CBT session #3: Anxiety triangle

Today’s session of cognitive behavior therapy was the best yet. I felt my mind figuratively expand, and lots of bells and lights of recognition went off.

My therapist reviewed the anxiety triangle with me, and it helped me tremendously in understanding my OCD and generalized anxiety disorder (GAD).

I won’t go into nearly the detail that my therapist did, but here’s an overview.



A copy of my therpist's notes. He illustrated his points as he explained the anxiety triangle. All the lines show the connections that the physical, thoughts and behavior have.



The three points of the triangle are the physical components of anxiety, thoughts and behavior.

A big message for me was that we cannot control what thoughts we have, but we can choose what thoughts to attend to and how we behave in response to our thoughts.

So we can control our attention and our behavior.

Another big message was this: the more we learn to tolerate and embrace our anxiety, the more we can appreciate and enjoy the time we have, the people we love and the small moments we live.

We’re going to work on this, my therapist said, a moment at a time.

The physical

As someone with OCD and GAD, I’m sympathetic dominant. I stay in the fight or flight mode a lot of the time.

That means tension, shakiness, fidgeting, difficulty relaxing, numbness, light-headedness and sometimes a feeling of floating.

Yeah, that’s me.

Interestingly, I revealed something about my level of anxiety without even recognizing it myself. I told my therapist about my writing exercise a couple of weeks ago, which I described here.

I told him that during the writing exercise, my anxiety level rose to a six or seven, but after the exercise was over, it quickly went down to a three or four.

“Like you hadn’t even done the exercise?” he asked.

“Yes,” I said.

Well, what I was saying was that I am nearly always at a level three or four of anxiety. As my therapist put it, I start out at about 5,000 feet on the mountain. My anxiety level rises to about 20,000 feet, and then returns to 5,000 feet. But I’m still at 5,000 feet.

Oh, my, I thought.

Thoughts

Someone like me, a worrier, tends to be biased towards danger. I pay attention to danger and ignore safety.

As an example, my therapist said someone with social anxiety might enter a room with a lot of people and wonder immediately, which ones don’t like me? That person would ignore the people with smiles on their faces and pay attention to the ones with frowns, even though the smiles and frowns had nothing to do with that person.

Along with the bias towards danger goes the tendency to underestimate one’s coping ability. A worrier like me would tend to think, I can’t handle it.

People with OCD also tend to experience meta-cognition, thinking about thinking. We tend to believe we should be able to control our thoughts. We tend to believe that if we think it, it’s as if we acted upon it. (He said you see this in scrupulosity sometimes, where people may have learned that thinking something bad was as sinful as doing it.)

The only things we can control about our thoughts are which ones we attend to and how we respond to them: our attention and our behavior.

Behavior

My therapist said situation A might cause anxiety, but when we practiced a particular behavior that lowered the anxiety, that behavior was reinforced.

OCD offers lots of examples of this. We may be very anxious about our hands being contaminated. But after washing them for 30 minutes, the anxiety lessens. So our brain associates the behavior—washing the hands for 30 minutes—with less anxiety. And that is what the brain is going for—less anxiety. Avoidance can also lessen anxiety.

We get caught up in rituals and avoidances in order to lessen anxiety. But really, we’re perpetuating and reinforcing behavior that causes us much pain and suffering.

What comes next?

My next appointment is in a week. Until then, I’m to work on the writing exercises more. But I’ll also include timed editing sessions and then—the hardest part—I will show the writing to someone.

I also need to self-monitor. When I have the symptoms of anxiety, I need to note what I’m thinking and what I’m doing and share that information at next week’s session.

I am so excited and hopeful!
Does this anxiety triangle make sense to you? Would you agree that the physical symptoms of anxiety, your thoughts and your behavior can feed off each other?