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Brief Interventions for Anxiety Disorders with Children and Adults

Section 6
Prevention of Anxiety

Question 6 | Test | Table of Contents

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3 Strategies for Distancing from Anxiety

♦ 1. Replacing Passive Statements with Active Statements: As we have said, the anxious person does not really "own" his emotions but often attributes them to other people and to external events. This passive role makes your client unable to see how he is creating his own feelings. A typical client will say "he," "she," or "it" was making me anxious. I encourage the client to make such effective statements in the active, for example, "I was making myself anxious," rather than the passive ("It was making me anxious").

♦ 2. Replacing "Why" Questions with "How" Questions: When the patient asks himself why he is anxious or why he cannot control his anxiety, he ends up with more thinking and less awareness. However, by focusing on how he is making himself anxious, he switches out of the thinking self and into the observing self.

♦ 3. Approaching Fears: An overriding strategy is for the client to approach what he fears. One reason is to provide the client with opportunities to discover what is feared. I, like you, find most clients are unable to identify their automatic thoughts and specific fears in the office but need to be in the anxiety situation to do so.

Experiencing Anxiety
Quite often the therapist has to work with the client to design ways for him to experience the anxiety so that he can discover his thinking. This is often the case with phobias where the client succeeds in avoiding the fear stimulus. Adam, with speech anxiety and with no speeches on the horizon, for example, was encouraged to ask questions at meetings he attended, a procedure that will usually produce the same or similar anxiety responses. Adam was able to identify his automatic thoughts by asking himself as he saw others giving speeches, "If I was up there right now, what would I be afraid of?"

The client often attempts to block his fearful thoughts and thus achieves temporary closure; however, his frightening thoughts reappear all the stronger. For this reason, as you know, you encourage your client to think through the unpleasant scenarios he is thinking to block out of his mind. Amy, afraid of losing control in public, was encouraged to stay with her feeling until she could identify her ultimate fear. The rationale given is, "The more you try not to think about something, the more you think about it." The client can be asked to not think about his nose, and then to observe what goes on in his mind.

The next step after identifying the fear, Adam increased his self-awareness by voluntarily choosing to distance himself from his anxiety. He did this by referring to himself as "it" or by his first name. In this exercise, the client refers to himself as a separate entity throughout the day and comments on his anxiety from a distance: "Adam seems to be scared. His heart is beating. He seems to be concerned that others are thinking poorly of him. Adam is focusing on the impression he is making." By distancing himself from his anxious response, the client gains a more objective picture of himself.

Peer-Reviewed Journal Article References:
Martinsen, K. D., Rasmussen, L. M. P., Wentzel-Larsen, T., Holen, S., Sund, A. M., Løvaas, M. E. S., Patras, J., Kendall, P. C., Waaktaar, T., & Neumer, S.-P. (2019). Prevention of anxiety and depression in school children: Effectiveness of the transdiagnostic EMOTION program. Journal of Consulting and Clinical Psychology, 87(2), 212–219.

Roos, C. R., Bowen, S., & Witkiewitz, K. (2017). Baseline patterns of substance use disorder severity and depression and anxiety symptoms moderate the efficacy of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 85(11), 1041–1051.

Zvolensky, M. J., Garey, L., Allan, N. P., Farris, S. G., Raines, A. M., Smits, J. A. J., Kauffman, B. Y., Manning, K., & Schmidt, N. B. (2018). Effects of anxiety sensitivity reduction on smoking abstinence: An analysis from a panic prevention program. Journal of Consulting and Clinical Psychology, 86(5), 474–485.

QUESTION 6
What is a technique to help the client distance himself from the anxiety?
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