"Alarm System" and "Automatic Thoughts"
Now we have
explored numerous interventions to use with an anxiety-disordered child or adult.
Before we go to some visualization interventions, let's look at exactly how the
anxiety process works in your client's mind.
I like to think of an anxiety
disorder as a hypersensitive alarm system. The anxious client is so sensitive to any stimuli that might be taken as indicating a disaster or harm, that he or
she is constantly warning themselves about the potential dangers, because almost
any stimulus can be perceived by him as dangerous and can "trip off"
the alarm. As you know, the anxious client experiences many "false alarms,"
which keep him or her in a constant state of emotional stress and turmoil.
The preoccupation with danger is manifested by the continuous, involuntary
occurrence of automatic thoughts (in verbal or visual form) whose content involves
possible physical or mental harm. These thoughts tend to occur repetitively and
rapidly and seem completely plausible to the client at the time of their occurrence.
Instant Replay Intervention
Many times a thought is so fleeting that your client is aware only of the anxiety
it has generated. An intervention used is called instant replay. I have found
clients can be trained, however, to perform an "instant replay" and
recover the automatic thought preceding their anxious reaction. This thought is
derived from the information-processing system that activates the effect.
Loss of Objectivity and of Voluntary Control
In addition to having repetitive
thoughts about danger which set off false alarms, ability to "reason"
with these thoughts is impaired. While the client may agree that these fearful
thoughts are illogical, his or her ability to evaluate them objectively (without
help) is limited. Your client behaves as though he or she believes in the validity
of the misinterpretations, though your client may suspect they are not totally
realistic. Objectivity is similarly lost when a client attempts to test the reality
of the visual images that may accompany or substitute for verbal cognition. For
example, Charles had constant visualization about getting stomach cancer, a disease
from which his father had died in childhood.
Another characteristic of
anxious thinking is its involuntary nature. Automatic thoughts exert a continuous
pressure even though a person has already determined that they are invalid and
would like to be rid of them. The involuntary character of the anxious thinking
and other mechanism blocking or "choking" of feelings may lead the client
to think he or she is "losing their mind." Earlier in the tape, you
received a specific technique to assist your client in controlling these automatic
Now let's look at anxiety as it relates to Stimulus, Generalization,
Catastrophizing, and Dichotomous Thinking. Think of a client you have had that
you may need to re-examine this with.
Let's look at Stimulus Generalization and anxiety first.
The range of stimuli that can evoke anxiety in generalized anxiety disorder may
increase until almost any stimulus is perceived as a danger. For example, one
of my clients in an acute state of anxiety had the following experiences: The
sound of the siren of a fire engine evoked the thought, "My house may be
on fire." An airplane flying overhead triggered a visual image of herself
in an airplane crashing into another plane. After seeing the scene of an accident
on television, she visualized herself bleeding and suffering. How does your anxiety-
disordered client generalize?
Next, re-evaluate this Catastrophizing. As mentioned earlier, clients tend to
dwell on the worst possible outcome of any situation in which there is a possibility
for an unpleasant outcome. Your anxious client overemphasizes the probability
of this catastrophic outcome and usually exaggerates the possible consequences
of its occurrence.
Examples of catastrophizing are: Jason, a successful college
student, when taking an examination was preoccupied with the possibility of his
failing. He imagined that if he failed the test, he would flunk out of college
and as a consequence, would end up as a homeless person. Ask yourself, from the
previously mentioned strategies, which one might you use to help your catastrophizing
client view situations more realistically.
Another characteristic in the thinking of an anxious client,
in addition to generalization and catastrophizing, is the tendency - when there
is any question of danger - to interpret events in dichotomous terms. Thus, unless
a situation is unmistakably safe, the person is likely to appraise it as unsafe. He has no tolerance for uncertainty or ambiguity. The rustling of the venetian
blinds indicates an intruder; the backfiring of an automobile sounds like the
firing of a gun; shortness of breath means that he may stop breathing entirely.
Peer-Reviewed Journal Article References:
Khattra, J., Angus, L., Westra, H., Macaulay, C., Moertl, K., & Constantino, M. (2017). Client perceptions of corrective experiences in cognitive behavioral therapy and motivational interviewing for generalized anxiety disorder: An exploratory pilot study. Journal of Psychotherapy Integration, 27(1), 23–34.
Notebaert, L., Masschelein, S., Wright, B., & MacLeod, C. (2016). To risk or not to risk: Anxiety and the calibration between risk perception and danger mitigation. Journal of Experimental Psychology: Learning, Memory, and Cognition, 42(6), 985–995.
Sussman, T. J., Szekely, A., Hajcak, G., & Mohanty, A. (2016). It’s all in the anticipation: How perception of threat is enhanced in anxiety. Emotion, 16(3), 320–327.
Online Continuing Education QUESTION
12: What are examples of characteristic thinking of an anxiety-disordered
client? To select and enter your answer go to .