When you are faced with a threat in life, it’s natural to start predicting outcomes: what’s going to happen in the next few minutes, tomorrow, next week, or next year? When the doctor tells you that your blood pressure is too high, your mind leaps to the future and you see yourself having to eat a very boring diet, gobble pills, struggle to get some kind of exercise, finally keeling over at an early age from a heart attack or stroke. Or you get a bad grade on a test and immediately you can see yourself flunking out, stuck in some menial job with no prospects, impoverished and alone.
Sometimes your worry about the future also includes rumination about the past. You dwell on how you might have brought high blood pressure on yourself with bad habits. You regret all the nights you stayed up late partying with your friends instead of studying.
A little of this is a good thing. Predicting outcomes, planning for the future, and learning from past mistakes are natural and beneficial. They are survival skills that help keep our species alive. But too much of this is a bad thing. When you think too long and too hard about all the things that can go wrong, you’re not just planning for the future, you’re worrying. When you ruminate obsessively on past mistakes and misfortunes, you’re not learning from the past, you’re just worrying about it.
In this chapter you will learn to respond to worry thoughts with a technique called cognitive defusion. The technique was developed by Steve Hayes, cofounder of acceptance and commitment therapy (Hayes and Wilson, 2003). Hayes realized that anxious people become “fused” with their fearful thoughts, being their thoughts instead of having their thoughts. He created a series of exercises designed to “defuse,” or distance yourself from your thoughts by observing and labeling them.
Cognitive defusion is similar to some Buddhist meditation practices in which you observe your thoughts, label them, and then let them go. Where Buddhism is a spiritual practice in search of serenity and detachment from material desire, defusion is a psychological technique designed to reduce worry by creating distance between you and your fearful thoughts.
In chapter 3 you assessed your anxiety in terms of what you are afraid will happen in the worst-case scenario, if everything you’re afraid of were to come true in the most horrific way. If you habitually imagine catastrophic outcomes, it makes anxiety worse because your mind does not make a clear distinction between imagined events and real events. Both can trigger the same alarm response. Thinking intensely about spider bites, high buildings, or a disapproving boss can make your heart rate and breathing speed up just as much as seeing a real spider, going up in a glass elevator, or being criticized by your boss.
For example, Pam was afraid of getting into a head-on collision when she was driving. Hours before she had to drive somewhere she would review the route and think about all the undivided highways and left turns. She visualized a drunk driver coming the other way and suddenly veering into her lane. She imagined some distracted teenager not seeing her turn signal and plowing into her car at a busy intersection. She imagined the air bag exploding in her face, the sound of squealing tires and crunching metal, the smell of smoke and blood. By the time Pam got into her car, she was nervous and shaky because she had already been in a dozen accidents in her mind.
Visualization Exercise
Do this when you are alone and can sit quietly and comfortably, without interruption.
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As the encounter unfolds, imagine that the very worst outcome happens. Indulge your tendency to worry and ruminate and dwell on every catastrophic detail. Really wallow in the scary details and let yourself have a giant worry-fest.
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What was your experience of this exercise? If you are like most people, the worrying will have increased your feelings anxiety. This is a small example of how your fear level is elevated and maintained at a high level by chronic worrying.
When you worry, your thoughts follow one after another in a long sequence, each one connected to the one before and the one after in a seemingly unbreakable and inevitable chain of scary logic. One fear reminds you of another, and that brings up a third, and so on and so on.
One way to slow down this chaining and begin to separate the links is by observing your thoughts. Instead of just having a chain of thoughts, you take one tiny step backward and watch yourself having a chain of thoughts. It seems like a small distinction, but it makes a world of difference.
When you observe your thoughts instead of just having them, you create a little space, a separation that lessens the emotional impact of each thought. Try it for yourself in these two exercises.
When Joan tried this exercise she stretched out on the couch late one afternoon and saw this news crawl: Okay, this is weird … just watching words stream … how can this work? How long do I have to do this? Should be shopping … need bread and milk … Tom’s dinner … he’ll be late … really working? With somebody else … That blonde … Doesn’t care … it’s not fair … got to be careful … Don’t say anything … be extra nice … no use anyway … he’ll leave me …
How was the exercise for you? Did you notice that the thoughts never really stop? Even if what you’re thinking is I’m not having any thoughts, or Maybe I’m doing this wrong, those are thoughts.
If you had trouble with the news crawl stopping or blanking out, it might be that you think more in visual images than in words. The next exercise is probably better for you. If the same thought kept repeating, that’s an indication of a particularly stubborn or “sticky” thought that is very central to your anxious feelings.
