There is a legend about how Alexander the Great was able to conquer in the East. When he entered the city of Gordium there was an enormous wagon so tightly tied with ropes that it could not budge. Legend held that it had been owned by King Midas, and that any attempt to untie the knot would make it tighter.

An Oracle had foretold that any man who could untie the knot would be able to conquer Asia. Alexander struggled with the knot for hours until he he spied a lynchpin with thick patina holding the old boards of the cart together. He pulled the pin from the cart and watched the rope untie itself as it crushed the pieces of the old cart in its grip. Defeating our own crippling anxiety often requires a similar “in plain sight” solution that force of will alone cannot solve.

Mindfulness works because in the present moment there is usually not that much to worry about.

Maybe we are a little tired, or hungry, maybe it is cold, but there is not much to deeply upset us. It is outside of the present where we can hear the twin dragons of our past and future whisper, threatening to devour us. In the past we flashback to things that we have done wrong, poor choices we made, or revisit painful things that have been done to us. In the future we are afraid that these awful things will happen again. We become afraid that our past is our future.

Our obsessiveness turns the future into an incomprehensible mess of terror and humiliation that we cannot help and cannot help but fail to exhaust yourselves trying to prepare for. The more we struggle against this gordian knot by trying to control the future, the tighter it gets. To escape this paralyzing cycle the answer lies back in the present, where we can breathe free from fear and make better decisions about what to do in the here and now so that we will be ready for the future. To do this we have to pull ourselves back into the moment, experience the feelings we are avoiding, and notice all the messages our body tells us that we often ignore.

Coping denial and narcissistic denial are the exact opposite of the obsessive anxiety cycle. To be in denial about the consequences of our past behavior or to deny that our actions now will affect us and others later is an intentional lie we tell ourselves. The lie necessitates that we hide in the present oblivious and blind. I find that patients who are trapped most deeply in the obsessive anxiety cycle usually developed the tendency in response to a caregiver or partner was oblivious to the past and future realities of life.

True mindfulness practice is different from denying or ignoring reality outside of the present in that it does not disconnect us from our life journey. It is a tool to reconnect our minds to our bodies and release the past trauma and fear of the future we store within. Intentional mindfulness is a way to ground ourselves so that we have a better point of view on the rest of our lives. I like to think of it as building a watchtower in the present moment so that we can see clearly far across the past and future in order to best understand, and prepare for, where we were and will be.

Beginning the Scan

When you begin the body scan make sure the room is quiet or you have a noise machine with a low tone active. Turn phones off and limit interruptions or distractions. Start by instructing the patient to begin open posture. Demonstrate open posture to engage the patient in the practice.

The scan usually works better if patient’s close their eyes, but if this makes them nervous, then ask them to “sweep” their eyes so that they are not concentrating on anything for long or becoming distracted.

If patients are interested, offer to let them record the practice on their phones for later. If you have a guided meditation that you like or use EMDR or IFS, I generally find patients engage with these models more easily after the body scan.

When speaking for the scan speak in a slow even tone and take a long pause between each instruction. For direct instructions in the scan stop to watch the patient complete the instruction.

“Unlock all of your joints and try and relax your muscles. Extend your palms and fingers outward and open. Sit with your spine straight, but comfortable. Feel loose like a gummy worm that would wobble with little resistance if someone pushed you.”

After the patient is in open posture, start the breathing exercise and have patients do the breathing exercise for about 5 – 10 minutes before you begin the body scan. Demonstrate the in and out breath for the patient with your hands, slowly up and down, to give them a visual guide.

“We are going to take a deep breath in and out, 2 seconds in, slow down for 1 second in the middle, and then 2 seconds out. When you do this, do it in a slow gentle motian like a wave. Don’t breathe in and stop before breathing out. Fill your lungs until they are deeply full but not uncomfortable. As you do this notice how your heart rate starts to slow and this will make your thoughts slow. Your brain may try and fight this process or go to other places, but eventually it will relax.”

When the patient has fallen into the breathing exercises, and you can see them relax then begin the body scan meditation. It is normal for a resistant patient to show resistance by giggling, fidgeting, or staring at you. If you can get these patients to lull into the mindful state they are usually the ones who go to sleep or get close to it by the end.

“Imagine that there is a point of light in the room like a laser pointer, or the reflection from a piece of metal in the sunlight. Imagine that the point of light becomes a ball that is the only thing you can concentrate on and see as it moves around in the room. Imagine that the point of light begins to brush against the tips of your toes on both feet. As it moves across your toes start to notice all the messages that your body sends you all the time that you don’t have time to notice.

