Changing Anxiety Interpretations
One of the central issues in anxiety is the way a person interprets situations as dangerous rather than neutral. Of course an interpretation is often just that, i.e. it isn’t a fact. The more dangerous we interpret a situation to be the more anxious we become about it. So in many cases of anxiety two things tend to stand out. The first is we overrate the seriousness of harm and the second is we underrate our ability to cope.
Getting away from extreme patterns of thought is an essential ingredient in reducing anxiety. Lets take panic as an example. Many panic sufferers have core beliefs that involve panic leading to heart attacks, collapse, feinting, strokes, going mad, losing control and so on. Every single one of these beliefs is false. A panic attack will certainly affect behavior. It may lead to the person wanting to sit down, run away, or cling onto something, but the core beliefs remain as they are – just beliefs.
Psychology Professor Paul Salkovskis makes the point that “the best way to decrease belief in a highly threatening idea which cannot be disproved is to build up belief in an alternative explanation. The alternative explanation does not have to be completely incompatible with the threatening belief; initially, it probably helps if it is not. “So how do we go about making more realistic estimates of the likelihood of harm? Well, one way is to break down the elements of the anxiety into smaller components.
Jenny is chronically anxious about physical exertion. She has a core belief that she has a weak heart. Every test (and there have been several) shows her heart is perfectly normal. The therapist suggests using an ‘anxiety formula’ in order to examine the issue:
- Likelihood of harm: “it is 100% likely that if I over-exert myself my heart will stop”
- Seriousness of harm: “if this happens it is 100% certain that I will die”
- Rescue: “there’s a possibility that if someone medically trained was nearby they may be able to help. But I’m 90% certain this isn’t likely”
- Coping: “it’s 100% impossible to cope with a heart attack”
- Overall anxiety: Very High
This shows a very high level of anxiety yet even with this example it is possible for Jenny to see how her beliefs don’t correspond with reality. For example, the therapist might explore times when Jenny has had to exert herself (dodging an oncoming car, lifting bags, being in a race at school) or been in situations where her heart rate increases (an anxious moment, a time when she was upset) in order to reinforce the fact that her heart is simply doing what it’s designed to do.
Sometimes it just takes another person to help illustrate there are ways to think differently that can help to reduce anxiety. In Jenny’s case she may benefit from some education about what the heart is actually capable of and how exercise ultimately benefits it. She may go on to undertake some behavioral experiments demonstrating she can increase her heart rate without experiencing problems. Every case is different and the therapist will account for this along the way.
Salkovskis, P.M (1996) Frontiers of Cognitive Therapy. New York: Guilford Press.