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50 Tools for Panic and Anxiety -- page 12
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 (cont.)

Suggestion 33: Thought-stopping Technique

Many people with catastrophic worries recognize that the belief is irrational but they complain that they are unable to stop the thought from recurring. Even though they don't believe the thought, it still has the power to create anxiety because of the sheer number of recurrences.

In addition, there are times that focusing on thoughts even what they are believed to be irrational can tend to reinforce those thoughts. Therefore, it is often better to not give those thoughts any attention at all. One method to do this is using a thought-stopping technique. However, do not use this method to stop thoughts that you have not challenged and believe to be true. In that case, you may be avoiding addressing the underlying issues. Instead, use this technique with thoughts you don't believe but keep occurring anyway.

Various methods are available to stop recurring unwanted thoughts. A very simple technique is the rubber band technique. This method involves wearing a rubber band on your wrist and whenever the unwanted thought occurs, you snap the rubber band. This does not need to hurt but just be noticeable.

This is considered a mild aversive deconditioning method. By applying an aversive stimulus (the slight pain of the snapped rubber band) you train your brain not to engage in the thought. An aversive stimulus is another word for punishment. However, you don't want strong punishment in this situation because you don't want to make yourself feel bad about having the thought. People with anxiety disorders often feel bad enough for having anxiety. We don't want to make that worse.

Another thought-stopping method is to say “Stop!” to yourself. You can do this internally and even use a visual cue such as picturing a stop sign. It may be helpful to use your name when saying “stop” because the use of your name can be a powerful cue to listen. In other words, you have already been trained to stop and listen from years of people using your name to address you. Therefore, you are more likely to listen when you use your name.

Sometimes people might need some training to make the thought-stopping stronger. A therapist can assist you with this process. Generally, however, the procedure involves having you say the irrational thought aloud and while you are in the middle of the thought, the therapist says “Stop!” while making a loud noise such as clapping hands or dropping a book.

The training would continue through many repetitions until it is difficult for you to hold on to the thought for any length of time. Eventually, you would practice engaging in the thought internally and telling yourself “stop” without requiring the external intervention from the therapist.

By practicing the thought-stopping it is more likely to be effective when you need it than just trying to tell yourself to stop without the practice. This is a common error people make with thought-stopping: they believe they should just be able to do it without practice.

Suggestion 34: Exaggerate the Fear

Another method to help recognize the unreasonable conclusions you have reached regarding the fear is to exaggerate the feared belief. This is similar to challenging the “what ifs.” Again, it is based on the idea that many people with panic and anxiety attempt to avoid the discomfort of the feared belief so they stop the thought rather than follow it to its logical conclusion.

By doing so, the feared belief continues to appear reasonable. However, many times when I have clients exaggerate the fear, they are able to see that their feared outcome may be unreasonable. For instance, let's return to the previous example of fear of embarrassment by having a panic attack in public. The questioning by the therapist may use humorous exaggeration: “What will your panic look like? Will you run up and down the aisles screaming and waving your hands?”

Given that most people have “quiet” panic attacks (i.e. not noticeable by others), the answer is “Well, no, I wouldn't do that.” This exaggeration helps the person to recognize that it would take extreme behavior for others to even know they are having a panic attack. This helps challenge the “what ifs” even further than the previously described questioning. For instance, in the example given above, the person would conclude that it is unlikely the police would be called because it is unlikely that anyone would even notice the panic attack. Thus, through this exaggeration, the individual is able to put the fear into perspective.

Suggestion 35: Identify Triggers

As noted above, many people with anxiety try to avoid thinking about the anxiety because they are afraid of triggering the anxiety. However, avoiding thinking about the anxiety prevents you from knowing the true triggers for your anxiety. Sometimes identifying triggers is the bulk of therapy. The reason for this is that many times the trigger can be addressed and resolved which then prevents the anxiety from occurring.

For example, a client reported “I have panic attacks when traveling a distance on the highway.” However, when this statement is examined it is determined that initially she didn't have panic attacks every time she traveled, but only some of the time. Eventually the panic began to occur every time because the panic became triggered by the expectation of having a panic while traveling.

