Thoughts are a powerful trigger for anxiety. Our cognitions can maintain, elevate, or lower our level of anxiety. Today I would like to give you a few tips to help you identify thoughts that might be contributing to your anxiety, as well as show you how a Cognitive Behavioral Therapist (CBT) might help you to start to address those thoughts.
First, let me tell you about two clients, Jim* and Alice. Like virtually all of my clients who suffer from panic attacks or high levels of anxiety, Jim was sharing with me how scary and terrible it is to experience his physical symptoms. “It’s like nothing else,” he stated, “my heart starts pounding, I’m out of breath, I’m lightheaded, I can’t stand the feelings” I looked at Jim. He was an active 21-year-old college student. At this point in our therapy I did not know much about what he liked to do for fun, but on a hunch I asked, “Jim, do you like to ride roller coasters?”
He paused, and said, “Well, yes, actually I love roller coasters.” “What do you like about them?” I queried. Jim replied, “I like anticipation of going up a big hill. I love the speed and the quick turns.” “What are you feeling in your body as you’re going up the hill?” Jim grinned. He had already caught on to where I was going with the questions. “Well, my heart is pounding, I feel butterflies in my stomach.” “And how do you feel when you get off the roller coaster?” I continued. “Light-headed. It’s hard to walk. A little out of breath.”
“Basically you feel the same symptoms in your body while riding a roller coaster as when you are experiencing a panic attack while sitting on your sofa.” “But, it’s not the same!" Jim protested at first, "riding roller coasters is fun. Having a panic attack is not!”
Jim’s argument essentially made my point for me. His cognitive interpretation of riding roller coasters is that it is fun. His cognitive interpretation of a panic attack is that it is terrible.
For those of you who cannot fathom anyone believing that riding a roller coaster could be fun, I will tell you about Alice. Alice was an avid exerciser. Alice was also afraid of when she experienced anxiety that she would have a heart attack because her heart was beating fast. “Alice,” I asked, “Why do you run on the treadmill every morning?” Alice looked at me as if I had just asked a very dumb question. “Cardiovascular exercise is good for my heart,” she replied. “So you make your heart beat fast on purpose?” “Well, yes, of course.” "And that doesn’t scare you?", I continued. “Of course not!” She replied, a little annoyed.
Again, same symptom but a different interpretation. One interpretation leads to panic, the other no panic. Interpretation of thoughts is key for controlling anxiety.
In order to change your interpretation about anxiety, you must first have a
lot of knowledge of what your thoughts are. Countless times I’ve asked people “What were you thinking when you started feeling anxious?” Countless times I’ve gotten the answer, “I don’t know.” It may sound amazing, but it is possible to have thoughts without being aware that we’re having thoughts.
The first step is to identify your thoughts. Here’s some ways to do that:
Find the “What ifs?”
For the next week, every time you have a thought that starts with "What if… " jot it down. At the end of your week take a look at your list. What if thoughts are just about always negative. In other words, no one thinks things like, “What if I win the lottery?” or “What if I have a great week?” or “What if nothing bad happens?”
Take a good look at your list of what if thoughts. How many do you have? How negative are they? Did any of them come true? How much did they affect your anxiety level? These are all important questions for you to consider as you begin to try to change your interpretation about your thoughts.
Event - Thought - Mood Record
Another way to identify your thoughts is to flag them when events occur that make you anxious. Make a three column chart with the headings, “Event,” "Thought, " and “Mood.” You are interested in events where you feel anxious, and it’s a good idea to rate your anxiety on a scale of 0-100, where 0 means you experienced no anxiety at all and a 100 would occur during the worst panic attack or anxiety that you’ve had. Write down a phrase that describes the event such as, “talked to my boss about the big project.” Then ask yourself, “What was running through my mind as I was experiencing this event?”
It may take a little practice, but after a few events, you should get better at identifying your thoughts.
Re-Interpretation of Thoughts: An Example
Once you identify some thoughts that you have while anxious, it’s time to consider whether your interpretation of them is accurate or not. Start by taking one of your “hot” thoughts. A “hot” thought is a thought that has a high level of anxiety associated with it, and is a thought that bothers you quite a bit. Let’s take the example of Alice, who had a hot thought, “If my heart beats fast, I could have a heart attack.” On a scale of 0-100, Alice ranked her anxiety in connection with this thought at an 85.
I asked Alice make two columns, one labeled “Evidence that supports my hot thought,” and “Evidence that does not support my hot thought.” For the first column I asked Alice to tell me every reason that supports the thought that she could be having a heart attack. Here’s what her column looked like:
Evidence that supports the thought that I could have a heart attack
“My aunt had a heart attack when she was 5 years older than I am now.”
“People who have heart attacks usually do not feel good right before them.”
After making the first column, we worked on the second column:
Evidence that does not support the thought that I could have a heart attack
“I had my heart tested and it is healthy.”
“When I get anxious, my heart beats fast from the anxiety, not from heart problems.”
“When I exercise, I raise my heart level on purpose, and I don’t think I will have a heart attack then.”
After making the two columns, I asked Alice to look them both over and form a “balanced thought” that incorporates the truth of the first column along with the truth of the second column. In other words, re-interpreting the hot thought does not merely mean that you take a negative thought and make it into a positive one. Rather, you acknowledge the nugget of truth that is present in the thought, but also acknowledge the truth that speaks against that thought. So here is what Alice came up with for her balanced thought.
“It is possible for me to have a heart attack (given my family history), but it is unlikely at this time given my good state of health.” She also reminded herself, “I do everything in my power to stay healthy, including regular physicals.” I asked Alice to re-rate her anxiety after forming the balanced thought. She rated it at a 40, which is a 45 point drop from her original rating of 85.
What I just described is just a brief example of what cognitive restructuring might look like. It takes a lot of practice, and can be a quite challenge to try to do on your own without help. A Cognitive Behavioral therapist is an excellent choice to help you learn how to reinterpret your anxious thoughts in order to lower your anxiety level. You can find a therapist in your area by going to the Anxiety Disorders Association of America (ADAA) website.
*Client names and details are alterted significantly to protect confidentiality. Sometimes client examples are composites of several people for that purpose.