By Brian Robinson.
If recovery from anxiety is to be both profound and sustained, it vital to deal with the causes of tension. And we know that what goes on in the mind is the single most significant contributor to high tension levels. This understanding has led to Cognitive Behavioural Therapy taking centre stage in the treatment of most anxiety disorders.
What goes on in our heads, covers such a vast area that it would be impossible to look at each and every way in which things might have gone wrong. Problems could range from stressing about a tiny pimple that has just appeared somewhere on your body, to worries about philosophical issues such as what it means to be human; finding your place in the universe; searching for purpose in life; or wrestling with a belief in a God. So for a start, let’s look at how a CBT therapist might approach the problem.
Very roughly, a cognitive therapist might begin by drawing the sufferer’s attention to some of the ways in which thinking might have gone awry. This might cover such things as perfectionism; emotional reasoning; black and white thinking; or taking a polemic view of things.
Perfectionist thinking can be a problem when standards are set unrealistically high. The perfectionism can be targeted inwardly on ourselves and focus on the way we perform, or it may be directed outwardly towards others. When the perfectionist’s criteria aren’t met, this can lead to problems. At the heart of the matter, lies the reality that we as humans are far from perfect, and we inhabit a world that consistently falls short of the mark. If we were perfect, and if the world was perfect, perfectionism wouldn’t be a problem.
Emotional reasoning is where we allow our emotions to act as guides to our behaviour. We are emotional beings after all, and we cannot and would not want to separate ourselves from that. And indeed, our emotions often act as positive guides. However, we have other things that can also show the way. For example, our instincts and intuitions can often point us in the right direction, especially where there is no existing argument for a particular course of action. But above all, a sense of reason is essential. Our rational mind should dominate, oversee, and if necessary, override our emotions and intuitions. Quite often with anxiety, reason does not sit at the table, and in some cases, it frequently has left the building.
Black and white thinking can be problematic because it tends to oversimplify things. While keeping things simple can be a good thing, we have to recognise that sometimes finding a solution is not always straightforward. Usually, things get complicated when lots of different people are involved and when they all have different views. Answers only come when people are prepared to compromise and realise that there will never be a one-size-fits-all solution.
Once these thinking traits have been identified and considered, the therapist might then go on to suggest some helpful strategies which might be used to tackle these issues. The advice might include some or all of the following:
1) We should always challenge our opinions or conclusions.
2) We should look at the evidence behind our thoughts and see if the evidence supports that particular view.
3) We should keep our reactions to events in proportion and aim at accurate perspectives.
4) We can re-focus, re-assess and re-evaluate situations, events and people where necessary.
5) We can try to shift our focus away from unwanted thoughts.
6) We should put thinking goals in place and begin to work towards more realistic and positive thought patterns.
The therapist might then involve the sufferer in the process of using the above strategies to try and resolve the thinking problems. To achieve this, cognitive therapists tend to use forms and homework to help make assessments as to where the truth lies. They use these to make evaluations as to how things might have gone off track. There are literally hundreds of different forms available and these are fundamental to the therapy. One possible reason why these form-filling exercises seem to work so well is they take the sufferer through a process of self-evaluation and self-discovery, and this is entirely different to listening to a therapist telling you where you may have gone wrong.
CBT, as set out above, works well and is usually done with the help of a therapist. However, this is meant to be more of a self-help guide, so the reality here, is the sufferer has to become the therapist. What that means in practice, is the person has to apply something like the above processes, perhaps minus the form-filling, and work their way towards calming their thinking down. What we will try to do now, is push that a bit further forward. However, because the range of thinking difficulties is so great, let’s first look at a formula that we can apply to all thinking problems. This involves four steps and we’ll identify these as we go along.
Step 1: Generally speaking, thoughts like to be acknowledged. They come into our heads for a variety of reasons, some of which may serve no purpose at all, but it makes no sense to ignore them. We also know from experience, that it is impossible to suppress a thought. The so-called ‘pink elephant’ experiment has demonstrated that. For the next five minutes, try not thinking about a pink elephant, and if you do that, you’ll find a pink elephant is precisely where your mind turns. So, the first step is to acknowledge and accept that the thought exists. We don’t need to agonise too much over the fact that it’s come into our mind or try to suppress it. Step 1 is to acknowledge.
Step 2: The second step involves a process of analysis. We do that to formulate our response to the thought and this always involves asking questions. Is the thought absurd; do I need to do anything about it; is it something I can’t solve but might be able to make some headway with, the list goes on? It’s also important to ask the right sort of questions as this is often where things go wrong. Ideally, questions should aim at the heart of the matter. Step 2 is analyse.
Step 3: Once we’ve finished the analysis, and we hopefully have drawn some solid conclusions, we should then be able to answer the thought. An answer or response to a thought doesn’t necessarily mean we have to solve the problem. For example, if the person is worrying about a debt, the answer might be to get some financial advice or to contact the creditor and try and set up a repayment plan. But the answer has to involve making a decision. Often, decisions are the things that are not made. The worry goes around and around in our head without drawing any conclusions or making any decisions. Conclusions and decisions in themselves can be very relaxing things. Step 3 is answer.
Step 4: Once we’ve arrived at a response to the worry, and made our decision as to what to do with it, we just allow it to be there. Once the thought has been responded to, it will have less power and shouldn’t be quite so troublesome. We might even go one step further, and write down the essential points of our process. This will tend to relax things even more. Once we’ve noted things down, there is no fear that we might then forget them, and we can just allow the thought to be there. . Step 4 is allow.
These are the four steps of the process: Acknowledge; Analyse; Answer; and Allow.
