By Matthew D. Federici, MA, LMHC
15 Minute Read
What is Anxiety?
Have you ever considered if your anxiety is well-founded? Through challenging anxious thoughts, putting “thoughts on trial,” and examining most likely outcomes one can find that worries, stressors, and other anxiety symptoms can often be reduced to a fleeting thought through empirically supported methods of cognitive-behavioral therapy. Even thoughts that do have clout can easily be surmounted with other techniques implemented with the self. With this guide, one can discover derivatives of this therapeutic battery for self-use in everyday scenarios.
We live in a day and age where we regard anxiety as a lifestyle. Rational worries and concerns, like daily responsibilities and obligations of life can add up quickly, and less rational worries have even less room in our mental capacity in an ever-increasingly busy world. Those not resilient to such struggle. According to the Anxiety and Depression Society of America (2019), anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year. Furthermore, people with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.
The Numbers
In regards to children, anxiety disorders affect 25.1% of children between 13 and 18 years old (2019). Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance use (2019).
This data suggests that a large percentage of the population meets DSM-5 criteria for a diagnosable mental disorder, but one could suggest that subclinical presentation of these criteria, i.e. presentation of anxious symptoms without enough evidence to meet criteria for the full disorder, may be even more prevalent. In terms of building anxiety resiliency, and the ability to deescalate such anxiety-ridden moments, one has to examine possible tools beyond physiological relief commonly taught by therapists and other mental health workers.
Many clients may struggle with the concept of simply “breathing deep,” or engaging in progressive muscle relaxation (PMR) purely for the reason that the symptoms are too distracting or overbearing to focus on these techniques. Other techniques and treatment such as medication and transcranial magnetic stimulation (TMS) have shown to have variable results across various populations (2019). Other avenues worth exploring include CBT-oriented techniques of anxiety de-escalation, including variants of the ABC/REBT model.
Cognitive-Behavioral Therapy
The development of Cognitive Behavioral Therapy was over half a century ago. Two of the earliest forms of Cognitive Behavioral Therapy (CBT) were Rational Emotive Behavior Therapy (REBT) – developed by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s (2011). These techniques essentially aim to identify the cyclical nature of behaviors, feelings, and thoughts, their implications on subsequent actions, and those implications on further behaviors feelings and thoughts, in relation to how individuals feel about the self, others, the world around them, and the future. This theory purports that, the way individuals think about and process the world around them can either perpetuate appropriate mental health or total despair.
Various Cognitive Techniques
There are many techniques that therapists use utilizing CBT/REBT models. Some techniques include cognitive challenging, cognitive reframing, and cognitive restructuring. These are thought to be implemented only by a therapist towards a client, however, these techniques can be implemented for the self as well.
Grounding involves creating physiological stability through cognitive methods with physical, mental and emotional attributions.
Cognitive challenging: is a therapeutic technique aimed to do just that – dispute a claim that is erroneous or distressful, or at the very least question such.
Cognitive reframing: involves examining things from a more positive, constructive, truthful, or otherwise more beneficial perspective.
Cognitive restructuring: involves using the data from the previous two interventions to come to a new understanding regarding a matter that is ideally better for mental functioning in accordance with the notion that thoughts, behaviors, and feelings are always influencing each other (2011).
Cognitive Therapy in Practice
Consider a potentially anxious scenario that may not be well-founded. This does not include actual threats prompting anxiety. Remember, anxiety, evolutionarily and biologically, serves to inform individuals that something is threatening, dangerous, or otherwise worth attention. Therefore, these methods should not be used to convince yourself that your house being on fire is “not a big deal” or that the grizzly bear in your garage is cuddly and friendly.
Consider the scenario of trying to finish an assignment for your company with thirty-three minutes left in the day on a Friday. Its a task outside your typical work assignment, but you took it up as part of a broader strategy in uniting different departments at your company. Your supervisor really wants it done – it will surely benefit the company, but it might not get done until the next week. One is to get fired for sure, right? Or, consider another scenario – your spouse is ambiguous, shut-off, unemotional, and seems uninterested – they’re surely having an affair, right? Looks like someone is getting dumped and fired, right? Probably not, and here is why. Some techniques that are typically provided by a therapist can be done on the self.
The Grounding Practice
Grounding is the practice of doing just that – bringing yourself off of a fearful mountain of angst, worry, and fear and back down to Earth. The term actually comes from the notion that our bodies form an electrical connection to the earth (and the same reason some people think humans were healthier before shoes with vulcanized rubber, a digression to the side).
Grounding also includes physical, mental, and emotional grounding (2007). Some techniques include the 5 senses – 5 things you see, 4 things you hear, 3 things you can touch, 2 things you can smell, 1 thing you can taste, in any particular order given the available stimuli. It sounds mundane, but it gets one’s mind off of the frightening thought at hand, even for a moment.
Other grounding techniques can include placing hands in water, savoring food or drink, even examining one’s own body – can you feel your hair on your shoulders or forehead?
Glasses on your ears or nose?
The weight of your shirt on your shoulders?
