They are usually talking to themselves at such a fast tempo that they become hyper–alert and stimulated, and aren't able to access other choices — rather like driving a car on the freeway while stuck in high gear, unable to change down into lower gears. At that fast speed, they lack choice; it's not possible for them to exit and turn off onto side roads, or stop for lunch. Slowing down the tempo of their internal voice makes it possible to have choices that simply weren't available to them when they were talking to themselves rapidly.
Congruence Check: Asking for Objections
Before beginning the exercise below, I do a thorough congruence check, to be sure it is appropriate to reduce or eliminate the anxiety or other unpleasant symptoms that they feel. If someone has very good reason to be anxious, and their anxiety keeps them out of dangerous situations, it would not be appropriate to change their feelings until and unless they had some other way to protect themselves from that danger.
However, often there is no real danger, only a perceived or imagined danger, or their response is to some past context, so the danger is no longer present. In order to distinguish between these different possibilities, it is important to find out if there are any positive outcomes that would be affected by eliminating the anxiety.
The simplest way to do this is to ask, "Does any part of you have any objection to having a more comfortable response in all the situations in which you have had these intense feelings?" Often an objection will emerge as an uncomfortable feeling or nonverbal incongruence. At other times, it may appear as an image of a potential problem, or a internal voice that is more explicit. "If I lost my anxiety, others would expect me to take charge and be more responsible." Any objection needs to be satisfied before proceeding, or it will tend to interfere with the process.
Whenever you find an objection, one option is to simply stop what you are doing until you have more experience with adjusting a voice, or until you have more experience with satisfying an objection. This is the safest option, but it prevents you from trying some changes that could be very useful.
Another option is to proceed with the process, with the full knowledge that any change can be reversed if it turns out to be unsatisfactory. If you assure any objection — whether that is a vague feeling, or a more specific image or internal voice — that you agree reverse any change if it objects to it later, it can be comfortable trying out a change to find out if it is satisfactory or not. This option is particularly useful when an objection is not based on a specific perceived danger, but only on a somewhat vague fear of the unknown — what might happen if the change was made.
Other objections are much more specific. For instance, "If I lost my anxiety, I wouldn't get out of dangerous situations fast enough," describes a protective function that needs to be respected. The simplest way to satisfy this objection would be to agree to keep the anxious feeling in any contexts that are truly dangerous, while exploring alternatives in other contexts.
Most anxiety doesn't actually protect someone by keeping them out of a context that is perceived as dangerous; it only makes them feel bad while they are in it. For instance, many people are anxious about flying, but it's not strong enough to keep them from flying, it only makes them miserable when they are on a plane. Once you have decided to risk getting on a plane, the anxiety is useless, so you may as well feel comfortable.
Yet another way to satisfy an objection is to ask the objection how it could be satisfied. "OK, you want to protect me from danger; how can you continue to protect me from danger, while allowing me to feel more comfortable?" In many ways this is the best option of all, because it gives the objecting part the task of finding a solution. Since it knows most about exactly what it wants to protect you from, it is in the best position to propose an effective solution.
Slowing Tempo Exercise Outline
In the outline below, sentences in "italics" and quotes give the exact language that I use, with explanatory remarks in parentheses, or in plain text.
1. Accessing the Internal Voice "Now I know from what you have told me that up until this point you have experienced this intense feeling on a number of occasions. I'd like you to bring one of these times to mind now, and let me know what you are either thinking or saying to yourself at these times, just before the feeling occurs. You can do this either with your eyes open or closed. Most people find it easier with their eyes closed"
Notice that this language is more immediate and associated than, "Think of a time when — " which is more ambiguous, and could result in them thinking of an experience by seeing themselves in it, rather than being in the experience and re–experiencing what they feel when that happens. Or they might run through a listing process, scanning across different examples, but without stepping into any of them. Either of these alternatives would make it more difficult to hear what they are saying to themselves.
Usually they are able to tell me immediately what they are saying to themselves, but sometimes they may have some difficulty. If they don't know what they are saying to themselves, they may be too separated from the experience at the moment, and this is often visible in their nonverbal behavior — their body is relatively motionless, and they don't look anxious. When this is the case, there are several choices.
One choice is to use my language to help them re–associate into the experience.
"When you are in that experience, what do you feel in your body? If you are sitting down, can you feel the shape, texture, and temperature ofthat particular chair, and your posture as you sit in it? If you are standing, can you feel how your feet contact the floor, and the position of your feet? Do you feel tense or relaxed, balanced or off balance?" Usually that will enable them to really be in that experience, making it easy to notice what they are saying to themselves.
However sometimes it is easier to accept and utilize their separation from the problem experience by asking them to imagine that they could see an image of themselves in the problem context. "IfI were to draw a picture ofyou in one of these experiences, as in a comic book, where the artist draws thought bubbles above each character's head, what should I put in the bubble over your head to indicate what is being thought at that precise moment?"
Or you can use some version of the "as if" frame: "If you did know what you are saying to yourself in that situation, what might it be?" or simply, "That's OK, just make up something" Since I will be adjusting the tempo, not the content, the exact content of what the voice says is really not that important. It is only important that they come up with something that fits well for them in that situation.
