Unfortunately, like any of our fears, if we have an uncomfortable or distressing experience the first time we try something, or we simply don't understand a situation, our anxious brain tends to blow it out of proportion making it ten times scarier than it actually is or was. In fact, we call this catastrophising - a common unhelpful thinking style - where we take a tiny lion cub and turn it into a life threatening roaring king of the jungle in our minds. Fear, anxiety and our fight/flight systems kick in accordingly. You can read more about that in our previous articles on anxiety here.
The purpose of this Coping Toolkit entry is to describe three brief and effective strategies for managing that claustrophobic feeling of being in an enclosed space such as in an MRI machine.
As you'll have read in my recent article Anxiety & the MRI, I recently had the opportunity to practice what I preach when I had to manage my own anxiety whilst in the MRI tunnel for one and a half hours!
For the uninitiated, MRI stands for magnetic resonance imaging and the machine looks like our feature photo at the top of this article.
Depending on what you are having scanned and whether you go in head first or feet first, there's a chance you can end up deep in that narrow tunnel for fairly lengthy periods of time. Lucky (not lucky!) me went in head first for a full spinal scan which meant that the further in my body went to the tunnel, the more my mind played tricks on me and the more anxious I felt. I will be writing about claustrophobia in the Analyse This section shortly - fascinating stuff!
If I'm honest, the anxiety began well before scan day and gradually built to peak levels the night before the appointment which was when I had to have a serious talk to myself which went along the lines of "For goodness sake, you're a psychologist, you know how to manage this stuff!" And so I did (because I had to).
At The Appointment:
Owen, my MRI guy, said that it was normal for people to become anxious when having an MRI and that most people swear by using an eye mask - if you can't see you're in a confined space, it's easier to relax. Not me.
I'd already made the mistake of looking into the tunnel first. I knew too much.
Plus, one article I read about claustrophobia said that the anxiety comes from the enclosed space blocking out important sensory information, so I figured that also blocking my vision couldn't possibly help.
Instead, I chose the angled mirror which helps you look out of the tunnel despite the fact that you are lying on your back and actually looking up at the top of the tunnel. In the last MRI I'd had (for 'fun' mind you, as a part of a research project) I used the mirrors and they'd helped me feel less confined, so I already had some confidence this would work again.
Owen also encouraged me to bring a CD into the appointment to listen to as the machine is very loud, so armed with my Learn Italian disc, I was fitted with headphones and given a buzzer to hold in my hand in case I needed Owen at any stage. All of this was very reassuring and comforting.
After positioning me on the machine, Owen left the room and my anxiety began to rise.
I can feel it again now recalling the memory of nine days ago. My chest became tight, my heart rate increased and the butterflies took flight in my stomach. Part of me worried that I would make a fool of myself in front of Owen.
Luckily, another thought process kicked in though and reminded me that this would be a good opportunity to try out some of the coping strategies I taught my clients. No pressure! I chose to use a controlled breathing technique.
I held my breath and counted to six. I wanted to take control back over my breathing which had automatically responded to the misconstrued 'threat' of entering the tunnel - good to see my fight or flight response was alive and well.
Then, I exhaled to the count of three.
Next, I inhaled, again to the count of three.
Slow, deep, purposeful breaths, controlled consciously by me.
One exhalation and one inhalation equalled one cycle.
I did nine of them, all the while, counting the length of my breaths as well as the cycles. This served to fill up my working memory. I was holding and manipulating information at the same time, occupying the limited capacity of my working memory so that other kinds of thoughts - the unhelpful ones! - couldn't creep in.
I'm happy to say, that by the end of cycle seven, my anxious symptoms had disappeared and I refocussed my attention onto thoughts about how successful that had been, and then onto my Italian lesson. Molto bene!
I've previously described the ABC Model which explains the close link between our thoughts and our feelings in other articles, but just a quick recap:
We generally have a situation - the A (an activating event) - followed by our thought/perception - the B (belief) - which then tends to influence our feelings - the C (consequence).
In this case, the A is having the MRI, the B's are what we tell ourselves about that scan, and the C's are our resultant feelings.
Some of my less-than-helpful thoughts included these:
"I won't be able to get out if I need to."