Do your arms feel loose or stiff at your sides?
Can you feel your heartbeat? Is it rapid or steady?
Does your stomach feel full, or are you hungry?
Are your legs crossed, or are your feet resting on the floor?
Is your back straight?
Using anchoring phrases – this might be something like, “I’m Full Name. I’m X years old. I live in City, State. Today is Friday, June 3. It’s 10:04 in the morning. I’m sitting at my desk at work. There’s no one else in the room.”
Other Cognitive Strategies
Other techniques could include humor, reciting a poem or song, thinking in categories, or visualizing yourself doing something you enjoy. There are also soothing techniques like being with pets, self-kindness, and positive affirmations (2007). Regardless of the method, grounding techniques serve to get our mind off of the distressful thought at hand (2007).
Other CBT-oriented techniques can be easily implemented as well. Challenging the self, or disputing a worry, or negative thoughts in general can easily be done with the self (2007; 2011). It’s as easy as saying to the self “are we sure this is accurate? Is this coming from a place of worry? Or fact? Might there be something more likely here?”
Other questions to ask the self include
“What evidence do I have for this?
What evidence do I have against this?”
There is also the highly potent “What’s more likely to happen?”
The latter is extremely useful because it still acknowledges the possibility, albeit a small one, that a stressor, worry, or concern does, in fact, exist, although probability calls for low possibility.
The Downward Arrow Technique
There is also a technique called the “Downward Arrow (2007; 2011)” that literally calls for one to ask the self “then what will happen, and then what will happen, and then what will happen,” etc. Considering putting it into practice with previously disclosed hypothetical scenarios of worry, let’s “put this thought on trial.”
Deadline Example
The deadline is coming, the assignment isn’t getting done, I’ll surely be fired. Really? Are we absolutely sure it will end in us getting fired? My wife isn’t answering my messages – she must be having an affair. Really? Are we so sure? Maybe, maybe I will get terminated for not finishing this on time, maybe my wife did meet someone else, sure, it is possible, but what’s more likely here? What evidence do I have for these highly serious outcomes? Let’s see, I’m good at my job, I know that, and I’m pretty sure my supervisors think highly of me, and highly of the work I do. Sure, someone might be frustrated that the assignment isn’t done, but with proper coordination with appropriate parties, would I really get fired for that? Would this one mistake really take away all the other good performances I’ve demonstrated?
The same could be said for if one is a few minutes late to work once in a blue moon – does it really call for the most serious of consequences? Sure, that might happen, but what’s more likely here? I’ll tell my supervisor I’m a few minutes behind, and chances are I’ll get a response that says “Okay – Drive safe (smile emoji)!”
Or we can use the downward arrow – What will happen if I don’t finish the assignment? My supervisor might be disappointed. Okay, now what will happen? My supervisor might talk to me, and I’ll explain how primary work took priority, which they’ll probably understand and be okay with. Okay, now what will happen? We will probably set a new deadline, and the assignment will still get done! In fact, I might even be regarded more highly for sharing vulnerability and being honest rather than submitting poor quality work. The same could be said about poor monthly quota – will it really result in layoffs, or me being terminated? Will I really be the sole person blamed for lack of numbers?
Even if I did somehow get fired. Okay, now what will happen? I will probably be sad, but then I will try to rebuild and maintain stability with the means at my disposal. Okay, then what will happen? I may struggle trying to find work, but I will persevere. Okay, then what will happen? I will keep looking for work, and eventually find something to replace my job, no matter what it takes.
Looking at it this way, even the worst outcome still has a happy ending.
Wife Example
Why isn’t my wife answering me? Evidence for it would suggest that due to her not answering, she must be up to no good, but the evidence in favor of that outcome ends there. Evidence against it is much more profound. She’s a busy woman with her own job, and her life doesn’t revolve around me. Perhaps her phone died. Maybe she’s driving. Possibly she’s at the gym – there are a million other possibilities for why someone’s spouse may not answer them immediately.
Let’s try downward arrow on this one, say I am looking at an affair. Okay, then what will happen? I’ll be sad for sure, and we may try to reconcile, maybe seek therapy for it. Okay, then what will happen? We will either heal, or begin to move on, and either way, it can only get better from there. Okay, then what will happen? If the relationship ends, I’ll work on myself, eventually resume dating, and maybe meet someone even better. If the relationship heals, we’ll probably be stronger than ever.
Constantly asking “then what will happen?” can sound highly mundane and repetitive, but if we “follow the downward arrow” we can find that many anxious thoughts are highly unfounded. Once we’ve gone through the processes outlined above, we can make a determination, or a “ruling” rather akin to a trial – is this anxious thought founded, or unfounded? Many times, it will be unfounded.
Consider other scenarios where this technique might be useful.
Phobias
These techniques may also work with phobias as well (2011).
Consider the scenario of being fearful of elevators or social anxiety-related concepts like crowded places. First, one must ask, “what am I really afraid of here?”
