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Living with shikai: generalised anxiety disorder in kendo

2014-03-15 22:01:00

To retain heijoshin (an even mind) is one of the greater goals in kendo.

Heijoshin reflects a calm state of mind, despite disturbing changes around you. [It] is the state of mind one has to strive for, in contrast to shikai, or the 4 states of mind to avoid:

  1. Kyo: surprise, wonder
  2. Ku: fear
  3. Gi: doubt
  4. Waku: confusion, perplexity

(Buyens, 2012)

In the following pages I would like to introduce you to generalized anxiety disorder, hereafter “GAD”. For sufferers of GAD every day is filled with two of these shikai: fear and doubt. While I am but a layman I do hope that my personal experiences will be of use to those dealing with anxiety disorders in the dojo. I will start off by explaining the medical background of GAD, followed by my personal experiences. I will finish the article by providing suggestions to students and teachers dealing with anxiety in the dojo.

 

Anxiety disorders: definition and treatment

All of us are familiar with anxiety and fear as they are basic functions of the human body. You are startled by a loud noise, you jump away from a snapping dog and you feel the pressure exuded by your opponent in shiai. They prepare your body for what is called the “fight or flight” reaction: either you run for your life, or you stand your ground and fight tooth and nail. These instincts become problematic if they emerge without any reasonable stimulus. The most famous type of such a disorder are phobias, the fear of specific objects or situations, which are suggested to occur in ~25% of the adult US population. (Rowney, Hermida, Malone, 2012)

Other types of anxiety disorders are:

For the remainder of this article I will focus on the disorder with which I have personal experience: generalized anxiety disorder.

Perhaps the easiest ways to describe GAD is to use an analogy: GAD is to worry, as depression is to “feeling down”. Just like a depressed person cannot “simply get over it” and is debilitated in his daily life, so does a person with GAD live with constant worry. As it was described by comic artist Mike Krahulik:

The medication I picked up today said it could cause dizziness. […] I had to obsess over it all afternoon: I drove to work today by myself, will I be able to drive home? What if I can’t? How will I know if I can’t? Should I call the doctor if I get dizzy? How dizzy is too dizzy? What if the doctor isn’t there? Will I need to go to the hospital? Should I get a ride home? I can’t leave my car here overnight. The garage closes at 6 what will I do with my car? What if Kara can’t come get me? Should I ask Kiko for a ride home? If I get dizzy does that mean it’s working? Does that mean it’s not working? What if it doesn’t work?” (Krahulik, 2008)

Paraphrased from DSM-IV-TR (footnote 1) and from Rowney, Hermida, Malone, criteria for GAD are that the person has trouble controlling worries and is anxious about a variety of events, more than 50% of the time, for a duration of at least 6 months. These worries must not be tied to a specific anxiety or phobia and must not be tied to substance abuse. The person exhibits at least three of the following symptoms: restlessness, exhaustion, difficulty concentrating, irritability, muscle tension and sleep disturbance.

Thus the symptoms differ per person, as does the potency of an episode. In severe cases of GAD episodes will result in what is known as a panic attack, which you could describe as a ten-minute bout of super-fear. Effects of a panic attack may include palpitations, cold sweat, spasms and cramps, dizziness, confusion, aggressiveness and hyperventilation. Because of these effects, people having a panic attack may think they are having a heart attack or that they are going plain crazy.

An important element to GAD is the vicious cycle or snowball effect. As my therapy workbook describes it (Boeijen, 2007), a sense of anxiety will lead to physical and mental expressions, which in turn will lead to anxious thinking. People with GAD will often fear the effects of anxiety, like fainting or throwing up. These anxious thoughts will create new anxiety, which may worsen the experienced effects, which in turn will feed more anxious thoughts. And so on. Thus, even the smallest worry could start an episode of anxiety, like a snowball rolling down a slope. What may get started with “The fish I had for lunch tasted a bit off.” may end up with “Oh no, I’m having a heart attack!“. If that doesn’t sound logical to you, you’re right! The vicious cycle feeds off of assumptions, worries and thoughts that get strung together. I’ll have two personal examples later.

Treatment of GAD occurs in different ways, often combined:

All sources agree that having proper support structures is imperative for those suffering from any anxiety disorder. Knowing that people understand what you are going through provides a base level of confidence, a foothold if you will. Knowing that these people will be able to catch you if you fall is a big comfort. Having someone to help you dispel illogical and runaway worries is invaluable.