The experience of watching your thoughts as printed words at the bottom of a screen helps you see them more clearly, slow them down, and achieve some distance between you and your thoughts. It’s a key experience of having thoughts instead of being your thoughts.
White Room Exercise
Some people experience their thoughts as vivid mental images rather than words. If you had trouble watching your thoughts as a news crawl of words, you might like this exercise better. It allows you to observe whatever visual imagery presents itself as part of a scary thought, and then label it with words. The basic idea is simple: see a thought, label it, and let it go.
How was this exercise for you? Was it difficult to let some thoughts leave the room? Did some thoughts circle back and transit the room again and again? Were some thoughts harder to classify and label than others? Did you have the same kind of thought over and over? Or did you experience a variety of thoughts?
When Roberto did the White Room Exercise, he saw many of his thoughts in the form of people: he saw a homeless woman pushing a shopping cart and labeled it “a what-if thought about losing my job.” He saw one thought as a stern police officer and labeled it “guilty.” A crying little kid went through the room and Roberto labeled that thought “catastrophe thought.”
Once you have some facility in observing your thoughts, your next task is to practice letting your thoughts go. The three exercises in this section draw on meditation techniques for letting distracting thoughts go and returning to focus on the present moment.
Present Moment Walk
How did you do? Were you surprised by how many thoughts came up? It is remarkably difficult to concentrate on the here and now. When Darcy took her Present Moment Walk, she found herself thinking about an upcoming dinner party, then returned her attention to the bike trail she was walking on. But thoughts of the dinner kept intruding: whether everybody liked Brussels sprouts, should she invite Jack’s coworker, did she have enough plates that matched, and so on. At one point, she was so distracted that a man on a recumbent bike almost mowed her down.
Breath Counting
This is a simple but profound experience, basic to several meditation traditions. How did you do? Did you get so distracted that you lost count? Did you get better at noticing the thoughts more quickly, or did the more interesting thoughts carry you away into an extended reverie? There’s no wrong way to do this exercise, since the goal is to notice how often your mind wanders away from the task at hand, and how you notice the distractions and return your focus to the here and now.
Leaves on a Stream
If you could not get a clear image of the scene, describe what you were thinking about while attempting the exercise:
Did you enjoy the stream imagery and letting your thoughts float away on the leaves? This exercise can show how persistent and “sticky” some thoughts are, and that you can eventually let them go. If you had trouble getting your stream to flow or got stuck on leaf, that’s cognitive fusion. When your stream was flowing freely and you could let leaves go, that’s cognitive defusion.
Some people prefer to do this exercise with different kinds of scenes: attaching thoughts to helium balloons and releasing them to disappear into the sky; or imaging that they are in their car at a railroad crossing, watching boxcar after boxcar carry their thoughts away.
Carl liked to do this exercise using the boxcars. He visualized himself in his pickup truck, watching the train cars go by with his thoughts spray painted on them like graffiti: father-in-law … graduation … stupid exercise … need a tune up … nervous … When Carl thought of specific people he sometimes saw them as photographic posters pasted on the boxcars, or as actual human figures clinging to the ladders and couplings. Once he put a poster of his wife on a boxcar and the train stopped moving and he couldn’t get it to start up again for quite a while.
When you have a “sticky” recurring thought that often causes you anxiety, consider these four questions:
I can take this thought with me and still:
Juliana completed her distancing exercise like this:
I can take this thought with me and still:
Talk to men I meet, accept invitations, and initiate phone calls.
As you go about your day-to-day existence, the same old thoughts will continue to come up:
When you have your fearful thoughts again, remember the defusion skills you have mastered in this chapter. You can imagine that the thoughts are merely a news crawl at the bottom of your screen, not the main program you are intent on watching. You can say to yourself, There’s that thought again, passing through the white room of my mind, and continue on your way. You can distance yourself from your thought by saying to your mind, Thank you, mind, for that thought.
When a thought keeps intruding, you can refocus your attention on your surroundings, seeing and hearing what is around you in the here and now, like you did in the “Present Moment Walk.” Or you can focus your attention on your breathing and count two or three breaths to calm and distract yourself from the thought.
You can also label thoughts as they come up: Oh, there’s another stranger/danger thought … there’s a catastrophic prediction again … I’m magnifying risk now. Imagine letting these labeled thoughts float away like leaves in a stream, balloons in the air, or boxcars on a train track.
There is one time when it is not helpful to use your defusion skills: right before or during an exposure exercise. In those situations, the goal is to actually experience the habitual thoughts and feel the anxiety that they inspire, so using defusion then would lessen the therapeutic effectiveness of the exercise.
The next chapter presents a new auxiliary skill in your anxiety arsenal: correcting your anxiety lens.