In the situation of the elevator, one might think they are fearful of the elevator malfunctioning, and fear entrapment, pain, or death from using such. In regards to socially anxious scenarios, one might be concerned with performance-oriented scrutiny, or judgment.
Let’s put these thoughts on trial as well too. “If I get in the elevator, what might happen?” Sure, the elevator may malfunction, it may become stuck, and it may even fall and result in injury, or worse, death. “But what’s more likely to happen here?”
It’s important to counter irrational thoughts with more rational thoughts. “Okay, so this elevator is inspected on a regular basis, look, here’s the certificate mounted in the car – it’s probably safe and functional. Many people ride this elevator every day, and nobody gets stuck in there, or falls to their death due to malfunction.”
Even if we did get stuck in the elevator somehow, chances are someone will know almost immediately, either due to the emergency call system inside, or simply due to the fact that people use elevators, and are sure to notice if one stops working. Help will probably be called, and rescue will probably come. The elevator actually resulting in personal injury is the least likely outcome here, and although possible, it has the lowest chances of happening. Chances are, we are going to be fine.
Used in Practice
In the situation concerning social anxiety, or performance anxiety, “what am I really fearful of here?” Might it be ridicule, or judgment, or embarrassment? In the case of fear of crowds specifically, am I fearful for my safety among strangers? Remember to ask “What’s more likely to happen here?” Sure, I may fail at some performance-oriented task, people may think lower of my skills as a result of such, people may laugh at me, but “What’s more likely to happen?” Rarely are you going to be on the receiving end of someone displaying sociopathic tendencies for the first time. If they were capable of horrible acts, chances are, this was previously discovered, and this person would not be a free-floating member of society where they can interact with you. Sure, you could be the first person they meet when they finally “snap,” but what’s more likely here?
In regards to performance-oriented circumstances, sure, someone may think less of your skills, but wouldn’t anyone who has ever given a performance probably have a good idea of what it’s like to give less-than-ideal performances? They’ve been in your shoes before, and chances are, outside of constructive feedback, they probably won’t be too harsh on you.
But what if someone laughs at me? Consider this, is an adult professional life similar to all stereotypical scenes in which an entire classroom of children may laugh at you? This isn’t a graded school. Even if this is in reference to a child being laughed at in class, “then what will happen?” Chances are, this child will have their feelings hurt, maybe even cry about it, but then they will probably seek support, or be observed to need support by the school system, learn resiliency skills, and be able to handle these situations better in the future, whether it be personal performance or resiliency to shame.
Through continued practices like this, we can reduce the power of phobias themselves as an auxiliary intervention to standard systematic desensitization (2011).
Substance Use Resiliency and Relapse Risk
Consider the situation of substance use resiliency and relapse risks. “I’m scared to leave treatment, what if I’m not ready?” Okay, now what will happen? I will probably tell my therapist my concerns, and they will make a recommendation accordingly.
What if I’m already out of treatment and I feel triggered to use? I will probably use my tools I’ve learned in treatment to delay gratification – I’ll seek my support system, call my sponsor, or use other intellectual processes to get myself into a better headspace.
Okay, now what will happen? The craving will probably subside, and now I know that if and when this happens again, I’ll probably be fine.
After all, people have decades of sobriety and still experiences cravings, but they’re ideally not going to use.
What if someone feels compelled to leave treatment due to work obligations, family obligations, or other responsibilities? “I need to leave to get back to work, otherwise the bills won’t get paid,” or “I need to leave to get back to the family/significant other otherwise they’ll realize they don’t need me.” What scenario is most probable here? Is our mortgage really going to foreclose, or be left by our significant other because we were purely bettering ourselves? Chances are, case management at a treatment center will assist in coordinating a leave of absence, or some sort of disability, either short or long term.
Is my significant other really going to leave me because I’m here for x amount of treatment? What’s more likely to happen here? Sure, they might become frustrated because I can’t assist with home responsibilities, or engaging with our children, but how good can I be at that in my active addiction? Even further, would they really leave me just because I need to better myself? If they do, good riddance, and they probably weren’t worth having in my life in the first place, but what if that does happen? Sure, I’ll be mourning, but I’ll use the support I have in treatment, and I will persevere.
The Reality
The reality is, most “what ifs” never actually happen. Most importantly, regardless of the outcome, chances are we will surmount and persevere.
Using grounding to get us through the distress, and intellectually processing with CBT-oriented techniques can be a profound gift for everyday usage. Through appropriate ability to stabilize our reaction to anxious thoughts, challenge our own anxious thoughts, process them accordingly, and truly classify them as anxious distortions we can see the fallibility in the thought processes we may have on a daily basis, and perhaps, as a result of such, have better quality mental health, and ultimately better quality daily living.
References
Anxiety and Depression Society of America (2019). Facts & Statistics. ADAA. Silver Spring, MD.
Beck, J.S. (2011). Cognitive Behavior Therapy: Basics and beyond (2nd ed.). New York, NY: The Guilford Press.
McKay, M., et al. (2007). The Dialectical Behavior Therapy Skills Workbook. Oakland, CA: New Harbinger Publications.
