The Cognitive Model Of Anxiety

The cognitive model of anxiety views anxiety as having three components: cognitive, emotional and behavioral. An anxious individual perceives threats in relation to self, the world, or related to the future. The perception of a threat elicits a physiologic reaction, known as a “flight or fight” response, associated with increased pulse, blood pressure, sweating, and an overall sense of high vigilance. For example, a person who is walking down a dark street hears footsteps behind them. Their first thought might be, “someone is following me”, their cognitive appraisal might be, “they’re going to hurt me”. The individual begins to experience increased arousal in response to perceived threat including physiological reactions such as an increased heart rate and sweatiness (fight or flight). The individual may then feel scared (emotional response) and begin running or “freeze” (behavioral response). The cognitive model of anxiety states that an individual’s beliefs impact their perceptions in several crucial ways. First an individual may have the belief that they cannot cope or manage stress effectively and thus would perceive situations that elicit stress or uncomfortable feelings as risky. Also, since anxiety elicits physiological symptoms through cognitions or images, these feelings alone may cause the individual to inaccurately assess a situation as threatening. The perception of a situation as threatening coupled with the person’s belief that they cannot cope with the situation serves to increase feelings of anxiety, and vigilance to “watch out” for threatening stimuli both internally and in the environment. For instance, as people become more vigilant, they become more “tuned in” to internal signs of anxiety (physical sensations such as heart racing, difficulty breathing, sweating, chest pain, numbness) they may make catastrophic interpretations of physical symptoms or of the situations itself. This increased vigilance leads to greater cognitive distortions of both internal and environmental stimuli, thereby increasing anxiety. Furthermore, this cognitive appraisal of internal and external experience may decrease the person’s sense that they could cope and increase the anxiety. The patient with intense anxiety tends to be “hypervigilant” for signs of danger or is preoccupied with “perceived” danger or threat. Therefore he is selectively “tuned in” to looking for signs of danger when it is maladaptive (Freeman, 1990). Because of his preoccupation the patient then is often unable to tend to other tasks and may complain of forgetfulness, lack of recall and ability for self-reflection may be restricted (Freeman, 1990). One of the main goals of cognitive therapy is to help the patient "test" whether a situation that has been "labeled dangerous is actually dangerous" (Beck & Emery, 1985). This is accomplished via exploration of cognitive processes, specifically by: 1) identifying automatic thoughts around the anxiety, 2) examining automatic thoughts, 3) challenging cognitions; and through 4) exposure, whereby the patient will be able to “detach and extinguish the fears that have been erroneously attached to a given situation or object” (Beck & Emery,1985). As the patient is able to identify automatic thoughts, they learn that there is a relationship between the occurrence of automatic thoughts relevant to danger and the anxiety experienced (Beck & Emery, 1985). This is extremely important to demonstrate to anxious parents, who tend to attribute their anxiety solely to external causes.
Some of the specific types of cognitive distortions associated with anxiety include: catastrophizing (predicting a disastrous outcome), selective abstraction (focusing on a single negative aspect of an event while excluding evidence that contradicts this information), personalization (viewing external events as relevant to them), overgeneralization (drawing global conclusions from single or small series of events) and dichotomous thinking (looking at things in "all or nothing terms"). For example, an adolescent with generalized anxiety may have the belief that he is a “failure”. His compensatory strategy then is to do flawless or perfect work. An automatic thought could be, “If I don't get an A on the exam I'm a failure.” Because anxious patients tend to look to external causes for their anxiety, it is often difficult for the anxious patient to identify automatic thoughts. Therefore, socialization to the cognitive model is critical in order for further therapeutic progress to occur.

-Anxiety restricts you to tunnel vision. No perspective because of perceived danger. When it lifts, everything returns to normal very fast.

-What is REALLY the worst thing that can happen? Unpleasant feelings, at most most!

-One day at the time. Break everything down.

