Living with shikai: generalized anxiety disorder in kendo
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:
- Kyo: surprise, wonder
- Ku: fear
- Gi: doubt
- Waku: confusion, perplexity“
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:
- Acute Stress Disorder
- Generalized Anxiety Disorder [GAD]
- Obsessive-Compulsive Disorder [OCD]
- Panic Disorder
- Post-traumatic Stress Disorder [PTSD]
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:
- Medical treatment of pre-existing physical ailments or other disorders.
- Medicinal treatment of the anxiety, with for example Prozac, Zoloft, Valium or Ativan.
- Support structures through the education of family and friends.
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:
- 13:10: Go outside to run an errand in a part of town I’m not familiar with.
- 13:11: “I wonder how my daughter is doing, with her gastric enteritis.“
- 13:12: My stomach rumbles noticeably.
- 13:13: “Gee, it’d suck if I got infected with enteritis as well.“
- 13:15: “Wait, what if I already am? I wouldn’t want to getunwell on my errand!“
- 13:20: “Crap, this place is further than I thought. I thought it was close by!“
- 13:21: I start feeling apprehensive and queasy.
- 13:22: “Maybe I should turn back. I think I’m panicking. No I need to conquer this!“
- 13:25: I get to the shop and place my order.
- 13:27: My panic gets heavier as the order takes very long. I am now having stomach cramps.
- 13:28: Being denied access to the shop’s lavatory I start hyperventilating. I crouch to feel safer.
- 13:30: Having paid I quickly leave. The thud of the door takes a load of my shoulders.
- 13:33: I’m feeling relieved, but still have cramps.
- 13:50: I arrive back at the office and feel exhausted and shaky but the panic is over.”
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.
- 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.
- 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.
- Reading and learning about kendo provides me with confidence that I may one day grow into a sempai role.
- 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!
- 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):
- Breathing exercises. They let me catch my breath and force me to focus my thoughts on one thing. You breathe in to the count of four, hold it for the two counts, and then breathe out to the count of five. Hold to the count of two and repeat. This exercise is also often used with hyperventilation issues. Various sources, including Paul Budden (Budden, 2007) suggest breathing through the nose instead of the mouth, to prevent over-breathing.
- Relaxation exercises. I scan my whole body for tense muscles in order to release them. For different sections of your body you will tighten up all the muscles up for a few seconds and then release them, which is repeated three times. You start with the facial muscles, making a scrunched up face and releasing it. Then the muscles in the neck. Then the left arm. The right arm. The torso. The buttocks. The left leg. The right leg. When moving to a new section, the previously exercised sections should stay relaxed and in the end you should end up with a completely relaxed body. This exercise is best done while sitting on a chair or bench.
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”