Fear of open water swimming is common among triathletes. There are three kinds of anxiety that can manifest in this context:

1)    Anxiety as a survival mechanism. Anxiety can serve to keep us out of potentially dangerous, life-threatening situations.

2)    Performance anxiety. This is a frequent phenomenon, affecting all kinds of performance (e.g. musical, sexual, public speaking).

3)  Separation anxiety. This is a universal, existential fear.

The Escape from Alcatraz triathlon is an iconic event. It consists of a 1.5 mile swim, from the island of Alcatraz to San Francisco, followed by a scenic bike ride and run. I have participated in this triathlon for each of the last ten years. In order to do so, I have had to overcome my own anxiety.

Swimming across San Francisco Bay is exhilarating, challenging and awesomely beautiful. Due to ever changing conditions (weather, fog, tides, currents), the swim is unique at each crossing. For the swim, 2,500 athletes are taken by boat to a position adjacent to Alcatraz. At the start of the swim, each swimmer jumps off the boat into the frigid waters of San Francisco Bay. At the beginning and end of the swim, one is surrounded by a large number of fellow swimmers. However, crossing the shipping channel between Alcatraz and San Francisco, the swimmers become separated. While there are, of course, numerous support craft surrounding the swimmers, there are nevertheless stretches during which one sees no one else in the water. These are the most psychologically trying times.

On the occasion of my first and second crossings, I made arrangements with an individual kayaker to serve as my personal escort for the swim. Neither attempt worked. It is impossible for a kayaker to identify and to follow one swimmer out of 2,500. In subsequent years, I simply entrusted my fate to a Higher Power.

Here are some of the techniques that have helped me to transform fear into exhilaration, and to achieve my goal. These techniques may help you to overcome your own fears, and to achieve your own goals.

1.  Training

For years, I met weekly with an open water swimming coach. This experience offers two take away lessons. The first point is the importance of asking for help. The second aspect is a technique known as in vivo desensitization. This phrase refers to a process of entering into the anxious situation gradually, progressively, usually in the presence of a reassuring other person. Doing so leads to a gradual extinction of the anxiety response.

2.  Positive self-talk

Take control of your mind through positive affirmations. Stop negative thoughts (e.g. there are probably sharks out there). Replace such thoughts with positive statements.

3.  Visualization

This technique is not limited to the realm of athletics. Visualize yourself achieving your goal, stroke by stroke. Incorporate as many senses as possible, as you rehearse your calm, confident, successful pursuit of your goal.

4.  Navigating
Navigating in the context of open water swimming involves sighting on landmarks. Metaphorically, we can use this technique in all situations. What are the landmarks you can use to assess your progress towards your goal? For the Alcatraz crossing, it is important both to focus on the finish line, as well as to cast the occasional glance back at Alcatraz. Doing so helps to verify that you are swimming in a straight line. In life as well, it is important to use where we have come from as a point of reference in staying on course to where we are going.

5.  Controlling your breath

Anxiety leads to hyperventilation, which in turn heightens our anxiety. It is a very helpful practice to develop an awareness of our breath, and to take slow deep breaths.

6.  Staying in the moment

All anxiety pivots on “what if’s.” Make it a continuous practice to stay firmly and completely present in this very moment. Doing so will steady your nerves and strengthen your resolve.

7.  Embodiment

Stay in your body. Maintain continuous awareness of your bodily sensations. This practice will keep you grounded in the physicality of your being. In the Bay, the body is a sensitive instrument for providing information regarding moment to moment shifts in tides and currents. So too in life.

8. Staying focused on your goal

This focus will block your anxiety response. In the Bay, I maintain an intense fire burning within me to reach my destination. This liberates me from doubt and fear.

9.  Faith in a Higher Power

Like getting on an airplane, jumping off a boat in the middle of San Francisco Bay is an act of surrendering the ego to a Higher Power. As in Alcoholics Anonymous, and many other spiritual traditions, this surrender, if whole hearted and complete, engenders inner peace.

For me, Escaping from Alcatraz is a metaphor for liberation from the shackles of past fears. Like in the Book of Exodus, following this path will liberate you from the Land of Pharaoh, and deliver you to the Promised Land.

Dr. John Deri’s next Blog Talk Radio Show: Healthy Mind and Body will be on Wednesday, June 9, 2010 from 8-9:00 PM Pacific Time

The topic of the episode will be:  Depression: A Holistic Approach

During this episode, Dr. John Deri will discuss depression from multiple perspectives: biological, psychological, social and spiritual.  Within each of these contexts, Dr. Deri will describe causes and propose paths to healing of the depressive state.

To listen to the show you can:

1.    Dial the phone in telephone number at (347) 989-0560

OR

2.    Tune in to our online channel at http://www.blogtalkradio.com/Healthy-Mind-Body

Due to popular demand, we have decided to rerun last week’s Blog Talk Radio Show – Panic Disorder: The Absent Self.  Our show Healthy Mind and Body will be on Wednesday, March 10, 2010 from 8-9:00 PM PDT.

The topic will be -  Panic Disorder: The Absent Self

Panic disorder is a terrifying, potentially disabling condition. It can be viewed as a specific form of separation anxiety: separation from the self.

