Written by Lauren Helm, Ph.D.
We’ve all felt anxiety at some point in our lives (likely many times over, in fact), though perhaps it manifested in different ways. You may have noticed the rapid increase of your heart rate, faster, constricted breaths, the growing tension in your shoulders and neck, cold or clammy hands, or unease in the pit of your stomach. The experience of anxiety is unpleasant, to say the least, and as it builds, it certainly has a way of getting our attention.
ANXIETY HAS A PURPOSE
Why do we experience the uncomfortable sensations of anxiety? From an evolutionary perspective, fear and anxiety (two related but slightly different emotions) have a function: they keep us alive. More specifically, fear and anxiety are emotions that occur in response to a perceived threat. When we believe that something may harm us or is dangerous, we feel these emotions and they motivate us to protect ourselves from the danger, typically either by avoiding or escaping the threat.
Without fear or anxiety, we may not react to truly dangerous situations in an adaptive way, and thus not survive as a species. Imagine walking along and crossing paths with a Grizzly Bear. It certainly would not be helpful to feel no fear, and to feel like running up and hugging it! Our emotions give us invaluable information about the environment and about what actions we should take to protect our survival, based on how we feel.
COGNITIVE ERRORS
As incredible as our brains are, they also are prone to errors. We are not always able to accurately assess the true amount of danger (or safety) that may be present in our surroundings. Sometimes this means that we may miss a true threat that was present and suffer the consequences. However, in our modern day society, more often than not we experience the opposite – we overestimate the true amount of threat and thereby experience excessive anxiety as a result.
The problem with excessive anxiety is that it can negatively impact the quality of our lives in multiple ways. Prolonged, pervasive anxiety has an impact on our physical well-being, in addition to our psychological well-being. Chronic stress and anxiety can lead to a deterioration of optimal physical functioning, preventing your immune system, digestive system, and heart from performing the best that they can. Chronic anxiety may also interfere with your ability to sleep, eat, and generally function as you’d like to in life.
Depending on the context, anxiety may be an adaptive or problematic force in our lives. In excess, the symptoms of anxiety can be overwhelming and interfere with our quality of lives, and thus it is often a worthwhile use of our time to become well-versed in the “language” of anxiety. Namely, how does it appear, and why? Once I understand anxiety, what can I do about it?
There are many different theories about what causes problematic anxiety, but this blog will focus on how anxiety may be developed and maintained by certain unhelpful thinking patterns. Cognitive distortions, or inaccurate thinking patterns, typically feed anxious feelings. They also may lead to avoidant behaviors, which perpetuate anxious thoughts and feelings. When the cycle of anxious thoughts, feelings, and behaviors occurs outside of our awareness, we can be left feeling baffled and as if our lives have begun to spiral out of our control.
PERCEIVED THREAT
From an evolutionary perspective, it can be considered advantageous to be very sensitive to possible threat. In other words, our primal ancestors were more likely to survive if they very quickly and accurately responded to potentially dangerous situations. However, in modern day, an over-active threat-detection system can become burdensome. A low threshold for perceiving threat (i.e. situations very easily feel threatening) and an attentional bias to threat (i.e. focusing and narrowing your attention on potential dangers that surround you) can be a constant source of anxiety. Our threat-detection threshold and anxiety-proneness may be partly genetic, but it also is likely a result of having a previous experience that was stressful, anxiety-provoking, or traumatic. Our brains generally keenly remember frightening experiences so that we will readily detect the warning signs in the future and be better able to avoid encountering a similar potentially dangerous situation again. It makes sense that our brains are designed to work this way, but it also means that we have to cope with the surge of anxiety that comes from many "false alarms."
CATASTROPHIC THINKING
Another thinking pattern that feeds anxiety is called catastrophic thinking. Catastrophic thinking occurs when our mind jumps to imagining worst-case scenarios when we are uncertain about an outcome. For example, our mind may imagine that our loved one has been involved in a car accident because they still haven’t returned home 30 minutes after they said that they would. Catastrophic thoughts may also be hidden from our conscious awareness, but still cause us to feel anxious and on edge. Catastrophic thoughts are often triggered by uncertainty and the unknown, and are attempts at anticipating and (ideally) preventing or avoiding very painful, negative imagined outcomes.
PROBABILITY OVERESTIMATION
Furthermore, probability overestimation occurs along with catastrophic thinking – this is when we overestimate how likely it is that the “worst-case scenario” has or will occur. When we are feeling anxious, we often feel very certain that the worst-case scenario will occur even though realistically-speaking, the chances are much lower (or are little to none) that what we fear will actually happen. This feeling of certainty that the negative outcome will occur motivates us to take action to prevent it from happening ("it's better safe than sorry!"). Unfortunately, we may anxiously expend significant energy and time trying to prevent something that is not actually like to happen at all, without finding substantial or long-lasting relief.