Notice if the skin on the tips of your toes is damp or dry. Notice if it is hotter or colder than the rest of the body. Notice how the open air, inside of the shoe, or feeling of your sock feels against your skin. Be with that awareness for a minute. Now notice if there are pockets of air in between your toes or if they are packed tightly together inside your shoe. Notice the way that feels. Now notice the temperature of your skin in those places. Notice how the hard shell of your toenail feels different than the skin on the top of your toes. Be with that awareness for a minute.

Now roll the ball of light back and forth from the tips of your toes to the ball of your heel under your foot. As you do this notice the way the skin is thicker in some places and thinner in others. Be with that awareness for a minute. Now move the ball of light inside your foot and find the bone. Notice the powerful structure holding your foot together. Notice the places where the bone of your foot is pressing against the ground. Feel the joints inside your toes, and roll the ball of light into the joint of the ankle. Feel the strength and flexibility of that joint as your foot rests upon the floor.

Now roll the ball of light up and down the bone in your foot, in between your ankle and your knee. Notice the strength of this bone, that can hold all of your weight as you run and as you walk.”

For patients who have problems feeling vulnerability or fear I spend more time talking about the power of muscles and the strength of their bones. How they are powerful and can let us run away from danger or stand firm against strong waves in the ocean, etc.

“Now move the ball of light through the muscle on the back of that bone, and be aware of the weight of that muscle as it hangs off the bone relaxed. Now feel the sensation of all of those strong fibers of muscle wrapping around the bone of your leg. Feel the way that wraps around your calf and thigh bone. Notice the power that you could feel in the muscle, and the strength if you were to flex it, but leave it relaxed. Feel the potential energy inside each muscle waiting for whenever you need it. Be with that awareness for a moment.

Sometimes when you relax a muscle that you use frequently you can feel twitches or jerks as enzymes discharge. Sometimes, but not always. Notice any involuntary movements if they are there. Now feel the skin around your calf and leg. Notice the sensations of pressure from the couch or from your body weight against your skin. Notice the temperature of your skin and the feeling of your clothes or the open air. Notice if you can feel the wind moving in the room room or if it is still. Be with this awareness for a second.

Now take the ball of light and roll it up into your tailbone. Roll it slowly up and down in between your tailbone and the base of your neck. As you feel it roll up and down notice all of the disks in your spine flex and bend together as you take long slow breaths. Your spine should feel like a slinky bending and resting on itself as you breathe in and out. Feel how your spine is smooth and flexible, able to support you when you move and bend.

Now take the ball of light and move your awareness on to the skin across your back. NOtice how your skin feels against your clothing. Notice where there is pressure on your back against where you are sitting. Be with this awareness for a moment.

Now roll the ball of light in a V shape. Start in the middle of your shoulder and then move down into the middle of your spine, and then back up into the middle of your other shoulder. We often store tension in the muscles here.

Breathe in and be with the awareness of some of that tension on the in breathe. On the out breath, push it out away from you into the room and feel it leave. Feel the muscle get slightly warmer and more relaxed.

Take in one more breath and identify with some more of that tension, tightness or numbness. And on the out breath push some more of that tension away from you out into the room. Feel the muscle start to melt slightly and get warmer as some of that tension starts to leave. Feel that as the muscle loosens blood can come back into capillaries and oxygenate spots where it has been cut off. Notice as this starts to happen there is a feeling of warmth that will come back to the tight spots in your muscles. Now take one more long deep breath and find the last few spots in that tension. Be with the awareness of it for a minute, and on the out breath push it out away from you into the room.

Now take the point of light and roll it up your neck, up onto the top of your scalp. Now feel all of the follicles of hair on your scalp. Notice if you feel weight or pressure from your hair, or feel any movement. Now notice if the temperature around your hair is different than the temperature of your skin around the rest of your face. Be with that awareness for a minute.

Now move the point of light into a triangle starting at the center of the top of your forehead and going down to the ends of your eyebrows. We sometimes hold tension in our temples, or across the middle of our forehead. This can feel like a rubber band is stretched across the center of your forehead, or it can feel like a small migraine inside the front center of your skull.

As you breathe in, notice some of the tension in the triangle and be aware of it for a minute on the in breath. On the out breath, begin to push the tension away from you into the room and feel it leave. Feel the small muscles get warmer, and get looser as you push the tension away from you into the room and feel it leave. And now on one more big breath, find a few more spots of numbness or tightness. Push them out away from you into the room, and the muscles in your face get warmer and go slack. Feel how your whole face droops down and hangs loose after you let go of this tension. Feel your face get warmer.

