Looking on the Bright Side

Jerry Kennard Health Pro
  • Having made the decision to undergo cognitive behavioral therapy for her anxiety and panic disorder ‘Lillykitten' finds the realities of life are clashing with therapy. She says:


                ‘Here I am facing my fears, doing CBT and slowly convincing myself that the car will not break down every time I drive and my family will not be struck down by fatal illnesses and in the last two weeks both these things have happened. Why don't I just save myself the money and give in to my chronic anxiety!' (looking on the bright side)


    At one level we can appreciate the irony of the situation but at another it's all too common. Life isn't static, so whilst it may be convenient to focus on certain central concerns there are always unforeseen issues that take priority.

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    From what Lillykitten has written it seems she is wrestling to accommodate a new way of thinking. At the outset these processes may be viewed by the patient with a certain level of caution and sometimes suspicion. But it is also quite effortful to change the way we automatically think about things. The therapist seems to be saying your illness can be cured by rational thought. But her condition seems to be more about feelings, emotions and physical signs and symptoms that make her feel terrible and that affect her behavior.


    CBT is a fairly pragmatic form of therapy. The therapist works with the patient to identify exactly what it is he or she expects from therapy and if this seems acceptable fairly explicit goals are drawn up and agreed. CBT, for example, isn't there to make a person feel happier with their life, although by reducing anxiety this may become a welcome side effect.


    Challenging unhelpful thoughts, exaggerations, and beliefs is a central part of the process. Some of the behavioral techniques employed during the process can feel a little uncomfortable for the patient, but they are done to illustrate a point and always with the guidance and support of the therapist. For example, a patient becomes anxious if they have to stand in a queue of people. They feel their pulse racing and start to think they might collapse. The behavioral aspect of CBT would be to encourage the person to stay with the situation and perhaps use breathing and relaxation techniques to reduce anxiety. It proves they won't collapse, or have a heart attack, or any of the other fears frequently associated with losing control.


    What Lillykitten is experiencing is akin to a test of faith. It's difficult enough for her to deal with anxiety as it is without these extra's being thrown in. And of course she has every right to share her concerns and frustrations. Therapy does require an amount of effort on the part of the patient. It needs commitment, focus, thought and practice. One of the most difficult parts can be shifting the way we automatically think about issues and reframing them in a way that is less severe or catastrophic and in ways that are more adaptive. I don't know what has happened to Lillykitten's family as regards illness, but when she says ‘fatal illness' and ‘family' I'm wondering does she literally mean this, or is this anxiety speak?


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    But what are your thoughts? Maybe you'd like to comment here or more directly to Lillykitten's comment, ‘Looking on the Bright Side.'

Published On: May 11, 2010