(Teach Yourself) Windy Dryden - Manage Anxiety Through CBT-Teach Yourself (2014)

®
Teach
Yourself
MANAGE
ANXIETY
THROUGH CRT
Develop an anti-anxiety philosophy (page 2) Discover
where anxiety comes from (page 15) Explore possible
alternatives to anxiety (page 23) Understand
why you feel anxious (page 28)
Cope when the
going [gets
tough (page
45) Find out how
to manage anxiety
(page 51) Learn to overcome social anxiety (page 133)
Find out about health-related anxiety (page 152)
Maintain your self-control (page 182) Identify your
irrational beliefs (page 188)
WINDY DRYDEN -
INTERNATIONAL LEADING EXPERT IN
COGNITIVE BEHAVIOURAL THERAPY
Digitized by the Internet Archive
in 2022 with funding from
Kahle/Austin Foundation
https://archive.org/details/manageanxietythrOOOOdryd
®
Teach
Yourself
Manage Anxiety
Through CBT
Windy Dryden
Hodder Education
338 Euston Road, London NWi 3BH.
Hodder Education is an Hachette UK company
First published in UK 2011 by Hodder Education
First published in US 2011 by The McGraw-Hill Companies, Inc.
This edition published 2011.
Copyright ©2011 Windy Dryden
Database right Hodder Education (makers)
The Teach Yourself name is a registered trademark of Hachette UK.
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system or transmitted in any form or by
any means, electronic, mechanical, photocopying, recording or
otherwise, without the prior permission in writing of Hodder
Education, or as expressly permitted by law, or under terms agreed
with the appropriate reprographic rights organization. Enquiries
concerning reproduction outside the scope of the above should be
sent to rhe Rights Department. Hodder Education, at the address
above.
You must not circulate this book in any other binding or cover and
you must impose this same condition on any acquirer.
British Library Cataloguing in Publication Data: a catalogue record
for this title is available from the British Library.
Library of Congress Catalog Card Number: on file.
10 987654321
The publisher has used its best endeavours to ensure that any
website addresses referred to in this book are correct and active at
rhe time of going to press. However, the publisher and the author
have no responsibility for rhe websites and can make no guarantee
that a site will remain live or that the content will remain relevant,
decent or appropriate.
The publisher has made every effort to mark as such all words
which it believes to be trademarks. The publisher should also
like to make it clear that the presence of a word in the book,
whether marked or unmarked, in no way affects its legal status
as a trademark.
Every reasonable effort has been made by the publisher to trace the
copyright holders of material in this book. Any errors or omissions
should be notified in writing to the publisher, who will endeavour
to rectify the situation for any reprints and future editions.
Hachette UK’s policy is to use papers that are natural, renewable
and recyclable products and made from wood grown in sustainable
forests. The logging and manufacturing processes are expected to
conform to the environmental regulations of the country of origin.
wwwrh()ddereducati<)m
Typeset by MPS Limited, a Macmillan Company.
Printed in Great Britain by CPI Cox & Wyman. Reading.
Contents
Meet the author vii
In one minute ix
1 Understanding the ‘ABCDEs' of Rational-Emotive Cognitive
Behaviour Therapy (RECBT) 1
Introduction 1
What's in a name: why Rational-Emotive Cognitive
Behaviour Therapy? 2
The key ideas of RECBT 2
RECBT’s ‘ABCDE’ model 5
How to use the ‘ABCDE' model 10
Give your informed consent and proceed 12
2 Understanding anxiety and its healthy alternative, concern 15
Understanding anxiety: the RECBT perspective 15
Routinely used safety-seeking measures in anxiety 21
Possible alternatives to anxiety 23
Understanding concern: the RECBT perspective on the
healthy alternative to anxiety 26
Why you are prone to anxiety 28
3 How you make yourself disturbed about anxiety 32
Introduction 32
Understanding the ‘ABCs' of your secondary disturbance
about anxiety 33
Understanding healthy alternatives to secondary
disturbance about anxiety using the ‘ABCs’of RECBT 45
4 How to manage anxiety: general principles andstrategies 51
Introduction 51
General principles for managing anxiety 52
5 How to manage performance-related anxiety 69
Introduction 69
Understanding test anxiety 70
Using RECBT to manage performance-relatedanxiety 85
Other issues 101
6 How to manage social anxiety 105
Introduction 105
Understanding social anxiety 105
Contents V
Using RECBT to manage social anxiety 133
Other issues 148
7 How to manage health anxiety 152
Introduction 152
Understanding health anxiety 152
Using RECBT to manage health anxiety 159
8 How to manage anxiety about losing self-control 170
Introduction 170
Understanding anxiety about losing self-control 171
Using RECBT to manage anxiety about losing
self-control 182
Other issues 200
Appendices 203
Index 211
VI
Meet the author
Welcome to Manage Anxiety Through CBTl
In this book I will discuss how to manage your anxiety using
insights from the therapeutic tradition known as Cognitive
Behaviour Therapy (CBT). In Chapters 1-3,1 will outline the
model on which this book is based and will show you how this
model helps you to understand anxiety. There are different
models in the counselling and psychotherapy world and they
all adopt a different approach to the understanding of anxiety.
Sometimes these differences are marked, while at other times
these differences are more subtle. However, my view is that
it is important for you to understand the approach that
informs this book. The approach is called Rational-Emotive
Cognitive Behaviour Therapy (RECBT) and it is an approach
that can be located within the cognitive-behavioural tradition
of counselling and psychotherapy. I will outline RECBT in
Chapter 1. In Chapter 2,1 will help you to understand anxiety
from an RECBT perspective and in Chapter 3 I will explain
what RECBT has to say about how people disturb themselves
about their anxiety.
In Chapter 4,1 will discuss what RECBT has to say about

what you need to do to manage your anxiety and will do so in
general terms. I will apply this learning to the major forms of
anxiety that people are likely to experience in Chapters 5-8.
In Chapter 5, 1 will show you how to manage performance

anxiety in a non-social setting. By this I mean dealing with
anxiety about your performance which takes place in a
setting where others’ attention is not on you. I have chosen
‘test anxiety' to be the best example of this form of anxiety.
In Chapter 6,1 will show you how to manage social anxiety
where you are anxious about how you are coming across in a
social setting where you consider that others' attention is on
you. In Chapter 7,1 will show you how to deal with health
anxiety. In this form of anxiety, you perceive threats to your
well-being and, because you cannot be sure that such threats
Meet the author VII

are innocuous, you conclude that they are highly dangerous.
Finally, in Chapter 8, I will show you how to manage anxiety
about loss of self-control. In this form of anxiety, you regard
a range of internal experiences as evidence that you are nor
fully in control of yourself and you consider these to be threats
which, if not quickly dealt with or eliminated, will lead you to
lose control of yourself completely. Such fears may be to do
with your physical or mental well-being.
1 suggest that you read Chapters 1-4 in their entirety since they
contain the necessary knowledge for you to use when focusing
on the form of anxiety that you particularly suffer from. In
Chapters 5-8, which are devoted to different forms of anxiety,
1 employ a common structure since there are certain things
that you need to do to manage any form of anxiety. However,
within this structure, I focus on the distinctive content of the
particular form of anxiety that 1 am writing about and show
you what you particularly need to do to manage that specific
form of anxiety.
I hope that you find this book of use to you as you set about
managing your anxiety. I welcome your feedback do the
publisher.
VIII
In one minute
Manage anxiety through CBT
You only become anxious when you perceive a threat to
your personal domain and when you hold a set of rigid and
extreme beliefs about this threat. In order to manage your
anxiety you need to learn to think rationally about threat.
Rational thinking is thinking that is flexible and
non-extreme. It helps you to face a threat, deal with it
effectively and get on with the business of living.
To think rationally, you need to:
► recognize what you want with respect to the threat,
but not demand that you have to get it
► evaluate the threat as bad, but not awful
► tolerate the discomfort of the threat
► accept yourself, others and life in the face of the
threat.
You have to practise rational thinking for it to take
root. Act on it and don’t just think it. If you do, you will
learn to be healthily concerned in the face of life’s threats.
In one minute IX
Image credits
Front cover: © Creative Crop/Digital Vision/Getty Images
Back cover: ©Jakub Semeniuk/iStockphoto.com, © Royalty -
Free/Corbis, © agencyby/iStockphoto.com, © Andy Cook/
iStockphoto.com, © Christopher Ewing/iStockphoto.com,
© zebicho - Fotolia.com, © Geoffrey Holman/iStockphoto.com,
© Photodisc/Getty Images, ©James C. Pruitt/iStockphoto.com,
© Mohamed Saber - Fotoiia.com
Understanding the ‘ABCDEs’
of Rational-Emotive Cognitive
Behaviour Therapy (RECBT)
In this introductory chapter you will learn:
• the key ideas of Rational-Emotive Cognitive Behaviour Therapy
(RECBT)
• RECBT's 'ABCDE' model which you can use to understand
your unhealthy negative emotions and what to do to change
them.
Introduction
In counselling and psychotherapy, we have a variety of approaches
that have been developed over the years to make sense of and alleviate
human suffering. It is important to understand the approach that
an author is taking towards a subject like managing anxiety so that
you can judge whether or not the approach makes sense to you and
whether or not you can use it. In my writings and in my counselling
practice, I stress an ethical principle known as informed consent.
This principle states that it is ethical for an author or counsellor
to inform you about the approach he (in this case) is taking on the
topic in hand (i.e. anxiety and how to manage it) and for you to give
your consent to using this approach before you proceed. So what
I aim to do in this opening chapter is to inform you about RECBT,
particularly its view on psychological problems and how they can
be tackled. At the end of the chapter, I will ask you to give your
informed consent to proceed.
1. Understanding the ‘ABCDEs’ of RECBT I

What’s in a name: why Rational-Emotive
Cognitive Behaviour Therapy?
You have probably heard of ‘Cognitive Behaviour Therapy'
(or CBT). In my view, CBT is a therapeutic tradition in which there
are a number of specific and distinctive approaches. One of these
specific CBT approaches is known as Rational Emotive Behaviour
Therapy (REBT) which was founded in 1955 by the famous
American psychologist Dr Albert Ellis (1913-2007). This makes
REBT the earliest and the most enduring approach within the CBT
tradition. I call this approach ‘Rational-Emotive Cognitive Behaviour
Therapy' to indicate that it is within the CBT tradition but that its
distinctive features are allied with REBT.
If we take the term ‘emotive' in ‘Rational-Emotive Cognitive
Behaviour Therapy', it is clear that it refers to emotions. You might
expect that an approach to counselling and psychotherapy would
place due emphasis on emotions - which RECBT does - and that
this should be reflected in the name of the approach. But why the
term ‘rational', you may be thinking? What does this term mean
and why is it important? In RECBT, the term ‘rational' has several
meanings. It refers to that which is flexible, non-extreme, true,
logical and helpful. Its antonym, ‘irrational', refers to that which
is rigid, extreme, false, illogical and unhelpful. As we shall see
presently, the terms ‘rational' and ‘irrational' are most often used
as adjectives to describe beliefs. One of the goals of RECBT is to
help you to think rationally rather than irrationally and this is
reflected in the name of the approach.
The key ideas of RECBT

In this section 1 will briefly outline three key ideas of RECBT:
1 the RECBT view of psychological disturbance
2 the RECBT view of psychological health
3 the RECBT view of psychological change.
THE RECBT VIEW OF PSYCHOLOGICAL DISTURBANCE

A major principle in CBT is summed up by the following quote
attributed to Epictetus, the Greek Stoic philosopher: ‘Men are
disturbed not by things, but by the views they take of things.’ This
shows the emphasis that CBT places on how we think in explaining
our disturbed emotions. RECBT’s position on this issue is more
specific. It is summed up in the following key insight.
Insight
People are not disturbed by the adversities they face; rather, they disturb
themselves about these adversities by the rigid and extreme beliefs that they
hold about them.
This key insight shows a number of things:

► It emphasizes the principle of emotional responsibility
whereby people are deemed to be actively responsible for their
disturbance. Note, then, that in RECBT we talk about people
disturbing themselves rather than becoming disturbed.
► It specifies how people disturb themselves - i.e. by holding rigid
and extreme beliefs. When taken together, these beliefs are
known in RECBT as irrational beliefs. I will discuss these beliefs
in greater detail later in this chapter.
► It shows that people disturb themselves about adversities. I will
also discuss this concept later in the chapter.
Unhealthy negative emotions comprise psychological
disturbance
In RECBT, we argue that psychological disturbance in the face of
adversity is comprised of one or more of the following emotions
that we call unhealthy negative emotions (UNEs): anxiety (which,
of course, is the focus for this book), depression, guilt, shame, hurt,
unhealthy anger, unhealthy jealousy and unhealthy envy.
THE RECBT VIEW OF PSYCHOLOGICAL HEALTH

The RECBT position on psychological health is summed up in the
following key insight.
Insight
People respond healthily to the adversities they face when they hold flexible
and non-extreme beliefs about these adversities.
This key insight specifies that flexible and non-extreme beliefs

underpin a psychologically healthy response to adversities. Taken
collectively, flexible and non-extreme beliefs are known in RECBT
as rational beliefs.
1. Understanding the ‘ABCDEs’ of RECBT 3

Healthy negative emotions comprise psychological health
In RECBT, we argue that psychological health in the face of adversity
is comprised of one or more of the following emotions that we call
healthy negative emotions (HNEs): concern (which is the healthy
alternative to anxiety), sadness, remorse, disappointment, sorrow,
healthy anger, healthy jealousy and healthy envy.
You may find it strange to read that a healthy response to an
adversity is a healthy negative emotion, but think of it this way.
An adversity is a negative event. If you experienced a positive
emotion about an adversity then you would have to believe that it
was good that the adversity happened and if you had no feeling about
an adversity you would have to believe that it didn’t matter to you
that the adversity occurred. Both of these responses would involve
you lying to yourself. Leaving these two responses aside, you can
only experience a negative emotion about an adversity. That negative
emotion will be unhealthy if based on irrational beliefs and healthy
if based on rational beliefs.
Insight
Unhealthy negative emotions (UNEs) stem largely from irrational beliefs
about life's adversities while healthy negative emotions (HNEs) stem largely
from rational beliefs about these same adversities.
THE RECBT VIEW OF PSYCHOLOGICAL CHANGE

The RECBT view of psychological change can he deduced from the
earlier sections on psychological disturbance and health. It is this:
in order to respond healthily to adversities you need to change your
irrational beliefs to their rational equivalents. In order for this change
to be meaningful you need to act and think in ways that are based
on your rational beliefs and do so repeatedly until you have strong
conviction in your rational beliefs.
Insight
Understanding intellectually that your beliefs are irrational is an important
first step, but it isn't sufficient to change them. To do this, you need to truly
see that your beliefs are irrational and you need to feel, think and act in ways
that are consistent with your rational beliefs.
4
RECBT’s ‘ABCDE’ model
In this section, I will briefly discuss RECBT’s ‘ABCDE’ model. In
the next section, I will outline how you can use it to help yourself
with an emotional problem.
‘A’= ADVERSITY
As I have already outlined, ‘A’ stands for adversity. An adversity is
a negative event that has occurred or that you think has occurred.
It represents the aspect of a situation about which you are most
disturbed. Whether or not the adversity at ‘A’ actually occurred, the
main point is that you are disturbed about it and, in order to manage
your disturbance effectively, we ask you to assume temporarily that
‘A’ is true. We do this so you can identify your irrational beliefs that
largely determine your disturbance.
‘B’= BELIEFS
As I have already mentioned, in RECBT we argue that irrational
beliefs (i.e. rigid and extreme beliefs) at ‘B’ about adversities at ‘A’
lead to psychologically disturbed responses at ‘C’. We also argue that
rational beliefs (i.e. flexible and non-extreme beliefs) at ‘B’ about
the same adversities at ‘A’ lead to psychologically healthy responses
at ‘C’. In this section, I will discuss in greater detail these irrational
beliefs and their rational belief alternatives. I will begin by discussing
irrational beliefs.
Irrational beliefs
Irrational beliefs are so-called because they are rigid or extreme, false,
illogical and unhelpful.
In RECBT, of the two types of irrational beliefs, rigid beliefs are
regarded as primary and extreme beliefs (of which there are three)
are seen as secondary conclusions from these primary beliefs.
RIGID BELIEFS
When you hold a rigid belief you not only outline what you want to
happen (or don’t want to happen), you demand that it must happen
(or that it must not happen). Rigid beliefs take the form of ‘musts’,
‘absolute shoulds’, ‘have-tos’, ‘got-tos’, etc.

EXTREME BELIEFS
As the name implies, when you hold an extreme belief you are
being extreme in your judgement of yourself, other people or life
conditions. In RECBT there are three extreme beliefs.
Awfulizing beliefs
► When you hold an awfulizing belief you are being extreme in
your judgement of an adversity. You are not just saying that it
is bad that the adversity has occurred; you are saying that it is
awful that it happened. Awfulizing beliefs take the form of
‘it’s awful that...’, ‘it’s terrible that...’ and ‘it’s the end of the
world that...’.
Discomfort intolerance beliefs
► When an adversity happens at ‘A’, and you hold a discomfort
intolerance belief about it, you are extreme in your judgement of
your ability to tolerate the adversity. You not only indicate that
it is difficult to tolerate the adversity, you hold that you can't
tolerate it. Discomfort intolerance beliefs take the form of
‘I can’t bear it...’, ‘I can’t stand it...’ and ‘It's intolerable...’.
Depreciation beliefs
► You can hold a depreciation belief about yourself, about
another person or about life conditions. When you do so,
you are extreme in your judgement to the extent that you apply
a global negative judgement to yourself (e.g. Tm worthless’),
to the other person (e.g. 'You are a bad person’) or to life
conditions (e.g. 'Life is bad').
Insight
In RECBT, rigid beliefs are primary in determining disturbed responses to
adversities. Extreme beliefs (i.e. awfulizing beliefs, discomfort intolerance
beliefs and depreciation beliefs) are derived from these rigid beliefs.
Rational beliefs
Rational beliefs arc so-called because they are flexible or non-extreme,
true, logical and helpful.
In RECBT, of the two types of rational beliefs, flexible beliefs
are regarded as primary and non-extreme beliefs (of which there
are three) are seen as secondary conclusions from these primary
beliefs. w
6
FLEXIBLE BELIEFS
When you hold a flexible belief you outline what you want to happen
(or don’t want to happen), but you do not demand that it must
happen (or that it must not happen). Flexible beliefs take the form
of ‘preferences', ‘preferential shoulds’, ‘desires’, ‘wishes’, ‘wants’,
etc. However, a defining characteristic of such flexible beliefs is a full
acknowledgement that you do not have to get what you prefer, etc.
NON-EXTREME BELIEFS
As the name implies, when you hold a non-extreme belief you are
being non-extreme or relative in your judgement of yourself, other
people or life conditions. In RECBT there are three non-extreme
beliefs.
Non-awfulizing beliefs
When you hold a non-awfulizing belief you are being relative in
your judgement of an adversity. You are saying that it is bad, but
not awful, that the adversity' has occurred. Non-awfulizing beliefs
take the form of ‘it's bad that...’, ‘it’s unfortunate that...’ and ‘it’s
troublesome that...'. However, a defining characteristic of such
non-awfulizing beliefs is a full acknowledgement that it is not
terrible, awful or the end of the world if the adversity occurs.
Discomfort tolerance beliefs
When you encounter an adversity at ‘A’ and you hold a discomfort
tolerance belief about it you are being relative or non-extreme in your
judgement of your ability to tolerate the adversity. You accept that
while it is difficult to tolerate the adversity, you can tolerate it and it
is worth it for you to do so.
Discomfort tolerance beliefs take the form of ‘I can put up with
it...’, ‘I can stand it...’ and ‘It’s tolerable...’. However, a defining
characteristic of such discomfort tolerance beliefs is a full
acknowledgement that it is worth it for you to bear the adversity,
not just that you can do so.
Unconditional acceptance beliefs
You can hold an unconditional acceptance belief about yourself,
about another person or about life conditions. When you do so you
are again being non-extreme in your judgement to the extent that
this acknowledges the complexity, fallibility and fluidity of a person
and the complexity and fluidity of life conditions. This judgement

is unconditional in nature which means that it remains the same no
matter what you do, what the other person does or what happens
in life.
It is important to point out that when you hold an unconditional
acceptance belief this does not preclude you from making a judgement
of an aspect of yourself, of the other person or of life conditions.
However, it does mean that you refrain from judging the whole of
you, the whole of the other person or the whole of life on the basis of
that specific and focused evaluation.
If we look at an unconditional self-acceptance belief, for example,
this takes the form of ‘I am fallible...', ‘I am a unique person...',
‘I am acceptable because I am alive...’. However, the defining
characteristic of such beliefs is a full acknowledgement that such
views are unconditional.
Similar points can be made with reference to an unconditional other-
acceptance belief and to an unconditional life-acceptance belief.
Insight
In RECBT, flexible beliefs are primary in determining healthy responses
to adversities. Non-extreme beliefs (i.e. non-awfulizing beliefs, discomfort
tolerance beliefs and acceptance beliefs) arc derived from these flexible beliefs.
C’ = CONSEQUENCES
There are three major consequences of beliefs: emotional,
behavioural and thinking.
Consequences of irrational beliefs held about adversities
When you hold a set of irrational beliefs about an adversity then your
consequences will be as follows:
► Your emotions will be negative and unhealthy.
► Your behaviour (or action tendencies) will tend to be
unconstructive.
► Your thinking will tend to be highly distorted and skewed to
the negative.
Consequences of rational beliefs held about adversities
When you hold a set of rational beliefs about an adversity then your
consequences will be as follows:
► Your emotions will be negative and healthy.
8
► Your behaviour (or action tendencies) will tend to be
constructive.
► Your thinking will tend to be realistic and balanced.
So far 1 have put forward the ‘ABC’ part of the ‘ABCDE’ framework.
This points out how you disturbed yourself and indicates possible
healthy alternatives at ‘B’ and ‘C’. I will now go on to discuss the
‘D’ and ‘E’ parts of the model.
‘D’ = DISPUTING IRRATIONAL BELIEFS

As we have seen, in the RECBT model irrational beliefs about
adversities are deemed to largely determine unhealthy responses
to these adversities. Conversely, rational beliefs about the same
adversities are deemed to largely determine healthy responses to
them. It follows, therefore, that in order to respond healthily to these
adversities, you need to change your irrational beliefs to rational
beliefs. In RECBT, this process is known as disputing (at ‘D’).'
In this process you do the following:
► Compare your irrational belief with its rational alternative
(one at a time) and ask yourself and answer three questions:
1 Which belief is true and which is false and why?
2 Which belief is logical and which is illogical and why?
3 Which belief is helpful and which is unhelpful and why?
► Commit yourself to strengthening your conviction in your
rational belief and to weakening your conviction in your
irrational belief.
► Act and think in ways that are consistent with your developing
rational belief and inconsistent with your irrational belief.
It is important to note that disputing is not only cognitive; it also
involves taking action.
‘E’ = EFFECTS OF DISPUTING

If you dispute your irrational beliefs and strengthen your conviction
in your rational beliefs as recommended earlier, eventually your
feelings will change. Overall you will experience the following effects:
► You will experience a healthy negative emotion in response to
the adversity rather than an unhealthy negative emotion.
'As you will presently see, I prefer the term ‘questioning’ to the term ‘disputing’.

► You will tend to respond behaviourally to the adversity in
constructive ways rather than in unconstructive ways.
► Your subsequent thinking about the adversity (i.e. that which
stems from your rational belief rather than from your irrational
belief) will tend to be realistic and balanced rather than highly
distorted and skewed to the negative.
How to use the ‘ABCDE’ model

In this section, I will outline, in general terms, how you can use the
‘ABCDE’ model to help yourself. Later in the book, 1 will show you
how you can use it to manage anxiety problems.
Although the framework that 1 have been discussing is known as the
‘ABCDE’ model and 1 discussed it earlier in that letter order, when
you use it you will most often use a ‘CABDE’ order for reasons which
will soon become clear. When you use this model it is helpful to work
with one unhealthy negative emotion at a time, as doing so will help
you to focus on this emotional problem all the way through.
ASSESS ‘C’
When you are experiencing a psychological problem, you will be
most aware of your feelings, how you act or ‘feel like’ acting and
how you think. Collectively, these three responses to adversity at ‘A’
are best regarded as consequences of your belief at ‘B’. When these
responses to adversity are basically unconstructive in nature they
stem from irrational beliefs and when they are basically constructive
in nature they stem from rational beliefs.
When you use the ‘CABDE’ order, you begin with ‘C’ not only
because these consequences will be to the fore of your experience,
but also because knowing the unhealthy negative emotion you are
experiencing will help you to identify what you are most disturbed
about at ‘A’.
Questions that are relevant here are as follows:

‘What emotion did I experience?’
'When 1 felt....... (specify emotion), what did I do or feel like doing?’
‘When I felt....... (specify emotion), what were the thoughts that
went along with this feeling?’
IO
When you have the answers to these questions, you will need to use
them again to determine your goals. These will be the same as the
‘C’ responses that you will experience at ‘E’ if your disputes have
borne fruit.
ASSESS ‘A’
If you recall, ‘A’ stands for ‘adversity’. This is the aspect of the
situation you are in that you are most disturbed about. Your
unhealthy negative emotion suggests the theme of your adversity;
I will discuss this for the case of anxiety later in the book. When you
identify your adversity (which is likely to be an inference), assume
temporarily that your inference is correct. This will help you to focus
on ‘B’. You will have an opportunity to question ‘A’ later.
The question that is most relevant here is some variant of:
‘What was that 1 most....... (specify emotion) about in the situation?’
IDENTIFY ‘B’
You have now assessed ‘A’ and ‘C’. Assuming that your ‘C’ involves
an unhealthy negative emotion, unconstructive behaviour or action
tendency and/or biased and skewed subsequent thinking, you are in a
position to identify your irrational belief and its rational alternative.
I suggest that you identify both because you will need both when you
dispute at ‘D’.
When you identify your irrational belief and rational belief alternative,
I suggest that you use the following rules:
► Unless there is a good reason not to do so, always identify your
rigid belief and its flexible belief alternative. In RECBT, our view
is that of all the irrational beliefs, rigid beliefs lie at the very core
of psychologically disturbed responses to adversities and flexible
beliefs lie at the very core of psychologically healthy responses to
the same adversities.
► With respect to identifying your major extreme belief and
major non-extreme alternative, when your problem involves
your self-esteem, then identify your self-depreciation belief and
self-acceptance belief alternative. However, when it does not
involve your self-esteem, then identify your awfulizing belief and
non-awfulizing belief alternative or your discomfort intolerance
belief and discomfort tolerance belief alternative.
1. Understanding the ‘ABCDEs’ of RECBT II

DISPUTE YOUR BELIEFS (‘D’)
The main point to remember about disputing is whatever order you
use, remember to question your irrational belief and rational belief so
that you end up by seeing that the former is false, illogical and largely
unhelpful and the latter is true, logical and largely helpful. Then you
need to plan to act and think in ways that support your rational belief
and that contradict your irrational belief.
THE EFFECTS OF DISPUTING (‘E’)

If you have disputed your irrational beliefs and have developed, acted
on and strengthened your conviction in your alternative rational
beliefs, then you will experience three major effects:
1 Your emotions about adversity will still be negative, but they
will be healthy.
2 Your behaviour (and action tendencies) in the face of adversity
will be constructive.
3 Your subsequent thinking about adversity will tend to be
realistic and balanced.
These effects of disputing at ‘E’ are the same responses at ‘C’ that you
would have had to the adversity if your beliefs were rational.
Give your informed consent and proceed

At the beginning of the chapter, I explained to you that this book is
based on Rational-Emotive Cognitive Behaviour Therapy (RECBT),
a distinctive approach within the Cognitive Behaviour Therapy
(CBT) tradition. I told you that what I would do in this chapter
would be to inform you about the key points of RECBT with respect
to understanding and managing emotional problems and then 1
would invite you to give your informed consent to proceed with the
book. That time has now come. So, if RECBT makes sense to you
and you would like to proceed with the book and use it to learn how
to manage your anxiety, then give your informed consent below.
If not, thank you for your time and interest and I suggest that you
look at alternative approaches to understanding and managing your
emotional problems, in particular your anxiety.
12
I (state your name).......................................... have read the above
material and understand RECBT's key points on understanding
and managing emotional problems. These make sense to me and
I give my informed consent to proceed with the book.
Signed....................................................................
Date......................................................................
1. Understanding the ‘ABCDEs’ of RECBT I3

THINGS TO REMEMBER
► This book is based on ‘Rational-Emotive Cognitive Behaviour
Therapy’ (RECBT), a distinctive approach within the Cognitive
Behaviour Therapy (CBT) tradition.
► RECBT holds that the way you respond to life’s adversities

is largely determined by the beliefs that you hold about these
adversities.
► These beliefs are either rational or irrational.
► Rational beliefs are flexible or non-extreme, true, logical, sensible

and largely helpful.
► Irrational beliefs are rigid or extreme, false, illogical and largely

unhelpful.
► When you hold rational beliefs about adversities your emotions

will be negative and healthy, your behaviour will be largely
constructive and your subsequent thinking will be largely
realistic and balanced.
► When you hold irrational beliefs about adversities your emotions

will be negative and unhealthy, your behaviour will be largely
unconstructive and your subsequent thinking will be largely
highly distorted and skewed to the negative.
► You can use the ‘ABCDE’ framework to understand and deal

with your emotional problems.
► In particular, you need to change your irrational beliefs to their

rational belief alternatives.
► To change irrational beliefs to rational beliefs, you first need to

see the irrationality of the former and the rationality of the latter.
Then, you need to think and act in ways that are inconsistent
with your irrational beliefs and consistent with your developing
rational beliefs and do so repeatedly.
14
Understanding anxiety and its
healthy alternative, concern
In this chapter, you will learn:
• Rational-Emotive Cognitive Behaviour Therapy's (RECBT’s)
approach to understanding anxiety
• why of all the possible alternatives to anxiety, concern is the
healthiest
• why you may be particularly prone to anxiety.
Understanding anxiety: the RECBT perspective

INTRODUCTION
In this section, I am going to outline RECBT’s perspective on anxiety.
In doing so, I will refer to the ‘ABC part of the ‘ABCDE’ model that
I discussed in the previous chapter. In that chapter, I pointed out
that it was important for you to be informed about and give your
consent to proceeding with RECBT’s explanation of how we disturb
ourselves in general and how best to address this disturbance. 7 he
same is true when it comes to RECBT’s view on anxiety. So, in this
chapter, I will present RECBT’s approach to the understanding of
anxiety and its healthy alternative which we call concern. As before,
I will then ask you to give your informed consent to proceed.
THE ‘ABC’ ELEMENTS OF ANXIETY

Here is a brief reminder of the 'ABC’ elements that I discussed in
Chapter i with reference to anxiety:
► ‘A’ stands for adversity or what you are most disturbed about
in a given situation.
2. Understanding anxiety and its healthy alternative, concern I5

► ‘B’ stands for the beliefs you hold about ‘A’ that largely
determine your responses at ‘C’.
► ‘C’ stands for the emotional, behavioural and thinking
consequences of ‘B’.
Thus, in understanding your anxiety, you need to know:
► what you tend to make yourself anxious about at ‘A’
► what beliefs you hold at ‘B’ about ‘A’
► how you act or tend to act at ‘C’ when you are anxious and
► how you subsequently think at ‘C’ when you are anxious.
WHAT YOU TEND TO MAKE YOURSELF ANXIOUS

ABOUT AT‘A’
In order to identify what you tend to make yourself anxious about,
it is first necessary for you to understand two concepts:
1 the personal domain and
2 inference.
Personal domain
The concept known as the ‘personal domain’ was originated in 1976
by Dr A. T. Beck, one of the grandfathers of Cognitive Behaviour
Therapy (CBT). Your personal domain has three features:
1 It contains people, objects and ideas in which you have an
involvement.
2 It is like an onion in that these people, objects and ideas
can occupy a central, intermediate and peripheral place
within it.
3 There are two basic realms within your personal domain - an
ego realm and a comfort realm. As you will see, anxiety can be
related to one or both areas.
Inference
An inference is an interpretation that you make about a situation
which goes beyond the data at hand and has personal meaning for
you. As such, you make an inference with respect to your personal
domain. An inference may be accurate or inaccurate and needs to
be tested against the available evidence. Often you do not know for
certain if an inference that you have made is accurate or inaccurate
and therefore the best you can do is to make the ‘best bet’ given the
data at hand.
16
Threat: the major inference theme in anxiety
People make the same type of inferences whenever they experience a
particular emotion in different settings. This is known as an inference
theme. For example, in depression common inference themes are loss
from the personal domain and failure within the personal domain.
When you are anxious, you are facing or think you are facing a threat
to some aspect of your personal domain. The aspect that you think is
being threatened helps to define the type of anxiety you experience.
For example, as I will show you in later chapters, when you experience
so-called ‘health anxiety’ the threat that you think you are facing is
different than the threat you think you are facing in social anxiety.
Insight
When you are anxious, you infer the presence of a threat to some aspect of
your personal domain.
THE CORE OF ANXIETY: IRRATIONAL BELIEFS AT ‘B’

According to RECBT, an inference of threat that you might make in
a situation does not account for your anxiety. It is possible for you
to make the same inference and be healthily concerned, but not
anxious -1 will discuss this shortly. In order for you to feel anxious
when you infer the presence of threat to your personal domain, you
have to hold an irrational belief.
As I explained in Chapter i, when you think irrationally you hold a
rigid belief and one or more extreme beliefs. While the rigid belief is
at the core of anxiety, the extreme beliefs that are derived from the
rigid belief often distinguish between whether you are experiencing
ego anxiety (where you depreciate yourself) or non-ego anxiety
(where you ‘awfulize’ or find the adversity intolerable). You may,
of course, experience both ego anxiety and non-ego anxiety in a
given situation.
Insight
Threat, on its own, does not make you anxious. Rather, you make yourself
anxious about threat by holding irrational beliefs about it.
THE CONSEQUENCES (‘C’) OF IRRATIONAL BELIEFS

ABOUT ‘A’
The RECBT view of anxiety is that when you perceive a threat
to your personal domain and bring a set of irrational beliefs to

that threat, then you will experience three major consequences -
emotional, behavioural and thinking - which collectively make up
the anxiety response.
The emotional consequence at ‘C’

Anxiety, then, is the emotion that you experience when you hold a
set of irrational beliefs about a threat. The intensity of your feeling of
anxiety will, in large part, depend on how central the aspect that is
being threatened is within your personal domain. The more central,
the more intense your anxiety will be.
THE SYMPTOMS OF ANXIETY
There are many bodily symptoms of anxiety, perhaps the most
common being the following:
pounding heart shaking, tremors and twitches

sweating muscle tension
stomach upset or dizziness headaches
frequent urination or diarrhoea fatigue
shortness of breath insomnia
As I will show you in the next chapter, you can also disturb yourself
about your anxiety symptoms, which can complicate the management
of anxiety.
Behavioural consequences at ‘C’

When you hold an irrational belief about a threat to your personal
domain and feel anxious, you will act or tend to act2 in a number of
ways, the most common of which are as follows:
You avoid the threat.

You withdraw physically from the threat.
You ward off the threat (e.g. by rituals or superstitious
behaviour).
You try and neutralize the threat (e.g. by being nice to people who
you are afraid of).
You distract yourself from the threat by engaging in other activity.
You keep checking on the current status of the threat hoping to
find that it has disappeared or become benign.
'An action tendency is an urge to act which can be suppressed or acted on. When the
latter occurs it becomes overt behaviour.
18
: You seek reassurance from others that the threat is benign.
: You seek support from others so that if the threat happens they
: will handle it or be there to rescue you.
: You over-prepare in order to minimize the threat happening or
: so that you are prepared to meet it (NB it is the over-preparation
: that is the problem here).
: You tranquillize your feelings so that you don't think about the
: threat.
: You overcompensate for feeling vulnerable by seeking out an
: even greater threat.
You will see from the above list that the main purpose of most of
these behaviours (and action tendencies) is to keep you safe from the
threat. However, such safety-seeking behaviour is largely responsible
for the maintenance of anxiety since it prevents you from:
► facing up to the situation in which you think that the threat exists
► dealing with the threat if it does exist, or
► seeing that your inference of threat is inaccurate if it is.
The final form of behaviour that I have mentioned in the list above
is worthy of comment. Some people are intolerant of the feeling
of vulnerability or non-coping that they experience when they are
anxious. They seek safety from the threat of non-coping by proving
to themselves in actuality that they can cope with a greater threat.
This is like a competition high jumper electing to jump a much
greater height than the one they have twice failed at. This is still a
safety-seeking measure in that the person seeks the safety that they
can cope with the smaller threat by proving to themselves that they
can cope with the bigger threat.
Insight
When you are anxious about a threat to some aspect of your personal
domain, you act in ways that prevent you from facing up to and dealing
effectively with that threat.
Thinking consequences at ‘C’

When you hold an irrational belief about a threat to your personal
domain and you feel anxious, you will tend to think in a number of
ways. The thinking that accompanies your anxiety is the result of
your threat being processed by your irrational belief and therefore it
is likely to be quite distorted.

There are two types of post-irrational belief thinking which are
important for you to understand in anxiety:
1 threat-exaggerating thinking
2 safety-seeking thinking.
It is worth noting that, in both types of post-irrational belief thinking,
such thinking may be in words or in mental images.
THREAT-EXAGGERATING THINKING
In the first type of post-irrational belief thinking that is associated
with anxiety - which 1 have called ‘threat-exaggerating thinking’ -
you magnify the nature of the threat and its consequences in your
mind as follows:
You overestimate the probability of the threat occurring.

You underestimate your ability to cope with the threat.
You ruminate about the threat.
You create an even more negative threat in your mind.
You magnify the negative consequences of the threat and minimize
its positive consequences.
You have more task-irrelevant thoughts than in concern.
SAFETY-SEEKING THINKING
The second type of post-irrational belief thinking that is associated
with anxiety is the thinking version of behaviour that is designed
to keep you safe in the moment. I call this form of thinking ‘safety
seeking thinking’. Here are some common examples:
You withdraw mentally from the threat.

You try to persuade yourself that the threat is not imminent and
that you are ‘imagining’ it.
You think in ways designed to reassure yourself that the threat is
benign or, if not, that its consequences will be insignificant.
You distract yourself from the threat - e.g. by focusing on mental
scenes of safety and well-being.
You over-prepare mentally in order to minimize the threat
happening or so that you are prepared to meet it (NB once again
it is the over-preparation that is the problem here).
You picture yourself dealing with the threat in a masterful way.
You overcompensate for your feeling of vulnerability by picturing
yourself dealing effectively with an even bigger threat.
20
In the final two forms of thinking the person is seeking safety from
the threat of non-coping by mentally creating images of masterful
coping.
One important point to note about these two forms of post
irrational belief thinking is that they are quite different: in ‘threat
exaggerating thinking’ you magnify the threat and in ‘safety-seeking
thinking’ you are thinking of ways to protect yourself against the
threat. You can, and people often do, switch rapidly between these
different forms of thinking, and to some extent the more your
safety-seeking thinking fails, the more you mentally elaborate and
magnify the threat.
Insight
When you are anxious about a threat to some aspect of your personal
domain, your thinking alternates between seeking safety and exaggerating the
nature and consequences of rhe threat. This prevents you from facing up to
and dealing effectively with the original threat.
Routinely used safety-seeking measures

in anxiety
A major reason why you may not benefit from facing threat - even
though, as I will discuss in Chapter 4, facing threat is the best way
to deal with anxiety - is that you may use a range of measures in the
situation in which the threat exists that are designed to keep you
safe in the situation. While these can be seen as behavioural and
thinking consequences of irrational beliefs of threat, I will treat
them differently here as their major purpose is to keep you safe
in the situation.
The effect of using these safety-seeking measures is that you do not
get to face the threat head-on and therefore never really experience
the benefit that doing so will give you.
Here is a list of safety-seeking measures commonly used by people in
situations that are potentially threatening.
BEHAVIOURAL SAFETY-SEEKING MEASURES

Behavioural safety-seeking measures are the actions you take in
situations that are potentially or actually threatening to you in
order to keep yourself safe from the threat. As 1 have said earlier,
2. Understanding anxiety and its healthy alternative, concern 21

the consequence of using such measures is that you do not gain
experience of actually facing and dealing with the threat.
Examples of such behavioural safety-seeking measures include:
► sitting at the end of a row so that you can get out of an
auditorium easily
► sitting at the back of a room so that you are unnoticed
► sitting by a fan to stop yourself blushing
► drinking alcohol to keep yourself from shaking
► using easy-to-pronounce words to stop yourself from
stammering
► asking for reassurance to convince yourself that the threat is
not real
► carrying out a variety of behavioural rituals all designed to show
you that the threat won’t occur (e.g. checking)
► carrying out a range of superstitious behaviours (e.g. having a
lucky charm with you to ward off threat).
THINKING SAFETY-SEEKING MEASURES

While behavioural safety-seeking measures involve you doing things
to keep yourself safe in situations that you find potentially or actually
threatening, thinking safety-seeking measures are internal ways of
achieving the same outcome. There are two types of such thinking
strategies: a) where the content of your thinking is important and
b) where the focus of your attention is important. Here are some
examples:
► seeking self-reassurance where you try to convince yourself that
you are safe from the threat or that the consequences of facing
the threat will be benign
► distracting yourself from the threat in some way (e.g. by
focusing on some non-threatening aspect of the threatening
situation).
While these safety-seeking measures largely interfere with you
facing up to and dealing with the threat, there is some evidence that,
if you use such a measure to get you into the situation and then
relinquish it so that you focus on and respond to the threat as it is,
then safety-seeking measures may have a beneficial effect.
22
Possible alternatives to anxiety
This book is about managing anxiety and, as such, you probably
have some idea about what you would accept as an alternative to
anxiety. I have noticed that when I ask clients in counselling who
suffer from anxiety what they would like to achieve as a result of
seeing me, they usually say one of the following:
► *1 don't want to feel anxious.'
► ‘I want to feel less anxious.'
► ‘I want to be cool and calm.’
► ‘I want to feel indifferent.’
► ‘I want to be in control.'
PROBLEMS WITH COMMON ALTERNATIVES TO ANXIETY

At first sight, the above alternatives seem reasonable, but there are
problems with each of them, which I will outline. Hopefully, my
arguments will dissuade you from setting any of them as your goals
with respect to managing your anxiety.
Problems with ‘I don't want to feel anxious’
If you have an anxiety problem and your goal is not to feel anxious,
then in my view' this goal is problematic for a number of reasons.
First, when you are anxious you are facing something that you find
threatening. This adversity is a negative event and therefore it is
healthy for you to experience a negative emotion, but one which is
healthy (unlike anxiety which is an unhealthy negative emotion).
It is not clear what you would be feeling about the threat if you did
not feel anxious, since ‘not feeling anxious' is not a feeling; rather,
it is the absence of a feeling.
Second, since ‘not feeling anxious' is not an emotion, you are, in
effect, saying that you want to live in an emotional vacuum in the
face of threat. That simply will not work. Humans do not live in
an emotional vacuum. So when you say that you don’t want to be
anxious in the face of threat, paradoxically you ensure that you will
remain anxious since, faced with a choice of feeling anxious vs. not
feeling anxious, you will experience the former since you cannot
experience the latter.

