Images and metaphors. Think of yourself as, for example, a sturdy tree withstanding a strong wind blowing against you, which can be an inspiring metaphor to represent you withstanding unreasonable criticism.
Proverbs, quotes and icons. Use ideas you've heard expressed in novels, religious literature, films, songs or quotes from well-respected people to keep you reaching for your goals.
Focusing on the benefits of change
People often maintain apparently unhelpful patterns of behaviour (such as consistently arriving late for work) because they focus on the short-term benefit (in this case, avoiding the anxiety of being on a crowded bus or train) at the time of carrying out that behaviour. However, away from the immediate discomfort, these same people may focus on wishing they were free from the restrictions of their emotional problem (able to travel carefree on public transport).
Completing a cost-benefit analysis
Carrying out a cost-benefit analysis (CBA) to examine the pros and cons of something can help galvanise your commitment to change. You can use a CBA to examine the advantages and disadvantages of a number of things, such as:
Behaviours: How helpful is this action to you? Does it bring short-term or long-term benefits?
Emotions: How helpful is this feeling? For example, does feeling guilty or angry really help you?
Thoughts, attitudes or beliefs: Where does thinking this way get you? How does this belief help you?
Options for solving a practical problem: How can this solution work out? Is this really the best possible answer to the problem?
When using a CBA form similar to the one shown in Table 8-1, remember to evaluate the pros and cons:
In the short term
In the long term
For yourself
For other people
Try to write CBA statements in pairs, particularly when you're considering changing the way you feel, act or think. What are the advantages of feeling anxiety? And the disadvantages? Write down pairs of statements for what you feel, do or think currently, and for other, healthier alternatives. Tables 8-2 and 8-3 show a completed CBA form. You can find a larger, blank cost-benefit analysis form in Appendix B, which you can photocopy and fill in.
After you've done a CBA, review it with a critical eye on the ‘benefits' of staying the same and the ‘costs' of change. You may decide that these costs and benefits are not strictly accurate. The more you can boost your sense that change can benefit you, the more motivated you can feel in working towards your goals.
Write out a motivational flashcard that states the benefits of change and costs of staying the same, drawn from your cost-benefit analysis. You can then refer to this card to give yourself a motivational boost when you need it.
A large aspect of achieving a goal, whether learning to play the guitar or building up a business, is about accepting temporary discomfort in order to bring long-term benefit.
Recording your progress
Keeping records of your progress can help you stay motivated. If your motivation flags, spur yourself on towards your goal by reviewing how far you've come. Use a problem-and-goal sheet like that in Figure 8-1, to specify your problem and rate its intensity. Then define your goal, and rate your progress towards achieving it. Do this at regular intervals, such as every one or two weeks.
1. Identify the problem you're tackling. Include information about the emotions and behaviours related to a specific event. Remember, you're feeling an emotion about a situation, leading you to behave in a certain way.
2. At regular intervals, evaluate the intensity of your emotional problem and how much it interferes with your life. 0 equals no emotional distress, and no interference in your life, and 10 equals maximum possible emotional distress, at great frequency, with great interference in your life.
3. Fill in the goal section, keeping the theme or situation the same, but specifying how you wish to feel and act differently.
4. Rate how close you are to achieving your goal. 0 equals no progress whatsoever, at any time, and 10 means that the change in your emotion and behaviour is completely and consistently achieved.
Change doesn't happen overnight, so don't rate your progress any more frequently than weekly. Look for overall changes in the frequency, intensity and duration of your problematic feelings and behaviours.
Figure 8-1: The Problem-and-Goal Sheet.
Mercurial desires
People often find that they want to change their goals on a whim or a fancy. For example, you may have a goal of being more productive and advancing your position at work. Then, after going to a Summer Solstice rave, you decide that really your goal is to be free and to travel the world, communing with the essence of life. What you choose as your definitive goal is up to you. But be wary of being influenced too easily by whatever's foremost in your mind. Constantly abandoning former goals and adopting new ones can be a mask for avoidance and procrastination. Use the SPORT acronym, as described at the start of this chapter, to assess the durability and functionality of each of your chosen goals.
Part III
Putting CBT into Action
In this part . . .
Sometimes it can seem as if no one understands your problem, but we do! These chapters give you CBT ammunition to surmount depression, obsessions, addictions, poor body image, anxiety and even unbridled rage. Read on to gain more control over your problems and really begin to realise recovery.