Now move your awareness into the middle of your chest. Find your heart beat there. Be with the awareness of that slow steady rhythm for a moment. Now imagine that your body is a still pond, and that there is a ripple out from your center on every heartbeat. And as the ripple spreads outward it warms your body and helps it to relax, as it brings blood and oxygen all the way down your legs to the tips of your toes… and down your arms to the ends of your fingers… and up to the top of your head… And feel the warmth… And feel yourself relax.”

Unpacking the Bodyscan

After the meditation ask the client what they noticed, and if they liked the exercise. It is fine if the client hated it! Usually you will learn some information that can inform treatment even if the client did not like the experience. Clients often have a hard time relaxing if they have a strong protection or control impulse and this resistance can be explored in future sessions. Ask the client what it is that they did not like and how the experience felt to them. Usually resistant clients will either have a strong defense against connecting to the body because of traumatic events, or they are afraid to relax because they believe they will be victimized when they are no longer aware of the future or their surroundings.

If the client enjoyed the exercise or is ambivalent have them concentrate on the parts that they found helpful or reductive stress. Have clients share things that they felt were the most memorable from the experience. Oftentimes clients can isolate specific parts of the bodyscan that they find the most grounding and integrate them into a ritual they can use in life to soothe themselves. Concentrate on specific body sensations that were surprising. Sometimes reconnecting to a certain part of the body is especially helpful to patients. In that case I like to combine reconnecting with other interventions, like making a mantra, that they can use while doing deep breathing during activating times.

If the client has strong resistance to the body scan meditation, exploring their fear can be a good entry point into beginning trauma therapy. When resistance is uncovered, use it to explore the client’s attachment beliefs about themselves and the world. For example many patients will say that they cannot relax because it is not safe. When this happens have them begin to relax, be with the awareness of that fear, and ask Why they are not safe.

Some patients may have a belief that they are not safe because they will be attacked. This can lead to therapy being used to rediscover when it was that they felt attacked. Sometimes patients may feel a lack of safety due to a loss of control. Such patients will generally have a negative core belief about responsibility. They will typically have an internal locus of control and take responsibility for others behavior and their inability to stop it. Therapy with these patients can address this belief and locate the patterns of obsession and hypervigilance that exhaust them.

Some patients who find the body particularly activating and upsetting should not be forced to reconnect with parts that upset them. These patients will likely have past trauma that has severed the connection to a certain part of the body experience for a reason. Therapy with these patients should slowly reconnect with the protective parts of the psyche keeping the connection severed.

If there are parts of the body that are activating for the client because they are associated with trauma these as well as the clients beliefs related to them should be noted by the therapist. The body scan can be modified in future sessions in order to help start to correct the underlying traumatic belief. For example, a patient who feels weak or vulnerable should be instructed to be with the awareness of the power of their body. The therapist should put a focus on the body’s ability to escape from situations heal itself, defend itself, and protect the patient. When the patient becomes more in tune with this awareness they will be able to begin to correct the underlying trauma belief.

Protective parts can be addressed directly in therapy in order to help define the clients underlying belief about the trauma. Often protective parts will be located inside a particular experience in the body. Eg. a tight chest, or a lump in the throat. Clients should be instructed to be with the awareness of the resistance and directly ask it what it is afraid of or what will happen if it lets go. This can be used to clarify the client’s underlying core beliefs resulting from the trauma.

For more benign resistance such as fidgeting or giggling simply stop the meditation for a moment and remain quiet each time the resistance occurs until the patient relaxes. If the patient continues to have difficulty, ask them what they are thinking about or go back to the deep breathing exercises, and try the bodyscan in a later session when they are more comfortable with the process.

Bibliography:

van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books, 2014.

Levine, Peter A. Waking the Tiger: Healing Trauma. North Atlantic Books, 1997.

Ogden, Pat, and Janina Fisher. Sensorimotor Psychotherapy: Interventions for Trauma and Attachment. W.W. Norton & Company, 2015.

Grand, David. Brainspotting: The Revolutionary New Therapy for Rapid and Effective Change. Sounds True, 2013.

Further Reading:

Porges, Stephen W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W.W. Norton & Company, 2011.

Rothschild, Babette. The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. W.W. Norton & Company, 2000.

Damasio, Antonio. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. Harcourt Brace, 1999.

Siegel, Daniel J. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. Guilford Press, 2015.

Emerson, David, and Elizabeth Hopper. Overcoming Trauma and PTSD. New Harbinger Publications, 2011.

Lanius, Ruth, et al. Healing the Traumatized Self: Consciousness, Neuroscience, Treatment. W.W. Norton & Company, 2015.

Arden, John B., and Lloyd Linford. Brain-Based Therapy with Adults: Evidence-Based Treatment for Everyday Practice. Wiley, 2008.

Mate, Gabor. When the Body Says No: Exploring the Stress-Disease Connection. Wiley, 2011.