Problems with ‘I want to feel less anxious’
When you want to feel less anxious as an alternative to feeling
anxious, you are in fact saying that you still want to experience a
less intense version. This is a bit like saying that if you have cancer
you want to keep your cancer, but reduce the size of your cancerous
growth. In order to achieve this emotional goal, you would have to
reduce the intensity of your desire not to experience the threat, but
retain your irrational beliefs about the threat. As you will see, there
is a much better and less complex alternative to anxiety than reducing
the intensity of this emotion.
Problems with ‘I want to be cool and calm’
As I have mentioned several times, when you are anxious you are
inferring the presence of a threat. When you want to feel cool and
calm instead of being anxious, you will lack the motivation to do
anything about the threat. It is again worth stressing that threat is a
negative event and therefore it is appropriate and healthy for you to
feel a negative emotion when you face such an event as long as this
emotion is healthy. The state of being cool and calm is a positive
state rather than a negative one and therefore by setting coolness and
calmness as a healthy alternative to anxiety, you are saying that you
want to feel positive about a negative event. I hope you can see that
this is not realistic and will involve you lying to yourself because you
will be attempting to convince yourself that it is good that this threat
exists. This won’t work.
Problems with ‘I want to feel indifferent’
The main difficulty with indifference as an alternative to anxiety is
similar to that with coolness and calmness. Indifference is a neutral
response which is based on the belief that you don’t care whether or
not the threat about which you were previously anxious exists. While
anxiety is an unhealthy negative emotion, one thing that it does show
is that you do care whether or not the threat exists. Indeed, since
when you are anxious you are demanding that the threat not exist,
you can be said to care too much about the existence of the threat.
If you try to convince yourself not to care about something about
which you previously cared too much, you will need a great deal of
self-deception to succeed. In my view, self-deception has little or no
place in the management of anxiety and, even if you do convince
yourself to be indifferent about a threat to your personal domain,
such conviction is likely to be unstable and temporary.
24
Put another way, when you infer the presence of a threat to your
personal domain, then this represents in your mind at the very least
a negative event. As 1 have pointed out several times already, it is
healthy to experience a negative emotion about a negative event
as long as this negative emotion is based on a rational belief rather
than an irrational belief. Since indifference is neutral, whether it is
regarded as a belief or an emotion, it is not a healthy response to an
adversity such as threat.
Problems with ‘I want to be in control’
You might think that there is nothing wrong with wanting to be in
control rather than anxious in the face of a threat to some aspect of
your personal domain. In some ways, you would be correct, but
the concept of self-control is a difficult one and when my clients say
that for them the healthy alternative to anxiety is to be in control
of themselves, I ask them to clarify what they mean. By being in self
control, most people mean that by applying certain techniques they
will not be anxious (see the previous discussion of the problems with
‘not feeling anxious’). The trouble with this goal is that it is often
underpinned by a rigid belief about self-control (i.e. ‘I must be in
control of myself’) which renders the person anxious about not being
in control. As such, with this belief you will be anxious if you are not in
control and also if you are in control (because you might begin to lose
self-control). In this way, the goal of being in control is problematic.
However, the concept of self-control can be looked at very differently
and this time from the perspective of holding a flexible belief about
self-control (e.g. ‘I would like to be in control of myself, but I don’t
have to be’). Applying this belief to the sense of not being in control
that you have when you are anxious, you will not be anxious about
being anxious (see Chapter 3 for an extended discussion of anxiety
about anxiety); rather you will be concerned about it (see below).
This flexible belief will help you to develop an accepting attitude
towards not being in control, which will help you to gain a sense of
control. This contrasts with the idea that self-control occurs when
you apply a set of techniques which gets rid of anxiety. For this
reason, I call the former ‘acceptance-based self-control’ and the
latter ‘elimination-based self-control’. So, if by self-control you mean
acceptance-based self-control, that is a healthy alternative to anxiety,
whereas if you mean elimination-based self-control, it is not. I discuss
managing anxiety about losing self-control more fully in Chapter 8.

Understanding concern: the RECBT
perspective on the healthy alternative
to anxiety
In this section, I am going to outline RECBT’s perspective on concern,
which is seen as the healthy alternative to anxiety. In doing so, I will
again refer to the 'ABC part of the ‘ABCDE’ model.
In the previous section, I discussed several alternatives to anxiety that
people mention as goals. During that discussion, I made clear what
criteria a healthy alternative to anxiety would have to meet. Thus,
it would have to be:
1 realistic - it would have to be a negative emotion since the threat
is a negative event
2 healthy - the negative emotion would have to be healthy
3 based on rational beliefs - the RECBT model outlines the general
view that rational beliefs underpin healthy negative emotions in
the face of adversity. This would therefore have to be the case in
the specific instance of the healthy negative emotion alternative
to anxiety.
In RECBT, concern is seen to meet these three criteria and is therefore
the healthy alternative to anxiety in the face of threat.
Insight
Concern is the healthy alternative to anxiety in the face of threat. Concern is
realistic, healthy and based on rational beliefs.
THE 'ABC9 ELEMENTS OF CONCERN

In understanding concern, you again need to identify:
► your‘A’
► what beliefs you hold at kB' about ‘A’
► how you act or tend to act at ‘C’ when you are concerned and
► how you subsequently think at ‘C’ when you are concerned.
WHAT YOU TEND TO MAKE YOURSELF CONCERNED

ABOUT AT‘A’
As concern is the healthy alternative to anxiety, you are aiming to
be concerned about the same 'A' about which you were previously
anxious.
2.6
THE CORE OF CONCERN: RATIONAL BELIEFS AT ‘B’
In order for you to feel concerned, but not anxious, when you infer
the presence of threat to your personal domain, you have to hold a
rational belief.
As I explained in Chapter i, when you think rationally you hold a
flexible belief and one or more non-extreme beliefs. According to
RECBT, a flexible belief is at the core of concern and non-extreme
beliefs are derived from this flexible belief. A flexible belief and
unconditional self-acceptance underpin ego concern whereas a
flexible belief and a non-awfulizing belief or a discomfort tolerance
belief underpin non-ego concern. You may, of course, experience
both ego concern and non-ego concern in a given situation.
THE CONSEQUENCES (‘C’) OF RATIONAL BELIEFS

ABOUT ‘A’
The RECBT view of concern is that when you perceive a threat
to your personal domain and bring a set of rational beliefs to that
threat, then you will again experience three major consequences -
emotional, behavioural and thinking - which collectively make up
the concern response.
The emotional consequence at ‘C’
Concern, then, is the emotion that you experience when you hold a
set of rational beliefs about a threat. The intensity of your feeling of
concern will, in large part, depend on how central the aspect that is
being threatened is within your personal domain. The more central,
the more intense your concern will be.
Behavioural consequences at ‘C’
When you hold a rational belief about a threat to your personal
domain and feel concern, you will act or tend to act in a number of
ways, the most common of which are as follows:
You face up to the threat without using any safety-seeking

measures.
You take constructive action to deal with the threat.
You seek support from others to help you face up to the threat
and then take constructive action by yourself rather than rely on
them to handle it for you or to be there to rescue you.
You prepare to meet the threat but do not over-prepare.
2. Understanding anxiety and its healthy alternative, concern

Insight
When you are concerned, but not anxious, about a threat to some aspect of
your personal domain, you act in ways that encourage you to face up to and
deal effectively with that threat.
Thinking consequences at ‘C’

When you hold a rational belief about a threat to your personal
domain and you feel concern, you will tend to think in a number of
ways. The thinking that accompanies your concern is the result of
your threat being processed by your rational beliefs and is likely to be
realistic and balanced, as can be seen below. Such thinking may be in
words or pictures.
You are realistic about the probability of the threat occurring.

You view the threat realistically.
You realistically appraise your ability to cope with the threat.
You think about what to do concerning dealing with the threat
constructively rather than ruminate about the threat.
You have more task-relevant thoughts than in anxiety.
Insight
When you are concerned, but not anxious, about a threat to some aspect of
your personal domain, your thinking about the nature and consequences of
the threat is realistic and balanced. This encourages you to face up to and deal
effectively with the threat.
Why you are prone to anxiety

While you may be temperamentally or genetically predisposed
to experiencing anxiety, I will be concerned here only with
psychological factors. Thus, if you are particularly prone to anxiety
you will be particularly sensitive to seeing threat where others, who
are not prone to anxiety, do not. In this section, 1 will explain why
you overestimate threat.
WHY YOU OVERESTIMATE THREAT

This is how you come to overestimate threat in your area of
vulnerability. I will illustrate this with reference to a common
general belief that people hold: 7 must not he criticized and if I am
I am worthless.'
28
► You take the threat theme of your general irrational belief, being
criticized, from the general irrational belief:
‘I must not be criticized and if I am I am worthless.’
► You construct a second general irrational belief that features
uncertainty about the original threat theme:
‘I must be certain that I won’t be criticized. 1 can't bear
such uncertainty. ’
► You bring this second general irrational belief to situations where
it is possible that you may be criticized and you make a threat-
related inference in the absence of certainty from the threat:
'Since I don’t have certainty that I won’t be criticized then
I will be criticized.'
► You focus on this inference and bring a specific version of your
original general irrational belief to this inference. For example:
Inference: ‘My boss will criticize me when I show him the
report.’
Specific irrational belief: ‘My boss must not criticize me
when 1 show him the report and I'm worthless if he does.’
I will discuss how to become less vulnerable to anxiety in Chapter 4.
Insight
You are particularly prone to anxiety when you overestimate the presence of
threat in your area of vulnerability. This occurs when you bring to ambiguous
situations the demand that you must know that the threat is absent. If you
don’t know this then you conclude that it is present.
I have now outlined the RECBT view of anxiety and concern, the
healthy alternative to anxiety. Having informed you about this, I am
again going to ask you to give your informed consent to proceed.
I (state your name).................................................. have read the

above material and understand RECBT’s view of anxiety and
concern. This makes sense to me and I give my informed consent
to proceed with the book.
Signed....................................................................
Date.......................................................................

In the next chapter, I will discuss a phenomenon which makes
managing anxiety particularly problematic. This is where, having
made yourself anxious about a particular threat to some aspect of
your personal domain, you focus on some aspect of your anxiety that
is particularly threatening to you and you make yourself anxious
about this second threat.
30
THINGS TO REMEMBER
► You make yourself anxious about an actual or inferred threat to
some aspect of your personal domain. The threat does not make
you anxious.
► When you are anxious about a threat, you hold irrational beliefs
about it.
► When you are anxious, you act and think in ways that prevent
you from facing up to and dealing effectively with threat.
► Many people think that healthy alternatives to anxiety involve

not being anxious, feeling less anxious, being cool, not caring
or being in control. All these alternatives are problematic in that
they are unrealistic, unhealthy and not based on rational beliefs.
► Concern is the only viable healthy alternative to anxiety in the

face of threat since it is realistic, healthy and based on rational
beliefs.
► When you are concerned, but not anxious, you act and think
in ways that encourage you to face up to and deal effectively
with threat.
► You are particularly prone to anxiety because you tend to

see threat when it is not there. You do this because you can’t
convince yourself that the threat is absent, so you conclude that
it is present. Your need to be certain that the threat is absent is
the main culprit here.
2. Understanding anxiety and its healthy alternative, concern 3I

How you make yourself
disturbed about anxiety
• that people not only make themselves anxious about threat, they
can, and often do, disturb themselves about their self-created
anxiety
• the major unhealthy negative emotions you may feel when you
disturb yourself about your anxiety
• what you disturb yourself about when you disturb yourself
about anxiety (the themes at 'A9)
• the healthy alternatives to the major disturbed emotions
about anxiety.
Introduction
One of the features of being human is that once we have disturbed
ourselves about an adversity, we can then focus on this disturbance
(or one or more of its features), which becomes a new adversity, and
then we disturb ourselves about this second adversity. The technical
term for this second level of disturbance is meta-disturbance, which
means 'disturbance about disturbance’.
In this chapter, I will consider what happens when you first make
yourself anxious about an adversity and then disturb yourself about
your anxiety or one or more of its features. I will consider, discuss
32-
and provide examples of some of the major types of this secondary
disturbance (as some people call it).
In this chapter, 1 will assume that you have made yourself anxious
about some threat to an aspect of your personal domain and I will
focus on what happens when you disturb yourself about this
original anxiety.
Before I present the ‘ABCs' of secondary disturbance about anxiety,
let me make two important points about such disturbance:
► The existence of secondary disturbance about anxiety may well
prevent you from managing your original anxiety.
► Secondary disturbance about anxiety may end up being more of
a problem for you than your original anxiety.
Understanding the ‘ABCs’ of your secondary

disturbance about anxiety
In this section, I will use the ‘ABC' framework, but will use a
fcCAB' sequence as the latter is the preferred sequence in the
assessment of emotional problems (see Chapter z).
‘C’; YOUR DISTURBED EMOTIONS ABOUT ANXIETY

When you disturb yourself about feeling anxious, it is important
that you identify as precisely as you can the unhealthy negative
emotion that you experience. Here is a list of the most common
disturbed emotions that people experience about their anxiety:
anxiety, depression, guilt, shame and unhealthy anger. When you
come to assess your meta-disturbance, it is best to deal with one
unhealthy negative emotion at a time.
If you find it difficult to identify your emotion by the feeling alone, you
may find it useful to refer to your behaviour (including your action
tendencies) and the thinking that accompanies your feeling. In Table 3.1,
in the left-hand columns, I present both the behaviour and the thinking
that accompany depression, guilt, shame and unhealthy anger.5 This
may help you to identify your disturbed meta-emotion at ‘C.
’I have listed the behaviour and thinking that accompany anxiety in Chapter 2.
3. How you make yourself disturbed about anxiety

z X> X> U-
z <Z 4- z 0 TO
C TO
TO
Cz CX
X>
X)
(Z) o
XJ
TO
X) c
z X*
a.
x>
z z cz
=3 o XJ TO
o z Z ex
D- < X)
z Z x> x>
z TO
'Ji
TO
TO x>
cz TO
X)
a. >
Z o E □ z (Z z o
X)
Z z z c
z z C Z o z Z TO z O
• <X> H a TO
z
z z c
z < o
£ U
<3 o
CL OX X)
cz> c x> x>
o X>
x>
X)
TO o
<3 E x» z Z x»
§
o z
iT) TO TO
iz TO
£ u Z QJ
z
OX
TO TO
X) <S)
TO TO
Z
•O o
•Ka TO
•—<
X) TO
X)
c
X) X» O
cz
o X>
E TO TO
x> u TO
C z
X)
s O s- c x> z OX O
X)
OX U| □ z a
C
TO Z Z E x> C X) E TO
• •<* z x> o o o
o z
u TO z E
O a TO
Z X> C X) E
x>
(Z) TO z
z x>
o
Z Z ox Eo z o
GJ X>
N O
Z TO
c o c
<3 X)
TO
TO c X) TO XJ
^0 CX z X)
x» o z - c o z
z Z Z
X)
£ x> z x>
z
cz
z ex a
t- TO tz x> Z TO a ex x>
z z c Z c X> x» z
cj TO
□
-S X
< O O o TO X» X)
Q-
c z a TO
x>
ex Z
ox
c X) TO Z
TO
£ TO O >
TO5 <z
u*
z OX
X>
X)
X) O
X)
(Z)
X>
XJ
</•«
z h z □ z □ CJ
Z TO
z
ex TO TO
o z o z z z ex
X) TO
CZ O X> X>
£ < x> o Z a OX
o O
<3 Q£ cz c XJ o
c
£ <3 c4
o
O
o <3
■c
•"». 8
K L. • ***•o •o
***
Xj
X> o
<3 £ 5 X)
IX) UQ CQ
34
o OX)
c (/)
r? c as st
 □
3 c o
X)
o X*
O
03 3 u
U O o </) c
X* 3 as
<S) x* O
3
o o X*
x>
as
X o 3 3 X)
3 03
3 3 X*
O X*
aS 3 3 'y>
03
3 X* 3 X*
u-
5 c 3
U U X*
(J E X*
C/5 O as O 3
x*
cj
X*
o x>
3
03
x»
as
QJ
c E X
3 x» a
X*
5 3
3 3
X*
X 3
3 x*
<L* 5 3
3
X* x>
□ □ 3 3 3 c
03 3
O O O O x* O
O 3
O X* >-
x*
X*
(J
c
X» x* 3
O X* </5
Qu <L* X*
*—
o x» X> X
3
3
-3 X*
*- O 3
O X* 3 O
O
C X)
& X* X*
ezi
X
aS
X*
3
X 3 a
03 3
3 X* O
3
o 3 C X> <7) >
X*
x* “ o x> O
3 i_ a-* CX x;
X* X*
Q. □ >
r
(/) L-
a X* o O
E
X> 3
3 (Z)
X* O X* 3
a> E
X
X* 3
3 E 03 
3 3 X>
X*
CX
V)
X*
3 3 X*
3 E 3
(J X* X* O
X
3 X*
L» as
E as E X 3 x>
o x* 
□
O
□ X* □ C
3
O O O O o
<L*
.E >
s:
x*
CO

Anxiety vs. Concern
afety-seeking thinking:
You withdraw mentally from the threat.
You try to persuade yourself that the
threat is not imminent and that you are
You picture yourself dealing with the threat

in a masterful way.
You overcompensate for your feeling of
vulnerability by picturing yourself dealing
effectively with an even bigger threat.
<L>
c
<D x
03 cr <D □ as
<v
— c
C3 O
(/)
cjj
<D
u
*—• os a O
O d>
■-*-
L> □ b£ <Z)
aS
o <73
<73 s <73
5 <73
C
2 O O
03
a o c <73
d> <D <D
bfj a OJ
dj
c/> b£) C C5
E aS *- E <73 M Q
N
•—4
o Cl c -4= c
u 3D —
C x>
<L> •~ b£) O
c o 3£ dj
O -
—-
a_> OJ 52 a O <73
03 c 
u
<73 o
£
C
— c
dJ
□ □ E dJ
o OJ ■1> o o o o <73 cx
□ OS u
c C <v
'73 '^) o <73 o
as
5 c CS
<73 <D
c CJj C3
c/> c d^ o 
03 <V
(V

a>
aS
ex
<73 5 a □
o dJ O d> o O o O
a O C3 5
o Q. as '-*-«
C5
c
o
c/>
d£
X 5
"§
□
□
OS -
X dJ
c/>
c OS dJ
o o 5 c
V)
<Z)
'X c/> □
d> c/)
o e
£X -± 03
9-:
x : c/)
Q : C C
o d> dJ
c/5 </> :/j
OJ dJ X
CX
dJ <U dJ
X x X
c C
OS 0303
□ □
o o O
C^
—
K. 53
O
'-6
X
X
X £
^3
c-n

38
o
a
You see the world as full of undeservedness
and unfairness (in plight-based depression).
You tend to ruminate concerning the source
of your depression and its consequences.
C/2
cc
GJ
3 3 £
GJ O
Cd C /■
GJ
CL 3 Cd Z GJ
Cd Z CZ 3
3
rd *-
O o 0
3
cz
gj
GJ
V-
3 y 3 3
GJ O GJ CL
O 3 O Cd
O
C/2
E cz
GJ
o
CL cd GJ
cd cd cd 'J2
cd
Gj
N GJ GJ GJ 3
<J
o
c cd <z
cd GJ 3 X O
GJ
GJ Z cd cz
Q.
GJ
Q
GJ
C CL GJ GJ
GJ
o 3 Z cd
3 o
Z C
cd
z CL u_
cd GJ
C/2 o Q- Q.
GJ
Q_ O 3 cd z CJ
3 GJ
GJ C c GJ GJ z L>
GJ cd 3 o rd c 3 p cd
3
cr, c cz
o C3 o O z o
Cd C/2
gj
CZ
E cd cd >
o GJ
3 3
GJ
3
3
cd
3 3
cd cd
3
c 0 u
cd Z z Z Z GJ Z O GJ GJ O
•Z E cd 3
□ u
o
X
a
Cd Z
Gj
Cl
z
CL 3 o
CL Z
3
O
o
3 3
3
cd
Z Z
c rd
cz
gj GJ Z G
cd
O
C^
Gj GJ
ITi cd c^ 3
c CL rd
GJ
'-J GJ Gj
rd 3 CZ
& E cd
E
Gj G o CL
3
GJ z C/2 Z
rd O
gj Gj
cz CZ
cd C/2 '/2
Gj GJ
rd
Gj
Gj
o
CZ
GJ Z E CL GJ 3 3
gj o 3 O GJ
GJ
E CL GJ
o Z S3l .22
CL O
Gj <Z Gj
rd . 3 cz,
< GJ
&
.E C z 3
3
X
Z Cd GJ
CL
Z E
o cd 3 rd Gj Z U
GJ
3 U
Gj Gj
3 o 'J2
Gj 3-
CL
cd CL y
GJ c
□ 3 - 3
Z
u
CZ 3
Z
3
Z Z-
3 z 3
C o < *—
3
O cd GJ O O
n£ □
aS u
£
S
*-*
• *** O
O
-
O <3
£
CQ

05
S) u-
<L>
os
o 05 (L>
05
(J 
O (D as O
a-> bn as
c co 3 □
a <D p
v-

□ b£
O <U o aS
u o- o O
05 co cu U
Q
aS C aS c '-J E ■£ o
c
as
o bO
C
as O C
□ S <L»
o
a C (D <S) as 3 o
0£ E c □ O
<D <D o
□ CO
co
aS S's,, s, □
C
u
as
o as
aS a C OS X
C
<D as
o
as
o
CL Q-»
□ o c □ co □ 3
O
a O O co O O
C
o aS □ O
CO o O
o

o aj
co
O co
CO O
c
’Si o
co c □
o
o CO a as
s as □ <D (U

tw
a Q O as
o
co
a
L> aS CO co
5 C '■J
as as
a
b£
u O □
O a
aS
C
O
O o as 0
o co co
IO v-
□
S) E 3
as
o aj as 
=3 co □ o
c co a O X
S O o

E S) c
bD
as o a C <L> aj
□ E o o □
C
o
co
co
QJ co
co
co u-
QJ o C X
c
X
c
O Z
E aS aS
co □
o
aj
co <D as
aS as
C
o
□
E 3 c C □ □ □ qj
o as aS o
□ as (D
□ H <u
o o o o 0 O o <
u O
O E
a: -c
£
bO
I’.s
• K
O
•Si •*—
o
3
s
LU
40
Behaviour ► You remove yourself from the ‘gaze’ of ► You continue to participate act:
others. social interaction.
► You isolate yourself from others. ► You respond positively to atterr
► You save face by attacking other(s) who others to restore social equilibri
have ‘shamed ’ you.
you (or your reference group) will receive. disapproval you (or your refere
You overestimate how long any disapproval group) will receive,
will last. ► You are realistic about how Ion
disapproval will last.

O <D <D OX)
OX) o cz OX) 75
OX)
c 3 73
c 73
75 O □ 3
75 "
o
5
o
o O
u o 75
O
Q- 73 CD 73 75 <D
3
E CD
□ CD
75
<D 5 c
c
75 □ iD z CD
E E
Cfj o C (D o 3
a cz
cz 3
Q
> OX) CD
D 73
o
c
c o
<D < a
CD
U <D
c 73 73
c
■z z 73 73
73 'Z
CD O
O
73
3
O o 3 3 3 3 3 □
O O O O o
E X H 75
O
>
3
o
u-
c
op: 73
a X
CD
CD <D
z
□
□
o <D
o 75 cz
CD
3 73 3
X : 01)
a
ID O
CD
CD OJ o
CD
■D
c 75
o
□ E
CD
cz
CD
Z
c c
□ □
3
73
o 73
3 o c
o
Z E 3
z <D O
Z O
z <D
75 75
3 OX) cz
§ <D cz
CD
CZ
CD * OX) 3 <D
<D 73 O
75 CD <D OX)
cz
0£ OX)
£ C 3
<D <D 75 C
<D (Z cz o
cz cz 73
2
U-
<D
<D CD
CD ID
573 CD
CD OX) OX)' OX) CD 75
CD
< 3 OX)
73
OX)
73
73 3
(D
X
3 z 73
<D CD z
o
c
3
E
73 73
o 75 75
73 O
U.
O
□ □ 3 3
o 3 § <D
73 □
O o <D o O O o 2
3 o 75
o
Insight
If you are unsure which disturbed emotion you experience about anxiety look at
your accompanying behaviour and thinking to help you to select the emotion.
‘A’.- WHAT YOU ARE DISTURBED ABOUT WITH

REFERENCE TO YOUR ANXIETY
As 1 discussed in Chapter i, 'A’ in the ‘ABCDE’ framework stands for
the aspect of a situation about which you are most disturbed. This
represents for you an adversity. The reason 1 suggested beginning
with ‘C’ when understanding your disturbed emotional reaction
to anxiety is because each of the five unhealthy negative emotions
listed in the previous section reflect different inferential themes in
relation to your personal domain.4 In this section, I will outline the
inferential themes with respect to anxiety, depression, guilt, shame
and unhealthy anger when these emotions are about anxiety.
Themes in anxiety about anxiety

When you are anxious about anxiety, it is clear that you think of
your original anxiety as some kind of threat. The most common
of these threats are:
► Anxiety is emotionally painful.
► ‘Anxiety means I am losing self-control.’
► ‘If I experience anxiety, it will mean that I have a personal weakness.’
Themes in depression about anxiety

When you are depressed about your anxiety your anxiety represents
something about which you feel depressed. There are three such major
representations and these should be regarded as inference themes at ‘A’.
1 Your anxiety represents personal failure within your personal
domain.
2 Your anxiety represents loss within your personal domain.
3 Your anxiety represents an undeserved plight.
Themes in guilt about anxiety

When you feel guilty about your anxiety, your anxiety represents the
following, which should be regarded as inference themes at ‘A’:
► Your anxiety represents a moral failing.
► You hurt someone’s feelings when you are anxious.
‘You will recall that the major inferential theme in anxiety is ‘threat’ to some aspect of
your personal domain.

Themes in shame about anxiety
When you feel ashamed about your anxiety, your anxiety represents
the following, which should be regarded as inference themes at 'A’:
► Your anxiety represents you falling very short of your ideal.

► Your anxiety represents a personal weakness.
► When you are anxious you think that you have let down a
reference group.
Themes in unhealthy self-anger about anxiety
When you feel unhealthily angry towards yourself for feeling
anxious, your anxiety represents the following, which should be
regarded as inference themes at 'A':
► Your anxiety represents you blocking yourself from achieving

an important goal.
► You have broken a personal rule when you feel anxious.
Insight
Each disturbed emotion has specific themes which will help you identify the
aspect of your anxiety you are most disturbed about.
B’: YOUR IRRATIONAL BELIEFS LARGELY DETERMINE

SECONDARY DISTURBANCE ABOUT ANXIETY AND ITS
REPRESENTATIONS
The RECBT model makes clear that when you disturb yourself about
your anxiety you do so largely because you hold a set of irrational
beliefs about the inferences that you make with reference to your
anxiety. Here it is useful to distinguish between ego disturbance and
non-ego disturbance.
Secondary ego disturbance

In ego disturbance you disturb yourself in areas related to the
ego (or self-esteem) realm of your personal domain. In secondary
ego disturbance about anxiety, you hold a rigid belief and a
self-depreciation belief about a perceived threat to the ego realm
of your personal domain (e.g. anxiety is personal failure or a
weakness).
‘A’ = Anxiety poses a threat to the ego realm of my personal domain

‘B’ = Rigid belief and a self-depreciation belief
‘C’ = Ego disturbance
44
For example:
‘A’ = My anxiety is a personal weakness
‘B’ = 1 must not have this personal weakness and I am defective
because I have
‘C’ = Shame
Secondary non-ego disturbance
In non-ego disturbance you disturb yourself in areas related to the
non-ego comfort realm of your personal domain. In secondary
non-ego disturbance about anxiety, you hold a rigid belief and
either an awfulizing belief or a discomfort intolerance belief about
a perceived threat to your comfort (e.g. anxiety is emotionally
painful, anxiety means I am beginning to lose self-control):
‘A’ = Anxiety poses a threat to comfort
‘B’ = Rigid belief and a self-depreciation belief
‘C’ = Non-ego disturbance
For example:
‘A’ = Anxiety is painful
‘B’ = I must not experience such pain and I could not bear it if I do
‘C’ = Anxiety
Insight
Disturbed emotions about anxiety are based on irrational beliefs. When such
disturbance is ego-related it is based on a rigid belief and a self-depreciation
belief. When such disturbance is discomfort-related it is based on a rigid belief
and either an awfulizing belief or a discomfort intolerance belief.
Understanding healthy alternatives to

secondary disturbance about anxiety using
the ‘ABCs’ of RECBT
In this section, I will again use the ‘CAB’ sequence to show RECBT’s
perspective on the healthy alternatives to secondary disturbance
about anxiety.
*€’.• YOUR HEALTHY NEGATIVE EMOTIONS ABOUT

ANXIETY
I argued earlier that when you disturb yourself about feeling anxious,
it is important that you identify as precisely as you can the unhealthy

negative emotion that you experience. It is now time for you to identify
the healthy alternatives to these disturbed emotions.
A healthy alternative to an unhealthy negative emotion is
► negative - after all, your ‘A’ (i.e. your inference about anxiety)
is negative
► healthy - unlike your unhealthy negative emotion its healthy
alternative will be associated with constructive behaviour and
realistic and balanced thinking.
Here is a list of the most common disturbed emotions that people

experience about their anxiety and their healthy alternatives:
► anxiety - concern
► depression - sadness
► guilt - remorse
► shame - disappointment
► unhealthy anger - healthy anger.
In Table 3.1,1 list the behaviour and thinking that accompany

both the unhealthy negative emotions (listed on the left) and their
healthy alternatives (listed on the right) so you can see at a glance
the differences that will accrue to you if you experience the latter
rather than the former.
‘A’.- THE THEME OF YOUR HEALTHY RESPONSE IS

THE SAME AS THE THEME OF YOUR DISTURBED
RESPONSE
As I discussed in Chapter 1, ‘A’ in the ‘ABCDE’ framework stands
for the aspect of a situation about which you are most disturbed.
This represents for you an adversity. Now that you have identified
the healthy alternative to your disturbed emotion about anxiety or
its representations, you need to understand one important point.
Your ‘A’ is the same whether your response is disturbed or healthy.
Thus, the themes that 1 outlined earlier in anxiety about anxiety,
depression about anxiety, guilt about anxiety, shame about anxiety
and unhealthy anger about anxiety are exactly the same as the themes
in concern about anxiety, sadness about anxiety, remorse about
anxiety, disappointment about anxiety and healthy anger about
anxiety. This is shown in Table 3.1.
46
For example, if you feel ashamed about being anxious because you
think that it represents a personal weakness, your healthy alternative
and, as I will show you in the next chapter, your initial therapeutic-
goal needs to be disappointment rather than shame. Now, you
might say at this point surely the best thing is to rethink the idea that
anxiety represents a personal weakness. Why work towards being
disappointed rather than ashamed about this personal weakness, if
you can see that it is not really a personal weakness? Well, in saying
so you would be both right and wrong.
You would be correct in that it is important for you to revisit the
inference that anxiety is a personal weakness at some point in the
change process. However, the time to do this is when you are not
disturbed (i.e. disappointed) about the personal weakness. If you
were to rethink the idea that anxiety is a personal weakness when
you are ashamed about it, this disturbed reaction would interfere
with the clarity of your thinking and you would be more rather than
less likely to conclude that anxiety is a personal weakness when
ashamed.
In short, in RECBT we argue that the best time to investigate your
inferences at ‘A’ is when you hold rational beliefs at ‘B’.
‘B’: YOUR RATIONAL BELIEFS LARGELY DETERMINE

YOUR HEALTHY RESPONSE TO ANXIETY AND ITS
REPRESENTATIONS
The RECBT model makes clear that your healthy responses (emotional,
behavioural and thinking) to anxiety depend in large part on you
holding a set of rational beliefs about the inferences that you make
about your anxiety. Let me first outline the rational beliefs that underpin
the healthy alternative to secondary ego disturbance about anxiety.
Rational beliefs that underpin healthy alternatives to secondary

ego disturbance
In the healthy alternative to secondary ego disturbance about anxiety,
you hold a flexible belief and an unconditional self-acceptance belief
about a perceived threat to the ego realm of your personal domain
(e.g. anxiety is a personal failure or a weakness).
‘A’ = Anxiety poses a threat to the ego realm of my personal domain
‘B’ = Flexible belief and unconditional self-acceptance belief
‘C’ = Ego health
3. How you make yourself disturbed about anxiety 47

For example:
fcA’ = My anxiety is a personal weakness
‘B’ = I would prefer not to have this personal weakness, but that does
not mean that I must not have it. If I do, it does not mean that
I am defective. It means that I am a fallible human being who
makes himself anxious
‘C’ = Disappointment
Rational beliefs that underpin healthy alternatives to secondary

non-ego disturbance
In the healthy alternative to secondary non-ego disturbance about
anxiety, you hold a flexible belief and a non-awfulizing belief or a
discomfort tolerance belief about a threat to the non-ego comfort
realm of your personal domain.
‘A' = Anxiety poses a threat to comfort
‘B’ = Flexible belief and a discomfort tolerance belief
‘C’ = Non-ego health
For example:
CA' = Anxiety is painful
‘B' = I would rather not experience such pain, but that does not mean
that I must not experience it. If 1 do, it would be hard to bear,
but I could bear it and it would be worth it to me to do so
‘C’ = Concern
Insight
Healthy negative emotions about anxiety are based on rational beliefs. In the
ego-related domain these emotions are based on a flexible belief and an
unconditional self-acceptance belief. When such emotions are discomfort-related
they are based on a flexible belief and either a non-awfulizing belief or
a discomfort tolerance belief.
In Chapter 4,1 outline general principles about how to manage

anxiety. You can also use these principles to deal with your feelings
of depression, shame, guilt and unhealthy anger about your anxiety.
Also, you may want to consult my book Be Your Own CBT Therapist
(Hodder, 2.011) to help you in this respect.
48
This brings to a close the part of the book that is devoted to
helping you understand RECBT and what general light it sheds
on understanding anxiety and concern (its healthy alternative).
In the next part of the book I will show you how to use RECBT
to manage your anxiety in general terms and how to apply it in
specific situations. In Chapters 5-8,1 will apply this theory to the
management of different forms of anxiety.

