Tom Andrews, Ph.D. Worry/Anxiety/Panic Cognitive-Behavioral Therapy without Medication

Therapeutic Metaphors

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Sometimes, a metaphor helps. 

Horse and rider: You don't want to put a nervous rider on a nervous horse.  Think of the rider as your mindful part and the horse as your sometimes upset, emotional, reactive part.  By trying to be appropriately calm on the upset horse, you are not lying to yourself; you know exactly how you feel and what you are doing. You are trying to avoid further upsetting the horse, with your negative, catastrophyzing thoughts, and even helping to calm it, so you can better deal with the overall situation.  
 
Optical: Your brain's emergency response tends to zoom in on danger. Rather than having the danger loom up in your face, over whelming you, sometimes it is better to zoom out, wide-angle, making the danger appear at a greater distance, allowing for dealing with it in a calmer, more effective way.

Public Address System: When the PA system squeals, don't rush over to the speaker with the microphone: the increased feedback will make the squeal worse. Likewise, drama sometimes makes things worse. Calmness, less drama, relaxed face, hands, arms and shoulders, and understatement are some of the ways to quieten a too emotional, noisy situation. Staying with the metaphor, I suppose you could think of using psychiatric medication as similar to turning down the gain on the PA system amplifier.


Smoke Alarm: Suppose you are cooking in your kitchen, and the smoke alarm goes off. It turns out that there is no fire; the cooking gases caused the smoke-alarm trigger to set off the alarm. The alarm is very loud and hard to ignore; but if you had to ignore it you could. The problem really is not the alarm itself; it is supposed to be loud and intrusive. If there is a problem, it is in the alarm's trigger's being too sensitive; it set off a "false alarm." This metaphor is useful in dealing with panic attacks. Clinical panic attacks are like the smoke alarm: very physical, "loud," and intrusive.  However, in the absence of a medical problem, out-of-the-blue panic attacks, in spite of how they feel, are not dangerous, only a real nuisance--they are false alarms. (Fear of panic attacks can be dangerous, by leading to agoraphobia.) 
 
Flashlight: Think of your attention as similar to using a flashlight in a dark room. You see most clearly what you shine it on. If you shine it in a different direction, some other object will be in focus. Your mind works in a similar way. You focus on one thing and then another. Your emotional and physiological  reactions depend largely upon what you are focused on. Focus on something scary and you will be anxious, fearful, or even panicky. Focus on something else and you will feel differently. Of course, this is sometimes easier said than done. The good news is that mindfully shifting your attention is something that you can get better at, with repeated practice.  Suppose, for example, you are remembering something hurtful. First you simply note that the memory is there,  then you gently shift to something else--repeat as many times as needed.  Recent work in brain science confirms that doing this repeatedly, as an exercise, enhances the parts of the brain that do the noting and shifting. You can get better at it and be more free from the intruding thought.