WORRY
Worry and catastrophic thinking go hand-in-hand. When we worry, we dwell on the many possible negative “what if” scenarios, and use extensive cognitive energy to plan for or prevent these potential future threats from occurring. In moderation, planning for future threats can be helpful, but when it begins to take excessive time and energy (which is quite exhausting), it becomes maladaptive and interferes with your ability to function optimally. More often than not, the cost of worrying exceeds the benefits (it may become a waste of energy) and actually feeds the anxiety that it is intending to placate. Because worrying tends to happen in the form of verbal or analytical thinking and planning, it is thought that worrying can act as a form of cognitive avoidance that prevents full processing of emotions associated with catastrophic thoughts. Excessive worrying that is difficult to control can cause us to be constantly on-guard and on-edge, leading to muscle tension, concentration & sleep difficulties, and trouble relaxing. Worrying can also be self-reinforcing - if we believe that we thwarted a negative outcome because we worried (a coping strategy, of sorts), we will most likely engage in worrying again in the future. Unfortunately, worrying rarely pays off in the way we intend for it to.
These are just a few ways that our patterns of thinking can create and maintain anxiety, leaving us feeling trapped in our minds. Now we will explore strategies intended to help individuals suffering from anxiety develop more adaptive ways of responding to anxious thoughts, so that they can get unstuck. We will explore two evidence-based treatments provide strategies for managing unhelpful, unproductive thinking patterns.
COGNITIVE BEHAVIORAL THERAPY
Cognitive-behavioral therapy (CBT) identifies how certain types of thoughts or ways of thinking in response to perceived threats actually create more difficulty for us, and potentially lead to anxiety, stress, low mood, and other problems. Simply put, situations do not cause negative emotions; our perceptions of them do.
Some of the unhelpful or inaccurate patterns of thinking (cognitive distortions) related to anxiety include catastrophic thinking, probability overestimation (overestimating the likelihood of a negative outcome), worry, filtering out the positive and only seeing the negative, jumping to conclusions, mind reading (thinking you know another person’s intent for acting in a certain way, when this may not be true), personalizing, and black and white thinking. CBT therapists help individuals to alleviate the consuming nature of anxiety by using various strategies to address these cognitive distortions.
The various approaches that are used in CBT to deal with these types of “inaccurate” thinking patterns have historically served a common purpose: correct and change the “thinking errors” that create anxiety. Over time, CBT has evolved and has placed more emphasis on helping people to generate more flexible, adaptive thoughts and responses to their thoughts. Instead of merely trying to replace one problematic thought with a more helpful one, CBT can help an individual to generate more balanced and healthy thoughts, and more easily identify and non-reactively respond to problematic, anxiety-provoking thoughts.
In other words, if you notice that you are thinking in inaccurate ways, it is likely best to recognize that it may not be helpful to act on this inaccurate thought, and better to generate a new, alternative way of thinking about the situation that helps you to successfully reach your goals. Instead of trying “not to think” a thought (suppressing or shut out a problematic thought), modern versions of CBT emphasize helping you create more thoughts that are based on a more balanced review of available information, and are informed by your goals in a particular situation. Cognitive rigidity, or getting stuck in one narrow way of thinking, is usually what contributes to us further being consumed by anxious thinking and behaving. Thus, CBT encourages you to increase your cognitive and behavioral flexibility (working towards developing a wide range of thinking and responding).
COGNITIVE RESTRUCTURING
Cognitive restructuring is a CBT intervention that helps individuals get “unstuck” from the “mind traps” that thinking errors create. Socratic questioning is often used to help facilitate cognitive restructuring and get at the truth. This approach is usually built into CBT therapy sessions to help change problematic thinking patterns.
change your thoughts
Here is an example of methods you might use with a therapist to "restructure" a problematic thought:
- Identify and write down the "hot" or emotionally-charged thought elicited in response to a particular situation.
- Challenge the thought (i.e. “Is this a realistic thought?” “Is it helpful?”) and write down your answers.
- Explore and write down the objective evidence for or against the thought (i.e. What are the facts? Has this happened before?) to discern whether the thought is accurate or not.
- Identify other possible alternative explanations that are based on the facts in order to put the thought in perspective.
- Generate and write down a new, balanced, and more helpful thought about the triggering situation from which to act on.