-Carefully understand ALL vulnerabilities (lack of sleep, tired, lack of energy etc)

-Do micro chain analysis on single event

-There is always either one defined prompting even or accumulation of small prompting events

-Accumulation factor. But like that bookshelf, it can bend but never break

-Some things are beyond immediate control

-Radical acceptance when possible, if not, step back

-User free minutes for mindfulness and breathing

-Beware of monkey mind

-Procrastination breeds anxiety

-Opposite action

-Do one thing you have mastery about

Distract with ACCEPTS

This is a skill used to distract oneself temporarily from unpleasant emotions.

The acronym stands for:

Activities: Push the pause button and turn to positive activities that center, ground, calm, and reconnect us to our strengths and wholeness.

Contribute: Acknowledge our strengths and gifts and offer them to others.

Comparisons: Practice seeing ourselves in the greater clan of humankind. We all suffer; we all feel challenged by our suffering; we all have the capacity to extinguish our suffering.

Emotions (evoking alternate emotions): Shift into humor and lightheartedness with activities that produce positive emotional states.

Push away: Put our heated situation on the back-burner for a while. Put something else in the forefront of our minds. This is not suppression; it is pushing the pause button and taking a breather.

Thoughts (evoking alternate thoughts): Direct our mind to think about something else which brings us a sense of safety and ease.

Sensations (evoking alternate sensations): Do something positive that has an intense feeling other than what we are feeling, i.e., taking a cold shower, putting on music, screaming into a pillow, dancing, etc

IMPROVE the Moment

This skill is used in moments of distress to help us relax.

The acronym stands for:

Imagery: Imagine relaxing scenes or other experiences that are pleasing and calming.

Meaning: Find purpose or meaning in what we are feeling.

Parenting Oneself: Talk to ourselves in a nurturing and comforting fashion. Coming up with a personal mantra or statement that is soothing.

Relaxation: Relax muscles, breathe deeply. This is also a self-soothing tool.

One thing in the moment: Focus our entire attention on what we are doing right in the moment. Coach ourselves to stay in the present moment (out of past and future thinking).

Vacation: Another form of pushing the pause button. Take a break from whatever is happening for a short period of time. Whatever is feeling urgent - is not as urgent as we might think. When we clear a space to pause - we interrupt the momentum of thoughts and feelings that cause a sense of urgency (code red).

Encouragement: Loving self-talk. See ourselves as our own cherished and vulnerable child. Be gentle and loving toward ourselves. This allows us to offer ourselves a deep and abiding acceptance and encouragement to get through the difficult moments.

DISTRACT with "Wise Mind ACCEPTS:'

• Activities (keep busy)
• Contributing (get your mind off yourself)
• Comparisons (could be worse...)
• Emotions (do something that makes you feel differently)
• Pushing away (block out thoughts and feelings)
• Thoughts (distracting thoughts)
• Senses (be aware of your senses)

SELF-SOOTHE the FIVE SENSES

• Vision
• Hearing
• Smell
• Taste
• Touch

IMPROVE THE MOMENT

• Imagine (better times, better things, success)
• Meaning (find one useful thing about the situation for you)
• Prayer (find some quiet place inside of you)
• Relaxation (quiet your body)
• One thing at a time (just this moment)
• Vacation (go someplace in your mind, or take a time out)
• Encouragement (tell yourself it will be OK)

What am I thinking now?
What am I afraid of now?

Guidelines for a Behavioral Chain Analysis and Solution Analysis

1. Describe the specific problem behavior

·         Be very specific and detailed. Avoid vague terms.

·         Identify exactly what you did, said, thought or felt (if a feeling is the targeted problem behavior)

·         Describe the intensity of the behavior and other characteristics of the behavior that are important

·         Describe the problem behavior in enough detail that an actor in a play or a movie could recreate the behavior exactly

2. Describe the specific precipitating event that started the whole chain   

          behavior.

·         Identify the environmental event that started the chain. Always start with some event in your environment, even if it does not seem to you that the environmental even “caused” the problem behavior. Here are some possible question to get at this:

1)      When did the sequence of events that led to the problem behavior begin? When did the problem start?

