Anxious People under Treatment

One of our interviewees, Abigail Klein told us about her experience with anxiety during her life and how she has learned to deal with it through. At the end of the interview she told us that she applies some of these principles with the people she works with. We told her our ideas about making anxiety tangible through senses and she loved it - ”I would like to try that with my patients.” - Seriously? - of course. We asked her if we could work with them and she said yes.

We were ready to take the world. A week later she told us her boss didn’t want strangers in the facility and that we had to go through the process of being interns for the organization. This represented a delay of 5 weeks that included tedious paperwork, orientations, criminal background checks, etc. But we did it! 

Community Access is an organization focused on housing services for populations in risk in NYC. One of their facilities is the East Village Access, where they provide mental health care for those  who have been diagnosed with a severe mental illness and have compromised effective behavior in society. They have been victims of several types of violence and trauma: homelessness, substance and sexual abuse, domestic violence, among other problems.  

Abigail Klein is in charge of an experiential therapy group called Embodiment and Recovery, where an average of eleven people learn tools to healthfully function in society. The approach is experiential therapy that consists of the use of their bodies and minds in controlled situations where they can learn and practice new skills before facing the world.

Each individual diagnosis is specific, but all of them are being treated at a certain level with the four kinds of anxieties: GAD, PTSD, OCD and or Social Phobia. Because of their previous problems with their behavior in society, their diagnosis for anxiety is connected with harmful experiences in their past.


Working with Community Access

Each session starts off with a regular exercise: Checking in with how they feel at the moment and what is their level of energy. People who have been in the program for a longer time mostly feel good, but a lot of them mentioned a certain level of distress related to their anxiety.  

We decided to follow this structure for our own session. Moreover, one of our thesis advisors, Tina Park, a partner at Diagram, a New York-based design studio that works to improve healthcare experiences, suggested trying to avoid to use the term “anxiety” during our sessions. People liked the sensorial experience so we decided for the participants of Embodiment and Recovery to explore their emotions freely.  

Incorporating the findings of the previous prototypes we created three workshops focused on the senses: Taste, Touch and Smell.

We listened, we learned!

Le Prat Thérèse (1895-1966): Mains de Roger Desmares dans “Le manteau” d’après Gogol (compagnie Marcel Marceau)

Le Prat Thérèse (1895-1966): Mains de Roger Desmares dans “Le manteau” d’après Gogol (compagnie Marcel Marceau)

We started our journey with interviewing many anxious people, we asked them to define was anxiety for them.

Anxiety manifests in a variety of ways for different people. However the root is the same - an attack to one’s core sense of being resulting in a loop of worrying and fear. Holding interviews, we understood that it is not easy to define anxiety. There were people that have been dealing openly with their anxiety for many years and were able to articulate it clearly:

“It’s the out of control thoughts that take over my mind” - Emily
“I went to ER because suddenly I started feeling extremely tense, and not part of this world anymore. I worried about this tension and was over thinking until I was sure that I’m was going to die.” - Jose

But for the most part, people’s definitions included examples of stress, depression and other mental states that are linked to anxiety, however they are not anxiety.

We went back to our neuroscience books and researched more about how the brain works.  

Here it is a nutshell:

The brain’s role is to solve problems! That’s its contribution and responsibility to the living organism it is part of. In order to achieve that, it works in a four phase feedback loop:

  1. Collecting information from the external world through our five senses: Seeing, Hearing, Smelling. Tasting and Touching

  2. Processing the information

  3. Coming up with an equation of cause and effect: Think of it like coding: “If THIS, then THAT…”

  4. Acting

Finally it stores this information in an ever growing database of past solutions

Now let’s go back to anxiety. Anxiety happens internally in our head. It is not tangible and can not be perceived with our five senses. Trying to define it, the brain uses its known tools with not much luck. This raises our cortisol level and more anxiety is generated.  Since it is a very ambitious and success oriented organ, it doesn’t give up trying to identify and understand these feelings, this results in a loop of worries and fears, hence more anxiety.

