Control and letting go

The other day I met with a patient I've been working with for the past several months.  About a year ago he was involved in an industrial accident; he developed posttraumatic stress disorder as a result of his experience.  He was extremely hopeful and enthusiastic when we started treatment.  Together, we identified a treatment program that I felt confident would significantly alleviate his symptoms.  Things went well initially, but after a few sessions we hit a road block.  We spent a lot of time identifying ways to get around the problem.  We even decided to meet twice a week in an effort to "speed up" the treatment process so he could get through the hardest part of it more quickly.  Unfortunately, nothing we tried was very helpful.  The patient was just stuck.

When I saw him this week he was feeling pretty hopeless.  He was frustrated and depressed.  He told me he no longer has hope that he's going to get better.

I know exactly what is keeping this patient stuck; it's a problem I've run into a quite a few times.  The patient himself told me what the problem is, although he didn't realize it at the time.  "The anxiety is so bad," he said.  "I can't control it."


And therein lies the problem; he is trying to control his anxiety.  What he really means by "control" is "get rid of."  In other words, he can't make it go away.

Of course, it's human nature to want to get rid of negative feelings (or to stay away from situations that cause those feelings).  Most of the time, however, trying to get rid of negative emotions just doesn't work.  The feelings might go away for a little while but they keep coming back.

Let's take posttraumatic anxiety, for example.  The anxiety a person experiences after a trauma comes from the fact that his illusion of control has been shattered.  Most of us go through life believing, "I can keep myself safe. If I am careful and make good decisions I can prevent bad things from happening to me."  When, despite all our precautions, something bad does happen, we can no longer believe what we've been telling ourselves.

The fact is, we were never in control; we just believed we were.  This belief helped us to feel safe.  When we realize that there are a lot of things in the world that are beyond our control, we feel completely vulnerable.

The thing is, you can't fix a problem caused by feeling out of control by trying to control it.  What you really want to control is the world around you; that way you can prevent anything bad from happening.  Unfortunately, you now know you can't control the world around you; this knowledge causes anxiety.  Since you can't control the world, you try to control your anxiety instead.  But even if you could control your anxiety it doesn't take away the fact that you still can't control the world.  As long as this knowledge causes fear the anxiety is going to keep coming back.

So back to my patient.  I told him that his efforts to control his anxiety are a big part of the problem  He was able to recognize this.  Knowing, however, is not enough.  I cannot teach someone how to stop trying to control and just let go.  Letting go is an intensely personal decision that requires intention, willingness, and a small leap of faith.  Letting go is a "try it and see what happens" approach.  Of course, I know that "what happens" is that nothing bad happens.  Unfortunately, that is something my patient has to experience for himself.  To do that, he has to be willing to let go.