THINGS TO REMEMBER
► Once people make themselves anxious about threat, they often
disturb themselves about some aspect of their anxiety.
► The major unhealthy negative emotions you may feel when you
disturb yourself about your anxiety are anxiety, depression, guilt,
shame and unhealthy anger. The behaviour and thinking that
accompany your disturbed emotion about anxiety will help you
to identify it.
► The theme of your disturbed emotion will help you to identify

the aspect of your anxiety you are most disturbed about.
► Your disturbed emotions about anxiety are based on irrational

beliefs.
► When such disturbance is ego-related it is based on a rigid

belief and a self-depreciation belief. When such disturbance
is discomfort-related it is based on a rigid belief and either an
awfulizing belief or a discomfort intolerance belief.
► The healthy alternatives to the major disturbed emotions about

anxiety are concern, sadness, remorse, disappointment and
healthy anger.
► Your healthy negative emotions about anxiety are based on

rational beliefs.
► In the ego-related domain, healthy negative emotions are based

on a flexible belief and an unconditional self-acceptance belief.
When such emotions are discomfort-related they are based on a
flexible belief and either a non-awfulizing belief or a discomfort
tolerance belief.
50
How to manage anxiety: general
principles and strategies
in this chapter, you will learn:
• how to determine whether you are feeling anxious about threat
or concerned, but not anxious, about it
• how to assess the important elements that explain your anxiety
• the importance of setting realistic targets for dealing with threat
• why you may be prone to perceiving threat and what you can do
about it.
Introduction
In this chapter, I will show you how you can manage your anxiety
in general; I will concentrate on managing specific, everyday forms
of anxiety in later chapters. Please note that I will not cover severe
forms of anxiety which are significantly debilitating such as panic
disorder, agoraphobia, post-traumatic stress disorder and specific
phobias. These are best dealt with using relevant face-to-face
psychological help. Your GP will effect a suitable referral for help
with these clinical problems. So, in this book, I concentrate on more
everyday, and less debilitating, forms of anxiety. Having said that,
since any form of anxiety is painful, I do not mean to minimize
your problem with anxiety. Rather, I mean to be optimistic and
show you how to manage forms of anxiety which, while painful,
are amenable to self-help with the use of a book such as this.
Before I begin, I want to stress that I am only discussing managing
anxiety that is psychologically based. It sometimes happens that
anxiety is one of the symptoms of a medical condition that has not
4. How to manage anxiety: general principles and strategies 5I

been diagnosed. In such cases, try as you might, you are not able
to find anything that you find threatening about which you have
made yourself anxious. If this applies to you, do not attempt to
use this book until you have discussed your symptoms with your
doctor. On a wider issue, this book is designed to be used when it is
reasonably clear to you what you are anxious about. If you know
that your anxiety is psychologically based, but you can’t identify a
threat to some aspect of your personal domain even after using the
information in this book, then again speak to your doctor because
you may need to be referred to a skilled CBT therapist who will help
you to identify and deal with the source of your anxiety.
General principles for managing anxiety

Although 1 will be presenting a number of general principles for
managing anxiety in a certain order using the ‘ABCDE’ model,
I urge you to use only the principles that apply to you and in the
order which makes most sense to you.
DETERMINE THAT YOU ARE ANXIOUS AT ‘O' IN THE

‘ABODE’ FRAMEWORK
The first thing that you need to do is to determine whether or not
you have an anxiety problem (‘C’ in the ‘ABCDE’ framework).
The term ‘anxiety’ is used quite loosely and therefore, when a person
says that she (in this case) is anxious, it is not always clear that she
is anxious, rather than concerned, for example, as 1 have used the
terms in this book. In this book, I assume that you have an anxiety
problem if you react to threat in unhealthy ways with the result
that you unwittingly perpetuate your problem rather than solve it.
Healthy ways of dealing with threat by and large involve you feeling
concerned about the threat, facing it and dealing with it effectively
so that you can move on. Unhealthy ways of responding to threat,
on the other hand, involve you feeling anxious about the threat,
avoiding it and thus failing to deal with it effectively so that you are
stuck with your problem.
If you are unclear whether or not you have an anxiety problem, consult
the relevant sections in Chapter z where I outline the ways in which
people tend to think and act when they are anxious (‘Understanding
anxiety’) and when they are concerned (‘Understanding concern’).
52
SPECIFY WHAT YOU ARE ANXIOUS ABOUT AT ‘A ’
IN THE ABODE’ FRAMEWORK
Once you are sure that you are anxious, rather than concerned, for
example, it is important that you are clear what you tend to make
yourself anxious about. This is 'A' in the ‘ABODE’ model. You will
recall from Chapter 2. that people tend to make themselves anxious
about threats to aspects of their personal domain. So take the concept
of threat and ask yourself such questions as:
► What type of things do I feel anxious about?
► When I am anxious, what do I find threatening?
► What would I go out of my way to avoid in case I get anxious?
In answering these questions, you are attempting to identify what
I call ‘threat themes’. Such themes specify what you find threatening
when you are anxious.
Here are some examples of such themes:
► the prospect of failing at important tasks
► the prospect of not being liked, loved or accepted
► the prospect of being negatively evaluated
► not knowing whether you are well or ill
► the prospect of losing control of yourself
► the prospect of acting inappropriately
► the prospect of showing that you cannot cope.
When you have identified the themes to your threat, make a written
note of them.
Insight
People make themselves anxious about threat, but what they find threatening
varies from person to person. Understanding the theme(s) of your threat will
help you manage your anxiety.
Deal with one threat theme at a time

In tackling your problem with anxiety, it is important that you focus
on one threat theme at a time. Otherwise, you will become confused
and end up not dealing with any theme effectively.
SPECIFY HOW ANXIETY IS A PROBLEM FOR YOU

It is important that you understand why anxiety is a problem for you.
This involves you specifying the effects that your anxiety has on you
and your life. Do this for each threat theme.
4. How to manage anxiety: general principles and strategies

UNDERSTAND WHAT HAPPENS WHEN YOU ARE
ANXIOUS AT ‘C’
In Chapter z, 1 outlined the behaviour and thinking that people
engage in while they are anxious. Using this information, specify how
you behave (or feel like behaving) and think when you are anxious
and do this for every threat theme. These are your behavioural and
thinking ‘Cs’.
IDENTIFY ROUTINELY USED SAFETY-SEEKING MEASURES

In Chapter z, I discussed the use of behavioural and thinking
safety measures in anxiety (see ‘Routinely used safety-seeking
measures in anxiety’). These are measures that you use in situations
to protect you and keep you safe from threat. It is important that
you identify these safety-seeking measures as they are, in part,
responsible for you unwittingly perpetuating your anxiety
problem as their use prevents you from properly facing and
dealing with the threat.
ASSUME TEMPORARILY THAT THE THREAT AT

‘A’ IS TRUE
Up to now I have focused on what you need to do to identify and
understand your problem with anxiety in each of your threat
themes. After you have done this you are ready to begin the process
of managing your anxiety. However, you first need to take one
important step. You need to assume temporarily that the threat
about which you are anxious at ‘A’ is true. For example, if you are
anxious about receiving negative evaluation whenever you give a
talk, then assume that you will receive such negative evaluation.
Doing so will enable you to identify the beliefs that underpin your
anxiety. At this point, if you question the accuracy of your inference
of threat and conclude that the threat does not exist, you will calm
down, but you will deprive yourself of the opportunity of identifying,
questioning and changing the irrational beliefs that underpin your
anxiety. If you assume temporarily that your threat inference is
accurate at this point, you will have the opportunity of re-evaluating
it later, but you will do so after you have dealt with your anxiety.
Insight
Assuming that your threat is accurate enables you to identify and deal with
the irrational beliefs which are deemed to be the main determining factor of
your anxiety.
54
SPECIFY YOUR GOALS: REALISTIC WAYS OF DEALING
WITH THREAT
In managing your anxiety, it is important to have a clear idea of what
you are aiming for. As I discussed in Chapter z, anxiety comprises
three components: emotional, behavioural and thinking. The healthy
alternative to anxiety - concern - also comprises three components:
emotional, behavioural and thinking.
Take each threat that you have identified and for each anxiety-based
component come up with a concern-based component. Collectively,
these concern-based components will serve as your goals in dealing
effectively with each threat. If you achieve these responses, these will
constitute ‘E’ in the ‘ABCDE’ framework.
Please note that your concern-based behavioural and thinking
components will serve as alternatives to your safety-seeking measures
discussed earlier.
Insight
Knowing what constitutes a healthy and realistic alternative to your anxiety
in the face of threat gives you something constructive to aim for.
IDENTIFY YOUR IRRATIONAL BELIEFS AND DEVELOP

RATIONAL ALTERNATIVE BELIEFS AT ‘B’ IN THE ‘ABCDE’
FRAMEWORK
When you are dealing with a specific theme about which you make
yourself anxious, your task at this point is to identify the irrational
beliefs at ‘B’ that account for your anxiety.
As I discussed in Chapter z, you may experience anxiety when you
infer a threat to the ego realm of your personal domain or when you
infer a threat to the non-ego, comfort realm of your personal domain.
Identify your irrational beliefs
When you identify your irrational beliefs at ‘B’ it is important to bear
in mind whether your anxiety is ego anxiety or non-ego, comfort
based anxiety. In ego anxiety, you hold a rigid belief and a self
depreciation belief about a threat to your self-esteem. For example,
let’s assume that you tend to experience anxiety about the prospect of
being rejected by significant others. Your irrational belief might be:
‘I must not be rejected by significant others and I am worthless if I am.’
In non-ego, comfort-based anxiety, you hold a rigid belief and an
awfulizing belief or a discomfort intolerance belief about a threat to

your comfort. For example, let’s assume that you tend to experience
anxiety about the prospect of losing control of your emotions. Your
irrational belief might be: ‘I must not lose control of my emotions
and it would be terrible if 1 did.’
Identify the rational alternatives to your irrational beliefs, also at ‘B’

When you have identified your irrational beliefs about threat, it
is important for you to identify the rational alternatives to these
irrational beliefs, also at ‘B’. As early as possible it is important to
see that you have choices in what to believe about threat.
The rational alternatives to your irrational beliefs in ego anxiety
are a flexible belief and an unconditional self-acceptance belief
(e.g. ‘I don’t want to be rejected by significant others, but that does
not mean that this must not happen. If it does, I am fallible, not
worthless’).
The rational alternatives to your irrational beliefs in non-ego,
comfort-based anxiety are a flexible belief and a non-awfulizing
belief or a discomfort tolerance belief (e.g. ‘I don't want to lose
control of my emotions, but I don’t have to be immune from doing
so. If I did lose control of my emotions, it would be unfortunate,
but not terrible’).
Insight
The idea that irrational beliefs are at the core of anxiety and rational beliefs
are at the core of its healthy alternative, concern, is a distinctive feature of the
RECBT approach to understanding and managing anxiety.
DISPUTE OR QUESTION YOUR BELIEFS AT ‘D’ IN THE

‘ABODE’ FRAMEWORK
Once you have identified your irrational beliefs and their rational
alternatives, the next step is for you to dispute or question them at
‘D’. The purpose of such questioning is for you to understand that
the irrational beliefs that underpin your anxiety are false, illogical
and unhelpful and their rational alternatives are true, logical and
helpful. Such understanding is known as intellectual insight and,
while important, it does not lead to emotional change. For such
change to occur, you need to embark on a programme of acting and
thinking in ways that are consistent with your rational beliefs and
inconsistent with your irrational beliefs. But this is for later. For now,
here are my suggestions concerning how to question your beliefs.
56
Questioning rigid beliefs and flexible beliefs
Whether your anxiety is ego-based or non-ego-based, take your rigid
belief and flexible belief and write them down on a piece of paper.
Ask yourself three questions of these beliefs:
1 Which belief is true and which belief is false and why?
3 Which belief is helpful and which belief is unhelpful and why?
1 provide illustrative answers to these questions in Appendix i.
Questioning awfulizing beliefs and non-awfulizing beliefs
If your anxiety is non-ego-based, and your awfulizing belief is the
major derivative from your rigid demand, take this belief and its
non-awfulizing alternative belief and write them down on a piece
of paper.
I provide illustrative answers to these questions in Appendix z.
Questioning discomfort intolerance beliefs and discomfort
tolerance beliefs
If your anxiety is non-ego-based, and your discomfort intolerance
belief is the major derivative from your rigid demand, take this belief
and its discomfort tolerance alternative belief and write them down
on a piece of paper.
I provide illustrative answers to these questions in Appendix 3.
Questioning self-depreciation beliefs and unconditional
self-acceptance beliefs
If your anxiety is ego-based, take your self-depreciation belief and
the unconditional self-acceptance alternative belief and write them
down on a piece of paper.

I provide illustrative answers to these questions in Appendix 4.
Insight
Questioning your irrational and your rational beliefs at the same time helps
you more easily to see the differences between them than does questioning
them separately.
FACE YOUR THREAT IN IMAGERY

Hopefully you have made a commitment to act on your rational beliefs
(i.e. flexible belief and relevant non-extreme belief). Assuming that
you have, your basic task is to face up to your threat while rehearsing
your rational beliefs, but without using any of the safety-seeking
behavioural and thinking measures that you employed to keep yourself
safe from the threat when you were anxious. I will discuss how to deal
with what 1 call post-irrational belief anxious thinking later (see the
section entitled 'Understand how your mind works ... in the field').
The best way to face threat is to do it in the situation where you infer
the existence of the threat. However, it can also be useful to prepare
for this by using imagery first. If you do this, I suggest that you do the
following:
► Take an upcoming situation in which it is likely (in your mind)
that you will encounter a threat to some aspect of your personal
domain and will thus feel anxious.
► Imagine this situation and focus on the threat.
► See yourself facing the threat while rehearsing your rational
beliefs and, as you do so, try to make yourself feel concerned
rather than anxious.
► Then see yourself take action without using the safety-seeking
behavioural or thinking measures you would generally use if you
were anxious. Make your picture realistic. Picture a faltering
performance rather than a masterful one.
► Recognize that some of your post-belief thinking may be
distorted. Respond to it without getting bogged down doing so.
Accept the presence of any remaining distorted thoughts without
engaging with them.
58
► Repeat the above steps until you feel relatively ready to face your
threat in actuality.
If you find facing your threat in your mind’s eye too much for you,
use a principle that I call ‘challenging but not overwhelming’. This
means that instead of imagining yourself facing a threat that you
find ‘overwhelming’ at the time, choose a similar threat to face that
you would find ‘challenging, but not overwhelming’. Then employ
the.same steps that I have outlined earlier. Work in this way with
modified threats until you find your original threat ‘challenging,
but not overwhelming’ and then use the steps again.
FACE YOUR THREAT IN VIVO

Whether or not you have used imagery as a preparatory step, you
need to take the following steps when you face your threat in vivo
(i.e. in reality):
► Choose an imminent situation in which the threat is likely to
occur (or you think it is likely to occur) and about which you
would ordinarily feel anxious.
► Make a plan of how you are going to deal with the threat and
resolve not to use any of your thinking and behavioural safety
seeking measures you have previously identified.
► Rehearse your rational beliefs before entering the situation so
that you can face your threat while in a rational frame of mind.
In addition, it would be useful to develop a shorthand version of
your rational beliefs to use while you are in the situation.
► Enter the situation and accept the fact you are likely to be
uncomfortable while doing so. Do not take any safety-seeking
measures and take action as previously planned. React to any
consequences from a rational frame of mind if you can.
► Recognize that even though you have got yourself into a rational
frame of mind some of your thinking may be distorted and
unrealistic and some may be realistic and balanced. Accept the
presence of the former and do not engage with it. Engage with
the latter as much as you can.
► Repeat these steps with other instances of your target threat and
with instances of other threats.
Identify and deal with obstacles to facing threat in vivo
Facing your threat directly without the use of safety-seeking measures,
while thinking rationally about the threat and doing so repeatedly is,
4. How to manage anxiety: general principles and strategies 59

in my view, the key to managing your anxiety. However, implementing
this key principle is easier said than done and often people fail to do
so for a number of reasons. Here are the most common obstacles to
facing your threat in vivo and how best to respond to them.
‘IT S TOO FRIGHTENING TO FACE THE THREAT’

If you think that facing a threat-related situation is too much for you,
utilize the ‘challenging but not overwhelming' principle discussed
earlier. This involves you selecting a threat-related situation that
would be a challenge for you to face, but not overwhelming for you
at that time.
I DON’T FEEL CONFIDENT TO FACE THE THREAT’
One of the thinking features of anxiety is that you hold the inference
that you think that you cannot deal with threat. In order to challenge
this limiting idea, acknowledge and implement the following:
► Show yourself that you don’t need to feel confident to face a
threat in order to face it.
► Realize that confidence develops from not being confident and
that the more you act without confidence, the more you will
develop confidence.
•I DON’T FEEL COMFORTABLE FACING THE THREAT’
If you wait until you are comfortable before facing the threat, you
will wait a very long time! Indeed, if you are comfortable about
facing a ‘threat’, then it is likely that you are not anxious about it.
Consequently, it is important that you realize that you are bound
to be uncomfortable about facing a ‘threat-related situation’. Show
yourself that you can tolerate this discomfort and that it is worth it
for you to do so.
‘I CAN’T FACE THE THREAT BECAUSE I DON’T FEEL
IN CONTROL’
By definition, when you feel anxious you are not in control. So if
you wait to feel in control before you face your threat then you
are caught in a bind. The way out of this bind is for you to hold
a flexible belief about feeling in control. If you believe that it is
preferable, but not essential, to feel in control before you face the
threat then you will take the un-preferable course of action because
it is the only course of action open to you. If you insist that you
have to be in control before facing the threat, you will not face it.
6o
(See Chapter 8 for an extended discussion of how to manage anxiety
about losing self-control.)
•I CAN’T FACE THE THREAT BECAUSE I DON’T KNOW WHAT
IS GOING TO HAPPEN’
This obstacle to facing threat is based on a rigid belief about
certainty. Here, you believe that you have to know the outcome of
facing threat before you face it. This, of course, is not possible and, if
you wait for such certainty, it is highly likely that you will perpetuate
your anxiety problem. The antidote to this is, as you might expect,
to hold a flexible belief about certainty. If you do this, you will
acknowledge that, while it would be nice to know the outcome of
facing threat, it is not necessary to have such certainty. All you have
is probability.
So, if you face threat, then the probable outcome is that you will
feel uncomfortable in the short term, but you will help yourself to
overcome your anxiety problem in the longer term. By contrast, if
you don’t face threat, you will remain comfortable in the moment,
but the probability is that you won’t overcome this problem.
Insight
Facing threat while rehearsing your rational beliefs and without using safety
seeking measures is the recommended way of managing anxiety in RECBT.
UNDERSTAND HOW YOUR MIND WORKS WHEN YOU

ARE ANXIOUS AND APPLY THIS KNOWLEDGE WHEN
ATTEMPTING TO MANAGE YOUR ANXIETY TN THE
FIELD’
One of the most important things that you need to do while
working towards managing your anxiety is to understand how your
mind works when you are anxious and apply this knowledge ‘in
the field’ - i.e. in situations in which you are anxious. It is therefore
important for you to understand that:
► When you are anxious, you feel like acting in ways that seek to
remove you from threat and you will feel this urge even when
you have resolved to face the threat.
► When you are anxious and you are seeking to manage it, your
thoughts will still, in part, alternate between seeking to keep
yourself safe from threat and exaggerating its nature and
consequences.
4. How to manage anxiety: general principles and strategies 6I

► When applying the principles in this book, you will know
that you need to refrain from using thinking and behavioural
safety-seeking measures while facing threat. You need to do this
even though you will want to go along with what your feelings
of anxiety are telling you, what your anxious mind is telling
you and what your urges to act are telling you. You need to be
mindful of these processes, but do not engage with them or try
to suppress them.
In summary, when you are anxious you need to go along with what
you know is true (i.e. your rational beliefs and associated behaviour
and thinking) even when you feel strongly that this is false and that
the opposite is true. You need to keep doing what you know is the
right thing even when your "anxious mind' tells you that you are
wrong. The best way of doing this is to recognize that it is your
anxious mind that is telling you that you are wrong. Understanding
this will help to weaken the persuasive hold of your anxious mind,
especially when you are acting according to the more rational, but
quieter, promptings of your developing "concerned mind'. The more
you act on the rational beliefs, the stronger a grip your concerned
mind will exert.
Insight
The distorted thinking that stems from your irrational beliefs will continue
to stay in your mind even when you face your threat w hile rehearsing your
rational belief. This is how your mind works, so accept it and don't fight
against it.
DEVELOP A HEALTHY ATTITUDE TO ANXIETY ITSELF

In Chapter 3,1 discussed a concept known as meta-emotional
problems. This involves you focusing on your anxiety and then
disturbing yourself about your anxious feelings. Quite often people
feel anxious about the prospect of being anxious and this results in
them avoiding situations that are threatening to them only because
they may experience anxiety. Indeed, for many people the prospect
of feeling anxious becomes their main threat.
The best way to deal with this is as follows:
► Assess this second-order problem.
► Question the irrational beliefs that underpin the problem and the
alternative rational beliefs as discussed earlier in this chapter.
62
► Face rather than avoid situations where you are likely to feel
anxious while rehearsing your newly developed rational beliefs.
UNDERSTAND HOW UNCERTAINTY AND YOUR CORE

BELIEFS AFFECT YOUR INFERENCES OF THREAT AT ‘A’
AND HOW TO EXAMINE ‘A’
Remember that in RECBT we encourage you to assume temporarily
that the inferences that you make of threat at ‘A’ in the ‘ABCDE’
framework are correct. We do this because we want you to focus
on identifying your irrational beliefs at ‘B’, questioning them and
developing a set of alternative rational beliefs. When you have done
this, you are ready to come back to ‘A’ to examine it, for it may well
be distorted.
Before you question your inferences at ‘A’, it is important to
understand the mechanisms whereby you routinely make distorted
inferences at ‘A’. There are two concepts you need to grasp in order
to understand why and how you routinely make distorted inferences
at ‘A’. These are:
1 general irrational beliefs
2 uncertainty.
General irrational beliefs
General irrational beliefs are general beliefs that relate to a specific
theme, but span across situations and tend to involve a group or
groups of people. For example:
7 must not be criticized by authority figures. ’
Uncertainty
The theme of uncertainty is often found in specific episodes and
general problems of anxiety that is problematic. When you are
uncertain, you do not know important aspects of the situation that
you are in. There are two different types of uncertainty:
1 uncertainty where you do not know what is going to happen,
whether it is positive or negative
2 uncertainty where you do not know that a bad outcome will
not happen.
In my experience, the second type of uncertainty is more prevalent
in anxiety.

Understand that you infer threat at ‘A’ when you relate the second type
of uncertainty to your general irrational belief
In this section, I will explain how your general irrational belief interacts
with the second type of uncertainty to produce your distorted inference
of threat at ‘A’. Let me detail this in a series of steps:
► Let’s assume that you hold the following general irrational belief:
7 must not be criticized by authority figures. ’
► Take the theme of this general irrational belief:
'Being criticized by authority figure'
► Let’s further assume that you bring the second type of
uncertainty to this theme. Here your revised general irrational
belief is:
7 must know that authority figures are not criticizing me.'
► Imagine that you take this revised general irrational belief to a
specific situation where you will be presenting to a group and
where you know that an authority figure will be in the audience,
but you don't know whether or not he will criticize you.
► Now because your uncertainty-based general irrational belief is
rigid, it leads in your mind to two possibilities:
'Either I know that the authority won 't criticize me or he
will do so. Since I cannot convince myself that he won't
criticize me then 1 conclude that he will do so.'
How to deal with your overestimations of threat

In order to deal with your overestimations of threat you need to take
a number of steps, which I will illustrate again with reference to the
above example:
► Construct general rational alternatives - both to your original
threat-focused general irrational belief:
7 would prefer not to he criticized by authority figures, but
that does not mean that they must not do so.'
and to your second uncertainty-focused general irrational belief:
7 would like to be certain that I won't be criticized by
authority figures, but I don't need such certainty. It is
difficult not having this certainty, but I can bear not having
it and it is worth bearing.1
► Question both sets of beliefs until you can see the rationality of
the two general rational beliefs and the irrationality of the two
64
general irrational beliefs and you can commit to implementing
the former.
► Bring your uncertainty-focused general rational belief to situations
where it is possible that you may be criticized by authority figures
and make an inference based on the data at hand:
7 am not certain if I will be criticized by an authority figure
so let's consider the evidence.'
► If there is evidence indicating there is a good chance that you will
be criticized by an authority figure, then use a specific version of
your general criticism-focused rational belief to deal with this.
For example:
Inference: ‘The authority figure in the audience is known
for being critical and thus he probably will criticize my
performance. ’
Specific rational belief: 7 don’t want the authority figure to
criticize my performance, but that does not mean that he
must not do so. If he does criticize my performance, that
is uncomfortable, but I am not worthless. I am the same
ordinary, unique, unrateable person whether or not he
criticizes my performance. ’
How to examine the accuracy of your inference of threat if necessary
If you are still unsure if your inference of threat is accurate or
inaccurate, answer one or more of the following questions:
► How likely is it that the threat will happen?
► Would an objective jury agree that the threat will happen? If not,
what would the jury’s verdict be?
► Am I viewing the threat realistically? If not, how can I view it
more realistically?
► If I asked someone whom I could trust to give me an objective
opinion about the truth or falsity of my inference about the
threat, what would the person say to me and why? How would
this person encourage me to view the threat instead?
► If a friend tells me that they are facing the same situation as
I am facing and are making the same inference of threat, what
would I say to him/her about the validity of their inference
and why? How would I encourage the person to view the
threat instead?

Insight
If you tend to see threat in a situation when others don't, you probably
hold an uncertainty-based general irrational belief related to the theme of
your threat. This means that in ambiguous situations, if you can't convince
yourself that the threat does not exist, then you think that it does exist. To
deal with this develop an alternative uncertainty-based general rational belief
and question your inference of threat at ‘A’.
A NOTE ON THE USE OF RELAXATION AND BREATHING

TECHNIQUES IN RECBT
Not too long ago, relaxation and breathing techniques were broadly
advocated as an integral part of anxiety management in CBT. We
are now more careful in recommending their use. What has changed
is a recognition that people can readily use relaxation and breathing
techniques as safety behaviours and, when they do so, they prevent
themselves from facing and dealing with situations in which they
infer the presence of threat.
So before you employ relaxation and breathing techniques, first make
sure that you deal with your threats by identifying, and changing,
your irrational beliefs to their rational belief alternatives. In doing so,
you will make yourself concerned rather than anxious about these
threats.
After you have done this, be clear with yourself what the true purpose
of using relaxation and breathing techniques is. If it is to help you
focus your attention on whatever you need to focus on in threat-
related situations, then this is a legitimate use of such techniques.
I lowever, don't use them if you are anxious about losing self-control
and you want to use these techniques to regain self-control. This
would be an example of their use as safety behaviours. I discuss how
to manage anxiety about losing self-control in Chapter 8.
A caution
Finally, some people find it useful to use relaxation or breathing
techniques to help them to get in the right frame of mind to deal
with their threat using the RECBT sequence. If you want to do this,
make sure that you do go on to employ this sequence. Some people
calm themselves by the use of relaxation and breathing techniques
and then do not use the sequence because they think they have their
anxiety under control. This may be true in a given instance, but it is
important to remember that the RECBT model states that anxiety
66
stems from holding irrational beliefs about threat and the use of
relaxation and breathing techniques on their own does not change
these beliefs. In this case, you may be using these techniques as safety
seeking measures and, if so, please do not use them.
In this chapter, I discussed how to manage anxiety in general terms.
In the following chapter, I will discuss how to use this material in
dealing with performance-based anxiety.

THINGS TO REMEMBER
In order to manage your anxiety in general terms, you need to
implement all or some of the following principles and strategies:
► determine that you are anxious
► specify what you are anxious about
► specify how anxiety is a problem for you
► understand what happens when you are anxious in terms of how

you feel, think and act
► identify routinely employed safety-seeking measures
► assume temporarily that the threat is real
► specify your goals, which are realistic ways of dealing with threat
► identify your irrational beliefs and develop rational alternative

beliefs
► question your beliefs
► face your threat in imagery
► face your threat in vivo and identify and deal with obstacles to
doing so
► understand how your mind works when you are anxious and
apply this knowledge when attempting to manage your anxiety
‘in the field’
► develop a healthy attitude to anxiety itself
► understand how uncertainty and your general beliefs affect your

inferences of threat at A' and how to examine v A'
► use breathing and relaxation techniques when necessary, but

largely after you have dealt with your threat rationally. Avoid
their use if you employ them as safety-seeking measures.
68
How to manage performance-
related anxiety
• how to understand and manage performance-related anxiety
as exemplified in test anxiety
• how to identify what you are most anxious about when taking
tests
• how to manage performance-related anxiety through the
example of managing test anxiety
• why you are prone to performance-related anxiety and what
you can do to become less prone.
Introduction
As you will see from this chapter and those that follow, different
forms of anxiety are more related to the context in which we
experience this emotion than to what we are truly anxious about.
My stance will be to go along with the tradition of referring to
the form of anxiety under discussion by its context, but to focus
on what you are particularly anxious about within this context.
In this chapter, then, I will discuss performance-related anxiety
where what you are anxious about relates to your performance on
a task or on some kind of test. Indeed, as the most common form
of performance-related anxiety is test anxiety, I will focus on this.
However, you should easily be able to apply what I outline to any
form of performance anxiety where being evaluated by others
present is not a prime feature.5
'I will discuss social anxiety in Chapter 6 where such evaluation is a prime feature.
5. How to manage performance-related anxiety

Test anxiety is so-called because it refers to the anxiety that we
experience when we are taking a test or, more frequently, when
we are about to take a test. So 'taking the test’ is the context in
which we feel anxious. While you might associate test anxiety with
taking an examination within academic settings, actually the term
‘test’ is broader than that. It encompasses situations that take place
outside the academic world such as taking a driving test or taking a
citizenship test.
Understanding test anxiety

As mentioned earlier, the term ‘test anxiety’, if you think about it,
does not explain what you are anxious about. If you experience
test anxiety, you need to use two concepts that 1 first discussed in
Chapter z to help you to identify what you are anxious about.
These concepts are threat and personal domain.
WHAT YOU ARE ANXIOUS ABOUT WHEN YOU

EXPERIENCE TEST ANXIETY
When you experience test anxiety, you infer the presence of a threat
to some aspect of your personal domain relevant to taking the
test. While people who experience test anxiety find different things
threatening when they take a test, there are some recurring themes
in what they find threatening. In this section, 1 will discuss the most
common of these threats. In doing so, 1 will distinguish between
threats to the ego realm and to the non-ego realm of the personal
domain relevant to your test-taking performance.
Threats to the ego realm of your personal domain in test anxiety
When you face a threat to the ego realm of your personal domain
relevant to your test-taking performance, this is most likely to be a
threat to your self-esteem (i.e. the degree to which you value yourself).
Here are some of the most common threats under this heading.
THE PROSPECT OF FAILING THE TEST (OBJECTIVE FAILURE)
Perhaps the aspect of taking a test that people find most threatening
to their self-esteem when they take a test is that they might fail it.
If this applies to you, you would be anxious about not achieving the
pass mark on the test, and consequently, knowing that you would
even scrape a pass would remove your anxiety. If you have such
‘failure-based' anxiety, you are scared of objective failure.
70
THE PROSPECT OF FAILING TO ACHIEVE YOUR DESIRED STANDARD
ON THE TEST (SUBJECTIVE FAILURE)
Here, it is not enough for you to pass the test. Rather, the threat to
your self-esteem resides in you not achieving a certain standard of
performance on the test. In Britain, for example, many students are
anxious about achieving what is colloquially known as a ‘Desmond’.
This refers to a lower second-class honours degree or a ‘2.2’.6
It is not enough for them to be awarded a degree. They need to
achieve a minimum of an upper second-class honours degree. Here,
knowing that they will pass would not be sufficient to remove the
anxiety of such people. Rather, knowing that they will achieve an
upper second would.
Thus, if your anxiety concerns failure to achieve your desired
standard, you are scared of subjective failure, since you regard failing
to achieve your standard as failure.
THE PROSPECT OF NOT DOING PERFECTLY ON THE TEST
For some people taking a test is threatening to them because that
may not produce perfect work. If you have perfectionistic-based test
anxiety, you have an idea of what constitutes perfection and you are
anxious about not reaching such a standard.
THE PROSPECT OF NOT ‘FEELING’ COMPETENT TO TAKE THE TEST
Here, you consider not ‘feeling’ competent when preparing for a test
a threat to your self-esteem.
THE PROSPECT OF NOT DOING AS WELL AS OTHERS ON THE TEST
For some people taking a test is not a matter of passing or achieving
a certain standard. Rather, it is a matter of competition and ranking.
Thus, if you have comparison-based test anxiety, you are anxious
about your performance on the test in relation to others. Here, your
threat may be that you will not come ‘top of the class’ or it may be
that you will not be placed in the top three, for example.
THE PROSPECT OF BEING JUDGED NEGATIVELY FOR YOUR TEST
PERFORMANCE ONCE YOUR PERFORMANCE IS KNOWN
Some people are anxious about taking a test not because they might
fail the test, fail to reach a certain standard or fail to achieve a certain
ranking, but because others may discover later what they achieve
on the test and judge them negatively. If you have this type of test
‘Named after Desmond Tutu (or 2.2).
5. How to manage performance-related anxiety 7I

anxiety, you will be anxious only if you receive (or think you will
receive) negative evaluation for your performance. In this case, if you
knew that nobody would discover your test performance or that they
would not judge you negatively for it, these factors would remove
your anxiety. It is important to note that the main difference between
anxiety about being judged negatively in a test-taking setting and
anxiety about being judged negatively in a social setting is that in
test anxiety the evaluating group is not physically present while
in social anxiety they are.
Threats to the non-ego realm of your personal domain in test anxiety

When you face a threat to the non-ego realm of your personal domain
relevant to your test-taking performance, this is likely to be a threat
to your sense of comfort broadly defined. Here are some of the most
common threats under this heading.
THE PROSPECT OF YOUR MIND GOING BLANK DURING THE TEST
A very common anxiety that people have in relation to the non-ego
realm of their personal domain related to taking a test is that their
mind will go blank during the test. This is most frequently related to
the person's sense of comfort broadly defined rather than to their
self-esteem. If you have this fear, then you see going blank as an
aversive state which threatens that part of your personal domain
concerned with the desired non-ego conditions for test-taking - in
this case, a fully functioning mind.
THE PROSPECT OF BECOMING ANXIOUS DURING THE TEST
Your mind going blank in a test-taking situation is both a
symptom of anxiety about some other aspect of your test-taking
performance and a threat to the non-ego realm of your personal
domain occasioning further anxiety. Since it is such a common fear
it merited a separate section. However, people also fear that they
may experience a number of other anxiety-related symptoms which
are deemed threatening because they are painful or indicate loss of
control. These symptoms may be emotional, thinking (e.g. you may
fear having task-irrelevant thoughts during the test) or reflect a range
of physiological symptoms (e.g. that you may urinate during the test).
THE PROSPECT OF NOT ‘FEELING’ PREPARED TO TAKE THE TEST
Here, when you sit down and work on preparing for the test, you get
anxious about not ‘feeling’ prepared to take the test.
72.
THE PROSPECT OF EXPERIENCING NEGATIVE CONSEQUENCES OF
FAILURE OR OF NOT DOING WELL ON THE TEST
Some people have rest anxiety not because they fear failing or not
doing well, but because they fear the negative consequences of
failing or not doing well. If you are anxious about taking tests for
this reason you predict that you will not achieve cherished outcomes
if you fail or do not do well on the test. For example, 1 mentioned
earlier that some students are anxious about achieving a second-
class honours degree. In that section, I discussed this anxiety as an
example of ego anxiety since such people see this as a threat to their
self-esteem. However, others fear getting a 'Desmond' because of the
non-ego implications of this result. For example, they infer, rightly or
wrongly, that their future career will be blighted with the consequent
negative impact on their lifestyle.
Insight
When you are anxious about your performance (e.g. on tests) you are anxious
about a threat to some aspect of your personal domain related to your
performance. This may be to your self-esteem or to your sense of comfort,
broadly defined.
IRRATIONAL BELIEFS UNDERPIN ANXIETY ABOUT

THREATS RELATED TO PERFORMANCE ON TESTS
As I have already mentioned, this book is based on a model of anxiety
that stems from Rational-Emotive Cognitive Behaviour Therapy
(RECBT). As I have discussed in Chapters i and z, this model
stresses the role played by irrational beliefs in the development and
maintenance of anxiety.
Irrational beliefs in ego-based performance-related test anxiety
In ego-based performance-related test anxiety you hold a rigid belief
and a self-depreciation belief about the threat to your self-esteem.7
I will illustrate these irrational beliefs in each of the ego-based
performance-related threats mentioned earlier (see the ‘Irrational
beliefs’ column in Table 5.1).
’You may also hold an awfulizing belief and a discomfort intolerance belief, but
these tend to be secondary to the self-depreciation belief. For the sake of simplicity,
work with only your rigid belief and self-depreciation belief if you have ego-based
performance-related test anxiety.

Table 5.1 Irrational and rational beliefs about
ego-based threats to do with performance on tests.
Threat Irrational beliefs Rational beliefs
The prospect Rigid belief: ‘I must Flexible belief: ‘I would

of failing not fail the test/ prefer not to fail the test,
the test but that does not mean
(Objective that I must not do so.'
failure) Self-depreciation Unconditional self
belief: ‘If I were acceptance belief:
to fail the test, 1 if I were to fail the test,
would be a failure.' that would be bad, but
it would not mean that
I would be a failure.
I would be the same
fallible human being
capable of succeeding
and failing whether I
pass or fail the test.'
The prospect Rigid belief: ‘1 must Flexible belief: ‘I would

of failing reach my desired like to reach my desired
to achieve standard on the standard on the test, but
your desired test.’ I don't have to do so.'
standard Self-depreciation Unconditional self
on the test belief: ‘If I were acceptance belief:
(Subjective to fail to reach my ‘If J were to fail to reach
failure) desired standard my desired standard on
on the test, I would the test, that would be
be a failure.' undesirable, hut would
not prove that 1 would be
a failure. 1 would be the
same person no matter
how well or badly I do
on the test and my worth
as a person is based on
my aliveness, not on my
achieving my desired
standard on the test.'
74
The prospect Rigid belief: ‘I must Flexible belief: ‘1 would

of not doing do perfectly on like to do perfectly on
perfectly on the test.’ the test, but that does
the test not mean that I must
do so.’
Self-depreciation Unconditional self-
belief: ‘If I were not acceptance belief: ‘If I
to do perfectly on were not to do perfectly
the test, I would be on the test, that would
a failure.’ be bad, but would not
prove that I would be
a failure. My worth as
a person is based on my
fallibility, my aliveness
and my uniqueness and
those remain the same
whether or not I do
perfectly on the test.’
The prospect Rigid belief: 'I must Flexible belief: U would

of not “feel” competent like to “feel” competent
‘feeling’ to take the test.’ to take the test, but
competent to this ingredient is only
take the test desirable, not necessary.’
Self-depreciation Unconditional self-
belief: ‘If I were acceptance belief: ‘If
not to “feel” I were not to “feel”
competent to take competent to take the
the test, it would test, that's a pity, but it
mean that I would would not mean that I
be an incompetent would be an incompetent
person.’ person. 1 would be the
same fallible human
being whether or not I
“feel” competent.'
(Contd)
5. How to manage performance-related anxiety 75

The prospect Rigid belief: Flexible belief: ‘I would

of not doing ‘I must do as well like to do as well as
as well as as others on the others on the test, but 1
others on test.’ don’t have to do so.’
the test Self-depreciation Unconditional
belief: "If I were self-acceptance belief:
not to do as well ‘If I were not to do as
as others on the well as others on the
test, I would be less test, I would not be less
worthy than them.' worthy than them. Our
worth is the same even
though our results may
be different.'
The prospect Rigid belief: Flexible belief: ‘I would

of being ‘I must not be prefer it if others don't
ludged judged negatively judge me negatively for
negatively by others for my my performance on the
for your test performance on the test, but that does not
performance test.' mean that they must not
do so.'
Self-depreciation Unconditional
belief: ‘If others self-acceptance belief:
were to judge me ‘If others were to judge
negatively for my me negatively for my
performance on the performance on the test,
test, I would be a 1 would not be a failure.
failure.' 1 can accept myself as
fallible and unrateable
with or without their
negative judgement.'
Irrational beliefs in non-ego-based performance-related

test anxiety
In non-ego-based test anxiety you hold a rigid belief and an awfulizing
belief or a discomfort intolerance belief about the threat to the
non-ego realm of your personal domain related to your performance
76
on tests.81 will illustrate these irrational beliefs in each of the
non-ego-related threats mentioned earlier (see the ‘Irrational beliefs’
column in Table 5.2).
Table 5.2 Irrational and rational beliefs about non

ego-based threats to do with performance on tests.
•••••••••••••••••••«•••••••••••••••••••«•• .............
The prospect Rigid belief: 4My mind Flexible belief: ‘I don’t

of your mind must not go blank want my mind to go
going blank during the test.' blank during the test, but
during the test it does not follow that it
must not do so.'
Awfulizing belief: LIt Non-awfulizing belief:
would be awful if my ‘It would be bad if my
mind were to go blank mind were to go blank
during the test.’ during the test, but it
would not be awful.'
or or
Discomfort Discomfort tolerance
intolerance belief: belief: fcIt would be
‘I couldn't bear it if difficult for me to bear it if
my mind were to go my mind were to go blank
blank during the test.' during the test, but I could
do so and it would be in
my interests to do so.'
The prospect Rigid belief: lI must Flexible belief: M would

of becoming not become anxious prefer it if I did not
anxious during during the test.' become anxious during
the test the test, but that does not
mean that it must not
happen.’
(Contd)
8You may have both an awfulizing belief and a discomfort intolerance belief. For the
sake of simplicity, work with your rigid belief and the one other non-ego extreme belief
that best accounts for your non-ego-based performance-related test anxiety. This will be
either an awfulizing belief or a discomfort intolerance belief.

