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50 Tools for Panic and Anxiety -- page 11
by Monica A. Frank, Ph.D.

Advanced cognitive restructuring requires not only the basic understanding of the cognitive therapy principles but also strong mindfulness skills.

Index to 50 Tools

Listen to 50 Tools

Advanced Cognitive Training

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These more advanced cognitive training methods are actually more of a combination of the previous training of mindfulness and cognitive restructuring combined because it is important to BE with the uncomfortable thoughts.

The attempts to avoid the thoughts is often due to the belief “If I think about the anxiety, I will cause myself to be anxious.” In one way, this may be accurate. If you dwell on the anxiety by worrying about having the anxiety, you can create more anxiety. However, it is important to recognize the difference between worrying about anxiety and examining it.

When using these methods you may have increased anxiety because you are having to bring the anxiety more to your awareness and examine it directly. That is why these methods are best used after you have learned the relaxation, mindfulness, and initial cognitive restructuring.

Instead of avoiding the discomfort caused by the thoughts these methods involve assessing, evaluating, and confronting the irrational thoughts. Initially, this may be uncomfortable but in the long-term it will aid you in managing the anxiety. Although these methods can be used without mindfulness training, previous mindfulness practice can be helpful in this process.

Suggestion 31: Identify Probability

Many fears are based upon believing impractical probabilities rather than distinguishing the actual probability from theoretical possibilities. This distinction is critical as it greatly influences emotions and behavior. A theoretical possibility is the question of whether something CAN occur. There are many things that can occur but are unlikely to occur.

For example, right at the moment I am writing this a meteorite could crash through my roof and kill me. Is that possible? Yes, it is possible. But the question we need to ask is: Is that probable? The answer to that question is “no.” Knowing that it is not probable I do not spend my day concerned about the meteorite.

However, that is what people are doing with many fears. They are worrying about something that is improbable. Therefore, all fears need to be assessed in terms of actual probability, not whether it is possible nor whether it FEELS probable. For instance, we know that flying is the safest form of travel but more people are afraid of traveling by plane than are afraid of traveling by automobile. Why is that? One major reason is that they are basing their assessment of probability upon how they feel rather than upon the actual probabilities.

If the actual probability of an event is high, then other steps need to be taken such as what can be done to manage the event or reduce the probability of a negative outcome. However, if you determine that the actual probability of your fear occurring is low, the next step is to convince your emotional self of that truth.

Irrational fear is when we know the probability is low but we listen to what we feel anyway. We often are able to understand something intellectually but we still feel uncomfortable because it doesn't “feel” right. The work, then, is to challenge the irrational belief as many times as you need to so that you listen to the challenge.

Just telling yourself once or twice “This is anxiety. It is not a heart attack” will not convince you when you are under a great deal of distress. However, firmly repeating the statement both when you have anxiety and when you do not will help you come to believe the rational challenge.

If you are uncertain of the probability, ask others. Obtain information on the internet. Just be certain to not accept what you “feel” without first finding the truth of what you feel.

Suggestion 32: Challenge Catastrophic “What ifs”

Another way of challenging irrational fears is to confront the “what if.” Most thinking with a “what if” in it indicates a catastrophic belief that is not likely. “What if I have a heart attack?” or “What if this anxiety never goes away?” This type of “what if” you can challenge by examining the actual probability as described above.

However, some “what ifs” are believed to be more catastrophic than they actually are. Challenging these beliefs can help you either determine the actual probability or recognize that the “what if” is not so catastrophic and can be managed.

Most people with “what if” thinking don't ever answer the question of the “what if.” As a result, they continue to believe how horrible it would be if the “what if” occurred without ever examining whether it IS truly horrible. They often are surprised when I turn the question back to them in an attempt to help them evaluate the belief. For instance, a common fear with anxiety is what others might think:

Client: “What if I have a panic attack in public?”

Therapist: “Well, what if you did?”

Client: “What do you mean?”

Therapist: “What would happen if you had a panic attack in public?”

Client: “People might think I'm crazy.”

Therapist: “Maybe. But what would they do?”

Client: “They might call the police.”

Therapist: “If they did, what would happen?”

Client: “The police might take me to the hospital.”

Therapist: “Why is that so terrible?”

Client: “Well, that wouldn't be so terrible, but what if it happened around people I will see again?”

Therapist: “Okay. What if it did?”

Client: “They would think I am crazy.”

Therapist: “And then what?”

Client: “They might tell other people.”

Therapist: “And then?”

Client: “People wouldn't talk to me.”

Therapist: “And?”

Client: “I don't know.”

Therapist: “Will you be all alone? Will no one ever talk to you? Will they take your children away?”

Client: “No, I don't think so.”

Therapist: “Then what is so catastrophic about having a panic attack in public?”

Client: “Well, they might think I am weak.”

Therapist: “So? Does that make it true?”

Client: “No, I guess not.”

Confronting the “what if” to the ultimate degree helps to determine the plausibility of the catastrophic event and to change the perspective. In addition, it helps to uncover other irrational beliefs that might need to be addressed such as the social anxiety issue in the above situation. READ MORE: page 12

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Dr. Monica Frank



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