How we think affects how we feel, and that is the basis of much of the therapeutic effect of Cognitive-Behavioral Therapy (CBT). CBT has proven effective in anxiety disorders and many other mental health problems. It is also true that how we feel affects how we think. In anxiety, the fear wiring of our brain and nervous system has been activated. Thus if we feel anxiety symptoms, our natural response is to think in terms of threat and danger. If we think about danger, that naturally makes us more anxious. To gain control over anxiety, it is important to identify and challenge anxious thinking.
There are different kinds of anxious thinking, and one obvious example is worry. In worry, we think about and dwell on one or more bad things that may happen in the future. Often one worry leads to another, which leads to another in a pattern I call “piling on” (like the penalty in football). Worry is wasted energy, like a car stuck in the mud, you’re pressing the accelerator, burning all kinds of gas, spinning your wheels, and going nowhere.
Another pattern of anxious thinking is what I call “the terrible what ifs”. The pattern often starts with thinking “what if” some minor problem comes up, but then that small thing leads to another what if, and it grows like a snowball rolling down a hill. At the end, we are focused on a worst case scenario which seems like an absolute catastrophe. “What if I start to feel anxious in the store?… What if I start feeling lightheaded in the middle of the checkout line?… What if I actually pass out? I’m going to wake up on the floor surrounded by people staring at me, the ambulance is going to come, and I will die of embarrassment.”
Obsessive thoughts are another type of anxious thinking. Obsessive thoughts are repetitive scary thoughts that have an intrusive quality. Common examples include thoughts of getting contaminated or infected, doubts about whether one has forgotten to do something which may lead to harm, or imagery of doing something terrible. The thoughts are unwanted, but the person feels unable to stop them. The obsessions are usually accompanied by compulsive actions which aim to prevent the possible harm envisioned, such as hand washing to prevent contamination.
Working with thinking is difficult. Often people believe that they think the way a book is written with sentences logically organized into paragraphs. Our thinking is not like that at all. We don’t generally think in complete sentences, but rather in fragments with one idea quickly jumping to another to which it may be logically unrelated. Our thinking is fast and slippery. Being aware of the thoughts that go through your head takes a conscious effort. Since the first step in solving a problem is identifying it, you have to identify the anxious thoughts that come up to able to challenge them.