Awfulizing belief: Non-awfulizing belief:

‘It would be awful ‘It would be unfortunate
if J were to become if I were to become
anxious during the anxious during the test,
test.’ but not awful.'
or or
intolerance belief: belief: 'It would be tough
‘I couldn't bear it for me to put up with
if I were to become becoming anxious during
anxious during the the test, but I could do so
test.’ and it would be worth it
to me to do so.'
The prospect Rigid belief: ‘I must Flexible belief: ‘I want

of not ‘feeling’ “feel” prepared to to “feel” prepared to
prepared to take the test.’ take the test, but it isn't
take the test necessary for me to
do so.’
Awfulizing belief: 'It Non-awfulizing
would be awful if I belief: ‘It would be
were not to “feel” disadvantageous if
prepared to take the I were not to “feel”
test.’ prepared to take the test,
but it would not be the
end of the world if
I don't.’
or or
intolerance belief: belief: ‘It would be a
‘I couldn't bear it if struggle for me to bear
I were not to “feel” it if I were not to “feel”
prepared to take the prepared to take the test,
test.’ but I could bear it and it
would be worth it to me
to do so.'
78
The prospect Rigid belief: ‘I must Flexible belief: ‘I would

of experiencing not experience the prefer not to experience
negative negative consequences the negative consequences
consequences of failing or not doing of failing or not doing well
of failure or of well on the test.’ on the test, but that does not
not doing well mean that I must not do so.’
on the test Awfulizing belief: Non-awfulizing belief:
‘It would be awful if 1 ‘It would be rough if I
were to experience the were to experience the
negative consequences negative consequences of
of failing or not doing failing or not doing well
well on the test.’ on the test, but not the
end of the world.’
or or
intolerance belief: belief: ‘It would be hard
‘I couldn’t bear it if I if I were to experience the
were to experience the negative consequences of
negative consequences failing or not doing well
of failing or not doing on the test, but I could
well on the test.’ withstand this and it’s in
my interests to do so.’
Insight
The main reason why you are anxious about performance-related threats is
because you hold a set of irrational beliefs about these threats. These beliefs
are rigid and extreme.
The impact of irrational beliefs about threats related

to performance on tests
When you hold irrational beliefs about threats related to your
performance on tests, doing so will have a great impact on your
behaviour and subsequent thinking.
SAFETY-SEEKING BEHAVIOUR AND THINKING RELATED
TO PERFORMANCE ON TESTS
When you hold irrational beliefs about threats related to your
performance on tests, you will act and think in ways designed to
keep you safe from the threat (see Table 5.3). This is the case both

in the test-taking situation and beforehand. The main problem with
such thinking and behaviour is that they do not help you to do what
you need to do - i.e. to deal effectively with your anxiety by facing
the situation in which your threat may occur and by developing
rational beliefs about it. Indeed, these safety-seeking measures
actively discourage you from doing so.
Table 5.3 Safety-seeking behaviour and thinking
stemming from irrational beliefs about threats
related to performance on tests.
Threat Safety-seeking behaviour Safety-seeking thinking
Ego ► Avoiding preparation ► Distracting yourself

based ► Taking a break every time from thoughts related
threat you think of objective or to your ego threat
subjective failure ► Thinking of a plausible
► Over-preparation reason to excuse your
► Taking stimulants to performance
improve performance or ► Distracting yourself
boost confidence from thoughts of
► Checking with others objective or subjective
that you are working failure
harder than them ► Self-reassurance that:
► Seeking reassurance > you will pass
from others that they or achieve your
will not judge you for standard
your performance t> others won't do as
► Superstitious behaviour well as you
in the test-taking > others won't judge
situation to ward off you negatively for
threat your performance
Non- ► Over-preparation ► Distracting yourself
ego- ► Frequent use of from thoughts related
based relaxation and to your non-ego
threat meditation exercises to threat
keep yourself calm ► Psyching yourself up
► Faking into the test mentally so you Teel'
taking situation an prepared
anti-anxiety drug just
in case you get anxious
80
Threat Safety-seeking behaviour Safety-seeking thinking
► Superstitious behaviour ► Self-reassurance that:

in the test-taking > your mind won’t go
situation to ward off blank in the test
threat > you won't be
► Psyching yourself up anxious in the test
behaviourally so you t> the negative
‘feel’ prepared consequences that
you fear if you fail or
don't do well on the
test won't happen
THREAT-EXAGGERATING THINKING RELATED TO
PERFORMANCE ON TESTS
When you hold irrational beliefs about threats related to performance
on tests, if you are not engaged in thinking designed to keep you
safe, your thinking is characterized by exaggerating the nature of the
threat and its consequences as shown in Table 5.4.
Engaging in this form of thinking prevents you from dealing
effectively with the threat. Indeed, it serves mainly to strengthen
your conviction in your irrational beliefs about the threat.
Table 5.4 Threat-exaggerating thinking that stems
from holding irrational beliefs about threats related
to performance on tests.
Threat Threat-exaggerating thinking
Ego ► I will fail very badly.

based ► 1 will fall very short of my desired standard.
threat ► I will make many mistakes on the test.
► If I don’t feel competent, I will do poorly.
► I will do far worse than others on the test.
► Other people will think very negatively of me when
they learn about my performance on the test.
Non- ► If my mind goes blank then I will fail the test.
ego- ► If I get anxious on the test, I will lose complete
based control of myself.
threat ► If I don’t ‘feel’ prepared to take the test, I will fail it.
► The negative consequences of failing the test or not
doing well on it will be catastrophic.
5. How to manage performance-related anxiety OT
Insight
When you hold a set of irrational beliefs about performance-related threat
it leads you to seek immediate safety from this threat and/or to exaggerate
its nature and consequences. Engaging with these effects interferes with you
managing your anxiety because it prevents you from facing and dealing
effectively with situations in which you infer rhe presence of performance-
related threat.
RATIONAL BELIEFS UNDERPIN CONCERN ABOUT

THREATS RELATED TO PERFORMANCE ON TESTS
I argued in Chapter z that concern about real or perceived threats
to your personal domain is the healthy alternative to anxiety about
these threats. In this section of the chapter, 1 will outline which
rational beliefs are likely to underpin un-anxious concern about
your performance on tests.
Rational beliefs in ego-based performance-related test concern
In ego-based test concern you hold a flexible belief and an unconditional
self-acceptance belief about the ego-based threat.91 will illustrate
these rational beliefs in each of the ego-related threats mentioned
earlier (see the 'Rational beliefs' column in Table 5.1).
Rational beliefs in non-ego-based test concern
In non-ego-based test concern you hold a flexible belief and a
non-awfulizing belief or a discomfort tolerance belief about the
threat to the non-ego realm of your personal domain related to
your performance on tests. I will illustrate these rational beliefs
in each of the non-ego-based threats mentioned earlier (see the
‘Rational beliefs' column in Table 5.2).
Insight
When you hold a set of rational beliefs about performance-related threat you
will feel concerned, but not anxious, about this threat.
I he impact of rational beliefs about threats related to performance

on tests
When you hold rational beliefs about threats related to your
performance on tests, doing so will also have a great impact on
your behaviour and subsequent thinking.
9You may also hold a non-awfulizing belief and a discomfort tolerance belief, but these
tend to be secondary to the unconditional self-acceptance belief.
82
BEHAVIOUR AND THINKING RELATED TO PERFORMANCE
ON TESTS
performance on tests, you will act and think in ways designed
to help you to face these threats and deal with them effectively
(see Table 5.5). You will notice from Table 5.5 that when you
hold rational beliefs about threats to your performance on tests
you still experience similar urges to engage in safety-seeking
behaviour and thinking as you did when you held irrational
beliefs about these threats, but you accept them and do not
actively engage in these urges.
performance on tests, then these beliefs will also help you to think
in a realistic and balanced manner about the nature of these threats
and their consequences (see Table 5.6).
Table 5.5 Behaviour and thinking stemming from

rational beliefs about threats related to taking tests
that help you to deal with these threats.
• •••••••••••••••••••a 4 •
Threat Behaviour designed to help Thinking designed to help

you deal with the threat you deal with the threat
£go- ► Appropriate level of ► Accepting the urge

related preparation to distract yourself
threat ► Accepting when you from thoughts related
think of objective to your ego threat,
or subjective failure but dealing with
and continuing with them instead
preparation rather than ► Accepting the urge to
taking a break think of a plausible
► Accepting the urge to reason to excuse your
check with others that performance, but not
you are working harder engaging in this mode
than them, but not of thinking
doing so
(Contd)

Threat Behaviour designed to help Thinking designed to help
you deal with the threat you deal with the threat
► Accepting the urge to ► Accepting the existence

seek reassurance from of thoughts of objective
others that they will or subjective failure, but
not judge you for your not engaging with them
performance, but not ► Accepting the following
doing so urges to engage in self
► Accepting the urge to reassurance but not
engage in superstitious doing so:
behaviour in the test > that you will pass or
taking situation to achieve your standard
ward off threat, but > that others won't do as
not doing so well as you
t> that others won't judge
you negatively for your
performance
Non ► Appropriate level of ► Accepting the urge to
ego- preparation distract yourself from
rela ted ► Accepting discomfort thoughts related to your
threat while preparing for non-ego threat, but
the test and in the test dealing with them instead
without using relaxation ► Accepting the urge
and meditation exercises to psych yourself up
to keep yourself calm mentally so you ‘feel'
► Not taking into the prepared, but not doing so
test-taking situation any ► Accepting the following
anti-anxiety drug just in urges to engage in self
case you get anxious reassurance but not
► Accepting the urge to doing so:
engage in superstitious > that your mind won't
behaviour in the test go blank in the test
taking situation to ward > that you won't be
off threat, but not doing so anxious in the test
► Accepting how you feel t> that the negative
without psyching yourself consequences that you
up behaviourally so you fear if you fail or don't
‘feel' prepared do well on the test
won't happen
84
Table 5.6 Realistic and balanced thinking that stems
from holding rational beliefs about threats related to
test-taking.
Threat Realistic and balanced thinking
Ego-related ► I may fail, but I also may pass.

threat ► I may fall very short of my desired standard,
but I may also reach it.
► I will make mistakes on the test, but not
necessarily many.
► If 1 don't feel competent, I may still do well.
► 1 may do worse than some, but may do better
than others. I may even outperform all others,
but may not do so.
► Some people may think negatively of me when
they learn about my performance on the test,
but others may not.
Non-ego- ► If my mind goes blank then this will probably
related not last long.
threat ► If I get anxious on the test, I can still be in
control of myself.
► If I don't ‘feel' prepared to take the test, I may
still pass the test.
► The negative consequences of failing the test
or not doing well on it may be catastrophic,
but they are more likely to be minor.
Insight
When you hold a set of rational beliefs about performance-related threat it
leads you to face and deal effectively with situations in which you infer the
presence of performance-related threat which you view in a realistic and
balanced wray with respect to its nature and consequences.
Using RECBT to manage performance-related

anxiety
In this section of the chapter, I am going to show how you can
use RECBT to deal with performance-related anxiety with special
reference to your performance on tests. While I am focusing on test
5. How to manage performance-related anxiety o

anxiety, you can apply my points to any other context where you are
anxious about your performance where being evaluated by others
present is not an issue.
STATE THE FEELING, BEHAVIOURAL AND THINKING

FEATURES OF YOUR ANXIETY ABOUT YOUR
PERFORMANCE ON TESTS CC’ IN THE ‘ABCDE9
FRAMEWORK)
It is important that you understand how you feel, act and think when
you are anxious about threats related to your performance on tests.
In particular, it is important for you to understand:
► what you do and think when you are anxious that is intended to
make yourself safe from threat related to your performance on tests
► how you exaggerate the nature and consequences of the threat to
your performance on tests when your safety-seeking manoeuvres
don’t work.
These features, once identified, will represent the ‘C' in the ‘ABCDE'
framework.
STATE WHAT YOU ARE MOST ANXIOUS ABOUT WITH

RESPECT TO YOUR PERFORMANCE ON TESTS (YOUR
THREAT AT ‘A9 IN THE ‘ABCDE’ FRAMEWORK)
As I discussed earlier in the chapter, it is important that you identify,
as precisely as you can, what you are most anxious about with
respect to your performance on tests. This will constitute the ‘A' in
the ‘ABCDE' framework. Most commonly found ego-based threats
related to your performance on tests are as follows:
► the prospect of failing the test
► the prospect of failing to achieve your desired standard
on the test
► the prospect of not doing perfectly on the test
► the prospect of not ‘feeling' competent to take the test
► the prospect of not doing as well as others on the test
► the prospect of being judged negatively for your test performance.
Most commonly found non-ego-based threats related to your
performance on tests are as follows:
► the prospect of your mind going blank during the test
► the prospect of becoming anxious during the test
86
► rhe prospect of not ‘feeling’ prepared to take the test
► the prospect of experiencing negative consequences of failure
or of not doing well on the test.
You may well find that you are anxious about a number of such
threats. If so, it is best to deal with them one at a time. When you do so,
it is very important at the outset that you assume temporarily that your
threat-related inference is accurate. You will have a later opportunity
to question this, but for the moment assume that your threat is true
since doing so will help you to identify and deal with the irrational
beliefs that underpin your anxiety response about your performance
on tests and to develop and strengthen alternative rational beliefs that
underpin concern, the healthy alternative to anxiety.
Use the ‘magic question’
What can you do if you are unsure what you find most threatening
about your test performance? My suggestion is to use what I call the
‘magic question’. This is what you do:
► Take a specific and typical example of your performance-related
anxiety with respect to taking tests.
► Focus on the situation in which you feel (or felt) anxious.
► Ask yourself what one thing would get rid of or significantly
diminish your anxiety in this situation.
► The opposite to this is your ‘A’.
Here is an example. The described situation is: Eric is revising for bis
upcoming test and is feeling anxious.
► Eric focused on the ‘situation’ he described:
‘I am revising for my upcoming test in my bedroom.’
► Eric asked himself what one thing would get rid of or
significantly diminish his feelings of anxiety:
'My future not being negatively affected if 1 fail the test.'
► The opposite to this is Eric’s ‘A’:
‘My future will be negatively affected if I fail the test.’
IDENTIFY YOUR GOALS (THESE WILL BE THE ‘E’ IN THE

‘ABCDE’ FRAMEWORK IF YOU ACHIEVE THEM)
While you may well overestimate the presence of your performance-
related threat - an issue I will discuss presently - the possibility of the
existence of the threat will invariably exist so it is important that you
accept this and develop a healthy alternative to anxiety in relation

to your performance on tests. As I have discussed in this book, this
alternative is known as concern and, as with anxiety, it has three
components: emotional, behavioural and thinking.
What you need to do here in relation to the performance-related
threat that you are dealing with in relation to test-taking is to set
concern-related goals. In particular, you need to specify behavioural
and thinking components which will enable you to face up to
and deal with your performance-related threat rather than keep
yourself safe from it - as happens when you are anxious about your
performance. If you achieve your goals they will constitute the 'E' in
the 'ABCDE' framework.
Insight
Setting realistic emotional, behavioural and thinking goals with respect to
your performance-related anxiety will help to focus your efforts in managing
this anxiety.
IDENTIFY YOUR IRRATIONAL AND ALTERNATIVE

RATIONAL BELIEFS f'B' IN THE 'ABODE9 FRAMEWORK)
Once you have listed your anxiety-related components and concern-
related components, you need to specify the irrational beliefs that
underpin your anxiety about threat related to your performance on
tests and the alternative rational beliefs that underpin your concern
about this threat. This represents the 'B' in the 'ABCDE' model.
I suggest that you use the following guidelines for identifying your
irrational beliefs that underpin your anxiety about threats related
to your performance on tests:
► If the threat related to your test performance about which you
are anxious is to your self-esteem, identify your rigid belief and
your self-depreciation belief about the threat.
► If your threat related to your test performance about which
you are anxious is to your sense of comfort (broadly defined),
identify your rigid belief and either your awfulizing belief or
your discomfort intolerance belief about the threat.
Identify your alternative rational beliefs
1 suggest that you use the following guidelines for identifying your
alternative rational beliefs that underpin your concern related to
your performance on tests:
88
► If you have identified your rigid belief and your self-depreciation
belief above, then identify your flexible belief and your
unconditional self-acceptance belief about your performance-
related threat.
► If you have identified your rigid belief and either your awfulizing
belief or your discomfort intolerance belief, then identify your
flexible belief and either your non-awfulizing belief or your
discomfort tolerance belief about your performance-related threat.
QUESTION YOUR BELIEFS CD9 IN THE ‘ABODE9

FRAMEWORK)
As 1 pointed out in Chapter 4, the purpose of questioning your
beliefs is for you to see that your irrational beliefs are irrational
(i.e. false, illogical and largely unhelpful) and that your rational
beliefs are rational (i.e. true, logical and largely helpful). Questioning
your beliefs together, but one at a time (i.e. rigid belief vs. flexible
belief; awfulizing belief vs. non-awfulizing belief; discomfort
intolerance belief vs. discomfort tolerance belief; self-depreciation
belief vs. unconditional self-acceptance belief), is, in my view, the best
way to do this, although I urge you to experiment with different ways
of questioning your beliefs. For help with this questioning process,
I suggest that you consult Appendices 1-4 for general help, which
you need to apply to your specific beliefs about threats related to
your performance on tests.
Insight
Questioning your beliefs helps you to see that your irrational beliefs are false,
illogical and largely unhelpful and that your rational beliefs are true, logical
and largely helpful and to commit yourself to strengthening your conviction
in the latter.
PREPARE YOURSELF, FACE YOUR THREAT AND

DEAL WITH IT
If we know one thing about the effective management of any form of
anxiety, it is that if you don't face up to what you are anxious about
and deal with it effectively, it is unlikely that you will learn to manage
your anxiety. Facing up to situations where the prospect exists of
encountering threats related to your performance on tests tends to be
incompatible with the use of safety-seeking behaviour and thinking in
these situations. This is because these measures are designed to keep
you safe by avoiding and neutralizing the threat. Put very simply,

if you avoid the performance-related threat or you neutralize it,
you will not face it and deal with it.
So rule number one is, if you are choosing to face test-taking
situations in which you may encounter your performance-related
threat, it’s important that you do so without using your safety
seeking behaviour or engaging with your safety-seeking thinking.
Once you have decided to face and deal with your performance-
related threat, here are some tips.
Think about the rate of change and the level of discomfort in choosing
a performance-related threat to face
Whenever 1 give lectures on managing anxiety, 1 ask the audiences a set
of questions. Here they are, related to performance-related anxiety’ in the
context of tests, and 1 suggest that you jot down your answers to them:
► Do you want to manage your anxiety with respect to your
performance on tests: a) very quickly, b) at a moderate rate or
c) slowly?
► How uncomfortable do you want to feel as you work to
manage your anxiety with respect to your performance on tests:
a) not uncomfortable, b) moderately uncomfortable or c) very
uncomfortable?
Now what were your answers? Most people say that they want to
manage their performance-related anxiety when they take tests very
quickly without experiencing any discomfort. Sadly, however, this
is not an option. If you want to manage your performance-related
anxiety quickly, you will tend to experience great discomfort, at
least at the outset. If you opt for the moderate speed, you will tend
to experience a moderate level of discomfort, and if you want to
spare yourself discomfort, you will spend a long time managing your
performance-related anxiety when taking tests.
My experience is that most people opt for the middle way, which I call
‘challenging but not overwhelming'. This means that you opt to face
a performance-related threat in the context of taking tests which is a
challenge for you at that time, but which is not overwhelming for you.
Insight
Probably rhe best way to face situations in which you infer the presence of
performance-related threat is to choose situations that are a challenge for you
to face, but that are not overwhelming at that time.
9°
Rehearse your rational beliefs
Before you face the situation in which your performance-related
threat may be present, it is important that you rehearse your set of
rational beliefs tailored for the test-taking situation you have decided
to face where your performance-related threat is likely to be present.
However, don't over-rehearse these rational beliefs. I suggest that
you rehearse your rational beliefs two or three times to get you into
a reasonably rational frame of mind ready for action.
Use imagery
Before you actually face the test-taking situation in which your
performance-related threat may be present, it may be useful to do
so first in your mind’s eye. If you decide to do this, see yourself
facing your performance-related threat while holding your rational
beliefs. Do not picture yourself facing in a masterful way the test
taking situation in which you infer the presence of your threat.
Keep a more realistic picture in mind where you are hesitant and
uncomfortable but where you face the test-taking situation in which
your performance-related threat may occur.
You may not be able to create a test-taking situation in reality where
your threat actually occurs. For example, if you are anxious about your
mind going blank during a test, you may not be able to bring on this
condition. Indeed, paradoxically, your attempt to do so may make it
less rather than more likely to occur. This is where the power of imagery
comes into its own. Thus, you can imagine being about to enter a test
taking situation and see yourself rehearse your rational beliefs about
your mind going blank. Then you can picture yourself taking the test
and imagine that your mind does go blank. See yourself responding to
this adversity with your set of rational beliefs rather than your irrational
beliefs and then picture yourself resuming your work on the test.
The purpose of facing a performance-related threat in your mind’s
eye, therefore, is twofold:
1 to give you practice at facing a test-taking situation in which
you infer the presence of your performance-related threat where
actual exposure to that test-taking situation may not result in
that threat occurring
2 to prepare you to face a test-taking situation where it is probable
that the performance-related threat will materialize (e.g. where you
are anxious that your performance on the test will not be perfect).
5. How to manage performance-related anxiety 9I

Insight
Using imagery to face situations in which you infer the presence of
performance-related threat is helpful in two ways. It provides you with the
opportunity to rehearse facing threat in your mind's eye before you do so in
reality and it gives you needed practice when you can't face threat in reality.
Face the actual test-taking situation in which you infer the presence
of performance-related threat
If you think about it, the concept of threat involves an event that
has not yet happened or the future implications of something that
has happened or is currently happening. For example, if you are
anxious about others doing better on the test than you, then even
when you are taking the test, you are still not actually facing what
you fear since the results are not in! So when I talk about facing your
performance-related threat, I mean actually going into the test-taking
situation and facing your threat in your mind's eye (e.g. imagining
that others are doing better than you). This is different from
facing your fear in imagination when you are not in the test-taking
situation. Thus:
EXAMPLE OF FACING A PERFORMANCE-RELATED THREAT IN
IMAGINATION
You are sitting in your living room imagining yourself in the
test-taking situation in turn imagining that others are doing better
than you and rehearsing your rational beliefs about this.
EXAMPLE OF FACING THE SITUATION IN WHICH YOU INFER THREAT
You are in the test-taking situation imagining that others are doing
better than you. Here, you will briefly assume that this threat-related
inference is true and you rehearse a shorthand version of your
rational beliefs about this.
The purpose of taking a test is to pass it, at the very least, and
to do as well as you can on it. Do not lose sight of this! Thus,
when you are dealing with your performance-related threat in
the actual test-taking situation, the purpose of rehearsing your
rational beliefs is to help you to focus on the test and to give of
your best. K
92
REFRAIN FROM USING SAFETY-SEEKING MEASURES
IN THE TEST-TAKING SITUATION
During this process of understanding your performance-related
anxiety (as exemplified by test anxiety) and dealing with the
particular threats about which you are anxious, it is very important
that you refrain from using behavioural and thinking measures
designed to keep yourself safe. If you use these measures at this point,
you will undo all the good work you have done to enable you to enter
the situation prepared to face your threat. However, if you refrain
from their use, you will help yourself in three ways:
1 You will have the opportunity of responding to the performance-
related threat if it does occur with your rational beliefs.
2 You will have had the opportunity of rehearsing your rational
beliefs even if the performance-related threat did not materialize.
3 In some cases (e.g. your mind going blank), you will have the
opportunity to see what will happen if you do not use your
safety-seeking measures. This is a very important point. For
example, let’s assume you think that if you have a rabbit’s foot
in your pocket then your mind won't go blank in the exam.
If, indeed, your mind does not go blank, you will be likely to
attribute the reason that your mind did not go blank to the
rabbit's foot in your pocket. The only true test of your inference
that your mind will go blank during the test is, in this case, to
take the test without the rabbit's foot in your pocket - in other
words without your safety behaviour. If you don't have the
rabbit's foot in your pocket and your mind does not go blank
then you can't conclude that the rabbit's foot keeps you safe by
preventing your mind from going blank.
Dealing with urges to re-engage with safety-seeking behaviour
Just because you have resolved not to use your safety-seeking
measures when you face test-taking situations, it does not follow
that you won't experience an urge to do so. Let me consider how
to deal with your urge to use safety-seeking behaviour first. As the
name implies, here you will experience an urge to do something that
is intended to ‘make’ you feel safe in the moment. Your therapeutic
goal, at this point, is to deal with the threat rather than to feel safe.
In order to achieve this you need to do the following:
► Acknowledge that you are experiencing the urge to engage with
a safety behaviour while in the test-taking situation.

► Show yourself that while you want to engage with the behaviour,
you don’t have to do so (i.e. develop and rehearse a rational
belief about the urge) and that there is a good reason not to do
so (i.e. engaging with your safety-seeking behaviour will prevent
you from dealing with the threat and thereby interfere with you
managing your performance-related anxiety in an effective way).
► Focus on whatever it is you would be focusing on if you did not
experience the urge to engage with your safety-seeking behaviour
and accept the anxiety or discomfort that you will experience as
a result of not acting on your urge.
► Recognize that your feelings of anxiety or discomfort will initially
increase under these circumstances, but then they will subside if
you accept their presence and do not try to eliminate them.
Dealing with urges to re-engage with safety-seeking thinking
As well as experiencing an urge to engage with safety-seeking
behaviour, you may also experience an urge to engage with safety
seeking thinking. As the name implies, this form of thinking is
designed to keep you safe in the moment from a performance-related
threat. The intent of such thinking may be to distract you from
the threat or to neutralize the threat (i.e. take the threat out of the
situation). The way to deal with such thinking is as follows:
► Acknowledge the existence of the thought without trying to
suppress it or to distract yourself from it. If you try to suppress
the thought you may unwittingly make it more likely to come
into your mind and if you distract yourself from it you are not
dealing with it.
► Do not engage with the thought. For example, if you are anxious
about other people doing better on the test than you, you may
try to neutralize this by thinking: 'I'm sure I will do as well
as most of the others'. If you engage with this thought, then
you will feel reassured. If you don't engage with the thought,
you won't feel assured, but will have the opportunity of either
rehearsing your rational belief about the threat briefly or getting
on with whatever you would be doing if you did not have the
thought (i.e. engaging with the test) even though you feel anxious
or uncomfortable in the moment.
94
You may well find it difficult to grasp the idea of having a
thought without engaging with it, so here is an analogy that you
may find helpful. Imagine that you are walking down a high
street and a charity worker approaches you and tries to engage
you in a conversation about a local charity. You know that
he (in this case) wants you to sign a direct debit form whereby
you pay a regular sum every month to the charity. Now, let’s
suppose that you neither want to give to the charity nor to talk
to the person. What is the best way of stopping the person from
talking to you without being overtly rude to him?
My view is that the best way to do this is not to respond to the
person. As you continue down the road, the charity worker
walks beside you and you are aware of what he is saying but you
say nothing in return. You give the person no eye contact nor
show him any recognition that he is there. If you take this tack,
after a short while the person will stop pursuing you. This is the
approach you need to take with your safety-seeking thoughts.
Acknowledge that they are present, but continue with what you
are doing while not engaging with the thoughts and without
trying to get rid of them.
Insight
When you face situations in which you infer the presence of performance-
related threat, it is important that you focus on that threat and rehearse your
rational beliefs as you do so. It is also important that you do not engage with
your safety-seeking measures as you face threat.
ACCEPT, BUT DO NOT ENGAGE WITH, THREAT

EXAGGERATING THINKING
Once you have decided to face a test-taking situation in which your
performance-related threat may be present and you have rehearsed
your rational beliefs, for a while you will still in your mind exaggerate
the nature of the threat and its consequences. You will do so because
your irrational beliefs are still active, to some degree, even though
you have challenged them and have rehearsed their rational belief

alternatives. This is how I suggest you deal with such thoughts, in the
following order:
1 Recognize the existence of such thoughts again without trying to
suppress them or to distract yourself from them.
2 Understand that these thoughts are the products of still-active
irrational beliefs.
3 Either briefly rehearse your rational belief about the threat or
get on with whatever you would be doing if you did not have the
thought (see above).
Insight
While you face situations in which you infer the presence of performance-
related threat and rehearse your rational beliefs, as you do so you may still
think in highly distorted ways about the nature and consequences of this threat.
This happens because your irrational beliefs are still active and produce such
thoughts. If you understand why these thoughts are present in your mind and
allow them to stay in your mind without engaging with them then eventually
they will fade away.
UNDERSTAND AND DEAL WITH YOUR PRONENESS TO

INFER THE PRESENCE OF PERFORMANCE-RELATED
THREAT
There are two reasons why people are particularly prone to
performance-related anxiety. First, they are prone to infer the
presence of performance-related threats. Second, they hold
irrational beliefs about such threats. In this section, I am going to
help you understand why you are prone to inferring the presence of
performance-related threats and show you how you can deal with
such proneness.
When you are prone to inferring the presence of your performance-
related threat, you overestimate the presence of this threat. I will
explain the factors involved in this process.
Why you overestimate the presence of your performance-related threat

This is how you come to overestimate the presence of your
performance-related threat in the context of taking tests. I will
illustrate this with reference to the following general irrational
belief:
7 must achieve my desired standard on tests and if I don’t,
I am worthless. ’
96
► You take the threat theme of your general irrational belief
(e.g. ‘I must achieve my desired standard on tests and if I don’t,
I am worthless’):
‘Not achieving my desired standard'
7 must be certain that 1 will achieve my desired standard
on tests. I can’t hear such uncertainty.’
► You bring this second general irrational belief to situations
where it is possible that you may not achieve your desired
standard on tests and you make a threat-related inference in the
absence of certainty from the threat:
'Since I don't have certainty that I will achieve my desired
standard on tests then I won’t achieve this desired standard. ’
Inference: 7 will not achieve my desired standard in my
maths exam. ’
Specific irrational belief: ‘I must achieve my desired standard
in my maths exam and I’m worthless if I don’t. ’
In order to deal with your overestimations of performance-related
threat you need to take a number of steps which I will illustrate again
with reference to the above example:
7 would like to achieve my desired standard on tests, hut
that does not mean I must do so. If I don’t, it’s unfortunate,
but it does not prove I'm worthless. 1 am a unique,
unrateable fallible human being whether or not I achieve
my desired standard on tests. ’
and to your second uncertainty-focused general irrational
belief:
‘I would like to be certain that I will achieve my desired
standard on tests, but I don’t need such certainty. It is
difficult not having this certainty, but I can bear not having
it and it is worth bearing. ’

the former.
► Bring your uncertainty-focused general rational belief to
situations where it is possible that you may not achieve your
desired standard on tests and make an inference based on the
data at hand:
7 am not certain if I will achieve my desired standard on the
maths exam or not so let’s consider the evidence. ’
not achieve your desired standard, then use a specific version of
your general performance-based rational belief to deal with this.
For example:
Inference: 7 won’t achieve my desired standard on the
maths exam. ’
Specific rational belief: 7 would prefer to achieve my desired
standard on the maths exam, but 1 don't have to do so. If
I don't, that would he unfortunate, but I am not worthless.
I am the same ordinary, unique, unrateable person whether
or not I achieve my desired standard on this exam.'
Insight
In order to become less prone to performance-related anxiety, you need
to develop two general rational beliefs: one about what you find most
threatening with respect to your performance and one which helps you to
deal with uncertainty about the presence of this threat. Doing this will help
you to be objective about the possible presence of the threat.
HOW TO EXAMINE THE ACCURACY OF YOUR INFERENCE

OF THREAT IF NECESSARY
If you arc still unsure if your inference of performance-related threat
is accurate or inaccurate, answer one or more of the following
questions:
► How likely is it that the threat (e.g. that others will do better on
the test than me) will happen?
► Would an objective jury agree that the threat (that others will do
better on the test than me) will happen? If not, what would the
jury’s verdict be?
► Am I viewing the threat (that others will do better on the test
than me) realistically? If not, how can 1 view it more realistically?
► If 1 asked someone whom I could trust to give me an objective
98
threat (that others will do better on the test than me), what
would the person say to me and why? How would this person
encourage me to view the threat instead?
► If a friend tells me that they are facing or about to face the same
situation as I am facing and are making the same inference of
threat (that others will do better on the test than her), what
would 1 say to her about the validity of her inference and why?
How would I encourage the person to view the threat instead?
Geoff, a 2.5-year-old mature student, managed his performance-

related anxiety about taking tests by using RECBT principles. Geoff
realized that the behavioural and thinking features of his anxiety
response were particularly important in perpetuating his anxious
feelings. When anxious, he would immediately stop working on
preparing for tests and watch television; get out his certificates to
remind himself he had the ability to pass tests; carry a good luck
charm into tests in his pocket; and leave it to the last minute to
revise and then spend all night working.
Geoff discovered what he was most anxious about by asking

himself the magic question: 'What would take away or significantly
reduce my anxiety about the upcoming test?’ Because his answer
was 'Passing the test’, he knew that its opposite - failing the test -
was what he was most anxious about.
He realized that concern would be the healthy emotional alternative

to anxiety about failing tests. When concerned, but not anxious,
about his performance on tests, he wanted to continue working
on preparing for tests, despite being tempted to stop and watch
television. He would notice the urge to get out his certificates and
to rely on a good luck charm but instead would make a sensible
revision plan, keep to it and wouldn’t spend all night working just
before a test.
Geoff’s irrational belief was: ‘I must pass tests. I’m a failure if I

don’t.’ His alternative rational belief was: ‘I would like to pass
tests, but that doesn’t mean I have to do so. If I don’t. I’m not a
(Contd)

failure, but a fallible human being, capable of succeeding as well as
failing.’
Geoff went over his rational beliefs three times a day, ten minutes
at a time, writing down why they were true, logical and helpful and
why his irrational beliefs were false, illogical and unhelpful. Once a
day, he imagined going into the test situation without his good luck
charm in his pocket, showing himself that he would like to pass the
test, but that he didn’t have to. If he failed, it was unfortunate bur
only proved he was fallible, not a failure.
Geoff realized that one of the main obstacles to managing his

anxiety was that he engaged in safety-seeking thinking and threat
exaggerating thinking. He dealt with his safety-seeking urges by
realizing they were counterproductive to him in the longer term and
that he didn’t have to act on them. He showed himself that he could
tolerate discomfort and that it was in his interest to do so and came
to accept that although the strength of these urges would increase in
the short term when he didn’t act on them, as he continued working
on his revision the strength of his urges diminished.
Geoff transformed his rigid belief that he had to pass the tests
into flexible beliefs such as: 'I can prove that there is no law of the
universe that states that I have to pass tests, for if there were such a
law then I would have no choice but to pass them.’ He recognized
that while failing tests was undesirable, he couldn’t eliminate
this possibility, but it wasn't inevitable. Moreover, failure didn't
define him as a person: he wouldn’t be a failure if he failed tests.
In changing his self-depreciation beliefs for unconditional self
acceptance beliefs, he embraced the idea of fallibility, but didn’t use
it as a form of safety-seeking thinking to neutralize threat. Having
rationally faced up to the possibility rather than inevitability of
failure, Geoff could revise appropriately.
Finally Geoff learned to respond to taking tests with healthy

concern rather than anxiety. While he still made himself anxious at
times about failing these tests, he dealt with these episodes using the
skills that he increasingly internalized.
1OO
Other issues
As you will know by now, this book is based on the RECBT
model which stresses the role played by rigid and extreme beliefs
in accounting for your anxiety problems and the importance of
developing rational beliefs in managing this anxiety and feeling
concern instead. Once you have developed such beliefs, you are in
a much better position to consider a range of other issues that may
help you to perform better at tests.
DEVELOPING SOUND TEST-TAKING SKILLS

Some think that test anxiety stems from a lack of good test-taking
skills. These people argue that if you develop such skills then you
will overcome this form of performance-related anxiety. While I do
not decry the importance of good test-taking skills, my view is that
they will help you with your performance-related anxiety only if they
encourage you not to infer performance-related threat. However,
if you develop such skills and still infer performance-related threat
you will remain anxious as long as you hold irrational beliefs - for
good test-taking skills do not, on their own, help you to change these
beliefs to their rational equivalents.
So, let me reiterate. RECBT suggests that you target for change
your irrational beliefs about performance-related threat concerning
taking tests and when you have done so, and have made progress in
developing rational beliefs, you are in a good position to consider
improving your test-taking skills.
When you come to consider improving your test-taking skills there
are numerous sources that you can consult. Two that are particularly
useful are:
Test-taking Strategies by J. Kesselman-Turkel & F. Peterson
(University of Wisconsin Press, 1981)
The Internet site Study Guides and Strategies
(http://www.studygs.net/tsttaki.htm).
THE USE OF RELAXATION AND BREATHING TECHNIQUES

The use of relaxation and breathing techniques in anxiety management
is generally recommended, but is less widespread than it used to be.
5. How to manage performance-related anxiety IOI

I discussed this issue towards the end of Chapter 4 and I refer you to
this discussion.
In the next chapter, 1 will show you how you can manage your
anxiety about your performance that occurs in a social context,
where how you view yourself and how you think you are being
evaluated by others are prime features.
102
THINGS TO REMEMBER
► When you are anxious about your performance you are anxious
about something related to your performance which you find
threatening to some aspect of your personal domain.
► Your performance-related anxiety may be about a threat to your

self-esteem or to some aspect of your sense of comfort, broadly
defined.
► The main determining factor of your performance-related

anxiety is the set of irrational beliefs you hold about these ego
and non-ego threats.
► When you hold irrational beliefs about performance-related

threats, you are very prone to engage in behaviour and thinking
designed to keep you safe from threat in the moment. However,
these safety-seeking measures interfere with you facing and
dealing constructively with these threats and, thus, unwittingly
serve to maintain your performance-related anxiety.
► When you hold irrational beliefs about performance-related

threats, you are also very prone to exaggerating the nature and
consequences of these threats.
► The goal of managing your anxiety about performance-related

threats is to become concerned, but not anxious, about these
threats when they do exist and to become less prone to making
inferences about the presence of these threats when they may not
be present.
► To manage your performance-related anxiety, you need, first and

foremost, to question your irrational beliefs and to develop and
strengthen your conviction in their rational belief alternatives.
You do the latter by acting and thinking in ways that support
these rational beliefs as you face situations in which you infer
the presence of performance-related threats.
► It is very important that you face situations in which you

infer the performance-related threat without recourse to your
5. How to manage performance-related anxiety I O3

safety-seeking measures and while accepting the presence of your
distorted negative thinking.
► To become less prone to performance-related anxiety, you first

need to understand the role that uncertainty plays in leading you
to infer the presence of performance-related threats in situations
that are ambiguous.
► Once you have developed rational beliefs about your

performance-related threats and about uncertainty related to
their presence, you are in a position to be more objective about
the presence of these threats, which will help you to become less
prone to this form of anxiety.
104
How to manage social anxiety
• how to identify what you are most anxious about when in
a social situation
• the main differences between ego-based social anxiety and
non-ego-based social anxiety
• bow to manage social anxiety
• why you are prone to social anxiety and what you can do to
become less prone.
Introduction
In this chapter, I will deal with social anxiety in which you normally
have two major foci. First, you are focused on your own social
performance and, second, you are focused on how you are being
evaluated by others present. While different people may be more
anxious about one or other of these two foci, both are present to
some degree in social anxiety and I will deal with both in discussing
this form of anxiety.
While we call the anxiety that we experience in social situations
‘social anxiety’, this does not explain, precisely enough, what
we are anxious about.
Understanding social anxiety

As I have just mentioned, the term ‘social anxiety’, if you think about
it, does not explain what you are anxious about, so, as in other forms
of anxiety, careful assessment of what you are most anxious about in
social situations is key to the effective management of social anxiety.
6. How to manage social anxiety IO5

If you experience social anxiety, you need to use the two concepts
that I first discussed in Chapter z to help you to identify what you
are anxious about: threat and personal domain.

