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Carrie, 27, came to my office severely anxious over the possibility of having acquired an STD through unprotected sex. Witness a section of our first therapy conversation.
Dr. G: Okay, Carrie, so you had unprotected sex and you're now beside yourself with anxiety. You’re worried that you may have contracted an STD. Did I get it?
Carrie: Yes.
Dr. G: Well, okay, let’s see if we can get to the bottom of what’s causing your anxiety. Let me first ask you a question. I want to emphasize that there is no right or wrong answer, I just want to bore into your head. Let’s assume for a minute that you did get an STD. To you, what would be so horrible about that?
Carrie: I don't know, it just would be.
Dr. G: But, how so? I can see why it might be a hardship. You would have to take medicine; it may cost you money; you may have to be celibate for a while; you may have to be extra careful in the future about using protection; some future boyfriend may stop seeing you once he finds out. So there would certainly be drawbacks. But, I don't see the horror here.
Carrie: Are you saying it wouldn't be horrible?
Dr. G: Well, I’m saying two things. One, you seem to think it’s horrible, and that why you’re so anxious. Two, if you think about it rationally, it wouldn’t be horrible. Look, let's assume the worst, that you did indeed contract an STD. What if you decided, “Well, it's certainly has its drawbacks and I don’t like it, but there’s nothing to it that I can’t handle.” If you thought this way, how do you think you’d feel?
Carey: A lot less anxious, I guess.
Dr. G: That's right. See, Carrie, what's going on is that you start with a rational belief: “It would be a royal pain to have to deal with an STD.” That makes sense. If you stuck with that belief, that it would be a pain, and then added something like, “but, that's all it is, a pain, and my life is just fine regardless,” you wouldn't have your anxieties. The problem is that you tell yourself instead that the hassles of the STD would be so horrible it would totally ruin everything in your life, now and forever. That catastrophic way of thinking causes your anxiety. Can you see that?
Carrie: I think so.
Dr. G: Here, let me draw it on the board for you. At A, here, the Activating Event, you may have an STD. At B, the Belief or self-talk, you tell yourself something like, “It would be so horrible and unbearable to have an STD that my life would be totally ruined.” Then, thinking that way, you cause yourself all this painful anxiety at C, the emotional Consequence.
Carrie: Okay, I understand.
Dr. G: Good! Now, let's hope you don't have to hassle with an STD. That would be great. But, even if you do, you still don't have to have anxiety. All you have to do is give up your catastrophic thinking about it. In other words, be realistic; if, unfortunately, you do, it only brings hardships, which you can handle, not the proverbial end of the world. How does that sound to you?
Carrie: I feel a little better already just hearing that.
Dr. G: Great. Let's now get to work on changing how you think about this possible hardship in your life so you can stop being so anxious.
Learning From Carrie 1 — LHT defined
What can we learn so far from the case of Carrie? Well, several things.
1. Like I told Carrie, her anxiety (the C, or the emotional Consequence) was not caused by the future possibility of finding out she had contracted an STD (the A, or the Activating Event). Rather, it was caused by her catastrophic thinking at B (her Belief). Notice the profound shift in thinking this communicates; it was not some onerous future circumstance, like an STD, that caused her anxiety, but her own over-the-top thinking that did it. Once she accepted her responsibility for causing it, she then claimed the power to transform her thinking into ways that would no longer cause her to feel so anxious.
2. Along with Ego Anxiety, which I discussed in last month’s blog, a second type of anxiety is LHT Anxiety. LHT stands for “Low Hardship Tolerance, created by the following type thinking:
• It would be awful, horrible, or terrible if this thing were to happen.
• I couldn't bear it, as it would ruin my life, now and forever.
• Therefore, it must not happen.
When a person, like Carrie, thinks along these lines about any onerous future event, he or she cannot help but to experience anxiety.
3. But, once a person understands that it is one’s own catastrophic thinking that causes the anxiety, then he or she is primed to eliminate the anxiety.
Back To Carrie
Dr. G: So, Carrie, let's see if we can debunk the idea that, if you contracted an STD, it would be so horrible that your life would be ruined. Let me ask you this: Why would it not be correct to think of it as horrible?
Carrie: Well, I wouldn't die, I guess.
Dr. G: That’s right, you wouldn't. You'd continue to live with an STD. Why else would it not be horrible?
Carrie: The people that love me would still love me. I'd still have my job. I'd still be me.
Dr. G: Good thinking. So, all you would face, at worst, would be some hassles or hardships, not horrors? Your family and friends are still there, as is your job, and everything else. Yeah?
Carrie: Yeah.
Dr. G: Okay, keep going. Why else is it nonsense to think an STD would be so horrible that you have to be wracked with anxiety?
Carrie: I guess there’s nothing I couldn’t handle, as you said earlier. What I’d face are only hardships. It’s not like my whole family got killed in a plane crash and I’d never see them again.
Dr. G: Excellent. Now our job is to get you to think this through, just like we just did, a bunch of times until you really get it lodged into your brain. Then you’ll be free of that damned anxiety. Let me now give you a couple of tools to do this. Okay?
Carrie: I’m ready, Doc!
Learning From Carrie 2
Before we get to the tools, let me summarize what we have learned from Carrie in this last section.
1. The catastrophic thinking behind LHT Anxiety is patently false and absurd for at least the following five reasons. These are true for Carrie and for all the awfulizing we all do to create our LHT Anxieties.
• Awful, horrible and terrible are magical concepts that have no basis in reality. Think of it: the most there can be of anything is 100%. Imagine a sportscaster saying that a basketball player put out 120% effort on the court. That would be impossible. He could only put out 100%. There could be no more effort. 100% is all of it. Similarly, there cannot be anything more than 100% bad. 100% bad is the worst anything can ever be. So, something that is awful, horrible, and terrible would have to start after bad ends, say at 101%, 125%, or 150% bad. This clearly can’t exist in reality.