Yet, when the initial attacks were examined certain triggers were identified that were not so clear by the time she had developed fear of traveling on the highway. In particular, the initial attacks occurred when traveling to her in-laws. She was in conflict at the time of the initial attacks because she felt uncomfortable staying overnight with them but felt it would be impolite to stay at a hotel. The internal conflict she felt in this situation had eventually generalized to all highway travel. By resolving the initial issue and recognizing the trigger, she was able to resolve her panic.

Triggers can be any number of things which is why it can be helpful to keep a log of high anxiety and panic attacks. This can be particularly useful in therapy because your therapist can look for patterns and help identify potential triggers to track.

As in the example, initial triggers can be some sort of internal conflict especially anything that causes you to feel trapped. Sometimes this can be certain thinking such as the “shoulds” discussed previously. “I shouldn't hurt their feelings by insisting on staying at a hotel” or “I shouldn't leave a meeting because of what people might think.”

Other triggers can include anything that can affect you physically such as lack of sleep, alcohol use, certain foods, allergies. Basically, anything that can cause a person to be out of sorts can potentially trigger anxiety and panic in someone who is susceptible.

In addition, there are certain underlying physical conditions such as hyperthyroidism that can be a trigger. By keeping a record of the anxiety and panic you will be more likely to find the patterns that can lead to proper diagnosis of underlying physical disorders.

Suggestion 36: Learn to Live with Anxiety

The demand to get rid of the anxiety often increases and maintains the anxiety. The more you believe “I have to get rid of this anxiety! I can't stand it!” the more anxiety you are likely to experience. However, conversely, the more you learn to tolerate and accept the anxiety, the more likely the anxiety will decrease.

On the surface this may seem illogical but the demand to get rid of the anxiety creates additional tension. This tension tends to maintain and create more anxiety. A simple way of testing this is to say the statement “I have to get rid of this anxiety! I can't stand it!” out loud with emphasis. As you do, notice what happens to your body. Do you feel more tension? Do you clench your fists? Do you breathe heavier? Does your heart rate increase? If such a simple thing can lead to increased tension, imagine what the constant demand of having to get rid of your anxiety does to your body.

However, this doesn't mean that you can't do anything about your anxiety. It just means to remove the demand of getting rid of it. I have worked with many people with Panic Disorder and have seen that when they can truly believe “So what if I have a panic attack? I can handle it” the panic attacks reduce significantly and even disappear.

The other aspect of learning to live with anxiety is that anxiety is an important tool to help us cope with life. We need to be able to listen to the message from anxiety to know when problems need to be addressed. Anxiety is meant to be a warning signal to help us be aware of problems and to engage in appropriate problem-solving. Therefore, by recognizing and accepting anxiety you can reduce the out-of-control anxiety and be able to use it more as it is meant to be used.

Finally, if you have an anxiety disorder, you may not be able to get rid of the excessive anxiety entirely. However, as I have mentioned previously, it is similar to chronic pain. By using these methods and coming to an acceptance of the anxiety it can become more tolerable and less intrusive in you life.

Suggestion 37: Create An Experiment

An experiment to help prove or disprove your belief can be helpful in challenging irrational beliefs. For instance, if you have the belief “I will lose control if I let myself feel anxious” you can create an experiment in which you create the anxiety and then observe what happens. Or, have someone else observe. Do you really lose control? What do you do? Is the anxiety noticeable to others? Does anything awful happen (other than feeling anxious)?

How do you set up an experiment to test a belief? First, identify an irrational thought. Then, determine how you can test that thought. You might need to be creative with this part. Also, not all thoughts can be tested in this way. However, if you are able to develop an experiment to test a thought it can be very powerful in changing the thought.

Another example related to our “what if” challenge previously described is an experiment related to what happens if you have a panic attack in public. The experiment would be to actually create a panic attack in public and then see what occurs. This allows you to see if your “what ifs” are accurate or not.

I once demonstrated a concept while giving a talk about Social Phobia by engaging in an experiment. In mid-sentence I walked out of the room without any explanation. When I returned a few minutes later I asked people what they were thinking. Primarily they responded with concern and thought that I might be ill or even anxious myself. Then I asked “What is so terrible about people thinking that?” This experiment was to show this group of socially anxious people that nothing horrible happens if you make a mistake or even look foolish in front of a group.

These types of experiments are best created and carried out under the guidance of a therapist because these experiments involve an element of exposure therapy which is discussed next. READ MORE: page 13

Kindle Books by
Dr. Monica Frank

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