The relationship between worry and anxiety was outlined in
the last blog. Common symptoms of
anxiety were also discussed, as were markers for predisposition. One of the most important points in my last
blog was that anxiety has served as an effective warning system for our mind and
body to communicate about impending danger.
It is only when that communication system gets over aroused or stuck in
constant danger mode that anxiety becomes a diagnosable condition.
Treatment for anxiety is not dependent on meeting diagnostic
criteria. Cognitive –behavioral therapy (CBT) has become the most widely
validated treatment option for anxiety related thoughts and symptoms. Let’s
explore some fundamentals!
A primary premise of CBT involves identifying, challenging and
revising our automatic thoughts. Automatic thoughts just “pop” into our heads,
they are so second nature to us that we neither actively think about them nor
question their accuracy. For example, an
automatic thought might be: “If I fail this exam, I’ll never graduate.” Well, it is almost a certainty that if this
individual does not “catch” that thought and challenge it (i.e. asking yourself
“really?”) that his or her body will react with symptoms of anxiety. Underlying our automatic thoughts is our core
belief. In this example a core belief
may be: “Only losers fail.” Those core
beliefs are rarely motivating and frequently paralyzing. The key is to catch the automatic thought – it
will lead to the core belief. Getting
there takes practice though. Initially
we often don’t catch the thought until after we begin to feel anxious! It all begins with identification of both the
automatic thought and the core belief.
In phase two, the goal is to challenge the automatic thoughts and their underlying core
beliefs. Sometimes it can be as simple
as asking yourself: “really?” Frequently
these thoughts are very exaggerated and their perceived assumptions extremely
dire! In the above example, it is highly
unlikely that one exam would prevent an
individual from graduating. It is also a
faulty assumption to connect one failed exam with identifying oneself as a
loser. The goal is not to deny reality;
it is to challenge the faulty assumptions or the exaggeration of those
assumptions so that our bodies don’t inadvertently prepare for battle. We have come to understand that when the mind
prepares for battle (worry), the body reacts with undesirable physical symptoms
(anxiety).
When recognizing and challenging our automatic thoughts becomes
second nature, the final task becomes to revise
those automatic thoughts and the core beliefs.
The premise is to remove the exaggerated thoughts and replace them with
more balanced thoughts and a more accurate core belief. For instance, one failed exam does not equate
with failure as a person. A revised automatic thought could be; “I need
to spend more time studying this topic.”
The core belief could be “ It takes effort to become successful.” The goal of these revisions would be
reducing the likelihood of any physical reactivity to the thought. Ultimately,
the process trains the mind-body alarm mechanism to exercise discretion in
responding. This often results in a more
empowered and confident individual!
Today the outline of this process has been simplified and is
meant to give a brief overview of one of the effective strategies utilized in
anxiety management. It is also often utilized
in concert with techniques of thought stopping (refocusing), visualization and
relaxation training. There are several user-friendly
workbooks that I have found to be a great adjunct to therapy. It is often very helpful when learning the
techniques of how to reframe our thoughts to be able to label the automatic
thought, the core belief, the challenge and the revised core belief in some
visible record. A workbook that offers
that template would be advisable.
If you are struggling with worry and anxiety, seek the
support of a licensed mental health professional that has received training in
Cognitive–Behavioral Therapy. Become a
wise consumer. Do not assume that all
therapists have received this training or that all therapists are equally
comfortable with this modality. Ask
them! Take the time to learn the foundations from a qualified mental
health professional. Then seek out the self-help workbooks as
practice tools if recommended by your therapist.
Remember that your anxiety did not occur over night; it will
take some time and considerable effort on your part to manage it! Be patient with yourself during the
process. Negativity and self-criticism
only compounds the very symptoms you are seeking to eradicate! The sooner you
begin the process, the sooner you can reap the rewards.
