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As easy as A B C

In my practice I work with lot of clients who are suffering with anxiety, and in particular with Generalised Anxiety Disorder (GAD). While most of us will feel anxious or worried now and then, especially when facing stressful situations such as an exam or a job interview this type of anxiety isn’t a problem and can actually help us to focus and perform better. GAD is different, however. People with GAD feel anxious and worried most of the time, not just in specific stressful situations, and these worries are intense, persistent and can significantly interfere with their day-to-day lives. Their worries relate to everything; work, health, family and/or financial issues. Even minor things such as household jobs or booking an appointment can become the focus of anxiety, leading to uncontrollable worries and a pervasive fear that something terrible is going to happen. Someone experiencing GAD will most likely notice some distressing physical symptoms which will add to their discomfort. It’s common for sufferers to experience heart palpitations, shortness of breath and nausea. Obviously, it is important to have any symptoms checked out to rule out an underlying physical cause, but if there are no underlying medical issues it is likely that these symptoms are a result of adrenaline. Adrenaline is the ‘fight, flight or freeze’ hormone that our body produces in response to perceived danger. It prepares the body to either stay and fight the danger, run away from the danger or freeze in the face of the danger. Some of the ways it does this include making the heart pump faster, taking blood away from where it’s not immediately needed (like the digestive system) and diverting it to where it is needed (such as the bigger muscles). It causes an increase in sweating (to help the body cool down from the physical exertion it anticipates). When we don’t actually fight or flee, the adrenaline doesn’t immediately leave the body, but we will experience symptoms such as legs shaking or heart pounding. These symptoms can be distressing, and an anxious person might start to try and avoid situations that seem to cause them, but this avoidance will set up a vicious cycle that can be hard to break out of. The vicious cycle of anxiety looks something like this;

  • Thoughts/images/beliefs cause feelings such as fear or anxiety

  • Feelings cause avoidant or safety seeking behaviour

  • Behaviour reinforces the negative thoughts and beliefs

A simple example of this in practice could be a person who has become very nervous of driving on busy roads. Their thoughts are that they are very likely to crash if they drive on a motorway. They will feel fear if for some reason they need to travel somewhere that involves motorway driving. They might take a much longer route to avoid the perceived danger. Doing this will reinforce the belief that the motorway is too dangerous to travel on so the next time they need to make this journey they are even less likely to try the motorway. Cognitive Behavioural Therapy (CBT) is very effective for treating this type of anxiety. It works on the assumption that it isn’t what happens to us that causes the problem but rather it is the story (thoughts and images) we tell ourselves that set up the vicious cycle. CBT works by challenging the thoughts and checking how accurate they are while looking for a more balanced view. Consistent challenge of negative thoughts builds up a habit of not automatically accepting the first negative thought as fact. In time the new habit becomes more ingrained and the anxious feelings flowing from the negative thoughts change to more balanced and realistic ones. CBT is effective for many different issues such as OCD, panic attacks, post-traumatic stress disorder (PTSD), anger management and phobias. ​In CBT terms A (activating event) + B (belief) = C (consequences) Something (A) happens and we apply a meaning (B) to it. These thoughts drive our feelings and behaviours (C) which often reinforce our thoughts in a negative cycle. We then are victims, not of events or of our feelings but of the story running in the background. The content of the story might vary but there will usually be a common thread running through it such as 'I am not good enough', 'the world is a dangerous place', 'I don't belong', The core belief drives the thoughts that drive the feelings and are an automatic response that occurs on a sub conscious level. Think of a time your boss called you into the office....was your first thought 'Uh oh, I'm in trouble' or 'Great, I must have won employee of the month!' Most likely it was the first ( if it was the second, congratulations; you have a healthy self-esteem!) In order to change the feelings you need to begin to question the thoughts that underpin your reaction to events. It may be that right now you can't change the circumstances of your life so challenging your thoughts and replacing them with more realistic ones will have a knock-on effect on your feelings. If you attend therapy, you and your therapist will work together as a team to firstly explore your thoughts and to gather evidence to check if those thoughts are actually accurate or if they are driven by a false belief. CBT helps you to see that your thinking is the piece that connects the event to your ultimate feelings and reactions. Those thoughts drive your emotions and your behaviour. It stands to reason that the place to focus attention is on thoughts. I mentioned earlier that the meaning we give to events is driven by our core beliefs. These are our automatic gut reactions to life and act as the filter through which we view the world. These beliefs are formed when we are very young, even before we are verbal and create our automatic negative thoughts (ANTs) when met with life events. Core beliefs fall into three main categories:

  1. Beliefs about yourself

  2. Beliefs about other people

  3. Beliefs about the world

These core beliefs act as a map or a rule book of our emotional world and are the automatic 'go-to' response to life's events. This explains how several people can share a similar experience but have hugely different responses to it. It takes time, but you can create a new habit by learning to challenge your negative beliefs and replace them with more rational ones. So now we have activating event (A) leading to beliefs (B) causing behavioural consequences (C). The challenge to the belief system gives rise to disputing beliefs (D) which creates a new consequence as an effect (E) of challenging the self-defeating belief.

I often recommend that clients continue to practice self-help methods after we finish therapy. This site is particularly good for self-help resources. ​If I can be of any help to you please get in touch on 086 2525132 or by email

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