A great deal of anxiety that human beings experience is illogical and even for the patient who realises that fact consciously, it isn’t enough to cause it to stop.
Enough is Enough
Essentially the shift in mindset that needs to occur within the patient is one that causes them to decide and truly believe that the anxiety no longer has permission to influence or predict how they will chose to experience and live their lives because they want to get on with being happy.
Counterconditioning can be used to reduce the intensity of a conditioned response (such as anxiety) by including an incompatible response (such as calm) to the conditioned stimulus (a snake for example).
It is important that the incompatible response evokes a very strong positive emotion in order to counterbalance the unwanted conditioned response.
Symptoms can also become inhibited when the stimuli to the anxiety are presented in a graded order and systematically paired with the calming response.
The first step is to establish the calming response. Then construct an anxiety hierarchy by considering how to approach the problem one step at a time. Many people who suffer with anxiety are guilty of predicting the future in a negative way and catastrophising an event that may not even occur. For example, someone with a fear of travelling on motorways may refuse to leave their home when invited to a party without even finding out where they would need to travel to. They refuse and miss the opportunity because they have leapt into the future and witnessed a horrible accident on the motorway, when in fact if they had spent the time looking at the map instead of predicting the future, they may have come to realise there is a shorter way to reach the party that doesn’t involve the motorway at all.
In this example, the steps required may include:
Create a list of the positive reasons for going
Check the location of the party on a map
Look at the streets you would travel on Google Earth
This feels so much more achievable and at this stage the patient hasn’t even had to leave the house. This also provides some essential mental preparation and by actively working toward the desired result it reduces the feeling that the patient is not meeting other people’s expectations of them.
If a step seems too large to comprehend, the patient should take the role of breaking it down into smaller chunks. Each step should feel somewhat challenging but also manageable.
When a patient reaches a stage where they know that their old way of thinking isn’t right but they do not yet completely believe in their ability to execute an alternative, this is called cognitive dissonance. It comes with a discomfort as the patients mind is attempting to support two conflicting beliefs. As uncomfortable as it may feel, it is important not to give justification to the old unwanted feelings of anxiety as cognitive dissonance is a sign that things are changing.
A way to manage expectation and results for the future is to create alternative balanced beliefs. For example if someone had suffered with social anxiety as a result of the belief “I am not loveable” the flip side thinking would be “everyone loves me”. However this is not a balanced thought in the context of ecology and would lead to disappointment in the longer term.
Balanced beliefs could include:
“I’d very much like to find someone to love me but I can also enjoy feeling connected to people that I care about even if I do not have a meaningful relationship.”
“If I am not completely loveable by absolutely everyone I can still enjoy my life and enjoy being with people.”
“I’m a good person and I know that some people will reject me whilst to others I will be a very important person in their life.”
When a balanced belief has been chosen, the patient should think to the future and consider what their success would look and feel like once achieved. This will enable them to generate the next steps they will need to take in order to reach their goal and offers the opportunity to practise new healthy actions.
If stifling unwanted thoughts occur, the zigzag technique can help the client regain control. It is the process of playing devils advocate within their own mind and if you listened into someone’s thoughts as they zig zagged, it may sound something like this:
– “The dentist is going to hurt me, the drill is going to slip.”
– “The dentist is a highly skilled professional who does this every day. The drill is incredibly safe.”
“I feel sick I shouldn’t go to the dentist today.”
– “You have taken the day off today especially to go to the dentist. Focus on your breathing and you’ll soon be feeling better.”
An important element of zig zag thinking is that the defence response is as, if not more, powerful in its tonality as the attack response.
Positive Data Log
Get the patient to record every small success that helps to verify their new belief, the positive implications it has had and how they feel as a result. Also ask them to note the positive effects their successes have had on others around them.
If the patient appears to have increased worry, is reverting back to unhelpful strategies or had an increase in physical symptoms, bring it to their attention so that they can become aware of their own early warning signs. Revisit the skills that have been helpful in reducing stress and anxiety previously and make sure they have the opportunity to talk openly and honestly about the setback. This doesn’t necessarily mean therapy but often problems appear bigger than they really are. Talking them through can help define perspective and help them to realise they are not, and never were alone.
By Gemma Bailey
NLP & Hypnotherapy Trainer