Chapter 9: Standing Up to Anxiety and Facing Fear
In This Chapter
Understanding the nature of anxiety
Developing attitudes that help overcome anxiety
Designing a programme to face your fears
Anxiety is a bully. And like most bullies, the more you let it shove you around, the pushier it gets. This chapter helps you get to know the nature of anxiety and to identify the ways in which it pushes you about. Fundamentally, you can beat anxiety, like any bully, by standing up to it.
Acquiring Anti-Anxiety Attitudes
Your thoughts are what count, because your feelings are influenced greatly by how you think. Feeling anxious increases the chance of you experiencing anxiety-provoking thoughts (refer to Chapter 6). Anxious thoughts can increase anxious feelings, and so a vicious cycle can develop. You can help yourself to face your fears by adopting the attitudes we outline in this section.
Thinking realistically about the probability of bad events
If you have any kind of anxiety problem, you probably spend a lot of time worrying about bad things that may happen to you or your loved ones. The more you focus your attention on negative events and worry about bad things being just around the corner, the more likely you are going to believe that they'll actually happen.
Proving for sure that bad events won't happen isn't that easy without a crystal ball or two, but you can acknowledge that you tend to overestimate the probability of bad things happening. Adjust your thinking appropriately to counterbalance for this tendency. Counterbalancing your attitude is a lot like riding a bike with the handlebars offset to the left - to steer straight, you need to turn the handlebars to the right, otherwise you keep veering off to the left. If you tend to always imagine the worst, straighten out your thinking by deliberately assuming that things are going to be okay.
Avoiding extreme thinking
Telling yourself that things are ‘awful', ‘horrible', ‘terrible' or ‘the end of the world' only turns up the anxiety heat. Remind yourself that few things are really that dreadful, and instead rate events more accurately as ‘bad', ‘unfortunate' or ‘unpleasant but not ‘the end of the world'.
Extreme thinking leads to extreme emotional reactions. When you mislabel a negative event as ‘horrible', you make yourself overly anxious about unpleasant but relatively non-extreme events, such as minor public embarrassment.
Taking the fear out of fear
When people say things like ‘Don't worry, it's just anxiety', the word ‘just' implies - wrongly - that anxiety's a mild experi
ence. Anxiety can, in fact, be a very profound experience, with strong bodily and mental sensations. Some anxious people misinterpret these intense physical symptoms as dangerous or as signs of impending peril. Common misreadings include assuming that a nauseous feeling means that you're about to be sick, or thinking that you're going crazy because your surroundings feel ‘unreal'.
If you have concerns about your physical sensations you may consider seeing your family doctor prior to deliberately confronting your fears. Your doctor may then be able to advise you as to whether deliberately increasing your anxiety in the short term, in order to be free of it in the long term, is safe enough for you. It is rare for people to be advised against facing their fears.
Understanding and accepting common sensations of anxiety can help you stop adding to your anxiety by misinterpreting normal sensations as dangerous. Figure 9-1 outlines some of the more common physical aspects of anxiety.
Figure 9-1: Common physical sensations of anxiety.
Undoubtedly, anxiety is an unpleasant, sometimes extremely disturbing experience. However, evaluating your anxiety as ‘unbearable' or saying ‘I can't stand it' only turns up the emotional heat. Remind yourself that anxiety is hard to bear but not unbearable.
Attacking Anxiety
The following are some key principles for targeting and destroying anxiety.
Winning by not fighting
Trying to control your anxiety can lead you to feeling more intensely anxious for longer (for more on this, read through Chapter 7). Many of our clients say to us: ‘Facing my fears makes sense, but what am I supposed to do while I'm feeling anxious?'
The answer is . . . nothing. Well, sort of. Accepting and tolerating your anxiety when you're deliberately confronting your fears is usually the most effective way of making sure that your anxiety passes quickly.
If you're convinced that your anxiety won't diminish by itself, even when you do nothing, test it out. Pick one anxiety-provoking situation that you normally withdraw from - examples include using a lift, travelling on a busy bus, standing in a crowded room and drinking alone in a bar. Make yourself stay in the situation and just let your anxiety do its thing. Don't do anything to try to stop the anxiety. Just stay where you are and do nothing other than feel anxious. Eventually, your anxiety will begin to ebb away.
Defeating fear with FEAR
Perhaps the most reliable way of overcoming anxiety is the following maxim: FEAR - Face Everything And Recover. Supported by numerous clinical trials, and used daily all over the world, the principle of facing your fears until your anxiety reduces is one of the cornerstones of CBT.
The process of deliberately confronting your fear and staying within the feared situation until your anxiety subsides is known as exposure or desensitisation. The process of getting used to something, like cold water in a swimming pool, is called habituation. The principle is to wait until your anxiety reduces by at least half before ending your session of exposure - usually between twenty minutes and one hour, but sometimes more.