EXPERIENCE SOCIAL ANXIETY
When you experience social anxiety, you infer the presence of
a threat to some aspect of your personal domain relevant to your
performance in a social situation and how you think you will be
evaluated by others present. While people who experience social
anxiety find different things threatening when they are in social
situations, there are some recurring themes in what they find
threatening. In this section, I will discuss the most common of these
threats. In doing so, I will distinguish between threats to the ego
realm of the personal domain relevant to your social performance
and how you may be evaluated by others and threats to the non-ego
realm of the personal domain relevant to these same elements.
Threats to the ego realm of your personal domain in social anxiety

relevant to your social performance and how you are likely to be
evaluated by others, this is most likely to be a threat to your
self-esteem (i.e. the degree to which you value yourself). Here
are some of the most common threats under this heading.
THE PROSPECT OF SAYING OR DOING SOMETHING STUPID

IN SOCIAL SITUATIONS
Perhaps the aspect of being in social situations that people find most
threatening to their self-esteem is that they may say or do something
stupid. If this applies to you, you may be particularly anxious about
what you might do (e.g. spilling a glass over someone or tripping
over and falling on your face) or what you might say (e.g. saying
something that is not relevant to the topic being discussed or getting
someone’s name wrong).
THE PROSPECT OF NOT LIVING UP TO YOUR DESIRED OR

IDEAL ‘SOCIAL SELF’ IN SOCIAL SITUATIONS
When you experience social anxiety, it may be that you have in
mind a desired or ideal ‘social self’ that you would like to live up
to but think that you won’t or even that you will fall far short of it.
106
For example, I have recently noticed that a number of my clients
who experience social anxiety have in mind an ideal of being ‘cool’
in social situations. By this, they mean that they feel and come
across to others as being smooth and unflappable in their social
performance. The reality is that these people feel nothing of the sort!
If you have in mind a desired or ideal ‘social self, the threat to your
self-esteem in this case resides in you not achieving this standard or
falling far short of it.
THE PROSPECT OF BORING OTHERS IN SOCIAL SITUATIONS

For some people being in social situations is threatening to
them because they think that they may bore others. If you are
anxious about boring others, you may have an idea that if you
are not entertaining all the time you are boring others and you
may overcompensate for this by trying to be a clown or otherwise
outrageous.
THE PROSPECT OF ‘DRYING UP’ IN SOCIAL SITUATIONS

I discussed in the previous chapter that one form of test anxiety is
reflected in the fear that your mind will go blank in the test-taking
situation. The parallel threat to your self-esteem in social anxiety is
that you will ‘dry up' in a social situation. If you think this way, you
may well consider that it is your responsibility to keep conversation
going smoothly.
THE PROSPECT OF BEING EVALUATED NEGATIVELY BY

OTHERS PRESENT IN SOCIAL SITUATIONS
The prospect of being negatively evaluated for your social performance
by others present is a very frequently expressed theme when people
with social anxiety discuss what they feel anxious about. What makes
this theme particularly difficult to address is that even when the person
with social anxiety is certain that the group will not actually express
their negative evaluation, he (in this case) is still convinced that they
will think negative thoughts about him.
THE PROSPECT OF BEING DISAPPROVED OF

For some people, social intercourse is particularly difficult because
they find the prospect of being disapproved of particularly threatening.
As a result, they will go out of their way to agree with people or to
seek approval.
6. How to manage social anxiety I 07

THE PROSPECT OF BEING CAUGHT OUT BY OTHERS
IN SOCIAL SITUATIONS
Some people who are socially anxious view others with suspicion
and think that, given an opportunity, these others will catch the
person out socially (e.g. by pointing out inconsistencies in what
they have said). As we will see, staying silent in a social situation is
a form of avoiding threat, but one in which the person remains in
the situation. People who are scared of being caught out are often
particularly afraid that someone will notice their silence and ask
them for their views in front of others present.
THE PROSPECT OF BEING RIDICULED BY OTHERS IN
SOCIAL SITUATIONS
I mentioned earlier that some people with social anxiety' are suspicious
of others and see them as wanting to catch them out. Others with
social anxiety see others as even more dangerous and consider that
others present will seize on an opportunity to ridicule the person.
Given this, the person who is anxious about this threat is very careful
about what they say and do in social situations and rarely takes social
risks as a result.
THE PROSPECT OF GETTING A REPUTATION FOR SOCIAL INEPTITUDE
While most forms of social anxiety are about what might happen
in the social situation in which the person is in or is about to enter,
some people are more anxious about gaining a more enduring
reputation for being socially inept. If this is your threat and you
are asked how you would feel if your social performance was inept
in a given situation, but you would not develop a more enduring
reputation for social ineptitude as a result, then you would not be
anxious if this threat was removed.
Threats to the non-ego realm of your personal domain in

social anxiety
When you face a threat to the non-ego realm of your personal domain
relevant to your social behaviour, this is likely to be a threat to your
sense of comfort, broadly defined.
THE PROSPECT OF BEING ANXIOUS IN SOCIAL SITUATIONS
Experientially, any form of anxiety is a painful emotion. It is meant
to be painful, since from an evolutionary perspective anxiety was
designed to alert you to the presence of real danger. Given that it is
a painful emotion, the prospect of being anxious in social situations
108
can serve as a threat to the non-ego realm of your personal domain.
As I will discuss in Chapter 8, anxiety may also be viewed as a
threat to your sense of being in control. This may apply to the
emotional, thinking or urges to act aspects of anxiety.
THE PROSPECT OF ‘FEELING’ SOCIALLY AWKWARD IN
SOCIAL SITUATIONS
Many people who experience social anxiety say that they also feel
socially awkward in that their social performance is not smooth.
1 his awkward 'feeling' can itself be a threat to those for whom
‘feeling’ comfortable in social situations is important.
THE PROSPECT OF SILENCE IN SOCIAL SITUATIONS
Many people who are socially anxious also say that they fear
silence, not because it is a threat to their self-esteem,'0 but because
they find silence to be very uncomfortable.
THE PROSPECT OF SOCIAL DISHARMONY
While for some a sense of intrapersonal discomfort is a non-ego
threat, for others it is a sense of interpersonal discomfort that is
particularly threatening to the non-ego realm of their personal
domain. Such people fear any kind of breakdown of social
harmony.
THE PROSPECT OF EXPERIENCING NEGATIVE CONSEQUENCES
OF POOR SOCIAL PERFORMANCE
Some people have social anxiety in the non-ego realm of their
personal domain not because they fear poor social performance
per se, but because they fear the negative consequences of social
failure. If you are anxious about coming across poorly in social
situations, you predict that you will not achieve desired outcomes
if this happens. Thus, you may infer, rightly or wrongly, that
your future career will be blighted with the consequent negative
impact on your lifestyle if you come across poorly in a particular
social context.
Threats to both realms of your personal domain in social anxiety:

the prospect of showing your anxiety in social situations
There is one fear that is very common in social anxiety which poses a
threat to both the ego and non-ego realms of your personal domain at
,oFor some, silence in social situations is a threat to their self-esteem. These arc people
who believe that it is their responsibility to keep conversation going.

the same time and this concerns the prospect of showing your anxiety
in social situations. This is particularly the case with symptoms of
anxiety that are particularly noticeable such as sweating, blushing,
trembling or shaking, stammering, being agitated, and irregularities in
breathing. In my experience, showing that you are anxious can pose
three main threats:
1 It indicates that you are losing control in a social situation and

thus poses a threat to your ideal or desired 'social self’ where
being in control is paramount.
2 You think that others will evaluate you negatively for showing
that you are anxious in a social situation.
3 Showing that you are anxious is an uncomfortable experience.
Insight
When you are anxious about your social performance, you are anxious
about a threat to some aspect of your personal domain related to your
performance or about how others evaluate you. These threats may be to
your self-esteem or to your sense of comfort, broadly defined.
IRRATIONAL BELIEFS UNDERPIN SOCIAL

ANXIETY
As I have already mentioned, this book is based on a model of
anxiety that stems from Rational-Emotive Cognitive Behaviour
Therapy (RECBT). As I have discussed in Chapters i and z,
this model stresses the role played by irrational beliefs in the
development and maintenance of anxiety.
Irrational beliefs in ego-based social anxiety

In ego-based social anxiety you hold a rigid belief and a
self-depreciation belief about rhe threat to your self-esteem."
I will illustrate these irrational beliefs in each of the ego-based
threats mentioned earlier (see the ‘Irrational beliefs’ column in
Table 6.i).
"You may also hold an awfulizing belief and a discomfort intolerance belief, but
these tend to be secondary to the self-depreciation belief. For the sake of simplicity,
work with only your rigid belief and self-depreciation belief if you have ego-based
social anxiety.
110
6. How to manage social anxiety III
being whether I “ dry up ” or not. ’
The prospect o f being Rigid belief: ‘I must not be Flexible belief: ‘I would prefer it if others
evaluated negatively negatively evaluated by others present in social situations did not evaluate me
by others present in present in social situations.’ negatively, but that does not mean that they
social situations must not do so.’
</>
<L>
O
□
03
(J
03
c
o
Q.
Q-
03
-C
*->
O
c
03
a
03

e
o
03
a
——
03
•
(J
o
53
6. How to manage social anxiety II

H4
Irrational beliefs in non-ego-based social anxiety
In non-ego-based social anxiety you hold a rigid belief and an
awfulizing belief or a discomfort intolerance belief about the
threat to the non-ego realm of your personal domain related
to your social performance and the reactions of others to that
performance.121 will illustrate these irrational beliefs in each of
the non-ego-related threats mentioned earlier (see rhe ‘Irrational
beliefs' column in Table 6.2).
Insight
The main reason why you are anxious about threats related to your social
performance and the reactions of others to that performance is because you
hold a set of irrational beliefs about these threats. These beliefs are rigid and
extreme.
The impact of irrational beliefs about threats related to social

performance and the reactions of others to that performance
When you hold irrational beliefs about threats related to your social
performance and the reactions of others to that performance, doing
so will have a great impact on your behaviour and subsequent
thinking.
Safety-seeking behaviour and thinking related to social performance

and the reactions of others to that performance
performance and the reactions of others to that performance, you
will act and think in ways designed to keep you safe from the threat
(see Table 6.3). This is the case both while you are in the social
situation and before you enter it. The main problem with such
thinking and behaviour is that they do not help you to do what you
need to do - i.e. to deal effectively with your anxiety by facing the
situation in which your threat may occur and by developing rational
beliefs about it. Indeed, these safety-seeking measures actively
discourage you from doing so.
,2You may have both an awfulizing belief and a discomfort intolerance belief.
For the sake of simplicity, work with your rigid belief and the one other non-ego
extreme belief that best accounts for your non-ego-based social anxiety. This will be
6. How to manage social anxiety I I5

Table 6.2 Irrational beliefs and rational beliefs about non-ego-based threats to your social
116
performance and how it will be evaluated.
The prospect of being Rigid belief: ‘I must not be anxious Flexible belief: ‘I would prefer not to be anxious
oV)
• ***
social situations situations.' does not mean that I must not “ feel" that wav.'
■ •—
——
st
o
o
o
•—
a
-C
o
o
u
E
<j
—
<u
OJ *—
rs • —-
o
4-* U-
*-•
— • •""•
. — cj
Q —•
o
-O
o
5
a C5 <U
<u ■*
o
o
K
Discomfort intolerance belief: Discomfort tolerance belief: ‘It would be hard
6. How to manage social anxiety

‘I couldn ’t bear it if I were to for me to bear experiencing silence in social
experience silence in social situations, but I could bear it and it ’s worth
situations.’ bearing.’
I I7
/C om
oc
• •—«
-a
—-
'J—
•—
•—
—
o.
••
■-*-
• —•
■ i ■■ i
<L>
-O
—<
J2
•—
X
z>
■ 1,1
u-
O
c
§3
R
o o s
■*- <Z)
R
□
•Z)
O R
-Z)
Cl R 'o
L?
r-<
H
O O
118
c
o
C5 C3
ex ’<) co
c
*—*
oco
o
c
<d O c
o C3
OJ
X
x> C3
o
o vs c
o CZ) C
o C3
u u
C C
o
o
oco
£ x>
co O
O C
(J
2
<J C o
o C5
eb 
E QJ
□
r3 o E
OL U o
OJ <l»
rz
QJ
C5
X»
O
§
S
o
£S o □
O
s co u
Q
£
6. How to manage social anxiety 119
120
C/1
rJ
c/iC
O
3
• *->•—
</l
C5□
c
o
s
A
before entering social situations > you will not show that you are anxic
► Inviting people with whom you feel safe in social situations
to go with you into social situations > others will neither judge you negativ
► Using relaxation and breathing techniques for your social performance nor act
to control anxiety badly towards you
CS
x
c
’S-
<L>
<s>
o
•—
□
• —*

<u
be th a t you can easily break them

e <D
o U
the negative consequences th a t you
social situation and if people react

z E Z3
fear if you perform p o o rly in the
negatively to you w o n ’ t happen

rd
C
CX

OJ
:. z o□ aj
>
CX
□ a o
01 O rd c QJ c
Bi C 0£ a o u-
o
c
o z□ o
u-
cd 5
Q
5
#:: <L»
z o
: C cd
□ o
QJ
z rd cd o z
O Q <D <d
'-Tj A A A
>
<D
CO
a
CX o
c
□
c > o rd
rd o £ v-
aj <D
u (U z o
O cd z
z □ (D O E
(L> z E
a E
Z c
CD a cd
cdO o <d cd rd
o o
cd cd o
C <d z □
c c
o O e cd o <L»
z o CX cd
z
<d a. a
s : Z z z E O rd
o : O o z
X
o rd
<D
cd o
cd
C cd CX
<D
<D
00 (J a
o <d
:
. cd <DC C o
z <d
O o <D O O c <d
-Ci : z Z CX <d
□ O c
C Z
c
g M a C
u
o cd rd
O
: CX <L>
*D ex z z ■z
z Z O c E C
c c
o
c =3 <D
O U
r • • Q- □ o - >ZZ
<D O cd <D <D
z < § O O <U X
<u
*3 <u
CQ
'D
'Z
<3
O
Jo
§
£
I 22
E GJ
o o c
re 3 re
X GJ re O
3 re E
GJ O
5 O
CZ gj 3
Z
X ■*-
re 3
re gj O 0 GJ re 3 g o
ru
cz
GJ cz
GJ
c cz
3
- u
ex re o c 3 x .O
ex
c 3
3 GJ re
3 o 3
- cz GJ re GJ
O re GJ 3 re
3
re O 3
cz
cz
> CZ O
cz 3
re
£ re gj GJ GJ 3
£ gj re O
GJ GJ
CZ re
cz Z
3 O O 3 3 3
z re
u u re
GJ
GJ
GJ
O 3
U
Z Z re
re
O
cz
Gj
c E GJ gj Z C
cz
3
re 3
re ■
gj X
O X re
tx
ex
3 3 x •= c -re
3
Gj
Qj
cz 3
re
O
X 3 o Z o r
x GJ GJ GJ
‘z u X 3
<s> re gj re re X
3 o
gj ex 3 GJ 3 3 re r-> cz
o
C
GJ E GJ 'S) 3- C
3 -3 'S';
cz gj
3 3
3
O Z O
re X re
3
3 re gj X
re 3
Gj cz re
3 c-
&X
GJ o
3
Z z 3
Z
□ GJ
C X.
3
x
E
cz 3 re
CZ GJ
cz
- re □
3 re 3 cz
o GJ
£
GJ GJ
Z
'y. ’S)
re
cz
3
3
gj o
cz Z re
Gu
GJ 3
gj x Gj
CZ — re cz
3
re 3
X o
x 3 cz
2? re o 3
O re
re
GJ re O
C
Z-Z 3
re
cz
cz cz 3
Z
’Z a 3 gj GJ re re o re
Gj Gj
Gj
re
x cz
Gj 3
re 0
3
go
c re
cz 'x:
>4
§

THREAT-EXAGGERATING THINKING RELATED TO YOUR SOCIAL
PERFORMANCE AND THE REACTIONS OF OTHERS TO THAT
PERFORMANCE
performance and the reactions of others to that performance, if you
are not engaged in thinking designed to keep you safe, your thinking
is characterized by exaggerating the nature of the threat and its
consequences as shown in Table 6.4.
from holding irrational beliefs about threats related to
my social performance and people's reactions to it.
Ego-based ► I will fall very short of my ideal ‘social self.

threat ► When I say something stupid everyone will notice
and evaluate me very negatively.
► I will bore everyone rigid.
► I will make many social gaffes.
► I won't be able to think of anything to say.
► Everyone will disapprove of me.
► If people catch me out, everyone will remember
this for a long time.
► If some people ridicule me everyone else will join in.
► If I get a reputation for social ineptitude,
it will stick with me forever.
Non-ego- ► If I get anxious in a social situation 1 will lose

based complete control of myself.
threat ► If I feel socially awkward, I won't be able to think
straight.
► If I don't break a silence. I'll be so uncomfortable
I'll burst.
► If there is any social disharmony, all hell will
break loose.
► If I perform poorly socially, the consequences will be
very, very bad for me. k
124
A DISTORTED IMAGE OR PICTURE OF YOURSELF CONTAMINATED
BY SOCIAL ANXIETY
When you hold a set of irrational beliefs about socially related
threat, you may develop an image or picture of yourself which is
grossly distorted, but one that you think at the time is accurate and is
how others actually see you. Basically you see yourself as a defective
social being. It is as if a caricaturist has drawn a caricature of you to
show a grossly distorted representation of your worst social features.
Here are some examples of such self-images or self-pictures:
► a jabbering wreck
► going as red as a beetroot
► very gangly with long arms like a baboon
► a quivering jelly.
Insight
When you hold a set of irrational beliefs about your social performance
and the reactions of others, it leads you to seek immediate safety from these
threats and/or to exaggerate their nature and consequences. It can also lead
you to develop a grossly distorted image or picture of yourself as a defective
social being. Engaging with these effects interferes with you managing your
social anxiety because it prevents you from facing and dealing effectively
with situations in which you infer rhe presence of these threats.

THREATS RELATED TO SOCIAL PERFORMANCE AND
THE REACTIONS OF OTHERS TO THAT PERFORMANCE
these threats. In this section of the chapter, I will outline which
threats to your social performance and the reactions of others to
that performance.
Rational beliefs in ego-based social concern

In ego-based social concern you hold a flexible belief and an
unconditional self-acceptance belief about the ego-based threat.'3
I will illustrate these rational beliefs in each of the ego-related
threats mentioned earlier (see the ‘Rational beliefs’ column in
Table 6.1).
’’You may also hold a non-awfulizing belief and a discomfort tolerance belief, but
these tend to be secondary to the unconditional self-acceptance belief.
6. How to manage social anxiety I25

Rational beliefs in non-ego-based social concern
In non-ego-based social concern you hold a flexible belief and a
non-awfulizing belief or a discomfort tolerance belief about the
threat to the non-ego realm of your personal domain related to
your social performance and how it and you are being evaluated by
others. I will illustrate these rational beliefs in each of the non-ego-
based threats mentioned earlier (see the ‘Rational beliefs' column
in Table 6.2).
Insight
When you hold a set of rational beliefs about your social performance and
how you are being evaluated by others for that performance, you will feel
concerned, but not anxious, about these threats.
The impact of rational beliefs about threats related to social

performance and the reactions of others to that performance
When you hold rational beliefs about threats related to your social
performance and the reaction of others to that performance, doing
so will also have a great impact on your behaviour and subsequent
thinking.
BEHAVIOUR AND THINKING RELATED TO SOCIAL PERFORMANCE
AND THE REACTIONS OF OTHERS TO THIS PERFORMANCE
performance and the reaction of others to this performance, you
will act and think in ways designed to help you to face these threats
and deal with them effectively (see Table 6.5). You will notice from
Table 6.5 that when you hold rational beliefs about threats to your
social performance and the reactions of others to this performance,
you still experience similar urges to engage in safety-seeking
behaviour and thinking as you did when you held irrational beliefs
about these threats, but you accept them and do not actively engage
in these urges.
performance and the reactions of others to this performance, then
these beliefs will also help you to think in a realistic and balanced
manner about the nature of these threats and their consequences
(see Table 6.6).
116
3 3
3 3-
e
Table 6.5 Behaviour and thinking stemming from rational beliefs about threats related to
O O dj 3
3 3 (J 33 C o
3
.......... .................................................... ....... . .................... . ................................................... . ...... . .......... . .......... . ...... .
E o 0 3 x 3
o x 3
dj
o
x
E
dj
33
Z
3 33 dj 33
C x 3 3 X
a
5 dj 33 3
3
X 3
ay 3 3 3 o d>
(X dj dJ ay
u_ c 3 o Z 3 u.
Behaviour designed to help you deal.......................Thinking designed to help you deal
dj 3 3
3 dj -x
O
dj
dj c 3
dj
x
<L>
33 O 3
o 3 a
3 Q. 33
33
dy
3
dj 3 z
X
O O zx E
□
O
O
3
3 'X O z 3 3
3
s. 3 0
3
33
3
ZZ 3
CJ
33 u 33
3 O
O 33 dj 3 oj 3
x 3 x
3 O o ex
O x o
5 O o □
3
O O x
3
5 CZ- 33
dj 3
z d>
O C dj 3 O 3 Z o 3 O
social performance and the reactions o f others to that performance.
33 dj o 3 3 33 33
3
x
dj
U» 3
3 3 dj
x
3 3 □ 3 33 d> ZZ3 dj
C
O
3
3
3
with the threat
3
c dj dj 3 O
dj dj
3 o 33 3 3 X
X C 33 x
dj
O
X
CJ 3
3 o 3 3 X; O
3
3 33 O 33 O 33 3 O
O 3 3
d> 33 33 33 O 3 X 3
3
dj
O
x
O
u
dj 3 3
33 3 3 dy
a Z
O
rt o Z dj
3 3 Q.
O
3 dj
dj Z
u M-H
o
X 3 x X x LU x A A
d>
X
3 X
O E a
3 O
dj o o E
3
3 a O
x
3
3
3
z
3 3 O 33 3 3
c 3
O O c 3
X
X 3 o 3 x O
X 3 o
3 C O x
C U 3 3 3
C
O O
'X E £ o
x 3 CL
d-» o 3
o
z dj a
3 dj O
3 3 3 Cu
Z O
(X 33
dj
ex
O
dj
33
3
o 3 Z
x
3 dj O dJ C
3 3 X
ex 3 33
dj
dj
x 3
3
3
C dj 33 33
3 dj
dj 3
Oj 3 
u- 3
o 3
dj O
dj dj c
£
3
x x
dj
E
dj
3
3
E
dj
33
3 zX O dj
X
ex E
dj 3 3 x d> dj
dj d> U- o O dj a 3 O
d>
X
o
x X 3
I 3
I u- X X x
'X
Threat
4—

E o
<D
CL> 3 3 o on
<D O 3
—
Z 3 3 X
—
03 03 o o 03
—
on 3 <D CD o D
<D o Z z o
3 O D 03
C
CD 3 3
<D a
<D 3 3 o E 3
o D 3 D
scene, but not engaging with it

z 3
O c
3 O
3 CD D
o D
on
3 o 3 On cz D > z
E 03 3
on E 03
u-
03
O
■ □ o 3 o 3 3 z
o
cz
3 03
z
03
cz
D
on
u o 3- o C
<D <D O CD
D
cz D
03
O <D
O
i <D 03
3
O
cz
on
o CD
3 <D
O c o C O
C <D
3 3
U-
— □
3 (J <D
on
qj (J
cz
cz o
o D D O O
■r Z 3
Z
3
—
o
(D
on
3
• •—*
E
3,
E t-. ..
3- D
3 E 3 on
o o c on
D <D <d .3 c
• CD 3
cz
on Z
3 3
O
o
z
•
3 3 D □ oh c
•h O OH 3 on jz on.
O o o CD
3
<D
*-*
3
on •
c o -S u
3
03
3
3 ’
on
D D
'27 A I a 3 <D GO d CO
r* E cz
O
CO
OX)
c O
cz
can make a quick getaway, but not doing so
on cz
u-»
cz
□
03 3 3
3
O c
<D
6 O
> 3 3
D cz
03 (D 3
z
o 03 on
3
3
3
c 3
•—•
— 0
CT
03
03 (J O o </> O
<D 3 □ D o E £ z O 03 z
Z cz — VA-4
a *->
cz o 3 on
3 O u a 3 D D
O •— cz Z
O 03
C z <D 3 o o £ 03
X
03 D on 3 <D cz (Z cz □
—«
X 03 03 —
3 03 o
CD
3
3 3 3
•— o
3 on
D 3 <D cz D *->
O 3 c
3 z
3 D CD
cz CD 3 E 03 E O
CD
Z
o 3 o <D o
o D □ 03
*->
<D
03
=5 z cz
O 3 Z
03 03
<D
3 o o O o cz
—
03
c
<D O CD
cz 3 <D o cz
on O z
3 3
OJj
<D E O c
3 o CD (D 3 O
c u- CD
4-*
•z
s CD z
<D 3
3
O
o
Q-
E
03
D
<D
g
O
3.
3
3
3
a
E -
O
U
on .
on .
3
3
Q-
a
E
3 D
——
cz D >
03
<D
Z £ o 3 ’
C D
on
o
on
c o 3 D 3 on ?
c on
3 on on 3 03 03 o 3 on
— ■u*
D <D
3
• •—•
3 —< 3
□
CD O D 03 ’d ’d .3
<D c a o CD
X 3 cn <D c £ c
• *** 03 CQ z GQ z co
CQ
s
7^
H
128
Vi st
<3 C o
O
o Z 03
□
03 XL
Vi C
a
X) Xi 03
c.
E Vi X)
03 O
z Vi
X) =
vi
X
o 3
X* O 03
Vi
XL 5
□ C c XL
c
z XL
— ’.J 03
XL
Z
o 03
XL X)
o
XL c
03
XJ □
Vi
Xi XL
Xi c
Vi X*
Z Xi Vi > 03
C cx Xi
z □ O 03
X* x> □
03
X>
£ C vi o U > V) L>
x» O —
x> C- x»
C 03 zr a 03
& c
E o o
vi 2- E o3 Vi X> u o
o
X) XL x>
-
<j
03 Z O O x> ex
03 X)
Xi Z
C
e 
o o a Vi □
vi □ 03 o E
Vi
X) Vi o >
Xi 03 Z
Xi Xi Xi Z
Xi
XL Vi 03 3 o
O X) 03 o Q-
C Z a
Z Vi
o o z Z X) □
o3 (J Vi vi a
Xi XL x> Vi o XL
03 XL 03 C z x> 3
o3 X>
XL Vi 03
O
Vi XL C
o Vi 03c z XL c Z XL O □ a
O Vi03 X> 03 x> V) Vi X>
a O X> 03
XL □ Z o 0 X>
o 03 o Xi
03
o X)
O Vi
X*
x- x»
o o o X)
x> 03 XL X* x> XL
XL Vi x» Vi x> 03 03
XL XL o O XL Xi o
x» Z XL
x> O □ o
3 z 2 x> □ c Xi C c Xi o o
vi
x> X x> x> □ a. □ x> Vi c
S o o
Xi £ 3 □ EXi a Q- Xi
3 3 O 3 O E 0
XL XL V) C
Xi
XL o o X) Vi
C c XL op O v> a Vi XL
C E O XL XL XL X>
c Z 03 03 XL
a 3 Xi
>03 z o x>
a X) C
E x> 03 1) o Xi X) X* 03 x> x» Xi o
I Xi x> I
o GO co z I ca Vi 5

<D <D 03 o3 □
and if people react negatively to

you perform poorly in the socia
The negative consequences that
cz O OX — CD
3 ex
O
o
-i a
o o
a
(Z)
<D
ex
c CJ
o
<d C
03
CD
<D 03
CD CJ
c o o 03 (J e
O u c □ D CD 3 *D
03 03 O
0
□ CD o
s- □ CD
□
o
ex
c
C
3 X c 03 CT)
-r C 03
o CD 03 03 03 <D
s 03
CD
o
CD "O
O
O
CD
a <1>
<D CD CD a
03
o
CD ex <d 03 ox CD
£ 01; 03 <D
O -c D c
•SP c c o
s C
<d
<D o
cz.
D *- D
OX ££ 03
c <D
o & <D
o
a
43 c q CD <d cd <D
c OX
C ox O □ <d qj
•S <D o O
*~4 o > 3 u CD <d
03 o o
s I c A A
t>
c
■§ <D
CO
o
CD
c
03 ox E
<D c
CD o 03
c U
03 C <D
E C 03 CT)
ox
a c
o o o
c
- u. 3
D c <D 03
O
c uu Q- X Q-
o 03 <D
C 03 <D <D
•Cl 03 03 CD O
□ 0 CZ) <D o
CD (Z)
CD c (D □ IZ)
o
03 03 □ o CD(S)
CD O CD Q CD o
O ex
CD
o o D
<D C/> X OX
'D •M OJ
c ? s <D c
Q- o <d c O
“T3 <d ECD CZ o
CD CX
g <5D C 03 03
o
*** <D ox c <D C *D o c
 Z E 2 ?
in social situations), but not doing so

s -
GJ z
cz e GJ E O
GJ
X o GJ □
z ej
c E E
O gj
O
gj
X
x .2
z:
X
'•S'. E C
E E
E
E
GJ
E e X E
E
E □ GJ E GJ z
<U E GJ z GJ
E E
GJ
3 c GJ E
'S. E E GJ z
z E E X cs C E Z X
o 3
E E GJ O E
X i- GJ O
z rz C E gj X
OJ
z
GJ GJ E
o 3 X
E E gj X
Z GJ O Z rZ o E Z E
X E
GJ ___
GJ GJ *-
z C3 E i ^J E
z Z
O O
rz Z E U gj gj gj
cz z gj E
GJ GJ
X
Z-
c E GJ x
E E
E c z E 3 E
z GJ GJ
E
E z s E
- z O X c GJ ex
GJ
E X
gj X z c
E
e U
3 3
E
X GJ
E
E
GJ z GJ GJ z GJ
U
GJ
E
X 02 X E 'Si X z X
z
z E
3
X
E
gj
E X Z
E !X C E
GJ E E
Z x 2
GJ u
rz E Z z z E
3 Z
Z
O ZL z z
E
<s. GJ
CZ a E E E
X
O
gj b E
E Z □ E
G> z GJ
E E
z
3 c E GJ
GJ
s z
Z z z z o
z E z
z
Gj
3 vs f E
Gj GJ z
O X 3 E
> Z
E E
E
E
3 Z z
gj cz
Z z
3 z E GJ gj Z □ GJ
u-
O
X ■y, E
Z gj
E O X
GJ gj X gj E
gj 3 <D GJ
C
E
E
-
GJ
z x E-.E O
Z E « o E
z G> o a/
GJ i
3 x .2 X Z
E
X Z E >rz Z X
E
E x E
C E E E E
gj X E
3 GJ
<z
E GJ
gj
GJ E E GJ O U
X E E I X X E
•*—
w
fS
6. How to manage social anxiety I3 T

my social performance and people’s reactions to it.
................................. ................................................................................
•....................................... ............................. ....................... ..............................
Ego-based ► I may fall very short of my ideal ‘social self’,
threat but it is more likely that I will fall a bit short
of this ideal.
► When I say something stupid some people
will notice and evaluate me very negatively,
but others will be more compassionate.
► I may bore some people rigid, but certainly
not everyone.
► I may make some social gaffes, but probably
not many.
► I will be able to think of something to say,
even if it may not be particularly interesting.
► Some people may disapprove of me, but not
everyone.
► If people catch me out, perhaps one or two will
remember this for a long time, but most won't.
► If some people ridicule me, one or two may
join in, but most won’t.
► If I get a reputation for social ineptitude, it is
unlikely to stick with me forever.
Non-ego-based ► If I get anxious in a social situation, it is

threat unlikely that I will lose complete control of
myself.
► If I feel socially awkward, it may affect the
way I think, but I will still be able to think
straight.
► If 1 don't break a silence, 1'11 be uncomfortable,
but that’s all that will happen in all probability.
► If there is any social disharmony, it will be
uncomfortable, but it is unlikely that all hell
will break loose.
► If I perform poorly socially, the consequences
may be bad for me, but they are unlikely to
be very bad.
132
Insight
When you hold a set of rational beliefs about your threats related to your
social performance and the reactions of others to this performance, doing
so leads you to face and deal effectively with situations in which you infer
the presence of these threats which you view in a realistic and balanced way
with respect to their nature and consequences.
Using RECBT to manage social anxiety

In this section of the chapter, I am going to show how you can use
RECBT to deal with social anxiety.

FEATURES OF YOUR SOCIAL ANXIETY (‘C’ IN THE
‘ABCDE’ FRAMEWORK)
It is important that you understand how you feel, act and think
when you are socially anxious. In particular, it is important for
you to understand:
► what you do and think when you are socially anxious that is
intended to make yourself safe from threat
► how you exaggerate the nature and consequences of the threat
when your safety-seeking manoeuvres don’t work
► the image you have of yourself when you are socially anxious.
These features, once identified, represent the ‘C’ in the ‘ABCDE’
framework.
STATE WHAT YOU ARE MOST SOCIALLY ANXIOUS

ABOUT (YOUR THREAT AT ‘A’ IN THE ‘ABCDE’
FRAMEWORK)
As I discussed earlier in the chapter, it is important that you identify,
as precisely as you can, what you are most socially anxious about.
This will constitute the ‘A’ in the ‘ABCDE’ framework. Most
commonly found ego-based socially related threats are as follows:
► the prospect of saying or doing something stupid in social
situations
► the prospect of not living up to your desired or ideal ‘social self’
in social situations
► the prospect of boring others in social situations

► the prospect of 'drying up' in social situations
► the prospect of being evaluated negatively by others present in
social situations
► the prospect of being disapproved of
► the prospect of being caught out by others in social situations
► the prospect of being ridiculed by others in social situations
► the prospect of getting a reputation for social ineptitude.
Most commonly found non-ego-based threats related to your
performance in social situations are as follows:
► the prospect of being anxious in social situations
► the prospect of 'feeling' socially awkward in social situations
► the prospect of silence in social situations
► the prospect of social disharmony
► the prospect of experiencing negative consequences of poor
social performance.
In addition, you may be anxious about the prospect of showing your
anxiety in social situations, which tends to be both an ego-based
threat and a non-ego-based threat.
You may well find that you are socially anxious about a number of
such threats. If so, it is best to deal with them one at a time. When you
do so, it is very important at the outset that you assume temporarily
that your threat-related inference is accurate. You will have a later
opportunity to question this, but for the moment assume that your
threat is true since doing so will help you to identify and deal with
the irrational beliefs that underpin your social anxiety response and
to develop and strengthen alternative rational beliefs that underpin
social concern, the healthy alternative to social anxiety.

about your social performance and the reactions of others to it?
My suggestion is to use what I call the 'magic question'. This is
what you do:
► l ake a specific and typical example of your social anxiety.

► Focus on the situation in which you feel (or felt) socially anxious.
diminish your social anxiety in this situation.
► I'he opposite to this is your 'A'.
134
Here is an example of using the ‘magic question' to identify ‘A’.
The described situation is:
Gemma is sitting with a group of fellow students in the
coffee bar between lectures and is feeling anxious.
► Gemma focused on the ‘situation’ she described:

7 am sitting in the coffee bar with a group of fellow
students between lectures.'
► Gemma asked herself what one thing would get rid of or
significantly diminish her feelings of anxiety:
‘That those present won't judge me negatively if
I blush.’
► The opposite to this is Gemma’s ‘A’:
‘The prospect of others judging me negatively if I blush.’
IDENTIFY YOUR GOALS (THESE WILL BE THE ‘E’ IN

THE ‘ABCDE’ FRAMEWORK IF YOU ACHIEVE THEM)
While you may well overestimate the presence of socially related
threat - an issue I will discuss presently - the possibility of the
existence of the threat will invariably exist so it is important that
you accept this and develop a healthy alternative to your social
anxiety. As I have discussed in this book, this alternative is known
as concern and, as with anxiety, it has three components: emotional,
behavioural and thinking.
What you need to do here in relation to your socially related threat
is to set concern-related goals. In particular, you need to specify
behavioural and thinking components which will enable you to face
up to and deal with your socially related threat rather than keep
yourself safe from it - as happens when you are socially anxious.
If you achieve your goals they will constitute the ‘E’ in the ‘ABGDE’
framework.
Insight
your social anxiety will help to focus your efforts in managing this anxiety.

RATIONAL BELIEFS (‘B’ IN THE ‘ABCDE’ FRAMEWORK)
6. How to manage social anxiety I3S

underpin your social anxiety and the alternative rational beliefs that
underpin your concern about your socially related threat.
irrational beliefs that underpin your social anxiety:
► If the socially related threat is to your self-esteem, identify
your rigid belief and your self-depreciation belief about the
threat.
► If your socially related threat is to your sense of comfort
(broadly defined), identify your rigid belief and either your
awfulizing belief or your discomfort intolerance belief about
the threat.
► If your socially related threat is to both your self-esteem and
your sense of comfort, then deal with the ego threat separately
from the non-ego threat and then follow the above two
guidelines.
alternative rational beliefs that underpin your social concern:
belief, then identify your flexible belief and your unconditional
self-acceptance belief about your socially related threat.
► If you have identified your rigid belief and either your
awfulizing belief or your discomfort intolerance belief, then
identify your flexible belief and either your non-awfulizing
belief or your discomfort tolerance belief about your socially
related threat.
QUESTION YOUR BELIEFS f‘D’ IN THE ‘ABCDE’

FRAMEWORK)
As I pointed out in Chapter 4, the purpose of questioning your
136
belief vs. unconditional self-acceptance belief), is, in my view, the
best way to do this, although I urge you to experiment with different
ways of questioning your beliefs. For help with this questioning
process, I suggest that you consult Appendices 1-4 for general
help, which you need to apply to your specific beliefs about socially
related threats related to your performance in social situations.
Insight
Questioning your beliefs helps you to see that your irrational beliefs are
false, illogical and largely unhelpful and that your rational beliefs are true,
logical and largely helpful and to commit yourself to strengthening your
conviction in the latter.

DEAL WITH IT
As I pointed out earlier, the effective management of any form of
anxiety depends on you facing up to and dealing with what you
are most anxious about. Facing up to situations where the prospect
exists of facing socially related threats tends to be incompatible with
the use of safety-seeking behaviour and thinking in these situations.
This is because these measures are designed to keep you safe by
avoiding and neutralizing the threat. Put very simply, if you avoid
the socially related threat or you neutralize it, you will not face it
and deal with it.
So rule number one is, if you are choosing to face situations in which
you may encounter your socially related threat, it’s important that
you do so without using your safety-seeking behaviour or engaging
with your safety-seeking thinking. Once you have decided to face
and deal with your socially related threat, here are some tips.
Think about the rate of change and the level of discomfort
in choosing a socially related threat to face
If you want to deal with your social anxiety quickly, you will
need to put up with quite a bit of discomfort as you do so. If you
want to avoid discomfort, it will take you quite a long time to
manage your social anxiety. Most people opt for the middle way
between these two, which I call ‘challenging but not overwhelming’.
This means that you opt to face a socially related threat which is
a challenge for you at that time, but which is not overwhelming
for you.
6. How to manage social anxiety T 37

Insight
Probably the best way to face situations in which you infer the presence of
socially related threat is to choose situations that are a challenge for you to
face, but that are not overwhelming ar that time.

Before you face the situation in which your socially related threat
may be present, it is important that you rehearse your set of rational
beliefs tailored for the social situation you have decided to face
where your socially related threat is likely to be present. However,
don't over-rehearse these rational beliefs. I suggest that you rehearse
your rational beliefs two or three times to get you into a reasonably
rational frame of mind ready for action.
Use imagery
Before you actually face the social situation in which your socially
related threat may be present, it may be useful to do so first in your
mind's eye. If you decide to do this, see yourself facing your socially
related threat while holding your rational beliefs. Do not picture
yourself facing this situation in a masterful way. Keep a more
realistic picture in mind where you are hesitant and uncomfortable
but where you face the situation in which your socially related
threat may occur.
You may not be able to create a social situation in reality where
your threat actually occurs. For example, if you are anxious about
others ridiculing you, you may not be able to bring about this
condition. This is where the power of imagery comes into its own.
Thus, you can imagine yourself entering a social situation where
others will ridicule you and see yourself rehearse your rational
beliefs about this impending threat and feeling concerned, but not
anxious, about it. Then you can picture yourself actually being
ridiculed and see yourself responding to this adversity with your set
of rational beliefs rather than your irrational beliefs and then picture
yourself feeling sad, but not depressed, about it.*4
I he purpose of facing a socially related threat in your mind's eye,
therefore, is twofold:
NWhen you hold irrational beliefs about an adversity that has not happened yet, but
you think that it will, then you feel anxious about this prospect. When the adversity
happens, your feelings change from one unhealthy negative emotion (i.e. anxiety) to
another (in this case, depression).
138
1 to give you practice at facing a social situation in which
you infer the presence of your socially related threat where
actual exposure to that situation may not result in that
threat occurring
2 to prepare you to face a social situation where it is probable
that the socially related threat will materialize (e.g. where you
are anxious that you will stammer in public where you actually
t have a bad stammer).
Insight
Using imagery to face situations in which you infer the presence of socially
related threat is helpful in two ways. It provides you with the opportunity to
rehearse facing threat in your mind's eye before you do so in reality and it
gives you needed practice when you can't face threat in reality.
Face the actual social situation in which you infer the presence
of socially related threat
If you think about it, the concept of threat involves an event that has
not yet happened or the future implications of something that has
happened or is currently happening. For example, if you are anxious
about others ridiculing you in a social situation, you are still not
actually facing what you fear since you have not yet exhibited any
social behaviour and they have not yet had a chance to respond. So
when I talk about facing your socially related threat, I mean actually
going into the social situation and facing your threat in your mind’s
eye (e.g. imagining that others are ridiculing you). This is different
from facing your fear in imagination when you are not in the
social situation. Thus:
EXAMPLE OF FACING A SOCIALLY RELATED THREAT IN
IMAGINATION
You are sitting in your living room imagining yourself in the social
situation in turn imagining that others are ridiculing you and
rehearsing your rational beliefs about this.
EXAMPLE OF FACING THE SITUATION IN WHICH YOU
INFER THREAT
You are in the social situation imagining that others are ridiculing
you. Here, you will briefly assume that this threat-related inference
is true and you rehearse a shorthand version of your rational beliefs
about this.

The purpose of being in a social situation is either to enjoy
yourself or to achieve a socially related task. Thus, when you
are dealing with your socially related threat in the actual social
situation, the purpose of rehearsing your rational beliefs is to
help you to focus on what is happening socially and to enjoy
yourself or to help with the relevant task.