Once they know what they are saying to themselves, I ask them to think of other situations in which they have their anxiety, and ask what they are saying to themselves in those. Typically it is either the same sentence, or one that is fundamentally similar, or has the same kind of presuppositions or implications — that they are about to die, or are in some kind of very difficult situation that they can't handle, or that has very unpleasant consequences. By doing this, I am helping them to create a larger category of experiences in which they have the same feeling of anxiety. Then when I help them change the feeling in one of these, the change is much more likely to generalize to all the experiences in the category.
2. Noticing the Tempo "So the sentence you have said to yourself is, 'The plane is going to crash into the sea' When you have said this to yourself, do you say it in your normal conversational speaking voice, or do you say this at a faster tempo?"
Here I am offering the client just two options; most will immediately confirm that they are using a faster tempo of speaking. If they say it's otherwise, I ask them to check; to date out of the more than 900 clients I have done this with, every one has been able to notice a much faster tempo.
3. Baseline Tempo "OK, now I am going to ask you to do three things. The first is to say or think this sentence exactly as you have done to date and notice how you feel in response to doing this " …
4. Slowing Tempo by One Third "OK, now I am going to say your sentence, slowed down by about one third. After I have said it, I want you to say or think this sentence to yourself at this slowed–down speed and notice what's different" …
Then I say their sentence out loud and slowed down, and then pause while they say it internally in the same tempo. In order to slow down the tempo they have to change their physiology — slow their breathing, relax the tension in their vocal cords and chest, how they shape their words, etc.
5. Even Slower Tempo "OK, now I am going to say the same sentence even slower, and when I am done I want you to do the same, and let me know when you have done so "
I then say the sentence out loud, and slow down the tempo dramatically, to demonstrate exactly what I want them to do. I allow at least two seconds between each pair of words, matching each word to their breathing out, so that each word is paired with the relaxation that naturally occurs when breathing out.
I watch them carefully to observe their increased tension as they anticipate when they will hear the next word, so that I can say the next word somewhat later than they expect. I pause even longer between the last two words of the sentence — at least double the length of the previous pauses. Then I pause to give them time to say the sentence in this slowed down tempo, and wait for them to tell me when they are done… .
6. Testing "OK, now when you try to think of this as you used to, what are you noticing that is different?" Usually their feeling of anxiety will be entirely gone; sometimes it will be greatly reduced. The tempo shift deconstructs the meaning of the old sentence, and changes their response. Very rarely it may not change much — or at all — and I follow with the visual variation below.
Another way to do the same exercise is to ask them to see the sentence in front of them as they say it to themselves, translating it from the auditory to the visual.
"Now I want you to see that sentence out in front of you, as if it's on a small billboard, and notice what the sentence looks like in detail Tell me how far away from you it is, what size the letters are, whether they in boldface, italics, or regular type, etc"…
"Now I want you to begin to stretch the sentence apart, creating longer spaces in between the words, first noticing the new locations of the words, and then to attending to the spaces in between the words, rather than the words themselves." …
This is a figure/ground shift of attention. If I don't see a dramatic shift in their breathing and posture, sometimes I ask them to put space between the letters as well as the words. "Now I want you to separate the letters in each word. Put spaces between the letters, and then pay attention to the spaces between the letters, rather than to the letters." This further changes the meaning of the sentence, and is also a demonstration that they can voluntarily change their feeling response.
If the sentence has a negation in it, like "I can't — " I have sometimes suggested that they, "Remove the apostrophe and the t in the second word of the sentence" being very careful not to say the word that I am referring to. This reverses the meaning of the sentence entirely, and they find themselves able to do what they previously thought, "I can't." I often delete any other word that causes a problem, for instance, "And now take the fourth word and do the same thing. Start to fade it out a little bit more, a little bit more. And then there's a certain point where — pfff — white it out. So it's not there. You know it's not there, because when you look now, it s not there." When doing this it is important to not say the word, but only refer to it indirectly by its position in the sentence.
Kinesthetic tactile variation
An additional variant is to ask the client to reach out and feel the words and letters in front of them, as if the words are solid, and they could touch them with their fingers, translating from the auditory or visual systems to the kinesthetic. Then I ask them to use their hands and fingers to spread out the words — and then sometimes to also spread out the letters — and to feel the empty space between them.
In some cases I will ask them to run both the auditory and visual versions of this exercise at the same time, or to add in the kinesthetic aspect as well.
After doing this, it is imperative to do a thorough congruence check again, by carefully rehearsing and testing the new response in all the different contexts in which they previously had the old response. Any concerns or objections need to be respected and satisfied in order to preserve any other useful outcomes that may have been served by the old response. This could include keeping the old anxious response in certain contexts, to maintain the protection. Usually an even better solution is to elicit or teach some kind of coping behavior in those contexts that are still perceived as dangerous, so that they no longer need the anxious response.
The verbatim transcript that follows is from a session that I did recently with a professional trombonist who got anxious whenever he played in an orchestra. In this example, I utilize aspects of both the variations described above. The transcript begins with me talking to Fred (His name has been changed):
When people come to see me, they're mostly in some kind of state of anxiety. They don't come because they think, "What shall I do? I've nothing else to do. I know — I'll just go and see Nick today." (Fred: Yeah.) So they arrive with something, number 1. Number 2, it's something that they're doing over and over again, so no matter how much they've thought about it, they don't feel any different. (Fred: Right.) So they've got to the point when they decide to see me, they're really thinking, "You know what, I've got to do something different." (Fred: Yep.) So everything's reached a bit of a boiling point. (Fred: Yeah.)
