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Section 12
Client Perceptions

Question 12 | Test | Table of Contents

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"Alarm System" and "Automatic Thoughts"
Now we have explored numerous interventions to use with an anxiety-disordered child or adult. Before we go to some visualization interventions, let's look at exactly how the anxiety process works in your client's mind.

I like to think of an anxiety disorder as a hypersensitive alarm system. The anxious client is so sensitive to any stimuli that might be taken as indicating a disaster or harm, that he or she is constantly warning themselves about the potential dangers, because almost any stimulus can be perceived by him or her as dangerous and can "trip" the alarm. As you know, the anxious client experiences many "false alarms," which keep him or her in a constant state of emotional stress and turmoil.

The preoccupation with danger is manifested by the continuous, involuntary occurrence of automatic thoughts (in verbal or visual form) whose content involves possible physical or mental harm. These thoughts tend to occur repetitively and rapidly and seem completely plausible to the client at the time of their occurrence.

♦ Instant Replay Intervention
Many times a thought is so fleeting that your client is aware only of the anxiety it has generated. An intervention used is called instant replay. I have found clients can be trained to perform an "instant replay" and recover the automatic thought preceding their anxious reaction. This thought is derived from the information-processing system that activates the effect.

Loss of Objectivity and of Voluntary Control
In addition to having repetitive thoughts about danger which set off false alarms, ability to "reason" with these thoughts is impaired. While the client may agree that these fearful thoughts are illogical, his or her ability to evaluate them objectively (without help) is limited. Your client behaves as though he or she believes in the validity of the misinterpretations, though your client may suspect they are not totally realistic. Objectivity is similarly lost when a client attempts to test the reality of the visual images that may accompany or substitute for verbal cognition. For example, Charles had constant visualizations about getting stomach cancer, a disease from which his father had died in childhood.

Another characteristic of anxious thinking is its involuntary nature. Automatic thoughts exert a continuous pressure even though a person has already determined that they are invalid and would like to be rid of them. The involuntary character of the anxious thinking and other mechanisms blocking or "choking" of feelings may lead the client to think he or she is "losing their mind." Earlier in the course, you received a specific technique to assist your client in controlling these automatic thoughts.

Now let's look at anxiety as it relates to Stimulus, Generalization, Catastrophizing, and Dichotomous Thinking. Think of a client you have had that you may need to re-examine this with.

♦ Stimulus Generalization
Let's look at Stimulus Generalization and anxiety first. The range of stimuli that can evoke anxiety in generalized anxiety disorder may increase until almost any stimulus is perceived as a danger. For example, one of my clients in an acute state of anxiety had the following experiences: The sound of the siren of a fire engine evoked the thought, "My house may be on fire." An airplane flying overhead triggered a visual image of herself in an airplane crashing into another plane. After seeing the scene of an accident on television, she visualized herself bleeding and suffering. How does your anxiety- disordered client generalize?

Catastrophizing
Next, re-evaluate this Catastrophizing. As mentioned earlier, clients tend to dwell on the worst possible outcome of any situation in which there is a possibility for an unpleasant outcome. Your anxious client overemphasizes the probability of this catastrophic outcome and usually exaggerates the possible consequences of its occurrence.

Examples of catastrophizing are: Jason, a successful college student, when taking an examination was preoccupied with the possibility of his failing. He imagined that if he failed the test, he would flunk out of college and as a consequence, would end up as a homeless person. Ask yourself, from the previously mentioned strategies, which one might you use to help your catastrophizing client view situations more realistically.

♦ Dichotomous Thinking
Another characteristic in the thinking of an anxious client, in addition to generalization and catastrophizing, is the tendency - when there is any question of danger - to interpret events in dichotomous terms. Thus, unless a situation is unmistakably safe, the person is likely to appraise it as unsafe. He or she has no tolerance for uncertainty or ambiguity. The rustling of the venetian blinds indicates an intruder; the backfiring of an automobile sounds like the firing of a gun; shortness of breath means that he or she may stop breathing entirely.
Reviewed 2023

Peer-Reviewed Journal Article References:
Bucher, A., Voss, A., Spaniol, J., Hische, A., & Sauer, N. (2020). Age differences in emotion perception in a multiple target setting: An eye-tracking study. Emotion, 20(8), 1423–1434.

Dekel, R., Solomon, Z., & Horesh, D. (2021). Predicting secondary posttraumatic stress symptoms among spouses of veterans: Veteran’s distress or spouse’s perception of that distress? Psychological Trauma: Theory, Research, Practice, and Policy.

Gallagher, M. W., Phillips, C. A., D'Souza, J., Richardson, A., Long, L. J., Boswell, J. F., Farchione, T. J., & Barlow, D. H. (2020). Trajectories of change in well-being during cognitive behavioral therapies for anxiety disorders: Quantifying the impact and covariation with improvements in anxiety. Psychotherapy, 57(3), 379–390.

Khattra, J., Angus, L., Westra, H., Macaulay, C., Moertl, K., & Constantino, M. (2017). Client perceptions of corrective experiences in cognitive behavioral therapy and motivational interviewing for generalized anxiety disorder: An exploratory pilot study. Journal of Psychotherapy Integration, 27(1), 23–34.

Notebaert, L., Masschelein, S., Wright, B., & MacLeod, C. (2016). To risk or not to risk: Anxiety and the calibration between risk perception and danger mitigation. Journal of Experimental Psychology: Learning, Memory, and Cognition, 42(6), 985–995.

Sussman, T. J., Szekely, A., Hajcak, G., & Mohanty, A. (2016). It’s all in the anticipation: How perception of threat is enhanced in anxiety. Emotion, 16(3), 320–327. 

QUESTION 12
What are examples of characteristic thinking of an anxiety-disordered client? To select and enter your answer go to Test.

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