward more values-based feelings and behavior.
You can take this exercise a step further and have clients create an entire animal that represents the mind. Animals are inherently innocent, so you can even pick a potentially frightening animal like a tiny spider, and anthropomorphize it by giving it a human or pet name. If Sarah can picture Sprinkles the Spider skittering around, whispering in her ear that something’s dangerous, that she needs to leave, it allows her to express herself in a way that’s not overwhelming and consuming. It also gives us a common narrative, a common metaphor to use to talk about some pretty big experiences in a playful way.
So further down the road when Sarah’s doing exposure work, instead of asking her what it was like when she felt she couldn’t breathe or started getting dizzy, we might ask, “What did Sprinkles do in that moment? What did Sprinkles say to you?” This gives her the space to pause, think, and be in her experience instead of being consumed by it.
Mindfulness
Sarah is also walked through some present moment awareness or mindfulness, in the form of brief grounding exercises such as coming into contact with her five senses. Something as simple as touching fingertips together and noticing the moment and tiny sensation when they touch can be effective. Because generally, when we experience physical panic symptoms, they usually show up between the neck and navel, in that core trunk of the body. Sometimes legs might feel shaky or hands sweaty, but usually the primary panic sensations aren’t at the extremities.
So we help a client turn their attention to milder sensations that are still within their control. This is not to distract or avoid what they experience in terms of panic, but brings in other experiences that help them see how part of their body and mind is telling them there is a threat, but other parts are neutral, more subtle. If we focus on all of that, we can achieve a more wholistic and realistic appraisal of what’s happening in that moment.
There are a number of different strategies outlined here, and you might have some you already use with clients effectively; you can mix these up based on what works best for a client. Sarah liked guided mindfulness exercises, but you may have clients who don’t feel comfortable with their eyes closed. In those cases, you could assign exercises like touching fingertips, or taking three breaths in a mindful manner. Tailoring exercises in this way helps clients to practice skills without feeling frustrated or like they’re failing.