Psychologists have known for several decades that anxiety is a multifaceted concept. While all of us would acknowledge having experienced anxiety, the reality is that our experience of "feeling anxious" is probably quite different from how others experience this emotion. Nearly thirty years ago, psychologist Peter Lang proposed three ways in which anxiety can be experienced. The first can be called the cognitive component—what people say to themselves or what they report to others. A man with a dog phobia, for instance, might say "I'm terrified" when he sees a Rotweiller running toward him. The second component is the physiological or somatic reaction. In our example, the dog-phobic man may experience a pounding heart or a knot in his stomach when he spots the Rotweiller. The third component of anxiety is behavioral—what our man does when he spots the dog. If he turns to run away, we can be safe in concluding that he is exhibiting a behavioral sign of anxiety.
What makes this concept so interesting is that these three components of anxiety do not correspond with one another very well. In our example above, this man may report to others that he is terrified of dogs, but he may not experience very much physiological arousal when he sees one. As a second example, I know a couple where the wife reports having a mild fear of public speaking, but despite her claim that her fear is slight, she absolutely refuses all invitations to talk to a group, even though it would be good for her business. Her husband, on the other hand, reports a pounding heart and feelings of sheer terror while speaking to groups, but he forces himself to accept invitations nonetheless. We cannot use what people say about themselves to predict with any accuracy what is going on inside them or how they will behave.
Falih Koksal and Kevin Power took this conceptualization of anxiety one step further. They argued that the cognitive compo nent of anxiety can be divided further—to the types of verbal self-statements people make and the subjective feelings they report. Verbal self-statements would be represented by item 10, "I sometimes cannot think of anything except for my worries," while subjective feelings are typified by item 7, "I often experience the feeling of embarrassment." They found enough evidence to support the four distinct dimensions of their Four Systems Anxiety Questionnaire, although they did report that verbal self-statements and subjective feelings were highly interrelated. As did previous researchers, they found much less overlap between these two components of cognitive anxiety and either somatic or behavioral anxiety.
Your scores on the Four Systems Anxiety Questionnaire will enable you to better understand how you experience anxiety. This is important, because the way in which you experience this emotion has important implications as to what you can do about it. If your highest score was on either the Feeling or Cognitive subscales, then modifying your cognitions is likely to be especially helpful. We will discuss this approach in detail in chapter 3, which deals with depression and the Automatic Thoughts Questionnaire, where the same principles apply. Using the test items as a guide, identify your irrational cognitions and write out more adaptive, rational thoughts you can use instead.
If your highest score was on the Somatic subscale, relaxation techniques can be especially effective. Psychologist Arnold Lazarus has published audiotapes that can guide you through these exercises. Remember, it takes some time to change your body's response to anxiety-provoking situations, so be patient, but practice both regularly and diligently.
Let us spend more time focusing on behavioral anxiety. If your highest score was on this scale, you are the sort of person who avoids situations because you anticipate they will make you feel anxious. People who allow their anxiety to influence their behavior tend to have restricted lives, which in turn can lead to depression. As always, if your tendency to avoid situations is severe, you should consult a mental health professional. It simply is not necessary for you to suffer so. But if you have a milder case of behavioral anxiety, you may be able to treat yourself successfully using a technique called in vivo desensitization. This term describes a process of overcoming anxiety by exposing oneself gradually to the real-life situations that elicit the anxiety. I met a woman once who successfully treated herself for agoraphobia using this technique even though she had never heard about it before. It is a commonsense approach that can be quite effective.
This woman, I'll call her Susan, developed a fear of leaving her house shortly after the birth of her first child. Within a few months, her fear was so severe that she would not venture past her front door unless she was accompanied by her husband. After suffering from this debilitating anxiety for several more months, she decided she had to do something about it. Intuitively, she concluded that the best way to overcome her fear was to attack it in small steps. So, for the first week, her goal was simply to walk out the front door and stand on her porch for brief periods of time. The first day, she was able to do this for less than a minute, but by the end of the week, she could stand outdoors for ten minutes without feeling uncomfortable. Her next goal was to walk down to the curb to check her mailbox. This took her nearly two weeks. At first, she would take a few steps off the porch and would feel overwhelmed by the anxiety. But each day she forced herself to take an additional step, and by the end of the second week, she could stand by the mailbox and look through her mail without any sense of panic.
Each time Susan accomplished one goal, she would set a slightly more ambitious goal for her next step. Her progress was slow but steady, and by the end of a year Susan was able to go where she wanted by herself. For several more months, she always felt "on edge" during these excursions, and occasionally the anxiety would become quite intense. During these episodes, she would park her car or sit on a bench until she could feel herself relax.
Others who have experienced agoraphobia may marvel at Susan's willpower, but behavior therapists who teach this technique would argue that it was Susan's "skill power," not her willpower, that allowed her to overcome her fear. Although she had no knowledge of behavioral psychology, Susan was able to skillfully apply these techniques to deal with her situation. The key was that she was persistent and that she did not give up.
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