Treat Anxiety by Becoming a Positive Realist.


Psychologists, who specialise in treating anxiety, find that the tendency to worry and look at life in a negative way, often plays a major part in the cause, development and maintenance of anxiety problems and disorders.

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This article is about becoming a positive realist in order to successfully treat anxiety disorders and counter worries, phobias and fears. Being a positive realist does not mean that you have an over rosy view of the world and that you ignore dangers, risks and problems. It means that you face life realistically with a positive outlook, and focus on possibilities and solutions, rather than on life’s worrying and fearful aspects. Developing this positive coping perspective reduces the anxiety, worry and types of negativism that are commonly associated with anxiety related problems. This in turn, not only helps to cure anxiety, but also enables you to handle people and problems more effectively and to experience a greater sense of joy and fulfilment in day to day living.


Negative Anticipation: “What If…?”

Psychologists use the term “negative anticipation” to describe the worry that is the tendency to dwell on negative, unpleasant of fearsome events that may happen in the future. The internal self-talk that is produced by this form of worry of starts with “what if…?” It is therefore often referred to as “what-if thinking”. This negative anticipation is a core feature of generalised anxiety disorder (GAD). It also plays an important role in other anxiety disorders. Therefore countering this negative anticipation is vital when psychologists treat anxiety disorders.

As an example consider Daniel who has been diagnosed with a panic disorder. Daniel is going to a party and while getting ready thinks: “What if I become anxious at the party?” Instead of assessing this worry objectively, Daniel jumps to the conclusion that he will definitely become anxious (referred to as “fortune-telling” by therapists), that this will be the worst think that can happen (known as “catastrophizing”) and that it will mean that he is an utter failure in life (“should/must thinking in the form of all-or-nothing thinking: “I should be calm and poised at all that I do/I should be perfect and have no problems at all like this”).

There are many ways of countering this type of thinking. The first one outlined is The Four-Step Analysis.

The Four-Step Analysis

When you find yourself worrying about an upcoming unpleasant or scary event that may occur, use the Four-Step Analysis to calmly and objectively assess the situation.

Step one: Determine the odds.

In order to determine the odds, you need to realistically work out the likelihood of the event that you fear actually happening. Try to state the odds of the event taking place as a percentage. For example: “There is a 10% chance of this happening”.

This initial step can be difficult for many with anxiety because they use emotional reasoning to estimate the probability that something is going to happen. For example, individuals with panic disorder often worry that they will faint when they go into a certain place that they associate with anxiety. When they are asked by psychologists how likely it is that they will faint, they frequently respond with an estimate of 50 to 100%. However, when they are then asked: “How many times have you actually fainted in the past” they usually respond “never”. These panic disorder sufferers overestimate the odds, because their estimate is based on the feeling that they may faint rather than on the reality of their past history.

Try to remember, that individuals who have a tendency to worry are terrible fortune-tellers. The vast majority of their predictions do not come true. If you wish to reduce the fortune-telling that turns a possibility into a probability, then recall your track record in reality and consider how you have actually performed in previous situations similar to the one that you are worried about. This enables you to be more realistic about feared situations.

Step two: Assess the consequences.

In this step, you assess the consequences, if the event you are worrying about, actually did happen. In essence, this means that you are considering the awfulness of the feared event. The simplest way to do this is by asking yourself: “On a scale from 1 to 10 ( where 10 is the worst thing that could happen to me), how bad would this be?”

This is the second place where people with anxiety tend to have difficulty because they have a habit of using magnification. Magnification is a form of distorted thinking. Going back to the previous example, when people with panic disorder are asked to rate on a scale of 1 to 10 the degree of dreadfulness of painting in public, they usually rated it at 10. However, when it is pointed out to these panic disorder sufferers that this scale would also include things such as: having a painful terminal illness or losing a loved one in a tragic way, they usually re-evaluate the dreadfulness of fainting to a level of three or four.

When you assess the degree of trauma of the situation, try to keep in mind that 10 is the worst thing that you can possibly think of. Comparing daily anxieties and worries with the things that are truly awful helps to avoid catastrophic magnification.

Step three: Construct a plan to prevent the feared event from happening.

