Cognitive challenging is another useful treatment for anxiety disorders. Cognitive challenging is based on the assumption that thoughts play a powerful role in producing and maintaining anxiety, as in the spider bite example discussed earlier. The theory behind cognitive challenging suggests that people develop automatic thoughts that are often inaccurate. These thoughts are called automatic because people are usually unaware of them. A common automatic thought may be "If I have a panic attack in the store, I will pass out and no one will help me." During cognitive challenging, clients are taught to recognize automatic thoughts, test their accuracy, and challenge thoughts that are inaccurate or unhelpful.
Using the example above, cognitive challenging would be done by first identifying the specific automatic thoughts, which in this case include (1) having a panic attack in the store, (2) passing out, and (3) not being helped. These thoughts are then examined for their accuracy. In examining the likelihood of having a panic attack, questions such as "How often have you been to the store before? How many of those times have you panicked? How many have you not panicked?" might reveal that in fact the likelihood of panicking in the store is quite high, and thus that that thought is not particularly inaccurate. In examining the likelihood of passing out, questions such as "Have you ever passed out from a panic attack?" may show that passing out isn't nearly as likely as the client is assuming. Finally, questions such as "Would you help someone?" or "Have you ever seen someone who needed help ignored?" may suggest that the probability of being left alone passed out on the floor is really quite low. Thus, while it may be likely that the client will have a panic attack, the feared consequences of that attack aren't nearly as likely as the automatic thoughts suggested. In addition, clients are taught to evaluate whether their feared consequences would really be so bad. For example, in this case, the consequences may be that the client would get bruises from falling, or be embarrassed by passing out in public, but that both of these are manageable and tolerable situations with no lasting harm.
Automatic thoughts may fall into two general categories, maladaptive thoughts and irrational thinking. Mal-adaptive thoughts are those that seem logical; however, focusing on them increases anxiety and supports irrational thoughts. Common categories of maladaptive thoughts in anxiety include cognitive avoidance and rumination. Cognitive avoidance is too little focus on anxiety-producing thoughts. These thoughts are avoided at all costs, to the extent that the client may not perceive the source of anxiety. Rumination is in some ways the opposite of cognitive avoidance: repetitive, intrusive anxious thoughts that do not help decrease anxiety. Rumination is commonly seen in clients with Generalized Anxiety Disorder, who may, for example, spend all day worrying about paying bills without actually putting a check in the mail. Cognitive avoidance and rumination are not mutually exclusive, and people with anxiety often alternate between the two.
A second category of automatic thoughts is irrational thinking. For example, someone with PTSD might think, "I was assaulted in a parking lot; therefore, parking lots are dangerous," an example of overgeneralizing. Catastrophizing, a common type of irrational thinking in anxiety, is the tendency to think that something is intolerable or unbearable. Using the panic attack example from earlier, the thought that passing out would be a horrible thing is an example of catastrophizing; it might not be pleasant, but it's not as awful a possibility as the person initially assumed. Two other common types of irrational thoughts are mind reading, when someone infers what another person is thinking, often assuming something negative while ignoring other possibilities, and emotional reasoning, when people make inferences about something based on their feelings, such as "Because I am scared driving over this bridge, the bridge must be dangerous." In all of these cases, the key to change is in realizing that thoughts and feelings are not facts, and need not be acted on as if they were. By identifying the specific thoughts, and evaluating their accuracy and utility, people can begin to challenge irrational or unhelpful thoughts, leading to less anxiety.
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This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.