"I'll be trapped inside the tunnel."
"I won't be able to breathe."
And of course, I had my whole repertoire of worries about the scan revealing my breast cancer had returned to keep trying to trick me into feeling scared.
About thirty minutes into the scan, my anxiety re-appeared.
This time, I chose a thinking strategy from a cluster of tools called defusion strategies - they come from Acceptance and Commitment Therapy (ACT) and are aimed at changing, not the thought content, but instead, our relationship with the thought.
There are many ways of doing this and I will go into these in more detail in a future article, however, the strategy I used in the machine relied on humour.
I took the thought, "I don't think I can stand this for a minute longer" which when it stands alone, is a fairly serious and scary thought, considering where I was and the fact I still had an hour left to complete the scan.
I knew I had to quickly let go of that worry - to 'de-fuse' from it - in order for it to stop impacting on my anxiety levels, so I chose to turn it into a funny thought - something I could laugh at instead.
I brought up an image of Sheldon Cooper from the television show The Big Bang Theory (image courtesy of atmedia.imgix.net). I pictured him sitting in his position on his red leather couch, wearing a short sleeved t-shirt over a long sleeved shirt and then I saw him look right through the camera at me, as he repeated my thought to me, word for word.
Before he'd even finished the sentence with his slow American Southern drawl, I'd already begun to smile at how funny it sounded and I was able to re-focus my attention onto other things.
I'd bought myself some emotional distance from the thought as it was now Sheldon's thought and not mine. The fact that I find him so funny also allowed me to easily detach from it and let it go.
Immediately my anxiety levels dropped.
Around thirty minutes later, now up to my lower lumbar spine, I was as far into the tunnel as I was going to get and upon that realisation, my anxiety began to peak again.
While the mirror had afforded me the luxury of watching every move Owen made in his office thanks to the large window between his room and mine, it began to have the opposite effect when his colleague joined him.
No sooner had she arrived when they both began to look incredibly concerned, frowns on their faces, pointing to the computer monitor!
Of course my mind went into over-drive - they'd clearly discovered something horrific in my spine! Unhelpful thoughts popped into my head faster than a speeding bullet feeding my anxiety. I knew I had to quickly regain control over my mind and where it was focussing its attention if I was going to remain in the machine as long as I needed to.
This time, I chose to re-focus my attention back into the present moment with a mindful grounding technique.
The most simplest form I can think of to practice mindful grounding is to take the position of the curious, open-minded scientist, and observe your immediate environment, asking yourself the following five questions:
What are five things I can see?
What are five things I can hear?
What are five things I can feel?
What are five things I can smell?
What are five things I can taste?
I chose to use my sense of sight and realised quickly that if I looked up and backwards from the mirror, there was a perfect gold sticker right above my head.
I began describing that to myself in great detail.
Mentally, I traced the outline of the sticker, noticing its rectangular shape and slightly rounded corners. I noticed how it sat flush with the machine, no parts of it had lifted and it contained no air bubbles. The bloom from the lighting in the back of the machine - it is very bright in there - caused the metallic gold to reflect and refract the light in lots of different ways.
While I marvelled at all of that, my anxiety once again calmed down. My mind was full of thoughts about an object that I chose to focus on and every time an unhelpful thought tried to trick me into feeling scared again, I noticed it (easy to do when you start to feel distressed!) and refocussed my attention back onto that sticker.
Once I finished with the sticker, I noticed a solid grey band that ran behind it and circled the entire tunnel, providing me with a new focus for my attention.
Once again, I'd managed to reduce my anxiety, quickly and effectively.
Described above are three quick and effective anxiety management tools: Controlled Breathing; Thought Defusions; and, Mindful Grounding.
Remember that I have been teaching and using these strategies regularly for years and so for me, they have become automatic processes.
In order to make them automatic for you too, I suggest you rehearse them when you are feeling calm initially. Try them on neutral or positive thoughts to get the hang of imagining your character or focussing your attention on an object.
Once they become easier and more automatic for you, perhaps then you can rehearse them during slightly more uncomfortable situations, gradually building your confidence in both using the strategies but also in their effectiveness.
Congratulations, you've just added three new tools to your Coping Toolkit!