I’ve treated a lot of people in my clinical practice who were dealing with overwhelming anxiety. For some, it was pervasive worry about nearly everything or fear of embarrassing themselves while giving a speech. For others, it was the nagging doubt of obsessive-compulsive disorder (OCD), or the terror of panic.
I specialize in cognitive-behavioral therapy (CBT), and the core of this approach is identifying and challenging problematic thoughts. The things our minds tell us can have powerful effects on our feelings and actions, and when anxiety is high, we’ll usually find predictable habits of thought related to danger.
Often these thoughts overestimated the probability of danger. Panic-related thoughts, for example, might tell us that we’ll drive off a bridge if we have a panic attack while driving across it. Social anxiety thoughts could tell us that everyone is going to think poorly of us if we blush.
These thoughts can drive up our anxiety, as we anticipate the worst. In classic CBT we work to pinpoint what we’re telling ourselves, and then we examine the evidence to see how accurate the thoughts are. With the bridge example, we might ask how many times we’ve panicked on bridges (probably many), and approximately how many of those times we’ve driven our car over the edge (the answer is always zero).
Anxious thoughts also tend to overestimate the severity of bad things that could happen. If we’re afraid of blushing, our minds might tell us it will be terrible if we do. As we examine that belief, we’ll find that most people actually don’t think badly of us when we blush—and there’s even some evidence showing positive reactions to others’ blushing.
We would take a similar approach when we’re worried about being a few minutes late for work. If our thoughts tell us it’s going to be a catastrophe, we could walk back that thought and take a more realistic view of the likely cost. In reality, it probably won’t be as big a deal as we fear.
Limitations of Arguing with Our Thoughts
Challenging unhelpful and inaccurate thoughts can be a useful way to reduce anxiety. However, it has its limitations. Early in my training, many of the people I was working with found little benefit from arguing with their anxious thoughts. No matter how low the probability of what they were afraid of, there was always the possibility that it could happen. Even if the likelihood was almost zero, it wasn’t exactly zero, so there was still a chance.
And even though the feared outcome had never happened in all the hundreds of times the person had worried about it, the mind would always treat the next time as different. There’s always a first time, our minds like to remind us.
The limitations of traditional CBT led me to mindfulness- and acceptance-based approaches, and to the work of Dr. Steven C. Hayes, creator of Acceptance and Commitment Therapy (ACT). I recently spoke with Hayes on the Think Act Be podcast and explored with him the pros and cons of a cognitive-based approach to anxiety—and why acceptance can be so powerful. SOURCE