 

My personal experiences with GAD

I am lucky that I suffer from mild GAD and that I have only experienced less than fifteen panic attacks in my life. Where others are harrowed by constant anxiety, I only have trouble in certain situations. I was never diagnosed as such, but in retrospect I have had GAD since my early childhood. At the time, the various symptoms were classified as “school sickness”, irritable bowel syndrome and work-related stress. It was only during a holiday abroad in 2010 that I realized something bigger was at hand, because I had a huge panic attack. I was extremely agitated, could not form a coherent strain of thought and was very argumentative. My conclusion at the time was that “I’m going crazy here, that has to be it. I really don’t want this, I need a pill to take this away right now!“. Oddly, I discounted the whole thing when we arrived home. It took a second, big panic attack for me to accept that I needed to talk to a professional.

This second panic attack progressed as follows:

(Sluyter, 2011)

This illustrates the aforementioned vicious cycle: an innocuous thought (“I wonder how my daughter is doing.“) leads to me worrying that I’m ill, which leads to me worrying about my errand, which gives me stomach cramps, which reinforces my fears about being ill, which makes me nauseous and dizzy, and so on. Worries express themselves, which creates anxiety, which in turn reinforces the earlier worries. It didn’t take my doctor long to refer me to a therapist for Cognitive Behavior Therapy, hereafter “CBT”.

CBT is one of many forms of therapy applicable to anxiety disorders and it is often cited as the most effective one. It is suggested (Rowney, Hermida, Malone, 2012) that CBT achieves “a 78% response rate in panic disorder patients who have committed to 12 to 15 weeks of therapy“. In my personal opinion CBT is successful because it is based on empowerment: the patient is educated about his disorder, showing him that it does not have actual power over him and how he can deal with it. As part of therapy, one learns to recognize the patterns that are involved in the disorder and how to pause or halt these cycles. Patients are given tools to prevent episodes, or to relax during an attack. CBT also relies upon the notion of ‘exposure’ wherein the patient is continuously challenged to overstep his own boundaries. The senses of self-worth and of confidence are improved by realizing that your world isn’t as small as you let your fears make it.

I have learned that the best way to deal with a runaway snowball of thoughts is to dispel the thoughts the moment they occur. Anxious thoughts often start out small and then spiral into nonsensical and unreasonable worries. By tackling each question when it comes, I maintain a feeling of control. Having someone with me to talk over all these worries is very useful, because they are an objective party: they can answer my questions from a grounded perspective. My wife has proven to be indispensable, simply by talking me down from the nonsense in my head.

I first started kendo in January of 2011, half a year before I started CBT. In the week leading up to class I devoured online resources, just so I wouldn’t make a fool of myself. In my mind I had this image that I would be under constant scrutiny as ‘the new guy’. I feared that any misstep would make my integration into the group a lot harder. I read up on basic class structures, on etiquette, on basic terminology and I even did my best to learn a few Japanese phrases in order to thank sensei for his hospitality. Even before taking a single class I already had a mental image of kendo as very strict, disciplined and unforgiving and I was making assumptions and having worries left and right.

I have now practiced kendo for little over two years and I have found that it is a great tool in conquering my anxiety disorder.

  1. I experience kendo as a physically tough activity. Seeing myself break through my limitations forces me to reassess what I am and am not capable of.
  2. The discipline in class feels like a solid wall holding me up and there is a sense of camaraderie. My sempai and sensei will not let me fail and I have a responsibility towards them to tough it out.
  3. Reading and learning about kendo provides me with confidence that I may one day grow into a sempai role.
  4. In kendo one aims for kigurai. As Geoff Salmon-sensei once wrote: “kigurai can mean confidence, grace, the ability to dominate your opponent through strength of character. Kigurai can also be seen as fearlessness or a high level of internal energy. What it is not, is posturing, self congratulating or show-boating“. (Salmon, 2009) Thus kigurai is a very empowering concept!
  5. Kendo is such an engaging activity that it grabs my full attention. Once we have started I no longer have time to worry about anything outside of the dojo. Or as one sempai says: “At tournaments I’m panicking all the way to the shiaijo, but once shiai starts I’m in the zone.

