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'Silly Nightmares' &
4 Key Steps to Overcoming Agoraphobia
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In the last section, we discussed various causes of anger:
ignored need to be loved; feeling controlled; and creating your own anger.
In this section, we will examine traits of anxiety related to sexual abuse and
techniques to deal with the anxiety.
As you know, anxiety is
one of the effects of sexual abuse. I have noticed in my work with sexually abused
clients that there are specific symptoms to look for related to anxiety. These
symptoms are: regressed behavior; physical restlessness; sudden, unusual, or multiple
fears; unusual shyness; sleep disturbances or nightmares; generalized fears relating
to the offender; withdrawal or isolation; and hyperalertness.
As you know, one of the most extreme forms of anxiety disorders
is panic disorder. Here, anxiety attacks can occur spontaneously and without warning.
Usually, there is no consistent avoidance. One of my sexual abuse clients named
Kevin, age 12, would have unpredictable shortness of breath, chest pain, and he
would say that he felt like someone was choking him. I asked him if there was
anything that he could tell that brought on these attacks.
Kevin stated, "It
happens everywhere. Sometimes in public and sometimes in bed. There's no one particular
place that it happens. It just happens all of a sudden." Because
Kevin's attacks were so sudden, the only way to handle them was to come up with
strategies to cope with his shortness of breath and other symptoms. To do this,
I told Kevin that, when he feels a panic attack coming on, to stop and take a
deep breath and hold it.
I expressed to him the importance of not cheating and
taking little breaths. In about 60 seconds, his body won't be able to keep itself
from breathing and it will force him to take deep breath, thus helping him in
his inability to breath. Do any of your clients have panic disorder? What are
other ways you can treat their symptoms?
♦ #2 General Anxiety
anxiety results when the client experiences such symptoms as muscle tension, hyperactivity,
apprehension about an unrecognizable fear, and excessive vigilance. Roy, age 9,
described himself as feeling always in danger. He said, "I feel like someone's
there, waiting for me. Like when I'm walking down an empty hallway, I feel like
someone's going to just jump out at me." He was terrified of being alone
in empty places because he thought that he might be harmed and Kevin suffered
from frequent nightmares of being attacked again. Roy, who was abused by a stranger
in a public bathroom, was, as you can see, suffering from hypervigilance.
To help Kevin with his sleep disturbances, I found the
"Silly Nightmares" exercise to be beneficial. I asked Kevin to draw
picture of one of the scenes from his Nightmare that he felt comfortable drawing.
Step # 1. I told him to exaggerate one part of his picture so it becomes silly instead of
scary. Kevin made the arms really, really small so, as he put it, "They couldn't
Step # 2. I told him to imagine that he had a powerful eraser to "wipe
out" whatever part of the picture he wanted. Kevin erased the booming voice
I had represented through large lines coming out of his mouth and he replaced
them with small, squiggly lines so that, "he'd only sound like a mouse."
Step # 3. I asked him to pretend that the picture is on a television screen and to simply
reach out and change the channel to a screen he wanted to see. Kevin changed it
to one of his favorite cartoon characters.
Step # 4. I asked him to imagine a bomb
blast that destroys the scary dream. Kevin said, "Like Wile E. Coyote."
the next few months, Kevin created his own ways of destroying his nightmare. Very
soon, he began to have less and less nightmares and his anxiety started melting
Lamont, a sexual abuse client of a colleague of mine,
had developed agoraphobia. At 15, he had been abused and as a result, ridiculed at family gatherings and by his peers. At 17, he refused to go to any public places.
He had lived in a small town of about 3,000, so any place he went, he was sure
to run into somebody he knew and who knew about his abuse.
Feeling extremely ashamed,
he soon developed a fear of seeing anyone he knew or being anywhere that contained
10 or more people. He also started spending much time in his room and in the basement.
By the age of 19, he had developed a full fledged agoraphobia.
Four Steps to Overcoming Agoraphobia
To help Lamont, his therapist, Dr.
Friber, used a "Four Step" strategy for helping him with his agoraphobia.
As you know, one of the most basic ways to cure a phobia is through exposure to
the object or place of which the client has a fear.
Step # 1 - First, Dr. Friber asked Lamont
to write out anything that gave him anxiety or caused fear. Lamont wrote, "Public
places. Lots of people. Talking to people I know."
Step # 2 - Second, Dr. Friber told
Lamont to write down a specific problem and goal that he definitely wanted to
work with now. Lamont wrote "going to public places" for his problem
and "go to the movie theater" as his goal.
Step # 3 - Third, Lamont was asked to
complete a checklist of his sensations.
The checklist included the following
-- I want to scream or run away.
-- My heart pounds and beats fast.
-- I freeze in my tracks.
-- I feel dizzy, faint, lightheaded, about to fall.
-- I tremble and shake.
-- I can't breathe properly.
-- I feel nauseated.
break into a cold sweat.
-- My stomach gets churned up or tight.
-- I feel that
I'm going crazy.
After writing out anything that gave him anxiety, writing
down specific problems, completing checklists
Dr. Friber then told Lamont
to use the items he checked as signals to use the coping devices he will choose
in step four.
Step # 4 - He asked Lamont to choose, from the following list of tactics, three
the he might find useful to do or say in order to cope with his anxiety. The list
included the following:
-- I must breathe "slow and shallow"-in and
out-and gradually learn to deal with this situation.
-- I feel horribly tense.
I must tense all my muscles as much as I possibly can, then relax them, then tense them again, then relax them.
-- What can I do? I have to stay here until I
can tolerate this panic, even if it takes an hour.
-- I have to get away, but
I know I must remain here.
-- I'm so embarrassed, but it's something I have to
get used to.
Step # 5 - Then, over small periods of time, Lamont began going to more and
more crowded places. He dealt with his anxiety through the tactics he had decided
on. As you can see, with help from a regimented system, Lamont was able to deal
with exposure to his phobia.
In this section, we discussed traits
of anxiety related to sexual abuse and techniques to deal with the anxiety.
the next section, we will examine the depression that many sexually abused boy clients
experience and techniques to facilitate recovery.
What are the four parts in the "Silly Nightmare" drawing
technique? To select and enter your answer go to .