DECATASTROPHIZING
To more specifically target catastrophic and probability overestimation, thinking traps that fuel anxiety, decatastrophizing is a cognitive restructuring technique that is very helpful for providing perspective and relief. Decatastrophizing helps to reduce the believability of catastrophic thoughts, which as mentioned above, often feel much more likely to happen than they actually are.
If you feel trapped in an anxious thought loop, you may try using decatastrophizing. A therapist trained in decatastrophizing can help you work through catastrophic thoughts that are particularly difficult for you to unhook from.
The first step of decatastrophizing is to more clearly uncover the catastrophic thoughts and negative core beliefs that are often lurking beneath surface-level anxious thinking. Specifically, the downward arrow technique is used to dig below the automatic thoughts that we are consciously aware of to get at the core negative beliefs that are driving our anxiety. For each thought that is uncovered, it is followed up by a "What If" prompt, such as "If that were true, then what would that mean? What does your mind tell you will happen?"
Here is a hypothetical example of how the downward arrow technique might be applied for someone struggling with social anxiety is as follows:
- Client: "I feel super anxious about going out with this new friend because I'm afraid I'll say something stupid."
- Therapist: "If you did say something stupid, then what would happen?"
- Client: "If I say something stupid, then they may think I'm stupid, and not like me."
- Therapist: "If that were to happen, then what would that mean?"
- Client: "If they thought I was stupid and didn't like me, then that might mean that I am unlikeable"
- Therapist: "What does your mind tell you would happen then, if you were unlikeable?"
- Client: "Well then no one would like me. I would have no friends. Actually, my mind is telling me that I would never be able to make friends."
- Therapist: "And then what? What would that mean? What's the worst case scenario?"
- Client: "If I didn't have friends, it would feel like I've lost everything - I would be miserable. I think it would also mean that there's something wrong with me. Something fundamentally flawed to make me unlikeable. That would be terrible"
- Therapist: "And on an emotional, experiential level, how likely does it feel that this would actually happen? How real does it feel?"
- Client: "Oh, like 98-100%"
By uncovering core catastrophic thoughts, and probability overestimation, we get a sense of what the client was actually guarding against by not going out with her new friend - facing the fear that she was fundamentally flawed, and thus would not be able to retain any relationships in her life. Usually, catastrophic thoughts and core beliefs like this drive entrenched anxiety and other painful emotions. By clearly identifying what thoughts are really behind our emotional and behavioral reactions, we can more directly and effectively challenge them.
The second phase of decatastrophizing can then move into nonjudgmental questioning and testing of these thoughts. Questioning the actual likelihood that these anticipated outcomes will come true by evaluating factual evidence that supports or does not support these thoughts, helps our minds begin to absorb in important information: whether or not we are likely to face these worst case scenario outcomes at all. Additionally, by bringing emotionally-charged thoughts more fully into our conscious awareness, and seeing what they are really made of, their believability and charge is diminished. Another component of decatastrophizing entails inquiring about and planning for how you would be likely to respond, even if the worst-case scenario were to happen.
- Therapist: "Based on the facts of your past experience, have you ever experienced having everyone dislike you before? Have you lost all of your friendships and relationships with others?"
- Client: "Well, no, I've lost a few friends before, but that wasn't because they thought I was stupid, as far as I know, we just realized we didn't have a lot in common. I guess I've never lost all my friendships, especially not all at once or forever - I've always had at least someone in my life, or connected with someone new later down the line."
- Therapist: "Based on the evidence, how likely would you say it is that you would actually lose all relationships in your life?"
- Client: "Haha, well in reality, it seems like it's pretty unlikely. Probably like 0-3% likely to happen."
- Therapist: "What would have to happen for you to actually lose all relationships in your life, so that you were never able to make any more friends?"
- Client: "Gosh, I guess it would have to take something really big...actually, I'm not really sure there would be something that would guarantee I had no friends, unless I just stopped wanting them entirely, which I don't really see happening..."
- Therapist: "And if you actually did lose all of your friendships at one point, how could you potentially cope and respond? How have you gotten through something similar in the past?"
- Client: "I probably would keep making the effort to put myself out there the best I could. Maybe make sure to go to events with people that are more likely to be nonjudgmental, and have similar interests in me. If I had trouble with it emotionally, I could go back to therapy and or support groups. It would be really hard, but I'd find a way."
- Therapist: "What's a new way of looking at this upcoming time out with your friend?:
- Client: "Well, now I realize more fully that I don't actually risk as much as I thought I would. If it goes well, great, but if not, it's not the end of the world. I feel in my gut that I will always have the connection I need, with someone. I guess it's worth the risk to go and try out this experience, and who knows, maybe I'll have some fun?"