In the dojo I may forget about the outside world, but there are many reasons for anxiety in the training hall as well. For example, after a particularly heavy training I will feel nauseous and lightheaded, which has led to fears of fainting and hyperventilation. I have also worried about sensei’s expectations regarding my performance and attendance to tournaments (“What if I can’t attend? What will he say? Will he reproach me? Will he think less of me?“).

I have also felt anxious about training at our dojo’s main hall, simply because their level is so much higher than mine. I felt that I was imposing on them, that I was burdening them with my bad kendo and that I was making a fool of myself. I finally broke through this by exposure: by attending a national level training and sparring with 7-dan teachers I learned that a huge difference in skill levels is nothing to be ashamed of. All of a sudden I felt equal to my sempai, not as a kendoka but as a human being.

Another great example of exposure was a little trick pulled by the sensei of our main dojo who is aware of my GAD. He had noticed that I allow myself to bow out early if I start to get anxious. So what does he do? We started class using mawari geiko (where the whole group rotates to switch partners) and right before it’s my turn to move to the kakarite side he freezes the group’s rotation. So now I’m stuck in a position where I have responsibility towards my sempai, because without me in this spot the opposing kakarite would need to skip a round of practice! On the one hand I was starting to get anxious from physical exhaustion, but on the other hand I would not allow myself to stop because of this sense of responsibility. His trick worked and I pulled through with stronger confidence.

In the dojo I regularly use two of the tools taught to me during CBT (Boeijen, 2007):

 

GAD in the dojo, for teachers

If one of your students approaches you about their anxiety disorder, please take them seriously. As I explained at the beginning of this article we all feel fear and have doubts, but an actual disorder is another kettle of fish. You will not be expected to be their therapist or their caretaker; all they need is your support. Simply knowing that you’ve got their back is a tremendous help to them!

In issue #5.2 of “Kendo World” magazine, Ben Sheppard in his article “Teaching kendo to children” (Sheppard, 2010) discusses the concept of duty of care. While the legal aspects of the article pertain to minors in certain countries, the general concept can be applied to any student who may require special care. It would be prudent to have some file containing relevant medical and emergency information. This should not be a medical file by any means, but having a list of known risks as well as emergency contact information would be a good idea.

Please realize that you are helping your student cope with their anxieties simply by teaching him kendo. Brad Binder offers (Binder, 2007) that most studies agree that the regular participation in a martial art “cultivates decreases in hostility, anger, and feeling vulnerable to attack. They also lead to more easygoing and warmhearted individuals and increases in self-confidence, self-esteem and self-control.” This may in part be due to the fact that “Asian martial arts have traditionally emphasized self-knowledge, self-improvement, and self-control. Unlike Western sports, Asian martial arts usually: teach self-defense, involve philosophical and ethical teachings to be applied to life, have a high degree of ceremony and ritual, emphasize the integration of mind and body, and have a meditative component.

Should a student indicate that they are having a panic attack, take them aside. Remove them from class, but don’t leave them alone. Have them sit down on the floor and against a wall to prevent injuries should they faint. Guide them through a breathing exercise, like described in the previous paragraph. Reassure them that they are safe and that, while it feels scary, they will be just fine. Help them dispel illogical anxious thoughts. Funny kendo stories are always great as backup material.

Finally, I would suggest that you keep on challenging these students. Continued exposure, by drawing them outside of their comfort zone, will hopefully help them extend beyond their limitations. Having responsibilities and being physically exhausted can lead to anxiety in these people, but being exposed to them in a supportive environment can also be therapeutic.

 

GAD in the dojo, for students

If you have GAD, or another anxiety disorder, I think you should first and foremost extend your support structure into the dojo. Inform your sensei of your issues because he has a need to know. As was discussed in an earlier issue (“Kendo World” #5.2, Sheppard, 2010), dojo staff needs to be aware of medical conditions of their students, for the students’ safety. If there’s a chance of you hyperventilating, fainting or having a panic attack during class, they really need to know.

If you are on medication for your anxieties, please also inform your sensei. They don’t necessarily have to know which medication it is, but they need to be made aware of possible side effects. They should also be able to inform emergency personnel if something ever happens to you.

If you feel comfortable enough to do so, confide in at least one sempai about your anxieties. They don’t have to know everything about it, but talking about your thoughts and worries can help you calm down and put things into perspective. They can also take you aside during class if need be, so the rest of class can proceed undisturbed and so you won’t feel like the center of attention.