Repeatedly confronting your fears
As Figure 9-2 shows, if you deliberately confront your fears, your anxiety becomes less severe and reduces more quickly with each exposure. The more exposures you experience, the better. When you first confront your fears, aim to repeat your exposures at least daily.
Figure 9-2: Your anxiety reduces with each exposure to a feared trigger.
Keeping your exposure challenging but not overwhelming
When confronting your fears, aim for manageable exposure, so that you can successfully experience facing your fears and mastering them. If your exposures are overwhelming, you may end up resorting to escape, avoidance or safety behaviours. The flipside of choosing overwhelming exposures is taking things too gently, which can make your progress slow and demoralising. Strive to strike a balance between the two extremes.
If you set yourself only easy, gentle exposures, you risk reinforcing the erroneous idea that anxiety is unbearable and must be avoided. The point of exposure work is to prove to yourself that you can bear the discomfort associated with anxious feelings.
Taking it step by step
Avoid overwhelming or underchallenging yourself by using a graded hierarchy of feared or avoided situations. A graded hierarchy is a way of listing your fears from the mildest to the most severe.
If you want to kill your fear, let it die of its own accord.
You can use the following table to list people, places, situations, objects, animals, sensations or whatever triggers your fear. Be sure to include situations that you tend to avoid. Rank these triggers in rough order of difficulty. Alongside each trigger, rate your anticipated level of anxiety on the good old 0-10 scale. Voila! You have a graded hierarchy. Table 9-1 shows you a blank form you can use.
After you have confronted your fear, rate the actual level of anxiety or discomfort you experienced. Then, tailor your next exposure session accordingly. Most situations are not as bad as you expect them to be. In the unlikely event that the reality is worse than your expectations, you may need to devise more manageable exposures for the next few steps and work your way up the hierarchy more gradually.
Jumping in at the deep end
Although we caution about striking a balance between under- and overchallenging yourself, jumping in with both feet does have its benefits. The sooner you can face your biggest fears, the sooner you can master them. Consider whether you can climb to the top of your hierarchy straight away.
Graded exposure is a means to an end. Going straight to your worst-feared situation without resorting to safety behaviours (which we talk about in the next section) can help you get rapid results, as long as you stick with the exposure long enough to discover that nothing terrible happens.
Shedding safety behaviours
You can overcome anxiety by turning your anxiety upside-down. The best way to make your anxiety go away is to invite it to do its own thing. As we explain in a bit more detail in Chapter 7, the things you do to reduce your fear in the short term are often the very things that start you feeling anxious in the first place. (Check out Chapter 7 for some common examples of safety behaviours.)
Recording your fear-fighting
Keep a record of your work against fear so you can check out your progress and make further plans. Your record can include:
The length of your exposure session
Ratings of your anxiety at the beginning, middle and end of your exposure session
A record helps you see whether you're sticking with your programme long enough for your fear to subside. If your fear doesn't seem to be reducing, make sure that you're still trying hard enough to reduce your fear by getting rid of those safety behaviours.
You can use the behavioural experiment record sheet in Chapter 4 to record your exposure and to compare your predicted outcome of confronting your fears with the actual outcome.
Overriding Common Anxieties
The following sections outline the application of CBT for some common anxiety problems. A full discussion of all of the specific types of anxiety problems lies outside the scope of this book. However, the CBT principles that we introduce you to here are the very best bet for overcoming most anxiety problems.
First, define what you're doing to keep your anxiety alive in your thinking (see Chapters 2 and 6), and alive in your behaviour (see Chapter 7). Then, start to catch your unhelpful thoughts and generate alternatives (Chapter 3), and test them out in reality (Chapter 4). Understanding where you focus your attention, and re-training your attention, can also be hugely helpful (see Chapter 5). We discuss anxiety about health and obsessions in Chapter 13,and fears of being ugly in Chapter 11.
Socking it to social anxiety
Attack social anxiety (excessive fear of negative evaluation by other people) by drawing up a list of your feared and avoided social situations and the safety behaviours you tend to carry out (check out Chapter 7 for more on safety behaviours).
Hang on to the idea that y
ou can accept yourself even if other people don't like you. Be more flexible about how witty, novel and entertaining you ‘have' to be. Systematically test out your predictions about people thinking negatively about you - how do people act when you don't try so hard to perform? Refocus your attention on the world around you and the people you interact with, rather than on yourself. For more help on retraining your attention, refer to Chapter 5. Once you've left the social situation, resist the tendency to play your social encounters back in your mind.
Cognitive Behavioural Therapy For Dummies Page 14