We realized that in order to make the brain work for us in dealing with anxiety, we need to use the tools it knows and is used to working with. We decided to create an intervention using the tools we have to perceive the outside world, in order to deal with our internal one - the 5 senses. Introducing a sensorial approach to dealing with anxiety.

 

Target Audience

Non Treated Anxious People

Many studies have indicated that urban dwellers have more than a 20 percent increased risk for anxiety disorders and an increased risk for mood disorders of almost twice that compared to rural citizens . In this context is where more of studies of the fours types of anxiety had been done: Generalized Anxiety Disorder (GAD), Post traumatic Stress Disorder (PTSD), Social Phobias and Obsessive Compulsive Disorder (OCD). On the other hand, our personal experience happened in a similar context. Two thirds of the population of 40 million adults in the US suffering from symptoms related to anxiety do not receive any treatment. We narrowed of scope to find people who could fit into the profile of GAD.

What's going on with Anxiety?

An estimated of 40 million adults in the US suffer from symptoms associated with anxiety according the National Institute of Health. According the The Anxiety and Depression Association of America anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.

People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders. Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

Finally, the Kim Foundation mentions that anxiety disorders frequently co-occur with depressive disorders or substance abuse. Moreover, most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5.

Current Approaches

A study “The Economic Burden of Anxiety Disorders” commissioned by ADAA (The Journal of Clinical Psychiatry) projected that Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country's $148 billion total mental health bill. More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses. This number is added to the estimated global cost of mental health care  at nearly as $2.5T in 2010, with a projected increase to over $6T by 2030.

The treatment consists of two branches: the first, medical treatment that includes cognitive and somatic therapy and/or prescribed medication, and second, non medical approaches that cover a broad range of methods including yoga, meditation, mindfulness, working-out, acupuncture, etc. In the last years, the boom of app developers have paid attention to this market. The therapy app SpaceTalk just raised $9.5M in capital investment to develop the platform to help people with anxiety and other mental health issues.

What's anxiety?

“ Anxiety is the apprehension cued off by a threat to some value that the individual holds essential to his security and core sense of personality...The threat may be to physical life (the threat of death), or to a psychological existence (the loss of freedom, meaninglessness). Or the threat may be to some other value one identifies with one’s existence (patriotism, the love of another person, “success”, etc.).”
Rollo May

We have five main emotions:

  • Fear
  • Anger
  • Disgust
  • Sadness
  • Happiness

To understand how anxiety forms, we first need to understand the role of emotions. Emotions are cued off as a reaction to a situation, object or event. The emotion is linked in the brain to a database which determines how one should behave with such an emotion. This triggers a reaction.

Emotions are part of our survival skills. Fear is important when a life threatening situation is ahead of us.  The emotion allows us to react accordingly. The problems begins when fear is hyper-triggered by non-life threatening situations. This results in anxiety.

Let’s have a look at realistic anxiety vs. neurotic anxiety

Realistic Anxiety is a rational threat as a result of a biological reaction between adrenaline and cortisol rise. The individual has sufficient ability to solve the threat and have a sharp reaction which will help a person develop and grow.

Neurotic Anxiety is based on irrational threats as a result of a biological nervous disorder. The result is insufficiency in solving the threat which can leads on compulsive behavior and panic attacks. The individual’s life can be affected in his or her relationships with him/herself and others.

There are four main anxiety types:

  1. Generalized Anxiety Disorder (GAD)

  2. Post-Traumatic Stress Disorder (PTSD)

  3. Social Phobias

  4. Obsessive Compulsive Disorder (OCD)

We will focus on Generalized Anxiety Disorder.

