CBT Part II – Testing a theory

I have just come back from another great session, which ended in a real climax of excitement! Its all happening in the NHS mental health support team!

We covered some exposure exercises, to simulate the feelings associated with a panic attack. It is important to familiarize yourself with these sensations, so as not to fear them. Once in an anxious situation, anxiety tends to peak and then starts to drop. So-called coping strategies prevent the natural decline of anxiety, and prevent the subconscious from ever properly learning that a dreaded situation (such as getting on a bus!), is actually not all that dangerous after all, and there is nothing to be anxious about.

By trying to avoid bodily sensations associated with anxiety, we lend them a power they do not deserve. I call this ‘mythologizing anxious sensations’, something which feeds into the cycle of avoidance and furthers fear. Eventually anxiety becomes a general dread which you will dedicate the whole of your life to avoiding! The short-term cure, avoidance, is worse than the disease. And those who say that time heals all ills have obviously never recovered from a panic disorder before! Time will not heal this.
I must now expose myself to these situations and bodily sensations. This will let the natural course of things play itself out, and the subconscious can learn once and for all that there is nothing to fear. Likewise, I will stop fearing the sensations in my own body, which I have already done much to achieve.

This is all made much easier by going into what I am really anxious about, which my therapist helped me with by proposing a theory. Before we get to the theory, we need to examine my true fears.

Today I boiled down my fears of a panic attack to two things: i) fear of embarassment, not being helped and public humiliation. ii) Fear of bodily weakness after a panic attack, losing my independence, being dependent without a trustful support network.
So we proposed two theories. Lets start with Theory A. This states that if I have a panic attack people will laugh, think I’m weak, and might film it on their phones. The evidence from this comes from seeing lots of humiliating incidents at school and the general shittiness of certain human beings. If theory A is true, then a panic attack would be rather devastating, and the best thing to do is to avoid panic attacks at all costs and restrict my freedom. On recollection, I believe this theory to be about 20% true. In other words, its a load of anxiety-induced shite.

So lets move onto the (infinitely more plausible) Theory B! This states the problem is worry that other people will judge me, be humiliating and unhelpful. But the evidence is against it: I would definitely help others if they needed it. Some people will always want to be helpful, even heroic in such situations. And some people have similar problems with anxiety and depression, so can actually be understanding. If Theory B is true, I need to try to think more realistically and positively about things, and dispel the power of the panic attack. This is as far as I got in working things out. My therapist took the next step.
She gave me an analogy which really helped explain what we had to do to truly see the theory through. Imagine an apprentice on his first day at a building site. The workers on the site put up a wall and tell him to hold it up, or else it will fall down! He spends the whole day standing there, holding up this wall, getting tired and uncomfortable. As night falls, his bosses tell him he has to stay there all night. Well, this just won’t do. So what does the apprentice do, now that he is in doubt about the worth of holding up the wall? He can gradually release his hold on the wall, he can release his support and slowly step away. But will this do? What if there is a gust of wind or something? To truly see if the wall is sturdy, he will have to give it a darn good push!

Ultimately, a theory needs to be tested. ‘If panic attack then people will be helpful, and there will be no harm’ is the crux of the more plausible theory. So lets just say that we might end up doing some field research soon!
I am most excited about the opportunity.
p.s. Get CBT if you can, its great. Just be prepared to look deep inside yourself and realize what needs to change inside you.