Those people who worry a lot usually never reached these last two steps. Worriers tend to get stuck thinking that a fearful event is very likely to occur and that it will be extremely traumatic when it does. When you observe individuals who do not worry excessively considering a negative possibility, psychologists find two things: Firstly non-worriers tend to be skilled at making realistic assessments of the likelihood of something dreadful occurring and the severity of how awful it would be if it did happen. Secondly, when considering a negative possibility non-anxious individuals spend their time with these last two steps: “How can I prevent this from happening?” And “How would I deal with this event if it did take place?”

Occasionally, there is nothing you can do to prevent awful events from happening. For example, there is little you could do to prevent an aeroplane crashing into your house whilst you are asleep. However, remind yourself how extremely unlikely this type of traumatic event is likely to be.

In general, for most everyday worries, there are often many practical strategies and tactics to reduce the possibility that these feared events take place. For example, one way to prevent the possibility of being involved in a car accident is to drive defensively. A university student worried about not passing an exam could list the things that could be done to study more effectively or get help with passing the exam.

Step four: Construct a plan for dealing and coping with the feared event if it does happen.

Worriers often fail to plan for the unthinkable. In other words “What would I actually do if this were to take place?” It is important when learning to treat anxiety, to concentrate on listing practical actions that you could take. Aim to be specific and concrete when listing the actions.

For example, if you are a car driver, it is likely that at some point you will probably be involved in an accident. Remind yourself that, the likelihood is, that it will not be a serious accident. Then make a list of the things that you would do if you were involved in a car accident, such as: exchange information with the other driver, file a report with the insurance company etc. The university student who is worrying about failing an exam could remind him or herself that it would not be the end of the world. It would simply mean that they would have to repeat the exam. In reality most individuals pass a failed exam on the second attempt. Whilst both of these situations would indeed require time, energy and money, they are in reality not that important when looked at from the perspective of an entire lifetime.

When you have completed the above steps, then summarise the analysis into two or three sentences. These sentences become coping self-statements that deal with your specific fears. If you are having to deal with a major concern then you could write them on a card that you can carry around. Then after reading the coping self-statements, redirect your attention to something neutral or positive.

If you find yourself thinking about the feared event again, then recall your summary by rereading the positive coping self-statements and then redirect your attention elsewhere.

Use the “So What If” Approach

What-if thoughts and statements that are characteristic of negative anticipation get us hyped up and then our bodies tend to make adrenaline and increase our level of tension. Many people find that it helps to rethink or repeat the statement or thought, but change the what if into so what if. To give examples:

  • “What if I begin to breathe funny?” is changed to “So what if I begin to breathe funny?”
  • “What if I start to become anxious?” is changed to “So what if I start to become anxious?”

What-if statements tend to produce adrenaline and make us feel tense, whereas so-what-if tends to calm us down. This calming effect can be further increased by following the so-what-if thought with coping self-statements that address the fear expressed in the what-if.

To illustrate further:

Michael was worried that people would be critical of him if he left the social event early.

  • The thought that made him anxious: “What if I have to leave the party early? I will be criticised.”
  • Rational self-talk that calmed him down: “So what if I have to leave. People leave these types of parties before they have ended frequently. I can use my coping skills. If I decide later to return, most people there will not even notice that I went. Those who do notice will not think anything of it.”

Increase your ability to accept uncertainty

Worry is often produced by a demand for a high level of certainty that is not possible. Many of us want a 100% guarantee that what is feared will not take place. Unfortunately, the requirement for a 100% assurance is reinforced by several forces in the modern high tech world. The world we live in is relatively safe (when compared with hundreds of years ago). Television and films reinforce the illusion that all problems can be solved easily and that life should be safe and wonderful. We do not like to consider the truth that uncertainty is a part of life. The media are also quick to look for someone to blame when something goes wrong and tend to imply that “accidents should not happen”. We like to demand that our food, transportation and medical treatment and everything else should be 100% safe. This is impossible.

By learning to accept the dangers and risks that accompany life we are able to live fully and creatively. Use positive self-talk to convince yourself that there is frequently a 1 to 10% uncertainty factor that we are live with and develop the attitude: “That is just the way it is”. Using the Four-Step Analysis to face your fears realistically is one way of developing this attitude. It also helps to look at the positive aspect to uncertainty. Remind yourself that a 1% chance of a scary event happening means that there is a 99% chance that it will not happen.


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