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Cognitive Maps or Frames of Reference
The Vicious Cycle model of anxiety
leads us to explore another facet of this Cycle known as a cognitive map or frame
of reference. What cognitive maps do your anxiety-disordered clients use?
to Beck, when a threat is perceived, the relevant cognitive patterns are activated;
these are used to evaluate and assign a meaning to the event. The specific thoughts
that are activated are relevant to the specific characteristics and context
of the threateningevent. A series of adjustments occur to "fit"
appropriate thought patterns concerning a specific threat. The client's final
interpretation is the result of interaction between the event and their thought
pattern or cognitive map.
Function of Cognitive Maps
Cognitive maps are essential for drawing meaningful
information from a particular situation. As you know, they allow us to extract
relevant data, pick out relationships, and form patterns from the environment
which would otherwise appear to be either bland and relatively homogeneous or
else a confused array of stimuli, each competing for attention. A cognitive set
helps us to rapidly process incoming data. The power of a cognitive set is increased
by its exclusionary capacity; it blocks out dissonant or irrelevant information
as exclusionary. Because of these Cognitive Maps, anxiety disordered clients tend
to form quote rules regarding their disorder.
in Anxiety Disorders
In anxiety disorders, the rules concern the concept
of danger and vulnerability and the client's estimate of their capacity for
coping with the danger and for compensatingforvulnerability. The application
of these rules take the form of predictions. I've had clients state, "I am
in immediate danger of dying"; "I am not capable of dealing with this
danger"; or, "I may lose my job." The specific rules triggering
these conclusions are applied to specific events: "My rapid heartbeat means
I'm having a heart attack, and I may die if I don't get help"; or, "If
I make a mistake, my boss will fire me." These are some examples of the rules.
In anxiety disorders, the rules are generally conditional in the form of
an "if then" statement: "If a specific event occurs, then it may
have adverse results." Thus, when the event occurs, it still will have a negativeoutcome.
Rules in Phobias
With phobias, the rules are conditional and apply to
situations that the client is successfully able to avoid: "If I go into a
closet, I might suffocate"; or, "If I go to an unfamiliar area, I may
get lost." In these cases, the client also operates under the rule, "I
won't be able to cope with the situation myself."
Although these rules assume
an unfortunate consequence to be highly probable, the client is often highly invested
in an assumption such as, "If a trusted person is with me, he can save me."
Hence, as you know, many of your phobic clients can enter a frightening situation
if a support source is available.
Discovering Your Client's "Rules"
The question here is ... How do you
discover your client's rules regarding their anxiety disorder? Here is a series
of questions you might try. I like to use "what" and "why"
questions followed by a"how" question.
Here's how it works. Client: I think I am dying. Therapist: What makes you think so? Client:
My heart is beating hard. Things seem blurred. I can't catch my breath... I am
sweating all over. Therapist: Why does that mean you are dying? Client:
Because this is what it is like to die. Therapist: How do you know? Client:
(after some reflection) I guess I don't know, but I think these are signs of dying
(Beck 1976, p. 99).
Vulnerability: The Core of Anxiety Disorders
Vulnerability is, of course, at the
core of Anxiety Disorders. According to Emberg, vulnerability can be defined as
a person's perception of himself as being subject to internal or external
dangers over which his control is lacking or is insufficient to afford him a sense
of safety. In the clinical syndrome, the sense of vulnerability is magnified by
certain dysfunctionalcognitiveprocesses. First, minimization occurs.
The client underestimates the positive aspects of his or her personal resources. Next, selectiveabstraction takes place. By that, I mean the client is inclined
to focus primarily on his or her weaknesses. Then, magnification -- he
sees each flaw as a gaping hole or each mistake as a disaster, each slip as a
potential slide into a catastrophe.
Because of the client's tendency to over-generalize
from each situation, he views a less-than-perfect, he feels increasingly vulnerable
with each mistake. For example, the abused wife who burns the pot roast becomes
preoccupied with her husband's evaluation of it and visualizes a permanent blot
on their marriage relationship. More than that, she may be primed to expect more
errors, building up to more verbal and physicalabuse.
Even large successes
in the past may have no permanent effect because the "vulnerable"
client believes that he or she can always fail in the future and that the
consequences of the failure will be far more drastic than any success could be.
The client appears to have greater access to negative memories of previous performances
than to positive ones. Thus, selective recall appears to be a function of being
the "vulnerability" mode. In a state of vulnerability, your client is
more likely to be influenced by past events suggesting flawsanddangers than
to factors relevant to success.
Case Study: Billy
For example, I had a 12-year-old client, Billy,
that was very anxious about his performance in sports, specifically baseball.
Billy's parents appeared to be supportive and non-pressuring. Billy was able to
play well in practice, but was having faintingspells from the pressure of competition
with other schools. Physical problems were ruled out. In talking with Billy, I
discovered his speech and visualizations tended to be images of himself performing
below his usual standard -- an image based either on specific "inadequate"
performances in the past or on a fantasy of how he will appear to the team if
he fails. This bring us to the role. Thus, Billy saw himself as vulnerable.
The Role of Skill Deficits
A person feels vulnerable if he believes
he lacks the important skills necessary to cope with a particular threat. Many
difficulties may turn into threats if he realizes that he does not have the minimal
skills for attacking a problem to make him successful. For instance, a dyslexic
child may become anxious while reading aloud in school because he or she feels
a lacking of the necessary skills. List in your mind some of your clients and
an accompanying list of skill deficits.
For instance, June, was recovering
from a stroke and experienced much anxiety due to speech rehabilitation. In short,
anxiety was produced due to a skill deficiency. However, by increasing June's
speaking ability, this counteracted her anxiety.
Take a minute to recall
a client you are treating or have treated whose anxiety was produced by a skill
deficiency. What steps could they take to acquire the skill they need? What resources
and referrals could you provide them with?
Cognitive-Behavioral Therapy for Anxiety Disorders:
An Update on the Empirical Evidence
- Kaczkurkin, A. N. and Foa, E. B. (2015). Cognitive-Behavioral Therapy for Anxiety Disorders: An Update on the Empirical Evidence. Dialogues Clin Neurosci., 17. p. 337-346.
Online Continuing Education QUESTION
14: Even large successes in the past may have no permanent effect because
the "vulnerable" client feels he or she will what? To select and enter
your answer go to CEU Answer