 

 

Awakening, Rodrigo's Personal Story

Rodrigo Muñoz, Co Founder IT MAKES SENSE

Rodrigo Muñoz, Co Founder IT MAKES SENSE

Urgency is a word I hate and love. I started loving it when I was a child and realized that doing things fast and well was giving me good results. Finishing homework the same day gave me more A’s and vacation time. I had two references after my parents got divorced. My mom used time and resources with efficiency. She accomplished both her mom and work duties; everything was running perfect. On the other hand, in the relationship with my father, I saw him as more impulsive and his results weren’t the best all the time. He was leaning to take care of himself alone and that meant many changes in work and living conditions. With this dichotomy I learned to do things fast and well by adhering to extremely detailed schedules. I wanted to have nice results.

Well, I am a good planner but it also means I don’t like when things don’t go as I was expecting them to. Procrastination is my nemesis. I just don’t understand how leaving things until the last minute can generate good results. The problem with this is that “no” was not a word in my vocabulary.

When I was 23 years old I started working at a TV company, where I was a designer until became the general producer, with the responsibility of producing 8 videos per week. I was able to produce an entire mini documentary in 3 days. That sounds pretty nice at that age but this routine became the antithesis of everything I enjoy about planning.  I was constantly worrying about so many things: the opinion and trust of my boss, the quality of the projects, budgets, the time I didn’t have for my boyfriend, my last year in college, etc. The relationship with my boss became really abusive. He used to use friendship as a control tool within the team. We used to feel guilty about not helping him even though it meant working during the weekend. Ultimately, even that “friendship” made me worry. I felt guilty because I couldn't say no.

I wasn’t just worried about things, I was afraid of everything that could happen in the future. I was totally scared of failure so my mind told me that worrying 24/7 was the right thing to do because it would help me to prevent bad things from happening. The worrying was exhausting. My thoughts started from my job and went to my personal life until moments when I thought I was going to die.

At that time I had a constant and really annoying sensation in my belly like nausea before the reflux.  I was afraid to go to sleep because of the horrible dreams.  I thought I was over magnifying everything, and it was just my crazy mind bubbling around. I had to have everything under control. I felt crazy sometimes.

One day, the weird sensation in my body started feeling more intense. - You should chill Rodrigo - I told to myself. The next day the sensation became pain. So intense I couldn’t even stand up, lie down or sit. I had pancreatitis, a severe inflammation of the pancreas that is common in alcoholics and/or people above the age of 50. I was 23. After couple months after this event I quit my job. I was so scared to work again, I felt stupid and useless. My body shook at night while I slept, remembering my time at work and in the hospital.

I started working out and enjoying nature. I slowed my schedule down, working on my garden and walking for hours in the forest close to my house in the suburbs of Quito, Ecuador.  Years later I found a quiz about Post Traumatic Stress Disorder, one kind of anxiety, I filled it out thinking about that horrible time now passed and I got a score of 50, when the average was 30. I didn’t know about anxiety until that moment, but I was sure I had felt it before. I learned I was not the only one dealing with anxiety. Everything started making sense.

Blessing and Curse, Rinat's Personal Story

Rinat Shezrer, Co-Founder IT MAKES SENSE

Rinat Shezrer, Co-Founder IT MAKES SENSE

Hypersensitivity is my blessing and curse. I was born with this sense of sensing everything and everybody. It is an extremely powerful gift. I can feel others on deep levels, empathize with them and give advice that comes from a genuine place. This gift greatly enhances my talent as a designer-engineer and an entrepreneur. However, it is also a curse. As I said, I feel everything and everybody. An angry man can pass down the street 100 feet away from me, and I would feel his anger taking over me. People’s sadness and misery get under my skin in a paralyzing way.

As a result of this hypersensitivity, I’ve been suffering from anxiety for as long as I can remember. It has always been something that I’ve had, a steady state of being. Even now, as I’m writing these sentences I feel the emptiness of fear filling up my body.