IN THE SOCIAL SITUATION
During this process of understanding your social anxiety and
dealing with the particular threats about which you are anxious,
it is very important that you refrain from using behavioural and
thinking measures designed to keep yourself safe. If you use these
measures at this point, you will undo all the good work you have
done to enable you to enter the situation prepared to face your
threat. However, if you refrain from their use, you will help
yourself in three ways:
1 You will have the opportunity of responding to the socially
related threat - if it does occur - with your rational beliefs.
2 You will have had the opportunity of rehearsing your
rational beliefs even though the socially related threat did
not materialize.
3 In some cases (e.g. people ridiculing you), you will have the
example, let’s assume you think that if you have a rabbit’s
foot in your pocket then other people will not ridicule you in a
social situation. If, indeed, others do not ridicule you, you will
be likely to attribute the reason that they did not do so to the
rabbit’s foot in your pocket. The only true test of your inference
that others will ridicule you during the social situtation is, in
this case, to be in the situation without the rabbit’s foot in your
pocket, in other words without your safety-seeking behaviour.
If you don’t have the rabbit’s foot in your pocket and others do
not ridicule you, then you can’t conclude that the rabbit’s foot
keeps you safe by preventing others from ridiculing you.
140
measures when you face social situations, it does not follow that you
won’t experience an urge to do so. Let me first suggest how you can
deal with your urge to use safety-seeking behaviour. As the name
implies, here you will experience an urge to do something that is
intended to ‘make’ you feel safe in the moment. Your therapeutic
goal, at this point, however, is to deal with the threat rather than
to feel safe. In order to achieve this you need to do the following:
a safety-seeking behaviour while in the social situation.
you don't have to do so (i.e. develop and rehearse a rational
belief about the urge) and that there is a good reason not to do
so (i.e. engaging with your safety-seeking behaviour will prevent
you from dealing with the threat and thereby interfere with you
managing your social anxiety in an effective way).
behaviour, you may also experience an urge to engage with
safety-seeking thinking. As the name implies, this form of thinking
is designed to keep you safe in the moment from a socially related
threat. The intent of such thinking may be to distract you from
the threat or to neutralize the threat (i.e. take the threat out of the
situation). The way to deal with such thinking is as follows:
► Acknowledge existence of the thought without trying to
suppress it or to distract yourself from it. If you try to suppress
the thought you may unwittingly make it more likely to come
into your mind and if you distract yourself from it you are not
dealing with it.
about other people ridiculing you, you may try to neutralize this
6. How to manage social anxiety T4 I

by thinking: ‘I’m sure they are far too polite to ridicule me.’ If
you engage with this thought, then you will feel reassured. If you
don’t engage with the thought, you won’t feel assured, but will
have the opportunity of either rehearsing your rational belief
about the threat briefly or getting on with whatever you would
be doing if you did not have the thought (i.e. engaging in social
intercourse) even though you feel anxious or uncomfortable in
the moment.

you pay a regular sum every month to the charity. Now, let's
Insight
When you face situations in which you infer the presence of socially related
threat, it is important that you focus on that threat and rehearse your
rational beliefs as you do so. It is also important that you do not engage
with your safety-seeking measures as you face threat.
I42
Once you have decided to face a social situation in which your
socially related threat may be present and you have rehearsed your
rational beliefs, for a while you will still in your mind exaggerate the
nature of the threat and its consequences. You will do so because
your irrational beliefs are still active, to some degree, even though
you have challenged them and have rehearsed their rational belief
alternatives. This is how I suggest you deal with such thoughts,
in the following order:
1 Recognize the existence of such thoughts again without trying

to suppress them or to distract yourself from them.
2 Understand that these thoughts are the products of still active
irrational beliefs.
get on with whatever you would be doing if you did not have
the thought (see above).
Insight
While you face situations in which you infer the presence of socially related
threat and rehearse your rational beliefs, as you do so you may still think
in highly distorted ways about the nature and consequences of this threat.
This happens because your irrational beliefs are still active and produce such
thoughts. If you understand why these thoughts are present in your mind
and allow them to stay in your mind without engaging with them, then they
will fade away.
DEALING WITH GROSSLY DISTORTED SELF-IMAGES

OR SELF-PICTURES
I mentioned earlier in this chapter that when you feel socially
anxious you may hold a grossly distorted self-image or self-picture
in your mind (e.g. seeing yourself as a jabbering wreck in the social
situation you are in). There are a number of ways of dealing with
such mental events:
► Focus on the self-image and take the horror out of it. In this
respect, it is useful to repeat this self-image until it loses its sting.
► Understand that if is a thinking consequence of an irrational
belief that is still active even though you have challenged it.
► Recognize that as such the self-image is a product of an irrational
belief rather than a statement of reality about yourself or an

indication of how others see you, and that this is the case no
matter how compelling the image is.
► Accept the presence of the image and allow it to be without
engaging with it or trying to banish it from your mind. If you do
either the power of the image will remain.
In addition, you may also at relevant points:
► trace the self-image back to the underlying irrational belief
and re-challenge this belief. The goal of doing this is to get
more experience of thinking rationally and not to rid yourself
of the self-image, which still may be present (albeit in a less
compelling form) even after you have re-challenged the
irrational belief.
► bring to mind a realistic self-image. On this point, it might be
useful to have a friend take a photograph of you in a social
situation which you can bring to mind as a realistic counter to
your self-image. If you use this technique, it is important that
you do not use it as a safety-seeking measure. It should be one
of the last techniques you use to deal with grossly distorted
self-images or self-pictures, not the first.
UNDERSTANDING AND DEALING WITH YOUR

PRONENESS TO INFER THE PRESENCE OF SOCIALLY
RELATED THREAT
There are two reasons why people are particularly prone to social
anxiety. First, they are prone to infer the presence of socially related
threats. Second, they hold irrational beliefs about such threats. In
this section, I am going to help you understand why you are prone
to inferring the presence of socially related threats and show you
how you can deal with such proneness.
When you are prone to inferring the presence of your socially
Why you overestimate the presence of your socially related threat
This is how you come to overestimate the presence of your socially
related threat. I will illustrate this with reference to the following
general irrational belief:
7 must not blush in social situations and if I do,
I am worthless.'
144
► You take the threat theme of your general irrational belief (e.g.
'1 must not blush in social situations and if 1 do, I am worthless’):
'Blushing in social situations.'
7 must be certain that I will not blush in social situations.
I can't bear such uncertainty.'
► You bring this second general irrational belief to situations
where it is possible that you may blush and you make a threat-
'Since I don’t have certainty that I will not blush in social
situations then I will blush. ’
Inference: ‘I will blush when I talk in my tutorial.’
Specific irrational belief: 7 must not blush in my tutorial
and I’m worthless if I do.’
In order to deal with your overestimations of socially related threat
you need to take a number of steps, which 1 will illustrate again with
reference to the earlier example:
7 would like not to blush in social situations, but that does
not mean I must not do so. If I do, it's unfortunate, but it does
not prove I’m worthless. I am a unique, unrateable fallible
human being whether or not I blush in social situations. ’
and to your second uncertainty-focused general irrational belief:
7 would like to be certain that I will not blush in social
situations, but I don’t need such certainty. It is difficult not
having this certainty, but I can hear not having it and it is
worth bearing.’
the former.
situations where it is possible that you may blush and make an
inference based on the data at hand:
6. How to manage social anxiety I4 5

7 am not certain if I will blush or not in my tutorial so let's
consider the evidence. ’
blush, then use a specific version of your general socially related
rational belief to deal with this. For example:
Inference: 7 will blush in my tutorial.'
Specific rational belief: 7 would prefer not to blush in my
tutorial, but that does not mean that I must not do so. If
I do, that would be unfortunate, but I am not worthless.
I am the same ordinary, unique, unrateahle person whether
or not I blush in my tutorial.'
Insight
In order to become less prone to socially related anxiety, you need to
develop two general rational beliefs: one about what you find most
threatening about your social performance and/or the reactions of others
to it and one which helps you to deal with uncertainty about the presence
of this threat. Doing this will help you to be objective about the possible
presence of the threat.
HOW TO EXAMINE THE ACCURACY OF YOUR INFERENCE

OF SOCIALLY RELATED THREAT IF NECESSARY
If you arc still unsure if your inference of socially related threat is
accurate or inaccurate, answer one or more of the following questions:
► How likely is it that the threat (e.g. that others will ridicule you)
will happen?
► Would an objective jury agree that the threat (that others will
ridicule you) will happen? If not, what would the jury's verdict be?
► Am 1 viewing the threat (that others will ridicule you)
realistically? If not, how can I view it more realistically?
threat (that others will ridicule you), what would the person say
to me and why? How would this person encourage me to view
the threat instead?
situation as I am facing and arc making the same inference of
threat (that others will ridicule you), what would 1 say to her
about the validity of her inference and why? How would 1
encourage the person to view the threat instead?
146
Karen, a 36-year-old computer operator, learned how to apply
RECBT principles in managing her social anxiety. Karen was
anxious about blushing and anxious about what people would
think of her for blushing. Whenever she could, she would avoid
social engagements and when this was not possible she would
wear light make-up which she thought would help to hide her
redness.
Karen was anxious about blushing because she regarded it as a

defect and was scared that others would evaluate her negatively
for displaying this defect. She realized that concern would be
the healthy emotional alternative to anxiety about both of these
socially related threats. When concerned, but not anxious,
about blushing and others’ presumed negative view of her for
blushing, she wanted to attend social events without camouflaging
make-up.
First, Karen assumed temporarily that both her threats were true
and worked on these one at a time beginning with her anxiety
about blushing. Thus, she assumed that her blushing was a defect
and realized that she was anxious about this because she held the
following irrational belief: ‘I must not have this defect and, as I do,
it proves that I am defective as a person.’ Karen then developed the
following rational belief alternative: ‘I would prefer not to have
this defect, but it does not follow that I must not have it. Having
it proves only that I am a fallible human being with a defect and
not defective.’ Karen then questioned these beliefs and realized
that a) she was not immune from blushing and nor did she have
to be so immune and b) she was a complex human being with
strengths and weaknesses and that if she were defective she would
be defective in all respects which was patently not the case.
Karen also assumed that others would evaluate her negatively

for blushing and realized that she was anxious about this because
she held the following irrational belief: ‘Others must not think
that I am defective for blushing and if they do they are right.’ Her
rational belief alternative was: ‘I don’t want others to think that
(Contd)

I am defective for blushing, but that does not mean that they must
not do so. If they do, I am not defective, but a fallible human being
with a defect.’ Karen's questioning of these beliefs led her to realize
that she had no control over what others thought and that she was
fallible no matter what they thought.
Karen resolved to strengthen these rational beliefs by going into

social situations (rather than avoiding them) and rehearsing
these beliefs but without putting on camouflaging make-up.
She also realized that the more she tried to stop herself from
blushing the more she was likely to blush. When she blushed
she also realized that she had a self-picture where she was as red
as a beetroot. She understood that this self-picture was a product
of her irrational beliefs that still exerted an influence on her
thinking and would do so until her conviction in her rational
beliefs was much stronger. She accepted the existence of this
self-picture, but saw it as false.
The more Karen went into social situations rehearsing her rational
beliefs and without camouflage, the more she became concerned,
but not anxious, about blushing. This was reinforced by her
allowing herself to blush rather than trying to stop it. When she
did blush under these conditions she realized that others, by and
large, were not bothered about this, although one or two did bring
her blushing to her attention. She did not like this, but did not
‘awfulize’ about it. Finally, Karen came to realize that blushing
was not a defect, but something of a handicap, one that was
much smaller than she originally thought.
Other issues
As you will know by now, this book is based on the RECBT
model which stresses the role played by rigid and extreme beliefs
in accounting for your anxiety problems and the importance of
developing rational beliefs in managing this anxiety and feeling
concern instead. Once you have developed such beliefs, you are in
a much better position to consider a range of other issues that may
help you to perform better in social situations.
148
DEVELOPING SOUND SOCIAL SKILLS
Some think that social anxiety stems from a lack of good social
skills. These people argue that, if you develop such skills, then
you will overcome this form of anxiety. While I do not decry the
importance of good social skills, my view is that they will help you
with your social anxiety only if they encourage you not to infer
socially related threat. However, if you develop such skills and still
infer socially related threat you will remain anxious as long as you
hold irrational beliefs - for good social skills do not, on their own,
help you to change these beliefs to their rational equivalents.
So, let me reiterate. RECBT suggests that you target for change your
irrational beliefs about socially related threat and when you have
done so, and have made progress in developing rational beliefs, you
are in a good position to consider improving your social skills.
When you come to consider improving your social skills there are
numerous sources that you can consult. Two that are particularly
useful are:
Conversationally Speaking (3rd edition) by A. Garner (Lowell
House, 1997)
The Internet site Mental Health Net, which has a webpage on
social skills: http://www.mcntalhelp.nct/poc/vicw_doc.php?
jyp^dpc^d=9.7.7.38jcn=35..3..
THE USE OF RELAXATION AND BREATHING

TECHNIQUES
The use of relaxation and breathing techniques in anxiety management
is generally recommended, but is less widespread than it used to be.
I discuss this issue towards the end of Chapter 4 and I refer you to
that discussion.
In the next chapter, 1 will show you how you can manage your
anxiety about your health where dealing with uncertainty is a
prime feature.

THINGS TO REMEMBER
► When you are socially anxious, you are anxious about something
related to your social performance and the reactions of others
to it which you find threatening to some aspect of your personal
domain.
► Your socially related anxiety may be about a threat to your

defined.
► The main determining factor of your socially related anxiety

is the set of irrational beliefs you hold about these ego and
non-ego threats.
► When you hold irrational beliefs about socially related threats,

you are very prone to engage in behaviour and thinking
dealing constructively with these threats and thus unwittingly
serve to maintain your socially related anxiety.
► When you hold irrational beliefs about socially related threats,

you are also very prone to exaggerating the nature and
consequences of these threats.
► The goal of managing your anxiety about socially related

threats is to become concerned, but not anxious, about these
threats when they do exist and to become less prone to making
inferences about the presence of these threats when they may
not be present.
► To manage your socially related anxiety, you need, first and

the presence of socially related threats.
► It is very important that you face situations in which you

infer the socially related threat without recourse to your
150
safety-seeking measures and while accepting the presence
of your distorted negative thinking.
► To become less prone to socially related anxiety, you first need

to understand the role that uncertainty plays in leading you to
infer the presence of socially related threats in situations that
are ambiguous.
► Once you have developed rational beliefs about your socially

related threats and about uncertainty related to their presence,
you are in a position to be more objective about the presence of
these threats, which will help you to become less prone to this
form of anxiety.
6. How to manage social anxiety I5I

How to manage health anxiety
• how to understand and manage health anxiety
• how to identify what you are most anxious about with respect
to your health
• the differential impact of irrational and rational beliefs about
threats related to your health
• why you are prone to health anxiety and what you can do to
become less prone.
Introduction
The way we speak about anxiety is, from one perspective, peculiar,
since what we call our anxieties do not reflect what we are anxious
about. Let's take so-called ‘fear of flying', for example. One of the
things that we are definitely not anxious about is that the plane we
are on or we are going to travel on is going to fly! Have you ever
heard anyone exclaim: ‘Oh my God, the plane is going to fly?'
It is similar with health anxiety; we are not anxious that we are
healthy. Rather, we are frightened that we are ill or even terminally
ill. I lowever, we refer to this anxiety not as ‘illness anxiety', bur as
‘health anxiety' as if we are scared to face up to what we are really
afraid of. I lowever, since this form of anxiety is generally known as
health anxiety, I will go along with this convention in this chapter.
Understanding health anxiety

There are three scenarios with respect to health anxiety. In the first
scenario, you have a symptom that you are worried about and you
are convinced that it is a sign of serious or even terminal illness.
I52
However, the reality is that you have not received an illness
diagnosis but you are in a state of uncertainty. This used to be called
hypochondriasis where you are convinced you are ill in the absence
of confirmatory evidence.
In the second scenario, you have been diagnosed with an illness
which does not pose a serious threat to your health, but which
you are anxious about, and in the third scenario, you have been
diagnosed as having a serious or terminal illness and you are anxious
about this. While I will touch on the second and third scenarios, I will
concentrate on the first since hypochondriasis is very common, a fact
which will be confirmed by any GP.
Please note that I have said that you are facing a state of uncertainty
when you are health anxious in a hypochondriacal sense, not that
you are not ill. The fact is that you don't know and, as you will see,
this is the core of health anxiety.15

EXPERIENCE HEALTH ANXIETY
When you experience health anxiety, then, you are focused on the
presence of a symptom which you regard as posing a significant
threat to your health or well-being and you are anxious about being
in a state of uncertainty where you do not know that this symptom
is not benign. You may have been told that the symptom is probably
benign (or even that it is definitely benign), but you are still in a state
of uncertainty about this.
With reference to the schema that I have been using in this book,
health anxiety concerns a threat to the non-ego realm of your
personal domain.
To recap, when you are health anxious:
► you experience a bodily symptom which you consider could pose
a significant threat to your health
► you may have been told that the symptom is definitely or
probably benign
► but you are still in a state of uncertainty and do not know
experientially for certain that the symptom is benign.
"Henceforth, unless I state the contrary, when I use the term ‘health anxiety' I refer to the
situation where you feel anxious about being in a state of uncertainty about your health.
7. How to manage health anxiety 53

Insight
When you are anxious about your health, you do not know for certain that
the symptom that you are worried about is nor dangerous.
IRRATIONAL BELIEFS UNDERPIN HEALTH ANXIETY

As I have already mentioned, this book is based on a model of anxiety
that stems from Rational-Emotive Cognitive Behaviour Therapy
(RECBT). As I have discussed in Chapters i and z, this model stresses the
role played by irrational beliefs in rhe development and maintenance of
anxiety. As I have just mentioned, health anxiety is a non-ego-based form
of anxiety and as such you hold a rigid belief and an awfulizing belief or
a discomfort intolerance belief about the threat to rhe non-ego realm of
your personal domain related to your health.16 Thus you believe:
► Rigid belief: ‘I must know for certain that this symptom is benign
(or not dangerous).'
► Awfulizing belief: ‘It is terrible not knowing for certain that this
symptom is benign (or not dangerous).'
► Discomfort intolerance belief: ‘I can't bear not knowing for
certain that this symptom is benign (or nor dangerous).'
Insight
The main reason why you are anxious about your health is because you hold
a set of irrational beliefs about being uncertain concerning the risk posed to
your health by a particular symptom you are focused on. These beliefs are
rigid and extreme.
THE IMPACT OF IRRATIONAL BELIEFS ABOUT

UNCERTAINTY-RELATED THREATS TO YOUR
HEALTH
When you hold irrational beliefs about uncertainty-related threats
to your health, doing so will have a great impact on your behaviour
and subsequent thinking.
Safety-seeking behaviour and thinking related to your health

When you hold irrational beliefs about uncertainty-related threats
to your health, you will act and think in ways designed to keep you
,6You may have both an awfulizing belief and a discomfort intolerance belief. For
the sake of simplicity, work with your rigid belief and the one other non-ego extreme
belief that best accounts for your non-ego-based health anxiety. This will be either an
awfulizing belief or a discomfort intolerance belief.
154
safe from the threats (see Table 7.1). The main problem with such
thinking and behaviour is that they do not help you to do what
you need to do - i.e. to deal effectively with your anxiety by facing
the uncertainty about the threat to your health and by developing
rational beliefs about it. Indeed, these safety-seeking measures
actively discourage you from doing so.
Table 7.1 Safety-seeking behaviour and thinking

stemming from irrational beliefs about uncertainty-
related threats to your health.
Safety-seeking behaviour Safety-seeking thinking
► Seeking reassurance from ► Self-reassurance that the

medical personnel and friends symptom is benign
in health care ► Picturing yourself well
► Seeking second or more medical and symptom free
opinions including repeated tests ► Repeating to yourself
► Seeking reassurance from assurances provided by
family and friends others
► Seeking reassurance from the ► Distracting yourself
Internet from health-related
► Checking and monitoring your thoughts when it would
symptoms be healthy to engage
► Avoiding checking symptoms with them
when it would be healthy to
check them
► Avoiding references to threat-
related symptoms (e.g. on TV
or in newspapers)
► Avoiding activities that might
bring about the symptoms
(e.g. exercise)
Threat-exaggerating thinking related to your health

When you hold irrational beliefs about uncertainty-related
threats related to your health, if you are not engaged in thinking
designed to keep you safe, your thinking is characterized by
exaggerating the nature of the threat and its consequences,
as shown in Table 7.2.
7. How to manage health anxiety I55

Table 7.2 Threat-exaggerating thinking that stems from
holding irrational beliefs about uncertainty-related
threats to your health.
Threat: not being certain that a symptom is benign or
not dangerous
► Thinking that you are seriously ill or dying

► Thinking that modern medicine will not he able to cure you
► Imagining that your loved ones are very upset about your
illness or death and unable to recover
► Worrying or brooding about your health
► Thinking that you would not be able to enjoy life at all if
you are ill
Insight
When you hold a set of irrational beliefs about uncertainty-related threats to
your health, it leads you to seek immediate safety from this threat and/or to
exaggerate its nature and consequences. Engaging with these effects interferes
with you managing your anxiety because it prevents you from facing and
dealing effectively with uncertainty-related threats to your health.

UNCERTAINTY-RELATED THREATS TO YOUR HEALTH
1 argued in Chapter 2 that concern about real or perceived threats
these threats. In this section of the chapter, 1 will outline which
uncertainty-related threats to your health. These are:
► Flexible belief: ‘I would like to know for certain that this
symptom is benign (or not dangerous), but I don't need such
certainty.’
► Non-awfulizing belief: it is bad not knowing for certain that this
symptom is benign (or not dangerous), but it is not terrible.’
► Discomfort tolerance belief: it is difficult for me to bear
not knowing for certain that this symptom is benign (or not
dangerous), but I can bear it and it is worth it to me to do so.’
156
Insight
When you hold a set of rational beliefs about uncertainty-related threat to
your health, you will feel concerned, but not anxious, about this threat.
The impact of rational beliefs about uncertainty-related threats

to your health
When you hold rational beliefs about uncertainty-related threats to
your health, doing so will also have a great impact on your behaviour
and subsequent thinking.
BEHAVIOUR AND THINKING RELATED TO YOUR HEALTH
your health, you will act and think in ways designed to help you to
face these threats and deal with them effectively (see Table 7.3). You
will notice from Table 7.3 that when you hold rational beliefs about
uncertainty-related threats to your health that you still experience
similar urges to engage in safety-seeking behaviour and thinking as
you did when you held irrational beliefs about these threats, but you
accept them and do not actively engage in these urges.
your health, then these beliefs will also help you to think in a realistic
and balanced manner about the nature of these threats and their
consequences (see Table 7.4).
Table 7.3 Behaviour and thinking stemming from

rational beliefs about uncertainty-related threats to
your health.
Behaviour designed to help you Thinking designed to help

deal with the threat you deal with the threat
► Accepting the urge to seek ► Accepting the urge to

reassurance from medical reassure yourself that the
personnel and friends in symptom is benign, but not
health care, but not doing so engaging with this thought
second or more medical picture yourself well and
opinions including repeated symptom free, but not
tests, but not doing so doing so
(Contd)

Behaviour designed to help you Thinking designed to help
deal with the threat you deal with the threat
► Consulting medical personnel ► Accepting the urge

when symptoms have not to repeat to yourself
cleared up and an appropriate assurances provided by
period of time has elapsed others, but not doing so
reassurance from family and distract yourself from
friends, but not doing so health-related worries,
► Getting on with the same but not doing so
activities as you would get
on with if you did not have
health worries/concerns
► Accepting the urge to seek
reassurance from the Internet,
but not doing so
► Checking and monitoring
your symptoms periodically
as a person would who did
not have health anxiety
► Accepting the urge to
avoid references to threat-
related symptoms, but not
avoiding them
► Accepting the urge to avoid
activities that might bring
about the symptoms, but not
avoiding them

from holding rational beliefs about uncertainty-related
threats to your health.

not dangerous
► Thinking that you are probably well or if you are ill that the
illness is not serious
► Thinking that modern medicine will probably be able to
cure you
158
not dangerous
► Imagining that your loved ones will be upset about your

illness, but not devastated
► Being concerned about your health, but not worrying or
brooding about it
► Thinking that you will still be able to enjoy life even if
you are ill
Insight
When you hold a set of rational beliefs about uncertainty-related threat to
your health it leads you to face and deal effectively with this threat, which
you view in a realistic and balanced way with respect to its nature and
consequences.
Using RECBT to manage health anxiety

RECBT to deal with health anxiety in the face of uncertainty about
the status of a symptom you are concerned about.
ACCEPT THAT YOU HAVE AN ANXIETY PROBLEM

One of the issues in managing health anxiety is accepting that you
have an anxiety problem. However, you may think that you are ill
and need medical treatment and not a psychological intervention
like CBT. In making your decision about this issue bear in mind the
following points:
► You have a health anxiety problem if you have on many

occasions thought that you were significantly ill when it turned
out that you were not.
► Your symptoms are real and not ‘all in the mind’. Some people
are reluctant to admit to a problem with health anxiety because
they fear being accused of inventing symptoms. You can have
anxiety about real symptoms. It is your conclusions about these
symptoms that may be affected by anxiety.
► Try the following experiment. Assume temporarily that you
have a health anxiety problem and follow the guidelines that
I am going to present shortly and see what happens. As you do
so, keep an open mind about this issue.
FEATURES OF YOUR HEALTH ANXIETY (‘C’ IN THE
‘ABCDE’ FRAMEWORK)
Assuming that you acknowledge that you have a health anxiety
problem or at least are willing to consider this as a possibility, then it
is important that you understand how you feel, act and think when
you are anxious about uncertainty-related threats to your health.
In particular, it is important for you to understand:
► what you do and think when you are anxious that is intended
to make yourself safe from your uncertainty-related threat to
your health
► how you exaggerate the nature and consequences of the threat to
your health when your safety-seeking manoeuvres don’t work.
framework.

RESPECT TO YOUR HEALTH (YOUR THREAT AT ‘A’ IN
THE ‘ABCDE’ FRAMEWORK)
I mentioned earlier in the chapter that I was going to concentrate
on the form of health anxiety that was previously known as
hypochondriasis. This is where:
► you experience a bodily symptom which you consider could
pose a significant threat to your health
► you may have been told that the symptom is definitely or
probably benign
► but you are still in a state of uncertainty and do not know
experientially for certain that the symptom is benign.
So, what you need to do at this point is to focus on what you are
disturbed about. This is not knowing that the symptom you are
anxious about is benign.
IDENTIFY YOUR GOALS (THESE WILL BE THE ‘E’ IN

THE ABCDE’ FRAMEWORK IF YOU ACHIEVE THEM)
It is important that you develop a healthy alternative to your anxiety
about the uncertainty-related threat to your health. As I have discussed
in this book, this alternative is known as concern and, as with anxiety,
it has three components: emotional, behavioural and thinking.
160
What you need to do here in relation to the uncertainty-related threat
to your health is to set concern-related goals. In particular, you need
to specify behavioural and thinking components which will enable
you to face up to and deal with your uncertainty-related threat rather
than keep yourself safe from it - as happens when you are anxious
about your health. If you achieve your goals they will constitute the
‘E’ in the ‘ABCDE’ framework.
Insight
your health anxiety will help to focus your efforts in managing this anxiety.

RATIONAL BELIEFS (‘B’ IN THE ABODE’ FRAMEWORK)
underpin your anxiety about the uncertainty-related threat to your
health and the alternative rational beliefs that underpin your concern
about this threat.
Identify your rigid belief and either your awfulizing belief or your
discomfort intolerance belief that underpin your anxiety about the
uncertainty-related threat to your health.
Now, identify your flexible belief and either your non-awfulizing
belief or your discomfort tolerance belief that underpin your concern
about the uncertainty-related threat to your health.
QUESTION YOUR BELIEFS (‘D’ IN THE ABODE’
FRAMEWORK)
As I pointed out in Chapter 4, the purpose of questioning your beliefs
is for you to see that your irrational beliefs are irrational (i.e. false,
illogical and largely unhelpful) and that your rational beliefs are
rational (i.e. true, logical and largely helpful). Questioning your beliefs
together, but one at a time (i.e. rigid belief vs. flexible belief; awfulizing
belief vs. non-awfulizing belief; discomfort intolerance belief vs.
discomfort tolerance belief), is, in my view, the best way to do this,
although I urge you to experiment with different ways of questioning
your beliefs. For help with this questioning process, I suggest that you
consult Appendices 1-3 for general help, which you need to apply to
your specific beliefs about uncertainty-related threats to your health.
7. How to manage health anxiety T 6I

Insight
in the latter.
FOCUS ON UNCERTAINTY WITH YOUR RATIONAL

BELIEFS AND THEN GO ALONG WITH PROBABILITY
If we know one thing about the effective management of any form of
anxiety, it is that if you don’t face up to what you are anxious about
and deal with it effectively, it is unlikely that you will learn to manage
your anxiety. Thus, facing your uncertainty-related threat to your
health from the perspective of your rational beliefs and acting and
thinking in ways that are consistent with these beliefs is perhaps the
most effective part of the health anxiety management process.
Before you focus on your uncertainty-related threat to your health,
it is important that you rehearse your set of rational beliefs. Show
yourself that you don't know for sure that your symptom is not
malignant and you don’t need to know. It may be uncomfortable
tolerating this uncertainty, but you can do so and it’s worth doing.
However, don’t over-rehearse these rational beliefs. I suggest that
you rehearse your rational beliefs two or three times to get you into
a reasonably rational frame of mind.
You have probably consulted a doctor about your symptom and

have probably been told not to worry. This means that probably
your symptom is benign. Go along with this probability, but do
not use it to reassure yourself. You are using it to reassure yourself
if you remind yourself that your symptom is probably benign
when you are anxious as a way of seeking safety from your threat.
Going along with probability basically means getting on with life
in the same way as you would if you did not have the symptom.

As you get on with your life, you will experience urges to engage in
behavioural and thinking-related safety-seeking measures. This is
162
understandable as, at this point, your irrational beliefs exert more
influence on you than your developing rational beliefs do. In order
to reverse this process you need to accept the existence of these urges
and not act on them. Let me deal with this point in greater detail.
measures as you face your uncertainty-related threat to your health,
it does not follow’ that you won't experience an urge to do so. Let me
consider how to deal with your urge to use safety-seeking behaviour
first. As the name implies, here you will experience an urge to do
something that is intended to ‘make' you feel safe in the moment.
Your therapeutic goal, at this point, is to deal with the threat
rather than to feel safe. In order to achieve this you need to do
the following:
a safety behaviour.
► Show yourself that w’hile you want to engage with the behaviour,
you don't have to do so (i.e. develop and rehearse a rational
belief about the urge) and that there is a good reason not to do so
(i.e. engaging with your safety-seeking behaviour will prevent you
from dealing rationally with uncertainty and thereby interfere
with you managing your health anxiety in an effective way).
designed to keep you safe in the moment from an uncertainty-related
threat to your health. The intent of such thinking may be to distract
you from the threat or to neutralize the threat (i.e. take the threat out
of the situation). The way to deal with such thinking is as follows:
► Acknowledge existence of the thought without trying to suppress
it or to distract yourself from it. If you try to suppress the thought
7. How to manage health anxiety I63
you may unwittingly make it more likely to come into your mind,
and if you distract yourself from it you are not dealing with it.
► Do not engage with the thought. For example, you might find
that a self-reassurance thought comes into your mind such as ‘the
doctor said that I was fine'. If you engage with this thought, then
you will feel reassured. If you don’t engage with the thought,
you won't feel assured, but will have the opportunity of either
rehearsing your rational belief about the threat briefly or getting
on with whatever you would be doing if you did not have the
thought, even though you feel uncomfortable in the moment.

you pay a regular sum every month to the charity. Now, let's
person. As you continue down the road, the charity worker walks
beside you and you are aware of what he is saying but you say
nothing in return. You give the person no eye contact nor show him
any recognition that he is there. If you take this tack, after a short
while the person will stop pursuing you. This is the approach you
need to take with your safety-seeking thoughts. Acknowledge that
they are present, but continue with what you are doing while not
engaging with the thoughts and without trying to get rid of them.
Insight
When you focus on the uncertainty-related threat, rehearse your rational
beliefs as you do so. It is also important that you do not engage with your
safety-seeking measures as you face this threat.
164
Once you have decided to face the uncertainty related to the
symptom you have and you have rehearsed your rational beliefs, for
a while you will still in your mind exaggerate the nature of the threat
and its consequences. You will do so because your irrational beliefs
are still active, to some degree, even though you have challenged
them and have rehearsed their rational belief alternatives. This is
how I suggest you deal with such thoughts, in the following order:
irrational beliefs.
Insight
While you face your uncertainty-related threat to your health and rehearse
your rational beliefs as you do so, you may still think in highly distorted ways
about the nature and consequences of this threat. This happens because your
irrational beliefs are still active and produce such thoughts. If you understand
why these thoughts are present in your mind and allow them to stay in your
mind without engaging with them, then they will fade away.
UNDERSTAND AND DEAL WITH YOUR PRONENESS

TO INFER THREATS TO YOUR HEALTH
There are two reasons why people are particularly prone to health
anxiety. First they are intolerant of uncertainty with respect to
possible threats to their health. Second, as a result of this uncertainty
intolerance they are prone to infer serious illness in the face of such
uncertainty. In this section, I am going to help you understand why
you are prone to inferring the presence of serious illness and will
show you how you can deal with such proneness.
When you are prone to inferring the presence of serious illness, you
overestimate the presence of this threat. I will explain the factors
involved in this process.
Why you overestimate the presence of your health-related threat
This is how you come to overestimate the presence of your serious
illness: You begin with your general irrational belief:
7. How to manage health anxiety J

7 must know at all times that I am well and if 1 don't I can't
bear the uncertainty/
► You bring this general irrational belief to situations where it is
possible that you may not be well and you make a threat-related
inference in the absence of certainty from the threat:
'Since I don't have certainty that this symptom is benign,
it is malignant.'
► In order to deal with your overestimations of serious illness you
need to construct a general rational alternative belief:
7 would like to know at all times that I am well, but I don't
need such certainty. It is difficult not having this certainty, but
I can hear not having it and it is worth bearing.'
► Question both your general irrational belief and its rational
alternative until you can see the rationality of the general
rational belief and the irrationality of the general irrational
belief and you can commit to implementing the former.
situations where it is possible that you may be ill and make an
inference based on the data at hand:
7 am not certain if I am well so let's consider the evidence.'
► If there is evidence indicating there is a good chance that you are ill
then take appropriate steps. If not then act and think accordingly.
Insight
In order to become less prone to health anxiety, you need to nurture a general
rational belief about uncertainty-related threats to your health. Doing this
will help you to be objective about the possible presence of serious illness.
Henry, a 44-year-old bus driver, learned how to apply RECBT

principles in managing his health anxiety. Henry was anxious about
getting cancer and, every time he found an unexplained symptom,
he would visit his Nl IS doctor and a private doctor for a second
opinion. I le would seek reassurance from people with a medical
connection and family and friends. He would consult the Internet
and popular and ‘Home Doctor' books for information about his
symptoms, hoping to learn that he did not have cancer, but after
consulting these sources would be convinced that he had the disease.
166
Henry was anxious about not knowing that his symptoms were
benign. Because he demanded the certainty that he could not get,
he concluded that his symptoms must be serious if he was not
convinced that they were benign.
At the outset, Henry was not convinced that he had an anxiety

problem, but was willing to be open-minded about this. In assuming
that his problem was psychological and not physical, Henry
realized that concern would be the healthy emotional alternative to
anxiety about such uncertainty and in order to achieve this goal he
did the following:
► He questioned both his irrational and rational beliefs about
cancer-related uncertainty and realized that he did not need
such certainty and could tolerate its absence.
► Henry strengthened his rational belief - ‘I would like to know
that I don’t have cancer, but 1 don’t have to know this. I can
tolerate this uncertainty although this is hard, but it is in my
interest to do so' - by refraining from seeking reassurance in
all its forms and by accepting the threat-exaggerating thinking
that he experienced when he tolerated, but did not act on,
his urge to seek reassurance. He also refrained from engaging
in self-reassurance, although he allowed these thoughts to stay
in his mind until they went. Henry also helped himself by only
checking his symptoms once a week, and by consulting his doctor
only when his symptoms got significantly worse. Although he felt
the urge to see his doctor when he thought he detected a minor
change, he refrained from doing so.
After he did this, Henry learned to live with uncertainty about his
symptoms and came to see that the most probable scenario was
that he was uncertain and well, rather than uncertain and in all
likelihood seriously ill. He acted on this and got on with life as he
would have done if he were free of his physical symptoms.
While not entirely free of his health anxiety after using RECBT
strategies, Henry considered himself significantly improved.
In the final chapter of this book, I will deal with anxiety about losing
self-control.
7. How to manage health anxiety T

THINGS TO REMEMBER
► When you are anxious about your health you are anxious about
being in a state of uncertainty concerning whether or not a
particular symptom is serious.
► The main determining factor of your health anxiety is the set of

irrational beliefs you hold about the uncertainty-related threat to
your health.
► When you hold irrational beliefs about uncertainty-related

threats to your health, you are very prone to engage in behaviour
and thinking designed to keep you safe from threat in the
moment. However, these safety-seeking measures interfere with
you facing and dealing constructively with these threats and thus
unwittingly serve to maintain your health anxiety.
► When you hold irrational beliefs about uncertainty-related

threats to your health, you are also very prone to exaggerate the
nature and consequences of these threats.
► The goal of managing your health anxiety is to become

concerned, but not anxious, about these threats and to become
less prone to inferring the presence of serious illness when you
are in a state of uncertainty.
► To manage your health anxiety, you need, first and foremost,

to question your irrational beliefs and to develop and strengthen
your conviction in their rational belief alternatives. You do the
latter by acting and thinking in ways that support these rational
beliefs about uncertainty-related threats to your health.
► It is very important that you face this uncertainty without

recourse to your safety-seeking measures and while accepting the
presence of your distorted negative thinking without engaging
with it.
168
► To become less prone to health anxiety, you first need to
understand the role that uncertainty plays in leading you to
infer the presence of serious illness.
► Once you have developed rational beliefs about this uncertainty,

serious illness, which will help you to become less prone to this
form of anxiety.
7. How to manage health anxiety I 69

How to manage anxiety about
losing self-control
• how to understand and manage anxiety about losing self-control
• how to identify what you are most anxious about when losing
self-control
• how to be duly concerned, but un-anxious, about losing
self-control
• why you are prone to anxiety about losing self-control and
what you can do to become less prone.
Introduction
One of the most common forms of anxiety concerns the prospect of
losing self-control and how we respond when we begin to experience
such loss of self-control. You can experience such anxiety in many
contexts and, as we will see, such threats to your sense of self-control
can exist in both the ego and non-ego realms of your personal domain.
The key to managing this form of anxiety is an accurate assessment of
what constitutes a threat to you about losing self-control as well as a
full understanding of how you try to protect yourself from this threat.
Your sense of losing self-control may be linked to your experience of
emotions (and where in the body these are felt), how you act or feel
like acting and what kinds of thoughts you have in situations. Perhaps
the two main emotions (with accompanying physical sensations,
behaviours and thoughts) that represent challenges to people's sense
of being in control are anxiety and unhealthy anger. Consequently,
I will refer to these emotions at various points in this chapter.
170
Understanding anxiety about losing
self-control
If you experience anxiety about loss of self-control, you need to use
two concepts that I first discussed in Chapter z to help you to identify
what you are anxious about: threat and personal domain.
WHAT YOU ARE ANXIOUS ABOUT WHEN YOU FEAR

LOSING SELF-CONTROL
When you experience anxiety about loss of self-control, you infer
the presence of a threat to one or two key aspects of your personal
domain. The first threat is to your sense of self-control itself and
the second is to how you think you will be evaluated by others who
may notice that you are losing self-control. In this form of anxiety,
some people are anxious only about the first threat while others
are anxious about both threats. I will deal with both threats in this
chapter.
I will also distinguish between threats to the ego realm of your

personal domain relevant to self-control and how you may be
evaluated by others and threats to the non-ego realm of your
personal domain relevant to these same elements.
Threats to the ego realm of your personal domain in

anxiety about losing self-control
relevant to being in self-control and how you are likely to be evaluated
by others, this is most likely to be a threat to your self-esteem (i.e.
the degree to which you value yourself). Here are some of the most
common threats under this heading.
THE PROSPECT OF NOT LIVING UP TO OR FALLING WELL SHORT OF

YOUR IDEAL STANDARD WITH RESPECT TO SELF-CONTROL
When you are anxious about losing self-control, it may be that
you have in mind an ideal standard for being in control and that
you think that you will not live up to this standard, or indeed
that you will fall far short of it.
For example, you may have an ideal of being unruffled in the face of
stress and, when you start to experience feelings of anxiety and tension,
this ideal is being threatened and this threat is to your self-esteem.
8. How to manage anxiety about losing self-control I7I

THE PROSPECT OF BEING NEGATIVELY EVALUATED
FOR LOSING SELF-CONTROL
If you are anxious about losing self-control, you may also be anxious
about being negatively evaluated by others for losing self-control.
The content of this evaluation often reflects what you think of yourself
for losing control. Thus, if you think of yourself as weak for losing self
control, and you fear what others think of you, then it is likely that you
fear that they may see you as weak as well. This process is known as
projection, where you project your view of you into the minds of others.
THE PROSPECT OF GETTING A REPUTATION FOR LOSS OF
SELF-CONTROL
If you are anxious about how others may evaluate you for losing
control, this most often refers to the immediate negative evaluation
from others. However, some people are more anxious about gaining
a more enduring reputation for losing self-control, most often in a
work context. If this is your threat and you are asked how you would
feel if you lost self-control in a given situation, but you would not
develop a more enduring reputation for loss of self-control, then you
would say that you would not be anxious if this threat was removed.
Threats to the non-ego realm of your personal domain in anxiety
about loss of self-control
When you face a threat to the non-ego realm of your personal
domain relevant to your sense of self-control, this is likely to be
a threat to your sense of comfort, broadly defined.
THE PROSPECT OF LOSING THE SENSE OF BEING IN
CONTROL OF YOURSELF
You may be anxious about losing self-control, not because of the
meaning that such loss has for you, but because you find the sense of
losing control of yourself anxiety-provoking. This most commonly
happens in anxiety, but it may happen in unhealthy anger as well.
This is not a threat to your self-esteem, but to your sense of comfort,
broadly defined. As you will presently see, one of the most prominent
features of this anxiety is the distorted predictions that you make
concerning what will happen to you if you don’t regain your sense
of self-control immediately.
THE PROSPECT OF EXPERIENCING NEGATIVE CONSEQUENCES
OF LOSING SELF-CONTROL
Some people are anxious about losing self-control in the non-ego
realm of their personal domain because they fear the negative
172-
consequences of such loss of self-control. If you are anxious about
losing self-control, you predict that you will not achieve desired
outcomes if you lose self-control. Thus, you may infer, rightly or
wrongly, that your future career will be blighted with the consequent
negative impact on your lifestyle if you lose self-control, particularly
in a social context.
Insight
When you are anxious about losing self-control and, possibly, how others
evaluate you for losing such control, these threats may be to your self-esteem
or to your sense of comfort, broadly defined.
IRRATIONAL BELIEFS UNDERPIN ANXIETY ABOUT