In this example, by the end of the exercise, the client's negative beliefs were put in perspective and objectively evaluated, given her the chance to obtain healthy distance from the thought that she may risk being rejected not only by this new friend, but all others in her life. The downward arrow technique and thought-challenging could have also been applied to the belief that the client was fundamentally flawed or unlikeable, which caused her to feel unsafe in herself and her relationships. There are many ways that these cognitive restructuring strategies can be used to help free ourselves from the anxiety-labyrinth created in our minds.
ACCEPTANCE & COMMITMENT THERAPY (ACT)
Acceptance and Commitment Therapy (ACT) guides individuals in becoming aware of not only their thoughts, but also their enmeshment, or fusion, with these thoughts. Cognitive fusion refers to how much we believe our thoughts, and thereby grant them power and “reality” in our lives. We often forget that every thought filters how we see the world, and dramatically impacts our direct experiencing of life. Regardless of how “true” our thoughts may be, they are still just thoughts.
COGNITIVE DEFUSION
Thus, ACT therapists help individuals practice cognitive defusion, reducing our entanglement with our thoughts. In other words, by taking our thoughts less literally, we learn how to become less attached to and controlled by our thoughts. We learn how to see them for what they really are. A thought is just a thought, an electro-chemical reaction. Thousands and thousands of thoughts stream through our minds per day. With ACT, we learn how to give them less power over us, and take back the power of choosing which thoughts we want to listen to (for example, being guided by a thought that supports us in acting in valued ways, as opposed to avoidant ways). With ACT, we focus less on changing the thought itself, and more on changing our relationship with the thought. We learn to relate to thoughts as just thoughts, products of a very active mind, instead of products of reality. Holding our thoughts lightly, seeing them from a healthy distance, and responding to them nonjudgmentally can allow us let them go so that we can get out of our minds and back into our lives.
Cognitive defusion techniques are practices that help us achieve this aim. These techniques may include exercises such as:
- Labeling your thoughts "I am having the thought that..." or "I notice that my mind is having a judgmental thought."
- Singing your anxious thought out loud (or in your mind) to the tune of a silly song (like Twinkle Twinkle Little Star or any other song of your choice)
- Thank your mind for the thought, such as "Thank you mind for that thought. I appreciate your contribution but I got this."
- Repeating an anxiety provoking word over and over in your mind until you begin to hear it as just a word
- Ask what the thought is in the service of. Is it in the service of your values or in the service of avoidance of discomfort?
- Watch your thoughts: Imagine your thoughts are like a news scroll reel, constantly streaming information that you can watch from a distance.
- Practice mindfulness of your thoughts, such as using the Leaves on a Stream mindfulness meditation.
These are just a few ways that cognitive defusion can be promoted, helping us to take our thoughts less seriously, leaving them with less power over us. When our thoughts have a less powerful hold on our experience, they become less threatening. We then have more freedom to invest our attention and energy elsewhere. For a more comprehensive list of cognitive defusion techniques, visit this list on the Association for Contextual Behavioral Science's website.
Additionally, ACT asserts that we have limited control over which thoughts or emotions we experience. The problem is less in the content of our thinking or feeling, and more in what we do with these thoughts or emotions, or how we relate to them. In other words, we can change our relationship with our thoughts so that we can focus our energy on what is truly worthy and important to us, instead of using most of our energy on trying to simply manage or reduce unpleasant thinking.
In sum, awareness of our thinking patterns is often the first step, and changing how we approach our thoughts is the next step along the way of healing and wellness.
These two approaches may resonate differently for different people. Both CBT and ACT are evidence-based treatments for anxiety, and can help those who struggle with the reign of anxiety get back into living full and meaningful lives.
References
Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.
Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.
Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. Basic Books.
Ellis, A. (1962). Reason and Emotion In Psychotherapy. New York: Lyle Stuart
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.
Sibrava, N. J., & Borkovec, T. D. (2006). The cognitive avoidance theory of worry. Worry and its psychological disorders: Theory, assessment and treatment, 239-256.
Whalley, M. G. (2015). Self-help tools for panic. Psychology Tools
RESOURCES
http://www.webmd.com/balance/guide/how-worrying-affects-your-body
http://www.apa.org/divisions/div12/rev_est/cbt_gad.html
Cognitive Distortions and Restructuring Handout:
http://www.reconnect.salvos.org.au/common%20mindtraps.pdf