We all experience anxiety from time to time. However, for some people anxiety can be a prevalent emotional state. Anxiety can be caused by a specific reason or can be free floating where you feel anxious but have no idea why. We may first notice our anxiety because we are experiencing physical symptoms such as sweating or feeling out of breathe. Or we may notice that a particular situation or thought in our mind precipitates the feeling of anxiety. Whether we notice it in our body or our mind, it all eventually comes back to the mind. If it starts in the mind, the mind is where you need to look to change the feeling state. Cognitive behavioral therapy (CBT) looks at our thoughts and beliefs as the starting point of change. CBT has you identify your thoughts and then reflect on the value or validity of them. Many of our thoughts and long held belief are problematic or simply untrue. By identifying and then changing your thoughts, you can change your emotions and behaviors.
Rebecca frequently experienced anxiety. If you met her, you would never know it because she manged to successfully hide her emotions by her very jovial and talkative manner. Rebecca was a talker and could strike up a conversation with most anyone and keep it going and going and going... The problem was that her conversations were very superficial. She could talk for an hour and you didn't feel like you knew her any better than the start of the conversation. Some people avoided her because the lack of depth in Rebecca's conversation left the other person unfulfilled. Rebecca sensed that people avoided her but she was unsure why. Rebecca felt she was not very smart or very interesting. She frequently compared herself to others and always felt less than them. When she was alone, her feelings of low self esteem became more intense and she craved sugar which she would indulge in. Sometimes her "binges" were extreme. Rebecca always felt worse after a binge, both physically and emotionally but for those few precious moments while she was eating, she felt better. Her therapist asked her to keep a log of her eating, all of her eating, not just the binges. She was instructed to reflect on a few questions in her log. Before she ate anything, she was to answer the following: What was happening just before you ate? What was the emotion before you began to eat? What was the thought before you ate? What was the physical sensation in your body just before you ate? She then was to record what she ate including the amount. Finally, she was to answer the following questions after she was finished: What was the emotion after you ate? What was the physical sensation in your body after eating. What were your thoughts about what you ate?
Rebecca's therapist asked her to do this on at least one day before her next session. The goal of the exercise was not to impress her therapist regarding her eating habits but to gain insight into how her emotions and eating were related. Her therapist made it clear at the outset that she did not want to see her actual food log but was more interested in her thoughts and feelings related to the onset of eating and the effect of her eating. Her therapist was purposeful in not wanting to see the food log because she wanted Rebecca to be honest with herself.
Being honest about her eating, even though it was just for herself, was not an easy task. She caught herself lying several times which was interesting. It was like some part of herself did not want the other part to know. Rebecca had to come to terms with the realization that she lied to herself. It wasn't easy because she considered herself to be an honest person. So why was she lying to herself? Then she realized she had always told herself that she was overweight because she had a slow metabolism, a genetic predisposition to being overweight, and a thyroid issue. Could it be that she was overweight because she ate too many calories? The idea that she was responsible for her weight sent her into an immediate panic. If she was responsible, then she really was a loser. Her self esteem plummeted and she felt the urge to eat. Fortunately her therapy session was the next day and she discussed her insights with her therapist. Her therapist helped Rebecca identify the underlying belief that was dysfunctional. Rebecca believed she had to be perfect like everyone else. Wait... what?! No one is perfect! Where did she get the idea that she had to be perfect or that other people were? Clearly this belief was untrue and problematic.
As Rebecca progressed through therapy she began to give herself a break. She realized that she, like everyone else, was a work in progress. When she made mistakes, whether it was in her eating plan or any other task, she took a step back and gave herself permission to make mistakes. Because she was allowed to make mistakes, she felt less of a need to hide her mistakes. She could admit to herself and others "Boy, I really screwed that one up." She actually began to get a sense of humor about her mistakes. This eased her social anxiety and allowed her to relax. She backed off from the constant stream of words and started listening. Once she could relax and listen, she noticed people started talking to her.