LOSING SELF-CONTROL
As you now know, this book is based on a model of anxiety that
stems from Rational-Emotive Cognitive Behaviour Therapy
(RECBT). As I have discussed in Chapters i and z, this model
stresses the role played by irrational beliefs in the development
and maintenance of anxiety.
Irrational beliefs in ego-based anxiety about losing self-control
In ego-based anxiety about losing self-control, you hold a rigid
belief and a self-depreciation belief about the threat to your
self-esteem.*’ I will illustrate these irrational beliefs in each of the
ego-based threats mentioned earlier (see the ‘Irrational beliefs’
Irrational beliefs in non-ego-based anxiety about losing
self-control
In non-ego-based anxiety about losing self-control, you hold a rigid
belief and an awfulizing belief or a discomfort intolerance belief about
the threat to the non-ego realm of your personal domain related to
losing self-control.'81 will illustrate these irrational beliefs in each of
the non-ego-related threats mentioned earlier (see ’fable 8.2).
’’You may also hold an awfulizing belief and a discomfort intolerance belief, bur these
tend to be secondary to the self-depreciation belief. For the sake of simplicity, work
with only your rigid belief and self-depreciation belief if you have ego-based anxiety
about losing self-control.
,8You may have both an awfulizing belief and a discomfort intolerance belief. For the
sake of simplicity, work with your rigid belief and the one other non-ego extreme belief
that best accounts for your non-ego-based anxiety about losing self-control. This will be
8. How to manage anxiety about losing self-control 173

Table 8.1 Irrational and rational beliefs about ego
based threats to self-control.
The prospect Rigid belief: ‘I must Flexible belief: ‘I want

of not living live up to (or not fall to live up to (or not fall
up to or well short of) my ideal well short of) my ideal
falling well standard with respect standard with respect to
short of to self-control/ self-control, but 1 don't
your ideal have to do so.'
standard Self-depreciation belief: Unconditional self
with respect ‘If I were not to live up acceptance belief: Uf I
to self- to (or if I fell well short were not to live up to (or
control of) my ideal standard if I fell well short of) my
with respect to self ideal standard with respect
control, I would be to self-control, that would
weak or defective? be unfortunate, but 1
would not be weak or
defective. I would be an
unrateable, fallible human
being whether or not I live
up to my standard.'
The prospect Rigid belief: ‘I must not Flexible belief: ‘I would
of being be negatively evaluated prefer not to be negatively
evaluated by others for losing evaluated bv• others for
negatively self-control.' losing self-control, but
by others for that does not mean that
losing self they must not do so.'
control Self-depreciation Unconditional self
belief: ‘If I were to be acceptance belief: ‘If I were
negatively evaluated to be negatively evaluated
for losing self-control, for losing self-control,
I would be worthless.’ that would be bad, but I
would not be worthless.
I would be the same
unique, unrateable human
being whether or not they
evaluate me negatively.'
174
The prospect Rigid belief: ‘I must Flexible belief: ‘I don't

of getting a not get a reputation for want to get a reputation
reputation losing self-control.' for losing self-control, but
for loss of it does not follow that this
self-control must not happen.'
Self-depreciation Unconditional self
belief: ‘If I were to get acceptance belief: ‘If I
a reputation for losing were to get a reputation
self-control, then I for losing self-control, that
would be worthless.' would be bad, but
it would not prove that
I would be worthless.
I would be the same
fallible human being
whether or not I have
such a reputation.'
Table 8.2 Irrational and rational beliefs about

non-ego-based threats to self-control.
The prospect Rigid belief: ‘I must Flexible belief: ‘I don't

of losing the not lose the sense of want to lose the sense
sense of being being in control of of being in control of
in control of myself.’ myself, but that does
yourself not mean that it must
not happen.’
Awfulizing belief: Non-awfulizing belief:
‘It would be awful if I ‘It would be bad if I
were to lose the sense were to lose the sense
of being in control of of being in control of
myself.’ myself, but it would not
be terrible.’
or or
(Contd)

Discomfort intolerance Discomfort tolerance

belief: i couldn’t bear belief: ‘It would be hard
it if I were to lose for me to bear it if I
the sense of being in were to lose the sense
control of myself.' of being in control of
myself, but I could bear
it and it would be worth
it to me to do so.'
The prospect Rigid belief: ‘I must Flexible belief:

of experiencing not experience any ‘I would much rather
negative negative consequences not experience any
consequences of losing self-control.' negative consequences
of losing self of losing self-control,
control but it does not follow
that this must not
happen.’
Awfulizing belief: Non-awfulizing
‘It would be awful if I belief: ‘It would be very
were to experience any unfortunate if 1 were to
negative consequences experience any negative
of losing self-control.' consequences of losing
self-control, but it
would not be awful.'
or or
Discomfort intolerance Discomfort tolerance
belief: ‘1 couldn't belief: ‘It would be a
bear it if I were struggle for me to put
to experience any up with experiencing
negative consequences any negative
of losing self-control.' consequences of losing
self-control, but I could
tolerate this and it
would be in my interest
to do so.'
176
Insight
The main reason why you are anxious about threats related to your sense
of being in control of yourself is because you hold a set of irrational beliefs
about these threats. These beliefs are rigid and extreme.
THE IMPACT OF IRRATIONAL BELIEFS ABOUT

LOSING SELF-CONTROL
When you hold irrational beliefs about threats related to losing self
control, doing so will have a great impact on your behaviour and
subsequent thinking.
Safety-seeking behaviour and thinking related to loss of self-control
When you hold irrational beliefs about threats related to loss of
self-control, you will act and think in ways designed to keep you safe
from the threat (see Table 8.3). This is the case both while you are in
a situation in which you think you may lose self-control and before
you enter it. The main problem with such thinking and behaviour
is that they do not help you to do what you need to do - i.e. to deal
effectively with your anxiety by facing the situation in which your
threat may occur and by developing rational beliefs about it. Indeed,
these safety-seeking measures actively discourage you from doing so.
Threat-exaggerating thinking related to your sense of being in control
When you hold irrational beliefs about threats related to your sense
of being in control, if you are not engaged in thinking designed to
keep you safe, your thinking is characterized by exaggerating the
nature of the threat and its consequences, as shown in Table 8.4.
effectively with the threat. Indeed, it serves mainly to strengthen your
conviction in your irrational beliefs about the threat. In addition,
you consider that the content of this grossly distorted thinking will
actually happen. Thus, at this point of the process, you may very well
think that you are going to lose control completely and are convinced
that you will do so - thus you have to prevent yourself from this
happening at all costs.
A distorted image or picture of yourself contaminated by
anxiety about losing self-control
When you hold a set of irrational beliefs about self-control-related
threat, you may develop an image or picture of yourself losing
self-control completely. While this is likely to be a grossly distorted
8. How to manage anxiety about losing self-control I 77

o 00 00
c 00 c
OZ O az a cd
aS OXj □ o c z
c e
OZ az □ o
OZ £ c OZ c OZ a
OX) o as
O Z o OZ o az z o o
OX) az 03 z ox C az
az 05 OZ □ az az
z 00 az az
c az
az az az
G □ aS □ z os z □ az z
O O □
o 00
as OZ □ az C as
c O o OX)
C
as az
• •**
as O c E S o z az E S
az az o az C
□ 00 c Z a, 03
E os C as 00 £ E
(X) O o c o az
o z
az o C c o
a o aS az OZ 03 az
£ aS z 03 5 o OZ C 03 o z z a
C c C □ C
O >
az z
az
C az o o 03
<D 00 az '•S) C Z az
•4^4 OZ □ O o Q- a az O az z a. “
<3 o aS O u £ C o C az O E az
01 az az as o az z C
□ aS a as u. O uc
c OX) -C OX) Q z az 00
V z z □ z $ c z az O az u z
C w c OZ aS z az 03
OZ o •-
z z az
z Z z az 00
c O cOX
az c az OX. Li aS o 03 az o co az O az
O § az 03
u.
az aS
az as ox, az
z az □ O c oo h OX) z
az !S) c > c O o o o O □ □
a i- c □
U. 03 az z □ OZ
^4 O Q O az az O az z z O
£ E D A A □
<3 az
co CQ
£ z
a
’Z z o
c az
o as u
c z C az
z O
• z aS az □ z □
□
o
az
> az
az Z
□ <S) C
O
CT
as
z O
o C a
o o
C O
•£ az
az
c
a O 03 az az
a az ox co
4— az z az az re a az
□ C 5 as az c az z E C z □
z a o c z
C □ az 00 C O c o az
o z O az a as 00
^3 C E aS □ az z
az
z az o az
az
z
as o aS Z E o as z □ □ as C a
3 □ z O dz O z az
o 03 az o C az a z z
az E az z
z □ O C
u C as E as az az az as as
□ az
c z as c c a o c az a c □ □ o
o aS O z > az as
as as o O
O O C az > aS □
cs az C c c z E as
* az az as as
OX)
Oj
az o
az OX) az 5 .2 o O C Q.
O az 03 □ C az
O C 03 as
bl i00 o t"
aS C aS z z az
z E z z 00 O z az
£ c O az
z
az az O
az 00 ><
as
o
oj OZ
OX) az
az O az □ az c
O o
□
O
az 00 az as C a. o az C az O <iz az az
az 00 00 az
a C C
z
00 O
OU az z O c az c o
•- OX) az C 6£> 00 c ■“ c C « S O
o V)
az □ O C az a c 00a az o C az c £az
as re az > C az 5 « 03 c as az
4-a o az E I C Oaz 5 2 c
□
az az z
□ 5
z □ CD >
*3 az
<3 CO CQ
--
Cz
OO ■KJ
§
o
i
Co
z 2
<3 £
GJ c- GJ c
► Picturing yourself being in control in the

CZ
OS
c 0 C5
c
Engaging in covert rituals to ward off

GJ z O
CL
GJ gj o
u u
r C
Z
GJ 03
cz CL CZ CL
Gj
c GJ
CL cZ
c □ c GJ GJ
O a cz
cs CL
5 CL _2
□ C C c c
E
o
03
E □
e o
GJ
GJ
c c o
r5 cc
C3 z GJ
GJ GJ GJ GJ
gj & GJ O
gj
gj (7)
o -- C
c GJ
non-ego threat
GJ
O
z gj c c u
cl;
Z CL
03
z C c
can ’t escape
•— 2 GJ
CL GJ
C i cz * □
GJ & (A z CT
situation
O GJ GJ gj
GJ
C GJ cz
GJ
GJ 5 GJ C
u_
GJ
z O GJ z
'S'- cz GJ
Z Q. z Gj
A A A
►
CQ
CL
Z o
os cz
a z z CL
GJ c
O C3 z z
z Gj 03 Z z z
Z Z z
X
<s> z
CL - z cs
cz
03 03 Gj GJ Z CL
GJ
<st z Z E y
c
£ z z Gj
GJ
c C5
E
Gj aS z GJ c3 CL
r3
re
C
a
cz
Z u Z c
z Z Z
z z 'Z z
z z Z u
u GJ z z Gj
cz Z z
3
z
Z > C3 c Z
C3
X
GJ
cz
z C3
O GJ C3
• *»< C3 r3
CL
Z 5b J2 z
Z Z GJ
Gj GJ c cz Gj
—■*
a GJ
CZ c cz Z GJ cz
lose self-control
GJ e
<D GJ z
z o
GJ
-22
GJ
cz
GJ
Z O (7) cz
GJ c
CI z QJ
Z o E §
z a cz C3
03 GJ
• V** Z
*- gj t:
CL ,C
CZ Gj z
GJ 05 cz Gj aS
Gu Z tL 'Z .. GJ c GJ
CL J-
c
Gj E z
GJ cz
— Z Z □ cz O
!z GJ GJ
«
GJ z z GJ GJ
z z
2- GJ
O z aS cz
X
C3 z 5
E GJ
GJ
CO GO
s O
£ i
O
Gj
,z>
*-*
GW
CL 3
z Gj -22 *-
8. How to manage anxiety about losing self-control

image, you think that it will actually happen if you don’t take steps
to prevent it from doing so. For example, Gemma avoided confined
spaces when she could, because she feared losing self-control if she
could not get out of a situation immediately. Her irrational beliefs
about the prospect of losing self-control led her to develop a picture
of her losing control of herself completely and smashing whatever
obstacle was in her way.

from holding irrational beliefs about threats related
to self-control.
•........... ••••••••♦
Ego-based I will fall very short of my ideal for being in

threat self-control.
When 1 begin to lose self-control 1 will quickly
spiral out of control and act very foolishly if
I don’t regain self-control immediately.
When 1 begin to lose self-control, people will
all notice and evaluate me very negatively.
When 1 begin to lose control, 1 will gain an
enduring reputation for not being able to
control myself.
Non-ego- When I begin to lose self-control 1 will
based threat quickly spiral out of control if I don't regain
self-control immediately.
If I lose self-control, the consequences
will be very, very bad for me.
Here are some other examples of such self-images or self-pictures:
► going berserk mentally and having to be restrained
crying uncontrollably for hours and hours
having a fit
talking absolute nonsense
ripping off one’s clothes to get some air
acting in a grossly uninhibited way
acting inappropriately sexually in a public place
going into an uncontrollable rage
stealing.
180
Insight
When you hold a set of irrational beliefs about losing self-control, it leads
you to seek immediate safety from these threats and/or to exaggerate their
nature and consequences. lr can also lead you to develop a grossly distorted
image or picture of you losing control completely. Engaging with these effects
interferes with you managing your anxiety about losing self-control because it
prevents you from facing and dealing effectively with situations in which you
infer the presence of these threats.

LOSING SELF-CONTROL
these threats. In this section of the chapter, I will outline which
threats to your sense of self-control.
Rational beliefs in ego-based concern about losing self-control

In ego-based concern about losing self-control, you hold a flexible
belief and an unconditional self-acceptance belief about the ego
based threat.191 will illustrate these rational beliefs in each of the
ego-related threats mentioned earlier (see the ‘Rational beliefs'
Rational beliefs in non-ego-based concern about losing self-control

In non-ego-based concern about losing self-control you hold a
flexible belief and a non-awfulizing belief or a discomfort tolerance
belief about the threat to the non-ego realm of your personal domain
related to your sense of self-control. I will illustrate these rational
beliefs in each of the non-ego-based threats mentioned earlier
(see the ‘Rational beliefs’ column in Table 8.2).
Insight
When you hold a set of rational beliefs about losing self-control, you will feel
concerned, but not anxious, about these threats related to such loss.
The impact of rational beliefs about losing self-control

When you hold rational beliefs about losing self-control, doing so
will also have a great impact on your behaviour and subsequent
thinking.
,9You may also hold a non-awfulizing belief and a discomfort tolerance belief, but these
tend to be secondary to the unconditional self-acceptance belief.
8. How to manage anxiety about losing self-control IoI

BEHAVIOUR AND THINKING RELATED TO LOSING SELF-CONTROL
When you hold rational beliefs about losing self-control, you will
act and think in ways designed to help you to face these threats
and deal with them effectively (see Table 8.5). You will notice from
Table 8.5 that when you hold rational beliefs about losing self
control, you still experience similar urges to engage in safety-seeking
behaviour and thinking as you did when you held irrational beliefs
about these threats, but you accept them and do not actively engage
with these urges.
When you hold rational beliefs about losing self-control, then
these beliefs will also help you to think in a realistic and balanced
manner about the nature of these threats and their consequences
(see Table 8.6).
Insight
When you hold a set of rational beliefs about losing self-control, doing so
leads you to face and deal effectively with situations in which such threats
exist but which you view in a realistic and balanced way with respect to their
nature and consequences.
Using RECBT to manage anxiety about

losing self-control
RECBT to deal with anxiety about losing self-control.

FEATURES OF YOUR ANXIETY ABOUT LOSING
SELF-CONTROL (‘C’ IN THE 'ABCDE’ FRAMEWORK)
It is important that you understand how you feel, act and think
when you are anxious about losing self-control. In particular, it is
important for you to understand:
► what you do and think when you arc anxious about losing
self-control that is intended to make yourself safe from
threat
► how you exaggerate the nature and consequences of the threat
when your safety-seeking manoeuvres don't work
► the images or pictures in your head that you have when you are
anxious about losing self-control.
182
ox
c GJ 3
O
O
o o
OX GJ
OX
73
E
GJ
cz ox
o
cz
GJ 3 a
gj GJ
cz OX 3
E 3 GJ
73 73 GJ 73
o 3
GJ
E OX
a >
Gj o GJ 73 ox cz
0 OX GJ 73 o
73 OX 73 Q. CZ 3 OX
Z 3
E GJ o GJ
GJ 75 3 3 GJ
Z GJ 3
Z o OX GJ o O
C 73 73 3
3 73 GJ 73
3 3
OX E cz 3 O
o 3 3
3 GJ O
GJ o cz
o GJ o
GJ OX
* OX' <Z GJ GJ
75 OX •— GJ
GJ GJ a bZ 3 OX cz OX 73
75 o GJ 3 3 73 GJ
3 GJ ox 3
z □ C O o
OX 3 C
O
Z O U 73 a
3 gj
a GJ cz
73 OX 5 3 GJ
3 cz o
75 cz a
2 C o GJ o o O
gj 73 u 3 GJ o
GJ c cz cz GJ 3
GJ o o c
gj
OX v GJ 3 □
o
GJ
GJ 73 GJ o
04 75 cz GJ O
c c 3 GJ
2 gj gj cz o c
□ - GJ
GJ
O
z ox ox cz
ox 73 E 3 CZ
CZ ox 3 GJ
3 GJ 73 CZ ox
- OX JZ 3 - c GJ 3
GJ a OX
C 73 73 GJ ox 3
o 3 3 GJ
CZ cz
CZ o
£o gj
Gj
gj
3
O o
3
73
E
Gj
x-
•—
cz
GJ GJ
GJ 3
GJ
u
GJ
CZ
73
o
o O
O 3
c GJ
"33 GO
CX o GJ
A A
S3 CO
GJ OX
u. 3 c 3 3
3 O
GJ
O
O 3
73
O
73 z
3 cz GJ
3 8 3 J 3 z
73 OX 3
O —- 73 GJ 3
O 3
75 GJ
z
OX 0
3 O «-» 75 E Z
3 3
C • cz
O E GJ
OX 3
75
—• 4-» 0
Uu u 4— O O 3
75 75 3 3 3 o
z 73 O 3 z 73
3 73 3 z 1z-
z •*—»* -X 73
3 (A 3
0 3
•— U i O
3
O 3
OX-d
3 -3
- . 3
OX
3
GJ
0 •— Gj
73 3 75 o o O
O £
73 3 OX X z cz
C
C
Gj 3 ST5 O
cz 73
GJ
O
z
OX
3
GJ
O
3
X-
Gj OX
3
z OX O 73 GJ
GJ oox.OX
3
3
3
O
3
C
O
U
O
o C
O GJ 3
3
73
3
GJ 3
GJ O
o
-0
z
3
GJ 75
OX u- GJ
z
O 73 3
C CJ o
3 3 O O z 3 O
3 3
GJ a
0 o c o
o O G> 3J 3 O
GJ Gj
OX
G>z GJ cz
3
3 GJ Gj
OX
cz
3
GJ C
OX’C 3
OX)
3
3 Gj
cz
GJ OX
3
GJ C 3 o 3
73
ox
3
- 3
3
GJ
Gj O CX GJ O
GJ z
Gj o <u .3 o
E-S cz Gj GJ
EGJ
GJE
C z
GJ Gj 3 3 Gj 3
OX — GJ 3 3
3 OX 73 GJ Uu O OX 3“ OX3
3 O O
GJ
3
E □ OX
3
C
3
OXm^
73
3 3 3
Gj
3 73 OX
3
3 3 GJ GJ GJ Gj
73 GJ 3 GJ GJ GJ
Q
O X O
CO CO cz
Gj
w % Gj
CO GJ
CZ
Gj
CO
^3
O Z Gj
bo <3

z GJ
o
co
3 o OX
CO o
CO co 3
GJ gj
E GJ
GJ 3 OXj gj GJ
GJ 3
o GJ co CO > O
3 gj gj a
O C5 c
c O GJ o
Thinking designed to help you deal with
OX Gj o
GJ OX co GJ 3 GJ Q
3 3 ox CO co C
GJ 3 3
gj
a E C3
GJ
co 3 GJ GJ o OX
GJ c OX GJ
GJ
Qu GJ co
E 3 c Gj
O GJ co
gj O GJ o OX O OX ox O
o
co 3 O
a
CO o OX □ ox gj o
c o 3
co o GJ co
o GJ
o OX o OX) GJ
o 3
CO 3 GJ CO 3 .U
— C
3 o 3 gj OX GO G3
o O GJ O
3 5 O 3 3 O 5 o
3 C Gj GJ C c
CO ex 3 o GJ co
c GJ
OX o o o '-J GJ GJ
3 ox X- □ Q- c gj □ c a O
GJ c C o o o
gj
C 3
OX)
5
GJ a Cu □ c 3
Gj
3
OX a OX OX c o
GJ a GJ GJ C E 3
J*
o
U- GJ GJ GJ
GJ GJ
a OX
the threat
3 CO
o O GJ
c a c
3 c
Gj
X
CD GJ a
o
gj OX
GJ □
gj
gj
O OX
OX GJ
3 c
GJ
gj c o GJ
co •u>
GJ Q. o
CQ Gj CO CO GJ A A
□
c
GJ o Q-
gj - O GJ 3 C5 O
co GJ GJ
gj 3
3 3 O 3 c o
Behaviour designed to help you deal with
O CO a GJ GO
<S) o CO
3
GJ
3
O ox GJ o
GJ gj co o
gj
GJ 3 O OX GJ co co
O GJ 3 3
gj Gj
3 GJ
c o 5 GJ
co 3 3
O
Gj
co ox
E GO GJ co <o ox GJ 3 OX CO
3 co 3 a
GJ GJ OX 3 CO O GJ
GJ co GJ 3 O 3 GJ ex 3 GJ
O
GJ a o
O O O
GJ a X
co GJ
gj o o o CO O 3
GJ
OX
co
3 O
GJ GJ
□ co O
CO 3 3 3 ox o O
GJ 3 3
o gj GJ
3 OX o OX)
c
GJ •0
3
3 3 3 O
GJ O
a c ox-F
co E 3 3
3
GO 3 GJ GJ 3
CD a GJ o GJ
ox □ 3 o 3
O
co
3
£
c
a OX
gj
GO
o
c
GJ co
3
GJ
3
o
OX 3
E
3
o OX
3
c GJ □
o c gj
o O
c O GJ o GJ 3
co
GJ 3 GJ E 3
3
GJ c GO GO 3 o OX
GJ O
GJ GJ GJ ox GJ GJ OX) -J GJ o GJ 3 3 GJ
o a
GO a 3 c 3 3
3
GJ
3
3
O O
OX Uh O
E O GJ GJ c
E E3 E
GJ c -I. GJ Qj o
U. GJ
GJ co 3
3
GJ X o 3
the threat
GJ c - -2 3 ■OX C
OX 1)
O o c O GJ ox 3 ex 3
GJ
co 3
3 CO
GO
aOX
c oGJ ox >
c 3E c
GJ 3 3 GJ
X
3
a
o
CQ E c
GJ
O' □GJ
Qu-O 02) O
gj
CQ
gj □ O
GJ
CQ
GJ 3
3 O
GJ
CO
3
3
co 3
o I GJ
GJ
GJ
GJ
□2)
Threat
I84
Threat Behaviour designed to help you deal with Thinking designed to help you deal with
the threat the threat
8. How to manage anxiety about losing self-control

T
framework.

self-control.
Ego ► I may fall very short of my ideal for being in

based self-control, but it is more likely that I will fall
threat somewhat short.
► When I begin to lose self-control I may quickly
spiral out of control and act very foolishly if
I don't regain self-control immediately, but it is
much more likely that 1 will still have quite a lot
of self-control and it is unlikely that I will act very
foolishly.
► When I begin to lose self-control, some people will
notice and evaluate me very negatively, but most
won't.
► When I begin to lose control, I may gain an
enduring reputation for not being able to control
myself, but it’s more likely that I won't.
Non- ► When I begin to lose self-control I may quickly

ego- spiral out of control if 1 don't regain self-control
based immediately, but it is much more likely that 1 will
threat still have quite a lot of self-control.
► If 1 lose self-control, the consequences may be very,
very bad for me, but if there are any consequences
they are unlikely to be so bad.

RESPECT TO LOSING SELF-CONTROL (YOUR THREAT AT
‘A’ IN THE ABCDE1 FRAMEWORK)
As 1 discussed earlier in the chapter, it is important that you identify,
as precisely as you can, what you are most anxious about with
respect to losing self-control. This will constitute the ‘A’ in the
‘ABCDE' framework. Most commonly found ego-based threats to
your sense of self-control are as follows:
186
► the prospect of not living up to or falling well short of your ideal
standard with respect to self-control
► the prospect of being negatively evaluated for losing self-control
► the prospect of getting a reputation for loss of self-control.
Most commonly found non-ego-based threats related to losing
self-control are as follows:
► the prospect of losing the sense of being in control of yourself
► the prospect of experiencing negative consequences of losing
self-control.
You may well find that you are anxious about a number of such
threats. If so, it is best to deal with them one at a time. When you do so,
it is very important at the outset that you assume temporarily that your
threat-related inference is accurate. You will have a later opportunity
to question this, but for the moment assume that your threat is true
since doing so will help you to identify and deal with the irrational
beliefs that underpin your anxiety about losing self-control to develop
and strengthen alternative rational beliefs that underpin concern about
losing self-control, the healthy alternative to such anxiety.
about losing self-control? My suggestion is to use what 1 call the
‘magic question’. This is what you do:
► Take a specific and typical example of your anxiety about losing
self-control.
► Focus on the situation in which you feel (or felt) anxious.
diminish your anxiety about losing self-control in this situation.
► The opposite to this is your ‘A’.
Here is an example of using the ‘magic question’ to identify ‘A’.
The described situation is: Graham is in a train which is stuck tn a
tunnel and is feeling anxious.
► Graham focused on the ‘situation’ he described:
‘I am on a train which is stuck in the tunnel. ’
► Graham asked himself what one thing would get rid of or
significantly diminish his feelings of anxiety:
‘Knowing that I won’t lose control of myself and
smash the windows.’
8. How to manage anxiety about losing self-control I

► The opposite to this is Graham's fcA':
'Not knowing that I won't lose control of myself and
smash the windows.’
IDENTIFY YOUR GOALS (THESE WILL BE THE T’ IN

THE ABCDE’ FRAMEWORK IF YOU ACHIEVE THEM)
While you may well overestimate the presence of a threat to your
self-control - an issue I will discuss presently - the possibility of the
existence of the threat will invariably exist so it is important that you
accept this and develop a healthy alternative to your anxiety about
losing self-control. As I have discussed in this book, this alternative
is known as concern and, as with anxiety, it has three components:
emotional, behavioural and thinking.
What you need to do here in relation to your threat to your sense of
self-control is to set concern-related goals. In particular, you need to
specify behavioural and thinking components which will enable you
to face up to and deal with the threat rather than keep yourself safe
from it - as happens when you are anxious about losing self-control.
If you achieve your goals they will constitute the ‘E’ in the ‘ABCDE’
framework.
Insight
Setting realistic emotional, behavioural and thinking goals with respect
to your anxiety about losing self-control will help to focus your efforts in
managing this anxiety.

RATIONAL BELIEFS f‘B’ IN THE ‘ABCDE’ FRAMEWORK)
underpin your anxiety about losing self-control and the alternative
rational beliefs that underpin your concern about this threat.
irrational beliefs that underpin your anxiety about losing self-control:
► If the self-control-related threat is to your self-esteem, identify
your rigid belief and your self-depreciation belief about the threat.
► If your self-control-related threat is to your sense of comfort
(broadly defined), identify your rigid belief and either your
188
awfulizing belief or your discomfort intolerance belief about
the threat.
alternative rational beliefs that underpin your concern about losing
self-control:
belief, then identify your flexible belief and your unconditional
self-acceptance belief about your self-control-related threat.
► If you have identified your rigid belief and either your awfulizing
belief or your discomfort intolerance belief, then identify your
flexible belief and either your non-awfulizing belief or your
discomfort tolerance belief about your self-control-related threat.
QUESTION YOUR BELIEFS (‘D’ IN THE ‘ABCDE’

FRAMEWORK)
As I pointed out in Chapter 4, the purpose of questioning your
belief vs. unconditional self-acceptance belief), is, in my view, the
best way to do this, although I urge you to experiment with different
ways of questioning your beliefs. For help with this questioning
process, I suggest that you consult Appendices 1-4 for general
help, which you need to apply to your specific beliefs about
self-control-related threats.
Insight
in the latter.

DEAL WITH IT
As I pointed out earlier, the effective management of any form of
anxiety depends on you facing up to and dealing with what you are
8. How to manage anxiety about losing self-control I

most anxious about. Facing up to situations where the prospect exists
of you losing self-control tends to be incompatible with the use of
safety-seeking behaviour and thinking in these situations. This is
because these measures are designed to keep you safe by avoiding and
neutralizing the threat. Put very simply, if you avoid the self-control-
related threat or you neutralize it, you will not face it and deal with it.
So rule number one is, if you are choosing to face situations in which
you may encounter your self-control-related threat, it’s important that
you do so without using your safety-seeking behaviour or engaging
with your safety-seeking thinking. Once you have decided to face and
deal with your self-control-related threat, here are some tips.
Think about the rate of change and the level of discomfort
in choosing a self-control-related threat to face
If you want to deal with your anxiety about losing self-control quickly,
you will need to put up with quite a bit of discomfort as you do so. If you
want to avoid discomfort, it will take you quite a long time to manage
your anxiety about losing self-control. Most people opt for the middle
way between these two, which I call ‘challenging but not overwhelming'.
This means that you opt to face a self-control-related threat which is a
challenge for you at that time, but which is not overwhelming for you.
Insight
Probably rhe best way to face situations in which you infer the presence of
self-control-related threat is to choose situations that are a challenge for you
to face, but that are not overwhelming at that time.

Before you face the situation in which your self-control-related threat
may be present, it is important that you rehearse your set of rational
beliefs tailored for the situation you have decided to face where
your self-control-related threat is likely to be present. However,
don't over-rehearse these rational beliefs. 1 suggest that you rehearse
your rational beliefs two or three times to get you into a reasonably
rational frame of mind ready for action.
Use imagery
Before you actually face the situation in which your self-control-
related threat may be present, it may be useful to do so first in your
mind’s eye. If you decide to do this, see yourself facing your self
control-related threat while holding your rational beliefs. Do not
picture yourself facing this situation in a masterful way. Keep a more
190
realistic picture in mind where you are hesitant and uncomfortable
but where you face the situation in which your self-control-related
threat may occur.
You may not be able to create a situation in reality where your
self-control-related threat actually occurs. For example, if you are
anxious about losing self-control if the Tube train that you are in
might stop between stations, then this may not happen. This is where
the power of imagery comes into its own. Thus, you can imagine
yourself being in that Tube train when it stops between stations for
a long time and you don’t know when you might be able to get out
and see yourself rehearse your rational beliefs about this threat and
feeling concerned, but not anxious, about it.
The purpose of facing a self-control-related threat in your mind’s eye,
therefore, is twofold:
1 to give you practice at facing a situation in which you infer
the presence of your self-control-related threat where actual
exposure to that situation may not result in that threat occurring
2 to prepare you to face a situation where it is probable that the
self-control-related threat will materialize (e.g. where you are
anxious that you will begin to lose control if you fly in a plane
where you actually have a bad self-control-related fear of flying).
Insight
Using imagery to face situations in which you infer the presence of self
control-related threat is helpful in two ways. It provides you with the
opportunity to rehearse facing threat in your mind’s eye before you do
so in reality and it gives you needed practice when you may not face that
threat in reality.
Face the actual situation in which you infer the presence of

self-control-related threat
If you think about it, the concept of threat involves an event that has
not yet happened or the future implications of something that has
happened or is currently happening. For example, if you are anxious
about losing control of yourself if you were to be stuck in a lift, you
are still not actually facing what you fear since you have not yet
gone into the lift and, if you have, the lift has probably not got
stuck. So when I talk about facing threats to your self-control,
I mean actually going into the situation and facing your threat in
your mind’s eye (e.g. going into a lift and imagining that it gets stuck
8. How to manage anxiety about losing self-control I9I

and you begin to lose self-control). This is different from facing your
fear in imagination when you are not in the situation. Thus:
EXAMPLE OF FACING A SELF-CONTROL-RELATED THREAT
IN IMAGINATION
You are sitting in your living room imagining yourself in the lift
in turn imagining that it gets stuck and that you begin to lose
self-control and rehearsing your rational beliefs about this.
EXAMPLE OF FACING THE SITUATION IN WHICH YOU INFER THREAT
You are in the lift imagining that it gets stuck and that you begin to
lose self-control. Here, you will briefly assume that this threat-related
inference is true and you rehearse a shorthand version of your rational
beliefs about this.
When you avoid situations where you fear that you may
lose self-control, there is usually a purpose for being in that
situation. Thus, if you are avoiding lifts or going on the
Underground, the purpose of being in these situations is that
using such modes of transport makes life easier for you. Thus,
when you are dealing with your self-control-related threat in the
actual situation, the purpose of rehearsing your rational beliefs
is to help you to use such modes of transport with a minimum of
anxiety so your life is made easier.

IN THE SITUATION
During this process of understanding your anxiety about losing self
control and dealing with the particular threats about which you are
anxious, it is very important that you refrain from using behavioural
and thinking measures designed to keep yourself safe. If you use these
measures at this point, you will undo all the good work you have done to
enable you to enter the situation prepared to face your threat. However,
if you refrain from their use, you will help yourself in three ways:
1 You will have the opportunity of responding to the self-control-
related threat if it does occur with your rational beliefs.
2 You will have had the opportunity of rehearsing your rational
beliefs even though the self-control-related threat did not materialize.
192
3 In some cases (e.g. where you think others will judge you
negatively for beginning to lose control), you will have the
example, let’s assume you think that if you listen to your MP?
player then others won't judge you negatively if you begin to lose
self-control. If, indeed, others don’t seem to judge you negatively
when you begin to lose self-control, you will be likely to attribute
the reason that they did not do so to listening to the MP? player.
The only true test of your inference that others won’t judge you
negatively if you begin to lose self-control is, in this case, to begin
to lose self-control without listening to your MP3 player, in
other words without your safety behaviour. If you don’t listen to
your MP3 player and others don’t judge you negatively, then you
can’t conclude that listening to your MP3 player keeps you safe
by preventing others from negatively evaluating you.
Just because you have resolved not to use your safety-seeking measures
when you face situations in which you might lose self-control, it
does not follow that you won’t experience an urge to do so. Let me
first suggest how you can deal with your urge to use safety-seeking
behaviour. As the name implies, here you will experience an urge to do
something that is intended to ‘make’ you feel safe in the moment. Your
therapeutic goal, at this point, however, is to deal with the threat rather
than to feel safe. In order to achieve this you need to do the following:
a safety behaviour while in the situation in which you might lose
self-control.
you don’t have to do so (i.e. develop and rehearse a rational
belief about the urge) and that there is a good reason not to
do so (i.e. engaging with your safety-seeking behaviour will
prevent you from dealing with the threat and thereby interfere
with you managing your anxiety about losing self-control in an
effective way).
8. How to manage anxiety about losing self-control I93

designed to keep you safe in the moment from a threat to your sense
of being in self-control. The intent of such thinking may be to distract
you from the threat or to neutralize the threat (i.e. take the threat out
of the situation). The way to deal with such thinking is as follows:
► Acknowledge existence of the thought without trying to suppress
it or to distract yourself from it. If you try to suppress the thought
you may unwittingly make it more likely to come into your mind
and if you distract yourself from it you are not dealing with it.
about losing self-control, you may try to neutralize this by
thinking: 'I’m sure I won’t lose control.' If you engage with
this thought, then you will feel reassured. If you don’t engage
with the thought, you won’t feel assured, but will have the
opportunity of either rehearsing your rational belief about the
threat briefly or getting on with whatever you would be doing
if you did not have the thought even though you feel anxious or
uncomfortable in the moment.

you pay a regular sum every month to the charity. Now, let’s
194
Insight
When you face situations in which you infer the presence of self-control-
related threat, it is important that you focus on that threat and rehearse your
rational beliefs as you do so. It is also important that you do not engage with
your safety-seeking measures as you face threat.