The climax of my anxiety was on a regular day in mid 2010. Before I tell you about this pivotal day, it is important to explain what anxiety is for me, as it has diverse forms and manifests in a variety of ways for different people. The root of anxiety is constant worrying and fear. My particular worries and fears were constantly accompanied by deep sharp, stabbing chest pains.

Back to that day in mid 2010, at the time I was leading the product launch of Israel’s most successful startup company. I was under immense tension and tight deadlines. My boss believed that shouting and endlessly demanding was a motivating approach. Being a hypersensitive person this did not do me well. My chest pains got worse and worse, I wasn’t able to eat without getting extremely nauseous. I was continuously worrying that any second something horrible is going to happen.

One morning, while I was driving to work my body started shaking, I’m saying my body because it actually felt like an external object to me, detached from anything I had control over. This shaking resulted in almost losing control of the car, luckily I managed to pull off the highway. I spent a good deal of time on the side of the road, shaking and throwing up.

Eventually this day of burnout lead me to quit my job and explore ways to live a better life and help myself and others with their anxiety. My self imposed program started off with half a year in India doing yoga and meditation from dawn to dusk and is still continuing on till this day with the creating of It Makes Sense.

My aim is to master the skills of how and when to use this special gift of hypersensitivity. To know how to control and manage it so I can protect myself from negative energies and use this ability to give goodness back to people. I envision a world where every person knows how to use their amazing gifts and hope to facilitate that for others.

 

We are Creatures of Senses

Project 128/ Padded cell

Project 128/ Padded cell

The cell with its simple structure is designed to contain all the information to create life. It lives in a dynamic between its inner and outer world. Our cell membranes are the filters that determine when to allow things come in or repel them. The cell’s internal structures are always ready to fight anything that could represent a danger. After thousands of years the simple cell has diversified into many varieties, each specialized  with specific tools of how to react against bad bacteria, virus, mutations or changes in the environments.

These diversified cells work together as a group; they align to create bones, tissues, organs, and ultimately our bodies. We have evolved from primates to homo sapiens. We have created culture as a method to survive and stay together, to eat, to have shelter, to hate and love.

We call “ourselves” to be what is contained within the limits of our skin and anything outside of this we refer to as the “world”. Just like the cell we determine when to let things come in and when to fight them. We needed to evolve with the best tools to interact with the world and react as fast as possible to danger. From the first moment of life we learn to use our body and minds in a perfect synchronization to build our database of good and bad.

There is a tiger in front of you, you can SEE its teeth. Maybe it’s hungry.

You can HEAR the growl. That makes you feel scared.

You can SMELL the dry blood on the fur, so you keep your distance. To TOUCH it is unthinkable.

You react to preserve  yourself and your community. You run or you fight.

 

We are creatures of senses. They are our tools to survive.

Where does that sensation of fear live? People say that we keep genetic memories based on what happened to our ancestors. When we feel cold, we put clothes on, when we hear a storm we look for shelter, and so on. We keep fear inside of every cell always ready to fight or flee. But what happens when the tigers are gone? What happens when the fear is invisible? When the trigger has no texture? When the only thing you’re sure of is that you can feel something is wrong.   

Even if our fears have no physical manifestation, our mind is going to try to create a logic after analyzing all the information coming from our senses. But when this information is weak, our mind gets into a crisis. It resets itself over and over trying to create a meaning  for the feeling of fear. Unable to react it does the best it can, looking always for more possibilities we start to worry. And because it doesn't make sense, we worry about worrying. We worry we are not worrying enough. We worry to prevent bad things from happening. And this becomes suffering for our bodies and minds.  

Anxiety is the “feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome (Oxford Dictionary)”. When the trigger is a tiger we react. It’s a healthy reaction. However, when the trigger only exists in the mind, anxiety could become overwhelming.

This is a journey of two anxious organisms, Rodrigo Munoz and Rinat Sherzer who realized they are not the only ones trying to make sense of the tiger living inside their minds.