In this episode, Dr. Deri will discuss psychological and pharmacological approaches to the treatment of panic disorder. The role of early life trauma as well as the potential co-occurrence of substance abuse will be highlighted.

Dr. Deri will discuss a clinical case, by way of illustrating and elaborating on these themes.

To listen to the show you can:

1.    Dial the phone in telephone number at (347) 989-0560

OR

2.    Tune in to our online channel at http://www.blogtalkradio.com/Healthy-Mind-Body

Dr. John Deri’s next Blog Talk Radio Show: Healthy Mind and Body will be on Wednesday, March 3, 2010 from 8-9:00 PM PDT.

The topic will be -  Panic Disorder: The Absent Self

Panic disorder is a terrifying, potentially disabling condition. It can be viewed as a specific form of separation anxiety: separation from the self.

In this episode, Dr. Deri will discuss psychological and pharmacological approaches to the treatment of panic disorder. The role of early life trauma as well as the potential co-occurrence of substance abuse will be highlighted.

Dr. Deri will discuss a clinical case, by way of illustrating and elaborating on these themes.

To listen to the show you can:

1.    Dial the phone in telephone number at (347) 989-0560

OR

2.    Tune in to our online channel at http://www.blogtalkradio.com/Healthy-Mind-Body

Richard was a 39 year old married man living with his wife and their two young children.  He was a self employed businessman.  He presented with an acute onset of panic attacks.  These episodes had been occurring with increasing frequency, during the weeks prior to our first session.

Richard and I worked together in twice a week psychotherapy for a period of four years.  His symptoms of panic disorder were relieved by high doses of antidepressant medication, during most of this time.

Early Life

Richard’s early life experience was powerfully influenced by his distant, critical, cynical father.  The father, a successful professional, was rarely at home.  Richard’s mother was comparatively more available to him.  However, she was primarily focused on her husband.  Moreover, she was largely preoccupied with her own painful feelings of isolation.  As a result, Richard was on his own emotionally.

Polysubstance Abuse

Like Sophia in my previous blog posting, Richard turned to alcohol as a young man.  He used alcohol as a way of deadening and escaping from his psychic pain.  Some years later, he began regularly using cocaine.

When I met Richard, he was drinking 6-9 drinks per day, as well as the occasional bottle of wine.  Despite this clearcut pattern of alcohol abuse and dependence, Richard was in complete denial about his alcoholism.

Themes in Therapy

The primary theme in Richard’s therapy was to draw his attention to his repetition compulsion.  He abandoned his family and himself much as he had been abandoned.  A recurring memory wove like a thread throughout the therapeutic work.  Richard had been put out in the back yard whenever he had cried as an infant.

A key dream, to which we often returned, consisted of a brief exchange between Richard and his mother.  In the dream, Richard told his mother, “I’m in pain.”  To which she replied, “I’m in pain, too.” In other words, Richard was entirely excluded from his parents’ minds.

As a young unemployed adult, Richard literally went hungry.  His wealthy parents withheld financial support.

As a mature adult, Richard abandoned his own family, through alcoholism and workaholism.  He was absent to himself as well.  He would often work for long stretches, without eating or sleeping.  He was entirely out of touch with his emotional states.  Alcohol and work were his psychic refuges of unconsciousness.

The Therapeutic Work

The initial therapeutic task was building Richard’s capacity for mindfulness regarding his own self states.  This work began with developing his attention and appropriate responsiveness to basic bodily sensations, e.g. eating when hungry.  This process of growing self awareness then extended to his emotional states.  During the early phases of our work, Richard would compulsively play video games, when he was neither drunk nor working.  Gradually, he learned to make space for his own psychic experience.  He developed an increasing repertoire of healthy activities in synch with his emotional states.

The next major hurdle in therapy was overcoming Richard’s denial of his addictions.  To put it briefly, this achievement was won as a result of a two year long intrapsychic and interpersonal tug-of-war.  Once Richard joined AA and CA, our therapeutic work truly blossomed.  The step work and the psychotherapy were mutually synergistic.

Within the context of the fourth step (“performing a searching and fearless moral inventory”), it became possible to draw Richard’s attention to his abandonment of his family.  This was an extraordinarily painful phase of the work.

Another key component in Richard’s healing process involved helping him to recognize and to neutralize his own inner critic.  This voice was a direct internalization of his critical father.

Finally, through a combination of the psychotherapy and the twelve step programs, Richard overcame his narcissism.  He developed a genuine, growing capacity for concern for others.  This transformation in his character was deeply moving for both of us.  Our own relationship with each other was immeasurably enriched accordingly.

Outcome

Richard became clean and sober.  His panic attacks resolved, off all medication.

His marriage dissolved.  His business went bankrupt.  His life, as he had known it, came crashing down around him.

Yet, paradoxically, Richard was happier and more grounded  than he had ever been in his life.  He had a greatly enhanced capacity for intimacy.

Once again, we encounter the archetype of death and rebirth: the phoenix rising from the ashes.

When I called Richard to request his permission to tell his story, he readily assented.  “I tell my story all the time in the [12 step] meetings,” he said.  “And, guess what?  I’ve just celebrated my fifth year of sobriety.”

When I ponder the question of the meaning of life, I no longer have to search for an answer.