Once you have decided to face a situation in which your self-control-
related threat may be present and you have rehearsed your rational
beliefs, for a while you will still in your mind exaggerate the nature of
the threat and its consequences. You will do so because your irrational
beliefs are still active, to some degree, even though you have challenged
them and have rehearsed their rational belief alternatives. This is how
I suggest you deal with such thoughts, in the following order:
irrational beliefs.
Insight
While you face situations in which you infer the presence of self-control-
related threat and rehearse your rational beliefs as you do so, you may still
think in highly distorted ways about the nature and consequences of this
threat. This happens because your irrational beliefs are still active and
(Contd)

produce such thoughts. If you understand why these thoughts are present in
your mind and allow them to stay in your mind without engaging with them,
then they will fade away.
DEALING WITH GROSSLY DISTORTED SELF-IMAGES

OR SELF-PICTURES
I mentioned earlier in this chapter that when you feel anxious about
losing self-control, you may hold a grossly distorted self-image or
self-picture in your mind (e.g. seeing yourself go crazy if you can’t
leave a situation immediately). There are a number of ways of dealing
with such mental events:
► Focus on the self-image and take the horror out of it. In this
respect, it is useful to repeat this self-image until it loses its sting.
► Understand that it is a thinking consequence of an irrational
belief that is still active even though you have challenged it.
► Recognize that as such the self-image is a product of an irrational
belief rather than a statement of reality about yourself or an
indication of how others see you, and that this is the case no
matter how compelling the image is.
► Accept the presence of the image and allow it to be without
engaging with it or trying to banish it from your mind. If you
do either, the power of the image will remain.
In addition, you may also at relevant points:
► trace the self-image back to the underlying irrational belief and
re-challenge this belief. The goal of doing this is to get more
experience of thinking rationally and not to rid yourself of the
self-image, which may still be present (albeit in a less compelling
form) even after you have re-challenged the irrational belief.
► bring to mind a realistic self-image. Here you see yourself losing
a bit of self-control, but not complete self-control. If you use this
technique, it is important that you do not use it as a safety-seeking
measure. It should be one of the last techniques you use to deal
with grossly distorted self-images or self-pictures, not the first.
UNDERSTANDING AND DEALING WITH YOUR

PRONENESS TO INFER THE PRESENCE OF
SELF-CONTROL-RELATED THREAT
There are two reasons why people are particularly prone to anxiety
about losing self-control. First, they are prone to infer the presence of
196
self-control-related threats. Second, they hold irrational beliefs about
such threats. In this section, I am going to help you understand why
you are prone to inferring the presence of self-control-related threats
and show you how you can deal with such proneness.
When you are prone to inferring the presence of your self-control-
Why you overestimate the presence of your self-control-related threat
This is how you come to overestimate the presence of your self
control-related threat. I will illustrate this with reference to the
following general irrational belief:
‘I must maintain self-control and it would be awful if 1 didn’t.’
► You take the threat theme of your general irrational belief
(‘I must maintain self-control and it would be awful if I didn’t’):
Not maintaining self-control.
7 must be certain that 1 will maintain self-control. I can’t
bear such uncertainty. ’
► You bring this second general irrational belief to situations where
it is possible that you may lose self-control and you make a threat-
‘Since I don't have certainty that I will maintain self-control
then I will lose self-control.’
Inference: 7 will begin to lose self-control if I get stuck
in a lift. ’
Specific irrational belief: 7 must maintain self-control if
I get stuck in a lift. ’
In order to deal with your overestimations of self-control-related
threat you need to take a number of steps, which I will illustrate
again with reference to the earlier example.
7 would prefer to maintain self-control, but I don't have to
do so. If I don’t it would be bad, but not awful. ’

and to your second uncertainty-focused general irrational
belief:
7 would like to be certain that I will maintain self-control,
but 1 don’t need such certainty. If I don’t have such
certainty, it would be hard to bear, but I can bear it and it
would be worth it to me to do so. ’
the former.
situations where it is possible that you may begin to lose self
control and make an inference based on the data at hand:
‘I am not certain if I will maintain self-control in the lift,
so let’s consider the evidence.’
► If there is evidence indicating there is a good chance that you
will begin to lose self-control, then use a specific version of your
general self-control-related rational belief to deal with this.
For example:
Inference: 7 will begin to lose self-control in the lift.’
Specific rational belief: 7 would prefer to maintain self
control in the lift, but that does not mean that I must do so.
If 1 don't, that would be unfortunate, but it would not be
awful.'
Insight
Jn order to become less prone to self-control-related anxiety, you need
to develop two general rational beliefs: one about what you find most
threatening about losing self-control and one which helps you to deal with
uncertainty about the presence of this threat. Doing this will help you to be
objective about the possible presence of the threat.
HOW TO EXAMINE THE ACCURACY OF YOUR

INFERENCE OF SELF-CONTROE-RELATED THREAT
IF NECESSARY
If you are still unsure if your inference of self-control-related threat
is accurate or inaccurate, answer one or more of the following
questions:
► How likely is it that the threat (e.g. that others will judge me
negatively for losing self-control) will happen?
198
► Would an objective jury agree that the threat (that others will
judge me negatively for losing self-control) will happen? If not,
what would the jury’s verdict be?
► Am I viewing the threat (that others will judge me negatively for
losing self-control) realistically? If not, how can I view it more
realistically?
opinion about the truth or falsity of my inference about the threat
(that others will judge me negatively for losing self-control), what
would the person say to me and why? How would this person
encourage me to view the threat instead?
situation as I am facing and are making the same inference of threat
(that others will judge her negatively for losing self-control), what
would I say to her about the validity of her inference and why?
How would I encourage the person to view the threat instead?
Belinda, a 33-year-old company director, learned how to apply

RECBT principles in managing her anxiety about losing self
control. Belinda avoided enclosed spaces outside her home and
also would not go outside what she called her ‘safe area’ in case she
began to lose control of herself. Belinda was rigid in her belief about
self-control and believed as a result that, if she began to
lose self-control, this would quickly escalate into complete loss of
self-control if she did not regain immediate control of herself or if
she did not withdraw from the situation immediately. Belinda had
a self-picture of herself falling apart and begging people to help her
that came to mind as soon as she began to lose control of herself.
While Belinda ideally wanted to learn some techniques that she

could use when she began to lose control of herself, she came to see
that it was better for her to learn to be concerned, but not anxious,
about beginning to lose self-control.
She achieved this by doing the following:

► She questioned both her irrational and rational beliefs about
losing self-control and realized that, if there were such a law
(Contd)

decreeing that she must not lose self-control, then it would
follow that she would not lose self-control. Obviously, it was
possible for her to lose self-control and therefore she needed
to deal with reality with due concern rather than with undue
anxiety.
► Belinda strengthened her rational belief - ‘I would like to
be in control, but I don't have to be. If I'm not it would be
unfortunate, but not terrible' - by going into enclosed spaces
and areas that she had regarded as forbidden. She did this by
using the ‘challenging bur not overwhelming' approach and
rehearsed shorthand versions of her rational belief before she
entered such situations and while in them.
► To help her she discarded her anti-anxiety drugs and stopped
using alcohol to gain a sense of self-control when she was
anxious about losing it.
► She desensitized herself to her distorted self-picture of her
losing self-control completely by imaginal repetition. This
helped her to take the horror out of this image and encouraged
her to stay in situations when she felt the urge to escape.
After using these strategies to encounter situations that she had

previously avoided, Belinda made significant progress in dealing
with this form of anxiety and even resolved to use them in dealing
with her fear of flying when she next takes a trip abroad.
Other issues
THE USE OF RELAXATION AND BREATHING
TECHNIQUES
The use of relaxation and breathing techniques in anxiety
management is generally recommended, but is less widespread
than it used to be. I discuss this issue in Chapter 4 and 1 refer you
to this discussion.
200
THINGS TO REMEMBER
► When you are anxious about losing self-control, you are anxious
about something which you find threatening to some aspect of
your personal domain relevant to self-control. It is important,
therefore, to identify as precisely as you can what you are most
anxious about when there is a chance that you may begin to
. lose self-control.
► 'l our self-control-related anxiety may be about a threat to your

defined.
► The main determining factor of your self-control-related anxiety

is the set of irrational beliefs that you hold about these ego and
non-ego threats.
► When you hold irrational beliefs about self-control-related

threats, you are very prone to engage in behaviour and thinking
dealing constructively with these threats and thus unwittingly
serve to maintain your self-control-related anxiety.
► When vou
z hold irrational beliefs about self-control-related
threats, you are also very prone to exaggerating the nature
and consequences of these threats.
► The goal of managing your anxiety about self-control

related threats is to become concerned, but not anxious,
about these threats when they do exist and to become less
prone to making inferences about the presence of these
threats when they may not be present.
► To manage your self-control-related anxiety, you need, first and

the presence of self-control-related threats.
8. How to manage anxiety about losing self-control 2.OI

► It is very important that you face situations in which you infer
the presence of self-control-related threat without recourse to
your safety-seeking measures and while accepting the existence
of your distorted negative thinking.
► To become less prone to self-control-related anxiety, you first

need to understand the role that uncertainty plays in leading you
to infer the presence of self-control-related threats in situations
that are ambiguous.
► Once you have developed rational beliefs about your self-control-

related threats and about uncertainty related to their presence,
these threats, which will help you to become less prone to this
form of anxiety.
We have now reached the end of this book. I hope you found it
helpful. As I said in the ‘Meet the author’ section at the beginning
of this book, I would appreciate your feedback c/o the publisher.
202
Appendices
Appendices
cz <D
o E CD
cz
bJj o <D O
cz □
<d 03
□ □ a- CD
’/j c o O cz a. 3
a D
<D o <D as
o
kJ c a <D CD
£ o OS 3 D o <D cz a. as
kj Cl aj c
c C 05 <D
S E
o
>aS &
cz (D
03 (X) O o
<3
O o 3
as
3 o C s. o
O b£i
o
cz
CL u E o
cz c z
03
D
C O H cd
O O
b£
c o
<L» cz 3
kj <z
3 D
cz o O 5 cz 3 □ CD
3 O D cz E
<D
c
OJ o □ o
cz
<D cj <D O
C
b£
kJ —
O aS cz
a c
<d
E <D 3
bo
as
'O O C- cz c O X
' ^j <D CL 3_ cz D c
: C O 3 as as E c 3 o
OJ a. c o
u. o O te cz
c c as
C
cz
as as C c
cz (A) o as as
cz CZ
C
o
D CD <J> 3
C C
<d Q 'D H E o
O
<d <D d <d CD as
<v cz O <v cz cz 3 c Q- c
D CD bL d <d 3 c E as aj
3
O 3
cz o C E
D CZ b£
CD (j <D o
<3 <d 3
3 as
3
3
3 <D
z 3 o Cl
3 cz 3 CZ c O
E 3
X X
aS □
Q
as X X CZ aS c o
So g <D D
CZ
C 'D <D kE 3
cz
CD O CZ o
.2 Q < < aS
a.
as aS
s
O C
as
3
o
a
C
cz
aS
b£
O
<3
cz
£ C
O a cz 3
as
aS O
3
o as X
C
c O CO cd d
cz b£ O b£
o c 3 c 3 C C
<d a
'✓) ■*—
c aS as (D
Cl E o as cz
c
as
3
c E c cz Cu
c Q D
<D
<3
c <D cz
aS
as o cz
(U O E
<3 c 3 -C o
C c o
'S) as aj x <D D
o cz
E 3
cz
(D
CD
cz
cz
OJ
o cz
□ C aj
<3 CD o c
cz 'Z E o C u E
cz (J as
c
bo kj
c c a o <D <D cz
D
cz
3 CZ
CD <v
<D
E o C
3
C 3
c as D c as
<3
 3 o
aS
aS
<u
3 c cz
CZ 03 □ Z CZ
c O c E
So E E o aS
as aj
3
cz
3
D cz
— kJ 3 as
<D
Um D 3 cz 3 b£
£ □ 3
as <D 0 cz aS
3
C cz
3 3 3 c
cz o z. b£
3 as
3
as □ 3
<D
cz
as o c C
<D O
CJ
’bJ ■^S bl cz
c bX b£ 3
CL 03
as Cl 3 □
as
o C
□
o C cz u- <D Cl 3
CZ
C
£ c c
o o o 3 as cz bC
o Uh <z u CL < O cz
kj
204
05 OS
■Ki
D
GJ
GJ
3
K
u.
O y
3
3
O
y
GJ
y
GJ
y y OS 3 u
GJ 03 - GJ
U o CO GJ O
GJ GJ
3 3 • 03 3
3 §
GJ GJ E 3
O' dX
3 O 3
GJ o 3 3
O’ y y O' O
GJ GJ O ’3
o5 O
y y y O 3
3 O GJ y
3 3 3 y O
gj
C O O o 3
□ 3
GJ gj E
o 3
GJ
GJ
5D CD — 3
3 gj OS
u_ -432: ex 03 GJ
Gj y 3
GJ 3 3 v- y os
3 D 03 C3 y
3 QJ - 3 O y GJ
GJ 3 N O
ex 3 GJ
O
GJ 3 £
3
ex o
gj -n
5
4-M GJ y
y GJ E
Gj O
Gj ex
3 03
—
$ O
y
03 tn
3 o
— — OS C GJ
GJ cd GJ 1 3 03
OS 3 u- 3
3 3 GJ
GJ
E
V GJ y S % v ■—’
y
03
y
03 O
y
3
Gj
3
3
O
o
s 5b
GJ
O
3
os
GJ
I % E
dS-C
O’ U
o
GJ
Uh
v
y 3 o 03 GJ
03 *—4 GJ 3
GJ 3 3 N y
St U 3 GJ
5b 3 C GJ O O GJ os
gj GJ y O GJ
GJ 3 y C
32 o
Gj y gj o ex
GJ 3 y
Gj GJ 03 ex 3
3 O Gj u os 3
GJ
gj
'j'. y
Z) a 03 y
OS
>
y Gj 3 GJ
Gj Gj £ Gj
y 03 O
Gj CD y 03
3 3
GJ 3 3 r- u. xO 3
Gj
y - b/> CD 3
GJ dX O'- O
O’ y
z 3. 3 O y
y O y
Gj Gj Gj 3
y y y O ^j O 3
o O
3 a Gj os • ^*4 •— O 3
•K. 3
Z o 3 03
3
GJ
o O

y 3
r-«
OS
ex GJ
Gj y 3
3
GJ
—
C5 £
o
£ y
E
5
3
1 03 O
O y
y
3
GJ
4—
GJ
y
—«
op J — O y O 03 03
Gj 3 y GJ
3 03 3 GJ Q-
c Gj a
3 3 _ 3 y
3 3 GJ GJ
O CX <3 gj
y y O GJ 03 u-
5b 3
3 'Z y 03
'-0 'St 32 Gj 3 3 O
03 gj
y
G 3
Cu ZI, o O
O
O
U 03 GJ
3 GJ O 32 3 y
GJ GJ GJ y — 3 GJ
3 U ex
•Si Gj
£ CX N
3 GJ
GJ
>
o tX
GJ GJ • •**< CD CD £ o 3
3 O GJ GJ —
ox
5b GJ O
oX S y
03
3 GJ GJ N
I
32) y C o
3 3 03 O
Si dX
3
03
o
3
3
O ^J CD
'X
cd
<z)
:
:
OS GJ
Gj
E E Z z
•2P K : 3 o
GJ <u c
C< O o o : y OS
Appendices 205
Awfulizing belief Non-awfulizing belief
206
An awfulizing belief is illogical A non-awfulizing belief is logical
An awfulizing belief is based on the same evaluation of A non-awfulizing belief is logical since both parts
badness as a non-awfulizing belief, but is transformed non-rigid and thus the second component logical!
as follows: follows from the first. Thus, consider following
o
cz
os
c
GJ
GJ
aS
c
c
3
GJ
0
o
3
3
o
N
•
gj
cz
cz
GJ
GJ
GJ
(f)
o
3
3
— o
3
0
OS
OS
3
3 -O
cz
cz
0
0
GJ
GJ
0
GJ
3
3
as
cz
cz
gj
3
3
o
£3
o
cz
o
0
QJ
GJ
GJ
0
3
3
Qu
Q-
xZ
03
cz
as
cz
cz
&
a
cz
E
E
GJ
GJ
aS
GJ
GJ
c
GJ
0
0
0
O
GJ
r-3
o
o
o
3
cz
o
Zj
O
Q-
a.
Cl
Z
03
cz
cz
c
cz
a
Gj
&r->
GJ
GJ
GJ
GJ
GJ
3
3
0
3
O
0
3
o
C3
3
o
gj
X
£
3
3
3
o
o
3
as
cz
cz
cz
E -
□
<S)
GJ
GJ
GJ
<u —
GJ
GJ
c
c
3
O
3
O
O
0
3
o
0
C3
GJ
3
o
gj
0
cz
0
3
K -
Q-
cz
as
cz
cz
cz
cz
c
c
c
E
E
CZ
GJ
X
GJ
GJ
CZ
aS
GJ
0
c
c
X
3
3
3
3
3
GJ
3
o
gj
53
u.
U
N
N
gj
3
3
aS
c
GJ
GJ
X 'Z
ejj
Cu —
cz
cz
cz
E
E
aS
3
3
GJ
GJ
GJ
GJ
GJ
3
0
3
o
0
0
3
o
u
3
3
3
CZ
CZ
X
U
0
03
3
3
0
o
o
o
E
GJ
GJ
GJ
GJ
Gj
Gj
S’ °
O
O
Eh
Cdj
CX
>,
o
z
E
X
E
Gj
aS
GJ
GJ
GJ
GJ
3
3
0
3
3
CZ
'■j
a
a
gj
gj
cz
E
E
o
0
3
GJ
GJ
0
X
GJ
GJ
cj
OL
CJj
cz
3
GJ
0
3
3
o
3
z
GJ
GJ
z
0
3
GJ
GJ
Q
An awfulizing belief has largely unhealthy consequences A non-awfulizing belief has largely healthy consequer
because it tends to lead to anxiety, unconstructive because it tends to lead to concern, constructive
behaviour and highly distorted and biased subsequent behaviour and realistic and balanced subsequent
thinking when you are facing a threat to some aspect of thinking when you are facing a threat to some aspec
the non-ego realm of your personal domain. of the non-ego realm of your personal domain.
ex czcz *-*
(S)
□ .E cz GJ R
□
•—*
X
O
fez Sj O o GJ
TO o O c TO
CX
□
c
cz O
TO
□
§ g
gj E gj GJ GJ o
TO □ U
GJ a
gj
GJ C TO cz
^3 C GJ GJ cz □
GJ
c a *- —
O c
ex o
TO
u- GJ cz c b£>
a
GJ a GJ gj tx
TO X
u-
i GJ
CZ
GJ
*—> GJ X GJ
TO c GJ
TO 3
2 § cz
GJ
c
C
O
c:
TO
oi— a o
cz
a •—
GJ
GJ
3 (S)
gj
cz
E cz
GJ
o
£2 GJ
GJ
c
*—
GJ
3(J
cz cc GJ
TO
c GJ
o
E O gj D- c Q- O c Q
Gj o GJ
GJ
GJ TO
o E
czu GJ <S>
GJ □ GJ
GJ GJ cz
c GJ TO GJ
GO >
•~-
kJ
TO
cz GJ GJ
Q
— GJ c
TO o
<3 s TO
GJ a— TO Gj GJ
CZ
*-
-
V-
TO
TO
u-
kU c
TO GJ Eh "gj E GJ
—
o o ocz
E •—
tx c O
o > E cz
^J
S3 £ TO
□ > o TO c
S3 obM o o cz GJ
go
a 3 O gj cz u-
O
E o TO
GJ GJ *—
-c cj
£
o Gj
cz C
TO
GJ
C £
cz □ 5 S.JC GJ
E
GJ CZ
Sh o
'z TO GJ
U- GJ cz
Sj Q
GJ
Sj kj TO
kj X
St S3 cz
S3 CX Gj
—— c □
a
O a □
cz
■*o—
o
(Z o
TO c c Gj a
c
* st O i> O o GJ
CZ
□
E— gj O
o ? o
*— TO a O
TO *—
TO cz
Gj GJ
St kJ GJ - c E Gj E □
is Gj C o o cgj o
cz
— TOu. ex cz cGJ ■z GJ
TO Gj
I Gczj X cz
a cz
—Gj• c TO Gj
TO —
cz o o O Gj
O GJ GJ
TO
st a CZ X
■z
'S>
— cz
S3 GJ
GJ
Gj
GJ TO
kj
go Gj O 3 GJ
Sj
kJ GO Gu o GJ GJ
u- C GJ GJ
Gj TO *-<
St Q
E o Gj
GJ u- G TO
x kJ kJ C o cz tx 'J o u-
Gj
Gj GJ
kJ cz —— Gj TO 'J U
o X St R TO
cz GJ TO
o ex TOCL
GO Sr Sj
S3 Sgoj X
s GJ
5
cz
TO
C
•—<
CZ
CL
TO
GJ o c GJ
TO
1—
GJ
Sj «R- *— TO TO X— u.
St Sr □ TOUh
C GJ —
s> o c GJ
GJ E TO
o
O GO st
E TO
E
u-
TO c o oo Gj cz
TO c
—
kj st ■*K—
o o
cz
a GJ
GJ
cz
'U
cz o GJ
O . c-
o
□ O cz
o
kj c o TO
—
X GJ cG GJ
GJ *-a
g c
E
> O
TO GJ j
o GJ
/ cGJ G j
o cz & *
U4 oGJ
Sj kJ cz
o
• 'Z
TO
GJ cz
§ § Q
GJ -
CL .
X -St
Appendices 207
c a
z
<D
o d O
C o 03 z D
c x> c
c D
z z
CD
E
>. a
r\ -□
CD 03
03
C
E
O E a
D
x: O <D o
o <D □ 03
v- CD
D
U
c — z
<d u C D O X
w a
03
» ■« D
u 5 a a <D
D
03 ex
o 03
H C Z o D o c o -O
Z
C <d □ 03 c c
CD □
P o
u 03 o D 03 c Q_>
o “3
O
05 03 D
q= 03 C
u O Z Z cd
d o O D c CD-^ 03
03
bii CD D 3
d
O 5 O
O 5 S
—
U
• —-
—< <D
o
O O <D
D
C/) z E
z z CD
O
c Z
<D
□ o
o 03 g 2 —•
03
C3
- 03
3
<S) O
c
D
E c E D
U z D
u-
D
D <D £- 2 z DD D
'4Z 03 O D
o o o — E ~a a
D D 03 < u.
D d o o o D i> a C CD
03
O
D z
d -
03 <D D
o <D £
CD D z 3 <D
Z G
c03
<D
c
<D
E
E □ o
c C
<D
0 03 o
D D
U
C
D 3
C
03 <D
o
O
u z c Q $ Z <S) CD 03 —•
CD
C
C
J- <D 03 O u- 03 > <D
D D O a 2 o o 03
z E •r 03
X <D -C
O o D
c O
o
u
z
d
O 03
C
03 c
03
D
z d 2— Z
D
-O
C
o
E D D □ u. D
o 05 D
o o E E <D o D
c o z o d (J > o
*- c • C
E
o
E
o
<D
•—
CD 3
O
C
<D o_ o
z D
D <D CD
o
E D (D
<D
z
'D
Z
u
Z
03
z u O
5 a.
03
c
<d
03
X
D Q
X
D a
u
U
Z
3 FT
C/)
-
3
*-
z
D
z
05
03
r-
CD = <D CD c O c
CD o a C
B I
03 o c 05
O O O c
C
c
O ex
c
CJ
O
u z
o
z T5
D
E
□ D
03 <D CD a
03 03 c 05 □
z
<U o
E
D o
CD
E D D CD O
D o C
'D c <D
D D a D
<D
o D D C
z
□ □ X 03 O
D ex £ CD O C
03 o D D 05 -F. □ E 05 o
D E
U C
□ z 03 D Z 03
CI, D 05 03 z U <D CD o 05 D
z c CD
O D D o c
05
r3 O X
03 O O
o O c
<D <D z D CD
z <D
z <D E CD 03 CD
o D
o D
z
C C
C
D C
a
D <D o D <D CD <D c
D z
<D O E E
Q.
□
o O
X
<D
D E
D D c 5
o D D
o 03 D z
E
•D
05 CD
D <D u z O z D
z p o
'D O z C <D z X
u □
c <D <D D
<D
O
<D
<D
• c 0 o
03 03
03
O
□ O
c
ex
C
05 c 05 D
z >
a
D <D z O Z 05 CZ D o
D □ 03
03
SC <D <D
c 03
□ D c 'C
D
ex
o o
D
z o a
<D
o z O (J D
C z
c c CD -O
o3
<D
o o H
D
o
c C
D
<D
<D 03
C
03
c 03 (D
CD <D o E «-*
£ z z >
£ E
□ E D CD U D D CD
o o o
<U
<D
O CD CD
D o U J z o o
E E z o □ u
X O C
C
D
a
D
3 z
o 05 E E p
o
'j
o
u
O z
C
^"E z
<D
<D
□ o
□
□
o
3
□"
z
z o 03
a
z z <D
z
C
05 £9 x::
<D
O o
c
o x*
z
O
a
c
CD
E
D
z
C
o
z CD
z
a
a
o
'D
CD
z
03
D
o
z
03
< z
z z C z
03
03
O
o
z
c
u
o
u
a <D
ex
208
QJ CZ)
CD
X QJ £
^3 QJ o
QJ QJ QJ
73
o □ U
CD
o o CZ)
>
QJ CZ)— O
Eb 5 c o
QJ CZ) C/)
73
C 73
QJ
□
oCD *—
CZ)
QJ c 73
□
CZ)
QJ
CD
CD EQJ
c 5b
c
O a
73
73
QJ □
QJ
3 QJ cz) "O cQJ o CD CZ)

C
Qj
QJ u- QJ 73 C 73
CZ)
QJ -r 73 w c
73
c
C o QJ
o Qj QJ
Qj C o
CZ) o QJ
c o
CZ) QJ □
CD QJ QJ u- CZ)
Q) u QJ
<3 > QJ QJ QJ
73
Cj
X Qj
D
Z C
QJ
CZ)
5b
QJ
QJ
□ QJ
CD
73
k) 73 c QJ CZ) X O 73 QJ
X □ CZ)
73
CZ)
QJ o QJ
CZ)
73 CZ) QJ
a
QJ
CD
a
a
<3 CD s D
CD
O QJ
cz) QJ o 73
73
u- 73
X 'D Qj X c O
<3 Qj
k> CD
O
CX
*-
73
C
C 9 E CZ)
*— QJ
0) c E CZ)
73 c CD
QJ
QJ
u- CD
CD
<3 QJ 73
QJ
QJ o -o OX) CD
73 73
£< ^J CZ) QJ > <j qj
0X2 c C 73
CZ) QJ
*—
QJ CZ) CZ)
0)V) 73
O x
QJ qj
73
QJ
t-
<D 73 QJ
73
QJ
73
QJ QJ
C QJ CZ)
■ **
O 73 o □ CD
*—•
o o CZ) QJ
*-•QJ oc
CZ) 5 u- 73
St C
c o QJ
c 73 a
73 CD
QJ
CZ) C
'Z) o QJ cz)
o
x 3 =!,
C C
c
73
CD X
CZ)
73
c
£
73
QJ
4-*
QJ
73
E 73CD
QJ
O u QJ
CZ) CD CZ)
St - O
C cz? □ c
o •z
C
QJ
QJ
QJ
z CZ) O
Qj •
Q
x
QJ a
QJ
c
k) st
CZ) 73
o
CD
CZ) vj c 73
CQ
c
t«
CD CD
X
QJ
C
,O5 -
Qj
CD
73 c CD
O
73
o □
o
•X o QJ
QJ
CZ)
73
CZ) CZ)
□
o
<s>
73 73 73 QJ
c o o
X, CZ)
O C —•
CD C cz) QJ
5b
CZ) QJ
X
O 73 Qj
c a
QJ
73
QJ QJ C a
VJ 5b QJ 0 > QJ 73
X QJ QJ
c
*— QJ
J QJ
X c CZ) O o a
CZ)
'Z)
QJ o QJ
73 cz. O
o o 73
<Zj X v5 CZ) u. C
Qj a
<3 X M73—
73
•—•
E
73
73 X CZ) QJ
u-
QJ
CZ)
»Z) CD QJ QJ 73 C —
• CZ) QJ QJ CD X QJ O QJ 73
CD X QJ QJ >
u- QJ 'D CX *-•
*— 73
MH G. CZ) c QJ QJ 73 CZ)
vj X —• —QJ—*
QJ QJ 5 QJ
CZ)
CX "2
c
X CD czj
x X *** CZ)
Qj
CZ)
O 73 73
C
73
QJ
— QJ
O O Qj QJ
QJ
CZ)
73
QJ
v—
73
QJ
CD 73
QJ
CZ) CD
□
E □o
cz cz) QJ CZ)
CD E □o 73 CZ) 73
X O w c
nrec:iatic
73 73
ons
^J QJ
thy
ex •
.0 c 73 o CD
QJ o
X O
X
QJ
CZj
QJ CZ) oCZ) CD
CZ) QJ
•3 o
C
CZ)
73 a 3 73
CZ) 73
•—•
H rS CD
■-
j
Qj □ a o O u-
QJ
QJ CD
QJ
O
3
QJ C
73
CD
QJ s
o C
Qj □ u.
CD
O
QJ 73
CZ)
u- a
QJ 73 o QJ
O
QJ
QJ
-C
QJ o
CD £
O
< ■ O
- QJ
<
CZ)
"0
C
O
o
CQ QJ
CZ)
1.5
Appendices 209
Self-depreciation belief Unconditional self-acceptance belief
2IO
......... ..... ...................................... ............... ............. ......... ....................... ................................................... ................
A self-depreciation belief is illogical An unconditional self-acceptance belief is logical
A self-depreciation belief is based on the idea that An unconditional self-acceptance belief is based on
•—
CZ
o
(X)
£
C
“O
3
E
3
3
3
C
<D
<D
C
cz
CD
(D
CD
CZ
3
<D
(J
3
<D
CD
3
3
a
3
C
0J
Q
D
cz
cz
O
<D
3
CD
3
CD
U
C
D
cz
•U
O
=3
c
<D
<D
<D
3
3
3
3
<D
3
iz
C
-
cz
CD
u
3
3
3
Q
3
3
D
U
U
O
3
cz
3
<D
<D
<D
D
04
Q.
04
(Z
cz
cz
cz
CD
(D
□
(D
O
<D
X
CD
3
<D
3
3
<D
a
O
3
a
U
C
D
'D
<d
cz
cz
d
cz
3
o
<D
3
<D
<D
3
3
<D
o
a
U
cz
az
o
cz
3
>
c
3
c
u
o
a
<D
CD
3
3
a
CZ
<D
U
u
o
3
•J
O
3
c
3
CZ
O
5
«D
<D
3
<D
3
o
<D
3
CZ
3
3
04
cz
cz
O a
c
3
3
<D
a
5
C
C
d
cz
CD
3
3
3
CD
CD
a
3
c
cd
(D
cz.
O
3
3
3
3
a
<D
CD
£
O
<D
3
3
CD
3
u
3
04
04
04
04
cz
cz
o
cz
cz
E
3
<D
a
o
3
O
O
<D
<D
CD
<D
<D
O
£<d
<D
Index
‘A’ adversity (threats), 5, 17, 21-2, awfulizing beliefs, 6, 48, 57, 205-6
26, 43-4 health anxiety, 154, 161
health anxiety, 160 losing self-control, 7 75-6
healthy response to, 34-42, 46-7 social anxiety, 7 7 6-7 9
losing self-control, 186-8 tests, 77-9
managing anxiety, 63-6
social anxiety, 133-135 behaviour and thinking: rational
specifying, 53 beliefs, 83-4, 126-131, 157-8,
test anxiety, 86-7 182-5
see also threats beliefs, 5-8, 11, 27, 55-6, 203-10
ABCDE model, 5-12, 33-45 beliefs about threats:
accuracy of threats, 98-9, 146, 198-9 losing self-control, 7 73-6
anxiety: social anxiety, 7 7 0-19
about anxiety, 43 test anxiety, 73-9, 173
about health, see health anxiety blushing, 144-8
alternatives to, 26-8
vs. concern, 34-6 ‘C’ consequences, 8-9, 10-11, 17-21,
depression about, 43 27-8
disturbance about, 32-50 disturbed emotions, 33-42
guilt about, 43 health anxiety, 160
performance-related, healthy negative emotions, 34-42,
see performance-related anxiety 45-6
shame about, 44 losing self-control, 182, 186
showing, 109-10 social anxiety, 733
social, see social anxiety test anxiety, 85-100
anxiety, managing, 51-68 case examples:
overestimation of threats, 64-5 health anxiety, 766-7
questioning (disputing) beliefs, losing self-control, 199-200
56-8 social anxiety, 147-8
relaxation and breathing, 65-6 test anxiety, 99-100
threats (adversity), 63-6 concern, understanding, 26-8
uncertainty, 63-4 concern vs. anxiety, 34-6
your mind,61—2
anxiety, understanding, 12-13, 15-31 depreciation beliefs, 6
alternatives to anxiety, 23-5 depression, 37-8, 43
concern, 26-8 disappointment vs. shame, 40-1
RECBT perspective, 15-21 discomfort intolerance beliefs, 6, 57,
safety-seeking, 27-2 77-9, 116-19, 176
symptoms of, 7 8 discomfort tolerance beliefs, 7, 57,
anxiety response, 7 8-19 77-9, 116-19, 176,207-8
Index 21 I
disputing (questioning) beliefs, 56-8 healthy response, 34-42, 46-7
see also questioning beliefs (D) hypochondriasis, 153
disputing irrational beliefs, 9, 12
distorted images, 125, 177, 180-1 identifying beliefs (B), 54, 55-6, 88-9,
disturbance about anxiety, 32-50 135-6, 161, 188-9
and adversity, 43-4 identifying goals (E), 87-8, 135-6,
emotions and alternatives, 160-1, 188
33, 34-42 imagery, using, 91-2, 138-9, 190—1
healthy alternatives, 45-8 inference, 16
irrational beliefs, 44-5 informed consent, 12-13, 28
irrational beliefs, 5-6, 17, 44-5,
‘E’ effects of disputing (goals), 9-10, 55- 6
12,87-8, 135, 160-1, 188 health anxiety, 154-5
emotions and alternatives, 34-42 losing self-control, 173-7
extreme beliefs, 6 social anxiety, 110-9
test anxiety, 88-9
facing your threat, 58-61, 89-92,
137-9, 189-192 losing self-control see self-control,
flexible beliefs, 7, 74-9, 111-114, anxiety about losing
116-119, 174-6,204-5
magic question, 87, 134-5, 186-8
goals (E), 9-10, 12, 87-8, 135, 160-1, meta-disturbance, 32-3
188
guilt, 39-40, 43 non-awfulizing beliefs, 7, 48, 57, 77-9,
116-19, 175-6
health anxiety, 152-169 non-extreme beliefs, 7-8
‘A’ adversity (threats), 160
‘C’ consequences, / 60 objective failure, 70, 74
case example, 166-7 overestimating threats, 28-9, 64-5,
goals (E), 160-1 144-6, 166-7, 197-8
identifying beliefs (B), 161
irrational beliefs, 154-5 performance-related anxiety, 69-104
overestimating threats, 165-6 beliefs, 73, 74-6, 77-9
questioning beliefs (D), 161—2, test anxiety, 70-85
204-8 threats, 70-1, 73, 96-8
rational beliefs, 156-9, 162 using RECBT, 85-100
safety-seeking, 154, 155, 162-4 personal domain, 16
threat-exaggerating thinking, post-irrational belief thinking, 20-1
155, 156, 165 psychological disturbance and health,
understanding, 152-9 2-4
using RECBT, 159-64
healthy anger vs. unhealthy anger, 42 questioning (disputing) beliefs ‘D’,
healthy negative emotions, 34-42, 56- 8,204-10
45-6 awfulizing beliefs, 57, 205-6
212
discomfort intolerance beliefs, safety-seeking thinking, 20-1
57, 207-8 health anxiety, 154, 155
discomfort tolerance beliefs, losing self-control, 178-9
57, 207-8 social anxiety, 115, 120-3
health anxiety, 161-2 secondary disturbance, 33-45
losing self-control, 189 emotions, 34—42
non-awfulizing beliefs, 57, 205-6 healthy alternatives to, 45-8
self-depreciation beliefs, 57-8, self-anger about anxiety, 44
209-10 self-control, 25
social anxiety, 135-6, 204-10 self-control, anxiety about losing,
test anxiety, 89 170-202
unconditional self-acceptance ‘A’ adversity, 186-8
beliefs, 57-8,209-10 ‘C’ consequences, 182, 186
case example, 199-200
rational beliefs, 6-8, 27, 47-8, 88-9, distorted images, 177, 180
162 facing your threat, 189-192
about threats, 74-9, 111-19,174-6 identifying beliefs (B), 188-9
and concern, 82-5, 125,156-7, 181 identifying goals (E), 188
Rational-Emotive Cognitive Behaviour irrational beliefs, 173-7
Therapy (RECBT), 1-14 magic question, 186-8
ABCDE model, 5-12 overestimating threats, 197-8
explained, 2-4 questioning beliefs (D), 189,
realistic and balanced thinking, 85, 132, 204-10
158-9, 186 rational beliefs, 174-6, 181, 186
RECBT, 1-14 relaxation and breathing, 65-6,
relaxation and breathing, 65-6, 101-2, 200
149,200 safety-seeking, 177, 178-9, 192-5
remorse vs. guilt, 39-40 self-images, 196
response to anxiety, 47-8 threat-exaggerating thinking,
rigid beliefs, 5, 74-9, 111-14, 116-19, 177, 178, 180-1, 195-6
174-6 threats, 171-3
understanding, 171-182
sadness vs. depression, 37-8 using imagery, 190-1
safety-seeking behaviour: using RECBT, 182, 186-200
health anxiety, 154, 155 self-depreciation beliefs:
losing self-control, 177, 178-9 losing self-control, 174-5
social anxiety, 115, 120-3 questioning, 57-8
test anxiety, 79, 80-1 social anxiety, 111-14
safety-seeking measures, 18-19, tests, 74-6
21-2, 54 self-images, 125, 143-4, 196
health anxiety, 162-4 shame, 40-1, 44
losing self-control, 192-5 social anxiety, 105-151
social anxiety, 140-2 ‘A’ adversity, 133-5
test anxiety, 93-4 blushing, 144-6,147-8
Index 2.1 3
social anxiety (Contd.) performance-related threats, 96-8
‘C’ consequences, 133 questioning beliefs (D), 89, 204-10
case example, 147-8 rational beliefs, 82-5, 88-9
developing social skills, 149 relaxation and breathing, 65-6,
‘E’ effects of disputing (goals), 135 101-2
facing your threat, 137-9 safety-seeking, 79, 80-1, 93-4
goals (E), 135 test-taking skills, 101
identifying beliefs (B), 135-6 threat-exaggerating thinking,
irrational beliefs, 111-19 8/, 95-6
magic question, 134-5 threats, 83-5, 86-7
overestimating threats, 144-6 understanding, 70-85
questioning beliefs (D), 135-6, using imagery, 91-2
204-10 using RECBT, 85-99
rational beliefs, 111-114, 116—119, test-taking skills, 101
125-32 thoughts, not engaging with, 94-5,
relaxation and breathing, 65-6, 141-2, 164, 194-5
149 threat-exaggerating thinking, 20
safety-seeking, 115, 120-3, 140-2 health anxiety’, 155-6, 165
self-images, 125, 143-4 losing self-control, 177, 180-1,
showing your anxiety, 109-10 195-6
threat-exaggerating thinking, social anxiety, 124, 143
124, 143 test anxiety, 81, 95-6
threats, 106-19, 133-5 threats, 17
understanding, 105-132 facing in imagery, 58-9
using imagery, 138—9 facing in reality, 59-61
using RECBT, 133-48 losing self-control, 171-3
social skills, developing, 149 overestimating, 28-9
subjective failure, 70, 74 performance-related anxiety,
symptoms of anxiety, understanding, 18 70-1, 73
social anxiety, 106-19, 133-5
lest anxiety: specifying, 53
‘A’ adversity, 86-7 lest anxiety, 83-5, 86-7, 89-92
beliefs, 73-9 see also ‘A’ adversity (threats)
‘C’ consequences, 85-100
case example, 99-100 uncertainty, 63-4, 162
dealing with threats, 83-5, 89-92 unconditional acceptance beliefs, 7-8
identifying beliefs (B), 88-9 unconditional self-acceptance beliefs,
identifying goals (E), 87-8 74-9, 111-14, 174-5
irrational beliefs, 88 questioning, 57-8, 209-10
magic question, 87 unhealthy anger vs. healthy anger, 42
214
®
Teach
Yourself
MANAGE ANXIETY THROUGH CBT
Using cognitive behavioural therapy, this book will show you how to
manage anxiety, in whatever form it appears. You will receive support
for dealing with your anxiety problems, using self-assessment exercises
and questionnaires. Discover how to be more resilient in the face of
life’s challenges, and find new, healthier ways of thinking that will free
you from anxiety.
Windy Dryden
Windy Dryden is Professor of Psychotherapeutic Studies at Goldsmiths
College, University of London. He is a leading authority on anxiety and
related issues, and the author or editor of over 150 books.
Time-saving Useful
Start to Practical str
feel better in for whateve
just 1 minute troubling yo
Motivating Flexible
See your life and Help and
your wellbeing support for
improve quickly struggling
Expert Jargon-fn
Straightforward Clear infor
advice from a with a sou
renowned expert therapeuti
ISBN 978-1-444-10221-5 £9.99

00999
9 781 444 1 0221 5

(Teach Yourself) Windy Dryden - Manage Anxiety Through CBT-Teach Yourself (2014)

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

(Teach Yourself) Windy Dryden - Manage Anxiety Through CBT-Teach Yourself (2014)

Uploaded by

Copyright:

Available Formats

®

In Chapter 4,1 will discuss what RECBT has to say about

In Chapter 5, 1 will show you how to manage performance

Meet the author VII

1. Understanding the ‘ABCDEs’ of RECBT I

The key ideas of RECBT

THE RECBT VIEW OF PSYCHOLOGICAL DISTURBANCE

This key insight shows a number of things:

THE RECBT VIEW OF PSYCHOLOGICAL HEALTH

This key insight specifies that flexible and non-extreme beliefs

1. Understanding the ‘ABCDEs’ of RECBT 3

THE RECBT VIEW OF PSYCHOLOGICAL CHANGE

1. Understanding the ‘ABCDEs’ of RECBT 5

1. Understanding the ‘ABCDEs’ of RECBT 7

‘D’ = DISPUTING IRRATIONAL BELIEFS

‘E’ = EFFECTS OF DISPUTING

1. Understanding the ‘ABCDEs’ of RECBT 9

How to use the ‘ABCDE’ model

Questions that are relevant here are as follows:

1. Understanding the ‘ABCDEs’ of RECBT II

THE EFFECTS OF DISPUTING (‘E’)

Give your informed consent and proceed

1. Understanding the ‘ABCDEs’ of RECBT I3

► RECBT holds that the way you respond to life’s adversities

► These beliefs are either rational or irrational.

► Rational beliefs are flexible or non-extreme, true, logical, sensible

► Irrational beliefs are rigid or extreme, false, illogical and largely

► When you hold rational beliefs about adversities your emotions

► When you hold irrational beliefs about adversities your emotions

► You can use the ‘ABCDE’ framework to understand and deal

► In particular, you need to change your irrational beliefs to their

► To change irrational beliefs to rational beliefs, you first need to

Understanding anxiety: the RECBT perspective

THE ‘ABC’ ELEMENTS OF ANXIETY

2. Understanding anxiety and its healthy alternative, concern I5

WHAT YOU TEND TO MAKE YOURSELF ANXIOUS

THE CORE OF ANXIETY: IRRATIONAL BELIEFS AT ‘B’

THE CONSEQUENCES (‘C’) OF IRRATIONAL BELIEFS

2. Understanding anxiety and its healthy alternative, concern I7

The emotional consequence at ‘C’

pounding heart shaking, tremors and twitches

Behavioural consequences at ‘C’

You avoid the threat.

Thinking consequences at ‘C’

2. Understanding anxiety and its healthy alternative, concern I9

You overestimate the probability of the threat occurring.

You withdraw mentally from the threat.

Routinely used safety-seeking measures

BEHAVIOURAL SAFETY-SEEKING MEASURES

2. Understanding anxiety and its healthy alternative, concern 21

THINKING SAFETY-SEEKING MEASURES

PROBLEMS WITH COMMON ALTERNATIVES TO ANXIETY

2. Understanding anxiety and its healthy alternative, concern 21

2. Understanding anxiety and its healthy alternative, concern 25

THE 'ABC9 ELEMENTS OF CONCERN

WHAT YOU TEND TO MAKE YOURSELF CONCERNED

THE CONSEQUENCES (‘C’) OF RATIONAL BELIEFS

You face up to the threat without using any safety-seeking

2. Understanding anxiety and its healthy alternative, concern

Thinking consequences at ‘C’

You are realistic about the probability of the threat occurring.

Why you are prone to anxiety

WHY YOU OVERESTIMATE THREAT

I (state your name).................................................. have read the