• Within the confines of reality, things that do close in on 100% bad, such as the Holocaust, in which millions of innocent people were murdered, are extremely rare. If we look at most of the hardships we face in life with that perspective, virtually all of them fall in the realm of 1% to 15% bad. These are hassles, not horrors. The truth is that most of our hardships rate more like a pain in the behind than a horror. Think how much anxiety we create for thinking our relatively low-level hassles are horrors.
• Awful, horrible, and terrible communicate that our life will be totally ruined by this hardship. But, very rarely does anything ruin our whole life. More realistically, these misfortunes add an undesirable element amidst all the other events in our lives, both good and bad, that are already there. But they don’t take away all of the good in our life. Without horribilizing, we can rue the bad, but still enjoy the good.
• When we awfulize about something, we communicate to ourselves that this hardship is unstandable. But, nothing is unstandable. Serious illnesses, physical abuse, and loss of a loved one, for example, are all severe hardships, but we stand them. We may grieve and be frustrated over the hardships, but we still stand them. To tell ourselves that we can't stand them only serves to reinforce the concept of horror and thus further arouses our anxiety.
• Finally, telling yourself that something is awful, horrible, or terrible implies that, since it’s so bad, it shouldn't exist. But, it does exist, whether you like it or not. Reality always exists, exactly as it is, no matter how bad it is, for as long as it does. It simply does. Fighting the reality of what is both reinforces the awfulizing and agitates you to no end.
2. It takes hard work to get this catastrophic thinking out of our head. Like ridding ourselves of any other false idea, we must recognize when we think it, think it through critically so that we can clearly see its absurdity, and replace it with new, rational perspectives. Carrie was led to do this for the first time in this segment, but she will need to do it many times before she’ll be reprogramed and thus anxiety free. So will you.
Back To Carrie Once More
Dr. G: So, Carrie, it would be a mistake for you to think of your therapy as only the 45 measly minutes we’ll spend in my office the next few weeks. You need to do your therapy every day on your own for, say, the next 50 days. You will have to work long and hard to first eliminate your habit of thinking catastrophically and then to ingrain new, rational thought patterns that won't lead to anxiety. Are you willing to make that commitment to work that hard?
Carrie: I am!
Dr. G: Okay. I first want to teach you how to do RIDS, which stands for Recall, Identify, Dispute, and Supplant (handing her a RIDS worksheet). Let me show you how it works, okay?
Carrie: Okay.
Dr. G: First, pick a standard time each day, say at 7:00 pm to do your therapy. Recall a situation in which you experienced anxiety. If you’ve had an anxiety-free day, remember a situation yesterday, the week before, or whenever. It is the B, your catastrophizing thinking, we’re trying to change, not the Activating Event.
Next, identify your catastrophizing thinking. Put these thoughts into full sentence form. Find the awful, horrible, or terrible words so you can clearly see them. Accept that this is exactly what you think to make yourself anxious. Label these thoughts your enemy.
Third, dispute them by revealing to yourself their falseness. Go over the reasons we’ve discussed, plus any more you can think of, why it’s absurd for you to think this thing is horrible. Really show yourself how absurd these beliefs are so that they begin to stick in your mind.
Lastly, supplant the catastrophizing with more rational thoughts that won't create your anxiety. For example, “I sure would hate to come up with an STD, but I can get along quite well in life even with it.”
Now, let's do one together (I led her through a complete RIDS protocol based on her fear of STD with her fully participating). Good work, Carrie.
Carrie: Thank you.
Dr. G: Now, there is one more therapy tool I want you to use each day, starting tomorrow. It's called The Six and The Five. Six times a day (breakfast, midmorning, lunch, midafternoon, supper, and before bedtime), take five minutes to apply rational thoughts to the possibility of an STD. For example, at breakfast, you might picture yourself at A with an STD. Then, at B, forcefully tell yourself: “Well, I sure hate having to deal with this, but I can. It’s not horrible, only a hardship.” Lastly, at C, picture yourself calm and resolute. Will you commit to doing this, along with your RIDS?
Carrie: I will!
Learning From Carrie 3
There are a couple of things you can take away from the nuts and bolts of this last interchange. Please heed them.
1. By the time you tackle your LHT Anxiety, you've probably thought in your catastrophizing ways so many times that they’ve become habitual, automatic, and deeply endorsed. If so, you'll need to work over the extended period of time to re-indoctrinate or re-habituate the way you think.
2. RIDS serves to destroy your irrational thinking, and both RIDS and The Six and The Five help you to indoctrinate new rational ways of thinking.
3. Like Carrie, you have to first take responsibility for causing your LHT anxiety, then second, identify your catastrophizing thinking, and, third, work long and hard to re-indoctrinate yourself with more rational thinking.
Action Plan
If you suffer from LHT Anxiety, take the time Carrie did to cure her anxiety. Do the following.
1. Identification – list all the situations in your life about which you experience your anxiety.
2. Then, schedule when and where you will do your daily RIDS, as well as your Six and Five. Be specific.
3. Enlist a support person to help you keep to your schedule. This person should be someone strong enough to nag you to do it and bitch at you for not doing it.
4. Follow through.
5. Reward yourself for following through. What positive treat can you give yourself at the end of the day for doing your RIDS and your Six and Five? Do it.
Going Forward
This blog post and the last one on Ego Anxiety form a pair. I hope the contents of these two blogs help you will live a life that is virtually free of anxiety. It will take hard work and persistent effort on your part, but I think you are worth the time and energy. Do you?
Please feel free to contact me at anytime by email. In the meantime, live healthy, happy, and with passion.
