Anxiety. Perhaps the most useful verbal suggestion you can make to someone who is in a severe state of anxiety that threatens their functioning is that they stick one finger down their throat and induce the gag reflex. This may seem a bizarre remedy, but is an old standby of actors with stage fright or people with interview fright, who feel so anxious that they are almost choking, as if words will never be able to come. Gagging in this way is physiologically inducing the first stage of vomiting, but unless you really do have an irritated stomach, it is unlikely that you will actually vomit. Your throat muscles, chest wall, and diaphragm will however contract abruptly. This does not have an emotional effect and will not aid understanding, but it 'short circuits' the anxiety, by mechanically opening the breathing passage (which anxiety has made tight and narrow) and temporarily breaking whatever tension has built up in the chest muscles through anxious breath holding. Gagging may also release any mask-like rigidity that has been creeping over the face. And it gets the person breathing more openly, making him or her more ready for action. It is not a pleasant experience, since it goes against the usual direction of flow in your digestive tube, but with a little practice it can become not really unpleasant, and the benefits in relief of anxiety far outweigh a moment's unpleasantness. ('A little practice' might be to try gagging before breakfast in the morning. It is not necessary to make a ritual of this, once you are comfortable with the knowledge that you can gag easily whenever you want.)

Anxiety may be suppressing pleasure and excitement. Take the example of a woman who is preparing for a huge party. Her anxiety is causing her to rush around repeating various actions compulsively, taking things out of the oven, putting them back in, and so on. If she runs out of compulsive actions to perform, her anxiety becomes her real distress. But it would be quite inappropriate to attempt the EFA of fear. Instead, encourage her to identify her underlying feeling. The odds are it will be simple excitement. Under the circumstances, the best thing is to suggest diversion of the energy into some other activity that is less compulsive, for example, that she and you take a walk before the party. Another example is the well known pre-exam anxiety suffered by students. This is not all fear. Much of it is excitement, a feeling of bursting with information and ideas. It does no harm to acknowledge this, and then undertake some unrelated activity that calms and diverts the person during the period of waiting. The ideas will burst to the surface the moment the exam begins and they are needed.

Freezing. Freezing most often occurs after a severe shock; such as an automobile accident. In such cases it is functional; it is of help to the organism not to react. People often report that in crisis circumstances, they have behaved not only calmly but 'almost like a machine,' or 'somehow they knew what to do.' The problem here is not that the person has become frozen in this functional way, but that as the frozen state thaws out, all the emotions of terror that have been suspended during the crisis flood to the surface. In some cases, it is weeks later when the nightmares and trembling start.

There are two options for EFA in such cases. The first is to attempt gently to thaw out the frozen state in a situation where you know the person is secure. (For example, if acute terror is to be experienced, it may as well be when there is a friend to help, not later when everyone has abandoned the scene and assumed the suffering person is back to normal.) The second is to wait for the person to unfreeze spontaneously and deal with whatever fears or terrors emerge piece by piece. There is something to be said for this second approach, since it is consistent with self regulation of the organism. In the final analysis, many organisms seem to know what is good for them. On the other hand, without pushing, when you are at hand to help it does make sense to try to provoke a sudden thaw of the frozen state, provided you do so gently and desist if such gentle efforts do not work. Too often a person will remain frozen for a long time, thaw suddenly when there is no one available for contact, and end up in a hospital under sedation or wondering if they are going insane, since the later surges of terror are disconnected by intervening time from the original emergency and tend to contain images and material from childhood.

Panic. This cannot be dealt with by merely verbal means— your words will not get through.

Contact 2: Touching

Anxiety. Although verbal reassurance alone is of doubtful value, we instinctively know that, if accompanied by gentle physical contact, it can come through to the person. Most of us are comfortable with taking an anxious person under our wing for a moment by putting our arm on their shoulder and squeezing them gently while uttering some words of reassurance. We then let go, having given them some of our energy, as it were, for the challenge in front of them. This process of gentle physical reassurance (the word 'reassurance' implies a regaining of a sense of physical 'sureness' that we can provide), alternating with letting go, seems to be more effective, perhaps because it respects a basic pulsation in human activity, than a physical touch which is unremitting. We have all probably had the experience of being physically comforted by a person for just a little too long. If the helping hand lingers, if the supportive embrace seems to cling to us, we may feel manipulated or confused: the protector may be out to get us after all, or is it in fact the protector who is frightened?

In other words, stay sensitive to your own feelings. If protecting a person by touching them is comforting you, do not fool yourself that you are helping. Rather, you are both doing the perfectly normal thing (although it is not EFA) of clinging to each other for protection. Similarly, if you offer support by literally holding someone up, stop it if you realize you are leaning on them.

Freezing. The challenge here is to try to jolt the person out of their frozen state without giving them a shock. If a few simple ways of triggering contact do not work, it is best not to push the situation, and to opt for standard methods of treatment such as providing warmth and rest. You might also, after a severe emergency such as an accident that has shocked the person without injuring them, try to make sure that there is the possibility of contact and comfort at hand for the person for some days ahead. The trouble is that the longer the person stays out of contact and copes mechanically with the aftermath of the crisis, the more intense the eventual thawing out may be (more like an overwhelming spring flood). Some simple ways of making contact and provoking a thaw are:

—Take the person's hand, look gently into their eyes and ask them to look at you. It may help to massage the hand gently, particularly the wrists. If looking provokes sobbing, you can proceed as for 'grief.'

—If you are already intimate with the person, take them in your arms, from the side, not smotheringly, 'under your wing,' embrace them firmly for a few moments, then ask them to look at you.

—Put your hands on the person's cheeks and ask them to look at you, turning their head gently toward you. (Be aware that touching a frightened person on the head or face may trigger an outburst of terror or anger.)

—If the person remains out of contact, encourage them to lie down in a fetal position. Make sure their body is folded forward with the knees up. Wait quietly with your hand touching them on the back of the neck. If intimate with them, you might try stroking their hair or gently massaging the scalp. (One of the main elements of freezing with fear is contraction of the scalp muscle; it is as if the whole upper head freezes.)

—If the person is lying down and still seems very stiff, rock his or her body gently with your hand on the shoulder, shaking it slightly. This may induce trembling, which you can encourage verbally.

—Ask the person to open the eyes very wide and look at you. Make sure they also raise their eyebrows in the basic fear expression. Ask them to breath in. If they hold their breath, make sure they breathe out. This may mobilize the fear.

Be prepared for any event or emotion as the person thaws out, and accept it, even if it is irrational rage turned against you or anyone else in the environment. Also accept your own fear. You are not superhuman, and as stated earlier, fear is infectious. In particular, if you are normally made anxious by trembling in your own body, you may be made anxious by the other person trembling. But let it happen. Do not try to brace the person against you: the more rigid the person remains, the more the fear will 'back up' to emerge later in a distorted form (such as nightmares or irrational outbursts at inappropriate moments). Trembling and shaking discharge accumulated tension.