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Track # 14
"Exploring How the Anxiety Process Works in your Client's Mind"
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Cognitive Map or Frame of Reference
---This Vicious Cycle that we have just talked about, the model of anxiety, leads us to explore another facet of this Cycle known as cognitive mapping or frame of reference. So what you might be asking yourself at this point is, hat cognitive maps do your anxiety disordered use?
---According to Beck, when a threat is perceived, the relevant cognitive patterns are activated; these are used to evaluate and assign a meaning to the event. The specific thoughts that are activated are relevant to the specific characteristics and context of the threatening event. A series of adjustments occur to "fit" appropriate thought patterns concerning a specific threat. The client's final interpretation is the result of interaction between the event and their thought pattern or cognitive map.

The Function of Cognitive Map
---Cognitive maps are essential for drawing meaningful information from a particular situation. As you know they allow us to extract relevant data, pick out relationships, and form patterns from the environment which would otherwise appear to be either bland and relatively homogeneous or else a confused array of stimuli, each competing for attention. A cognitive set helps us to rapidly processes incoming data. The power of a cognitive set is increased by its exclusionary capacity: it blocks out dissonant or irrelevant information as exclusionary. Because of these Cognitive Maps, anxiety disordered clients tend to form quote rules regarding their disorder.

Rules in Anxiety Disorders
---In anxiety disorders, the rules concern the concept of danger and vulnerability and the client's estimate of their capacity for coping with the danger and for compensating for vulnerability. The application of these rules take the form of predictions. I've had clients state "I am in immediate danger of dying"; "I am not capable of dealing with this danger"; or, "I may lose my job." The specific rules triggering these conclusions are applied to specific events: "My rapid heart beat means I'm having a heart attack, and I may die if I don't get help"; or, "If I make a mistake, my boss will fire me." These are some examples of the rules.
---In anxiety disorders, the rules are generally conditional in the form of an "if then" statement: "If a specific event occurs, then it may have adverse results." Thus, when the event occurs, it still will have a negative outcome.
---With phobias the rules are conditional and apply to situations that the client is successfully able to avoid: "If I go into a closet, I might suffocate"; or, "If I go to an unfamiliar area, I may get lost." In these cases, the client also operates under the rule "I won't be able to cope with the situation myself." Although these rules assume an unfortunate consequence to be highly probable, the client is often highly invested in an assumption such as "If a trusted person is with me, he can save me." Hence, as you know, many of your phobic clients can enter a frightening situation if a support source is available.
---The question here is ... How do you discover you client's rules regarding their anxiety disorder? Here is a series of questions you might try. I like to use "what" and "why" questions followed by a"how" question. Here's how it works.
---Client: I think I am dying.
---Therapist: What makes you think so?
---Client: My heart is beating hard. Things seem blurred. I can't catch my breath... I am sweating all over.
---Therapist: Why does that mean you are dying?
---Client: Because this is what it is like to die.
---Therapist: How do you know?
---Client: (after some reflection) I guess I don't know, but I think these are signs of dying. (Beck 1976, p. 99)

Vulnerability: The Core of Anxiety Disorders
---Vulnerability is of course at the core of Anxiety Disorders. According to Emberg, vulnerability can be defined as a person's perception of himself as being subject to internal or external dangers over which his control is lacking or is insufficient to afford him a sense of safety. In the clinical syndrome, the sense of vulnerability is magnified by certain dysfunctional cognitive processes. First, minimization occurs. The client underestimates the positive aspects of his or her personal resources. Next, selective abstraction takes place. By that ,I mean the client is inclined to focus primarily on his or her weaknesses. Then, magnification - he sees each flaw as a gaping hole or each mistake as a disaster, each slip as a potential slide into a catastrophe. Because of the clients tendency to over-generalize from each situation he views a less than perfect, he feels increasingly vulnerable with each mistake. For example, the abused wife who burns the pot roast becomes preoccupied with her husband's evaluation of it and visualize a permanent blot on their marriage relationship. More than that, she may be primed to expect more errors, building up to more verbal and physical abuse.
---Even large successes in the past may have no permanent effect because the "vulnerable" client believes that he or she can always fail in the future, and that the consequences of the failure will be far more drastic than any success could be. The client appears to have greater access to negative memories of previous performances than to positive ones. Thus, selective recall appears to be a function of being the "vulnerability" mode. In a state of vulnerability your client is more likely to be influenced by past events suggesting flaws and dangers than to factors relevant to success. For example, I had a 12 year old client, Billy, that was very anxious about his performance in sports, specifically baseball. Billy's parents appeared and to be supportive and non-pressuring. Billy was able to play well in practice but was having fainting spells in the pressure of competition with other schools. Physical problems were ruled out. In talking with Billy I discovered his speech and visualizations tended to be images of himself performing below his usual standard-an image based either on specific "inadequate" performances in the past or on a fantasy of how he will appear to the team if he fails. This bring us to the role. Thus Billy saw himself as vulnerable

The Role of Skill Deficits
---A person feels vulnerable if he believes he lacks the important skills necessary to cope with a particular threat. Many difficulties may turn into threats if he realizes that he does not have the minimal skills for attacked a problem to make him successful. For instance, a dyslexic child my become anxious while reading aloud in school because he or she feels a lacking of the necessary skills. List in your mind some of your clients and an accompanying list of skill deficits.
---For instance, June, was recovering from a stroke and experienced much anxiety due to due speech rehabilitation. In short, anxiety was produced due to a skill deficiency. However, by increasing June's speaking ability, this counteracted the her anxiety.
---Take a minute to recall a client you are treating or have treated whose anxiety was produced by a skill deficiency. What steps could they take to acquire the skill they need? What resources and referrals could you provide them with?

QUESTION 14: Even large successes in the past may have no permanent effect because the "vulnerable" client feels he or she will what? Back to the top