Now we’ve got a bit of a formula, let’s say a few general things about thoughts before we move on. Just because a thought is negative, that doesn’t necessarily mean it should be seen as unhealthy. There are lots of negative things that happen in our lives that require our attention. There is nothing unhealthy in that. However, the process we apply to those negative thoughts should be positive and not one that is never-ending or over-complicated.
The other thing to say is it’s not unusual to have negative thoughts pop into your mind for no apparent reason. Often, these can be annoying or troublesome, and there may be lots of them. But these only become unhealthy when we pay them too much attention or award them too much meaning. Provided we see them for what they are, and treat them as random and meaningless, they shouldn’t cause too much of a problem. These thoughts only become an issue when we think about them too intently and for too long. So, the two thinking things we have to be careful about, are intensity and duration.
The next thing we could do is try and place thoughts into categories to help decide how much attention they may or may not deserve, or, how much of a process we need to put them through. For example, things that could be described as anxiety thoughts will be experienced by all sufferers. These could be something like: I’ll never be able to recover; I must be going mad; I’ll never be able to cope; I’ve bought this on myself. These thoughts are all natural when in anxiety and therefore do not need to be put through too much of a process. We will need to form a response to meet these thoughts, but that will not involve much work. These type of thoughts will always exist to some extent, so we’re never going to eliminate them altogether. We can understand them; see them for what they are; and recognise that we do not have to focus on them.
Some people may find it easier to identify anxiety thoughts than others. An excellent way to test for these is to ask would I be thinking like this before I had anxiety? We could also recall that we have already made the point that recovery is something we can be quite optimistic about, and if we buy into that notion, then we can see that many of these thoughts are without foundation. They are not indicative of a truth, so we can allow them to sit there without paying them too much attention.
If these thoughts persist though, and if we find we are thinking about them for far too long, then we need a plan of how to deal with them. Blocking and distracting from these thoughts is a simple but effective technique. Blocking could be something as simple as creating a picture in your head which reminds you that you need to shift your focus away. This could be something like imagining a policeman with his hand held up asking you to stop, or a school crossing patrol person with their recognisable stop sign. These are sometimes referred to as ‘arresting images’ and it’s worth remembering that pictures can be far more potent than dialogue. Language is still quite a new thing for us humans, but the brain is very adept at understanding things like images and body language.
Once you block something, it can still be difficult to pull away from that thought so we may need to have a distraction. To this end, we should always have both mental and physical distractions in place so we can switch to them. A mental distraction would be something like planning a holiday in your mind, or doing a visualisation where you take yourself off to somewhere calm and relaxing. A physical distraction would be where you say play a game on your phone or do a crossword.
Another example of a category of thought would be where we worry about something unduly or unnecessarily. Worrying is a frequent thinking problem so we would want to give this particular issue some thought. Again, this means asking questions. Am I taking my work home with me? Am I reading too much into what someone has said? Do I need to be spending so much time stressing about my health? Assuming the worry is unwarranted, if we ask enough of the right questions we should soon be able to reach some conclusions and make some decisions which will allow us to pay less and less attention to the particular worry.
Once we have made decisions about thought issues, it is a good idea to try and come up with a new view about the thinking trait. For example, when considering worry, we might realise that human beings are naturally programmed to have a negative default thought setting. This is not a matter of coincidence. We are far more likely to survive if we focus on negative problems especially those relating to danger. We are not programmed to dwell on positive things. When positive thoughts come into our heads, they hardly ever linger. This natural trait is something we have to manage, because the reality is, negative thinking can take on a life of its own and spiral out of control. And that’s when it ends up as worry. So our new view, should be that we are the ones who decide what does or does not go on in our heads. It’s fine to have concerns and act on them; but pure worry gets us nowhere.
After we’ve done the analysis of a thought problem, made our decisions, and taken a new view, it can also be helpful to come up with a ‘relaxing statement’. This is something we can apply to the thought whenever it returns. For example, if the thought problem is very complicated with no obvious solution, we could always meet it with a statement like ‘no matter what happens I will do my best’, or, ‘I’ll try and do what’s right for everyone’. All-embracing statements like these can be very relaxing and help to take some of the heat out of the situation.
Even though problems might be complicated or intractable, it might still be possible to make some positive headway. Breaking a problem down into manageable chunks can be a good way of tackling it. Quantify the problem by setting it out carefully; identify the issues involved; ask what considerations need to be brought to the table; draw some conclusions that will allow you to make your decisions.
Quite often, it is we who over-complicate the problem. We bring too many considerations to the table, and when we do that, decision-making becomes impossible. We have to know what are the important considerations and the critical questions to ask.
Beliefs and perceptions are fundamental to us as human beings, but if they become a bit skewed, this can lead to problems in thinking. We are all prone to cultural, social or religious conditioning, and this can be difficult to rise above and find the universal truths we are looking for. Our view of things can become too narrow or specific and the way we see things can end up making us unhappy. Sometimes freedom is right under our noses: and happiness is just around the corner.
When the way we see things and our beliefs about things becomes too rigid and inflexible this may be part of the problem. Having a more open mind about things; allowing for other views; having some flexibility in our beliefs; being willing to discuss our position, and being open to change, are all healthy positions to adopt.
Apart from all that’s been said about thinking, there are many things about what it is to be human which can end up affecting our state of mind. Making poor assessments of situations; rushing to conclusions about people; adopting unrealistic life expectations; maintaining an unhealthy work/life balance; having unreasonable attitudes towards others, or displaying an unwillingness to compromise, all these things and much more have to power to make life hard and fuel anxiety.
Hopefully, what has been said about thinking will be of some use to the self-help therapist, but there are limits as to what can be achieved in a guide. And quite apart from that, it is not for a guide to tell people how they should think or how they should act.