Being prepared can give you a lot of peace of mind. I bring a first aid kit with me to the dojo that includes a bag to breathe into (for hyperventilation) and some dextrose tablets. I also look up information about the dojo and tournament venues I will be visiting, to know about amenities, locations and such.

If you aren’t already in therapy, I would sincerely suggest CBT. CBT can help you understand your anxiety disorder and it can provide you with numerous tools to cope. Anxiety is not something you’re easily cured of, but by having the right skills under your belt you can definitely make life a lot easier for yourself!

And let me just say: kudos to you! You’ve already faced your anxieties and crossed your own boundaries by joining a kendo dojo! The toughest, loudest and smelliest martial art I know!

 

Footnotes and references

1: DSM-IV-TR is Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. A document published by the American Psychiatric Association that attempts to standardize the documentation and classification of mental disorders.

 

Binder, B (1999,2007) “Psychosocial Benefits of the Martial Arts: Myth or Reality?”

Boeijen, C. van (2007) “Begeleide Zelfhulp – overwinnen van angstklachten”

Budden, P. (2007) “Buteyko and kendo: my personal experience, 2007”

Buyens, G. (2012) “Glossary related to BUDO and KOBUDO”

Krahulik, M. (2008) “Dear Diary”

Rowney, Hermida, Malone (2012) “Anxiety disorders”

Salmon, G. (2009) “Kigurai”

Sheppard, B (2010) “Teaching kendo to children” – Appeared in Kendo World 5.2

Sluyter, T. (2011) “Dissection of a panic attack”


This article appeared before in Kendo World magazine, vol 6-4, 2013 (eBook and print version on Amazon). The article is republished here with permission of the publisher.


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Anxieties and living with them

2013-02-24 21:27:00

The past few months I've been dealing with my anxieties in what, I hope, is a better way than before. Having been through CBT has certainly been empowering and educational. That doesn't mean that I'm free of anxiety, but it does mean that I've learned ways of dealing with them. 

Funnily, yesterday I had a bout of anxiety when we dropped off Dana with her grandparents in Friesland. Plenty of doubts and worries pent up about her sleepover, which led to some physical effects while we were there and on the drive home. I was also a bit anxious about the night's kendo practice. All of that was mostly resolved by talking about it with Marli, which certainly is one of the prime methods I've learned: dispeling illogical and worrisome thoughts with the help of others. 

I am writing an article for Kendo World magazine, based on my experiences with anxiety and kendo. The article will explain what anxiety disorders are, how they are treated, how I've experienced it and how it can occur in a kendo dojo. If everything goes as planned it'll be printed in the next issue. Exciting!


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That didn't go too well (some good stuff as well)

2012-10-17 07:44:00

All of yesterday I'd been feeling crappy, so I wasn't altogether too confident going to kendo. It was nice going together with Herman and Charl though :)

As I'd feared I had to bow out during kihon practice, because I was soo tense and out of breath that I'd keel over if I didn't. I don't know what was up yesterday, but all my muscles are/were tight as heck and my breathing patterns were a complete mess. Meh. So I quickly joined Roelof-sensei and Herman at the beginners' side. There I practiced oki-men, sayu-men and the semete-men movements we've been working on for the past weeks.

Pointers that I was given during class:

During class I noticed that I'd cracked one of the take on my newer shinai. ( ;_;) I guess Roelof-sensei sure had a point when he said I was hitting too hard. I'll see if I can fix that tonight, otherwise I'll find another solution.

EDIT:
When it comes to good stuff (it's not all bad), I've been writing a lot for the new Renshinjuku kendo dojo website. Aside from summaries of the classes I attend and some news posts about kendo events, I have also started a series of lexicographical articles. I know from experience that all the Japanese terms and phrases can be confusing for beginners, which is why I want to take the time to explain them. Of course there's the dictionary list compiled by our teachers, but that only provides translations and little explanation.

First up in the series is an explanation of the various types of geiko ("training"). Next up, to be published on sunday, is an explanation of all the commands used during warming-up and the various types of suburi. In the near future I'll also write about the commands in seiretsu (plus some background on dojo layout) and about our equipment.