2)      What was going on the moment the problem started?

3)      What were you doing/thinking/feeling/imagining at that time?

4)      Why did the problem behavior happen on that day instead of the day before?

3. Describe the vulnerability factors happening before the precipitating event. What factors or events made you more vulnerable to a problematic chain? Areas to examine include the following:

·         Physical illness, unbalanced eating or sleeping, injury

·         Use of alcohol, misuse of prescription drugs

·         Stressful events in the environment (positive or negative)

·         Intense emotions, such as sadness, anger, fear or loneliness

·         Previous behaviors of your own that you found stressful

4. Describe in excruciating detail the chain of events that led up to the problem behavior.

• What next? Imagine that your problem behavior is chained to the precipitating event in the environment. How long is the chain? Where does it go? What are the links? Write out all links in the chain of events, no matter how small. Be very specific, as if you are writing a script for a play

1)      What exact thought (or belief), feeling or action followed the precipitating event? What thought, feeling or action followed that? What next? What next?

2)      Look at each link in the chain after you write it. Was there another thought, feeling or action that could have occurred? Could someone else have thought, felt or acted differently at that point? If so, explain how that specific thought, feeling or action came to be.

3)      For each link in the chain, ask yourself: Is there a smaller link I could describe?

5. What were the consequences of this behavior? Be specific. (How did other people react immediately and later? How did you feel immediately following the behavior? Later? What effect did the behavior have on you and your environment?)

6. Describe in detail different solutions to the problem

• Go back to the chain of your behaviors following the prompting event. Circle each point or link where, if you had done something different, you would have avoided the problem behavior
• What could you have done differently at each link in the chain of events to avoid the problem behavior? What coping behaviors or skillful behaviors could you have used?

7. Describe in detail a prevention strategy for how you could have kept the chain from starting by reducing your vulnerability to the chain.

8. Describe what you are going to do to repair important of significant consequences of the problem behavior.

• When stuck - distract.
• This is a game and I will not be bullied.
• Don’t take anything seriously, especially yourself
• Time warp
• Worry period
• Stuck in the mud
• Leafs down the river
• Accumulation factor
• Moods
• Impermanence (this too shall pass)
• Check every though for being non-judgmental
• Full smile
• Be aware of the pendulum. Building things up and bringing them down.
• Breathing exercises.
• Watch out for ANTs
• Beware of oversensitivity
• Visualize beautiful places
• Take example from others (ex. Koshurin, Fox, Yardershtein)
• Fake it till you make it
• Do what you are afraid of, over and over and over and over again. Scary emotions are very short-lived
• Don't fear of relapse. You will deal with it if/when it happens. Base everything on facts, not emotions or fear
• Staying in the now, step back and observe.

Coping Card

    1. What’s the worst that can happen? And based on my experience, and NOT on my emotions, how likely is that to happen?

2. Feelings are sometimes painful, but are time-limited.

3. It will get easier each time I practice.

4. My success is measured by taking skillful action, not by whether I was anxious when I did it.

5. I’m not going to let a lapse get in my way. I’m going to continue making progress towards my goal.

6. Feeling I can’t do it is NOT the same as not being able to do it. Stick to the plan.

7. Good job—I’m staying in the situation, even though it’s hard.

8. I’m going to make it.

9. It’s a sign of strength to ask for help in an effective way.

10. Knowing when to ask for coaching is a skill in itself.

11. I am a unique person, and I have unique reactions. Only I can determine how I SHOULD feel in any given situation.

12. My feelings are not right or wrong, they just simply ARE.

13. A feeling of certainty is not the same as the truth.

14. My painful emotions happen for a reason and are an important source of information and direction for me.

15. Urges are a natural part of emotions and of being human. Having an urge (even a strong urge) does not mean that I have to DO anything at all.

        16. You are not your emotions or thoughts. Step back.

-breathing exercises 4 times a day, especially in the morning
-meditation
-make a routine
-name objects
-become non-judgmental observer of everything
-no major changes in life. steady.