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Anxiety and discouragement

2012-04-03 17:19:00

Last time I went to the Amstelveen dojo, I had an anxiety attack (only a slight one) after being thoroughly exhausted by the training. At the time it wasn't safe for me to drive myself home, so I was lucky to have Martijn with me. That one event has thrown up a barrier for me to go to Amstelveen alone.

Last week I had an excuse not to attend training in the form of my Standby Duty for $CLIENT. This week I was happy to have Peter-sempai come along, so he could be my proverbial savior if things went wrong again. But unfortunately Peter had to call off because of work, so now I am left to face my anxieties.

I do not want my anxieties to stop me from practicing kendo in Amstelveen. But I would lie if I said I wasn't a bit nervous about going tonight. I'm alone, with no alternative driver to take me home.

as I said: I don't want my anxiety to interfere with my training! I'm going tonight, come what may! I'll just have to be smart about it! If I feel that I've overexerted myself, I will stop for the night. And as always I am prepared for problems! I have enou fluids with me, I have dextrose and a snack with me, I always carry a bag for hyperventilation. I'm just as prepared as I could ever be! Nothing to stop me!

Thus ends the pep talk. :)

EDIT:

I went. It went fine. I was a bit tired at the end, but some dextrose helped out. I trained with the beginners' group and served as motodachi for harai-kote practice. Gave me a good chance to practice my posture and kamae. Roelof-sensei remarked that I was way too tense. He also showed me the proper technique for receiving blows in kirikaeshi.


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"Survival of the fittest", he said...

2012-03-21 20:27:00

The day before yesterday, Heeren-sensei taunted me on Facebook warning that class was going to be "survival of the fittest". I had no idea what that meant, but was sure it was going to be hard work. Well, he didn't lie! Because last night's class was really something else!

After warming up we were told to form pairs with someone of comparable height and fitness. Naturally, Martijn and I teamed up: we're just as tall and out-of-shape and we're bonded through our Almere dojo. What followed was 45 minutes of "interval training", as Jouke called it. We would be taking turns in various exercises meant to completely exhaust our arms and shoulders.

I'm really quite hazy about last night's details, so I might've missed a step here or there. I went to bed immediately when coming home, so I didn't even make notes!

As I mentioned, the whole point of this gruelling exercise was to exhaust us up to a point that we couldn't do anything but efficient kendo. With our arms so tired we just have to be relaxed and we have to do proper striking. Jouke repeatedly asked us to memorize the feeling of all of this, so we could try and emulate it later. 

For the last half hour of class we did jigeiko. I faced three people, including mr vd Velde and Raoul-sempai. I'm very sorry to say that I've probably forgotten some of the important points.

Raoul-sempai took his time with me. Instead of full-on geiko, he told me to strike and that he'd let me through if it looked like a good strike. He primarily coached me on my small strikes and fumikomi

By the end of class and in the shower I was feeling completely drained. In the dressing room I sat there, slunk a bit. While I was having a chat with Heeren-sensei I got faint and got a panic attack. Luckily I manage to nip that in the bud, by using breathing exercises. Thank $DEITY Martijn was with me, so he could drive us both home. 


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Conquering myself: anxiety and restraint

2012-02-16 07:16:00

enryo

Starting this week, my desk at the office has been rearranged somewhat. All of my gear's been moved to the right, thus providing unihibited view of the divider board. This board is now adorned with a piece of A5 paper, bearing the kanji shown left: enryo, 遠慮(picture source).

Enryo is the Japanese concept of (and word for) restraint. The kanji consists of the words for distant and prudence.

I've chosen this word as my mental goal for this year, next to my physical education goal of fumikomi. Why? Because restraint will help me both at work, in kendo and in my anxieties. At work, because I've repeatedly gotten in trouble for being too hasty. In kendo, because I show way too much of what goes on in my head. In my anxieties, because control over mind and body will aid in preventing and fighting panic attacks.

Here are two excellent articles about the concept of enryo in Japanese culture:

Speaking of my anxiety disorder. I visited my therapist again yesterday and he's quite happy about my progress. He was disappointed that I had not continued with the progressive relaxation exercises, but was glad that I'd replaced them with concepts from kendo and tai chi. From here on I will be setting exposure goals for myself, where I simply go out and expose myself to situations I loathe, of ever-increasing difficulty. We will meet up only once more after this, after which my therapist is confident that I can continue the training on my own.

Finally, just to keep track of stuff: in the middle of the night I had a mild bout of hyperventilation.


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