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 Anxiety  Holistic-online.com

Cognitive Behavioral Therapy for Panic Disorders

Contextual Therapy

Six points for contextual therapy are:

  1. Expect, allow, and accept that fear will arise.

  2. When fear comes, stop, wait, and let it be.

  3. Focus on and do manageable things in the present.

  4. Label your level of fear from 0 to 10. Watch it go up and down.

  5. Function with fear. Appreciate your achievement.

  6. Expect, allow, and accept that fear will reappear.

#1: Expect, allow, and accept that fear will arise. 

Because of your biological makeup and/or your past experiences, certain thoughts and situations can automatically trigger your fear reactions. If you have panic disorder without phobias, the fear reaction can surface "out of the blue. " In either case, rather than trying to fight the spiraling process of anxiety-which only increases it-recognize what it is and give it permission to be there. This shifts you from hopelessly trying to escape panic toward accepting its inevitable appearance and learning ways to keep the fear from running your life.

#2: When fear comes, stop, wait, and let it be.

Once fear or anxiety arises, you usually expect the worst to follow and automatically start to think about and prepare to escape from anticipated disasters. This intensifies the frightening feelings and physical sensations. Point #2 teaches you to do just the opposite: to remain in the challenging place or situation and simply let the feelings be. As difficult as this sounds, each time you succeed you further reinforce your confidence in trusting that by waiting, rather than running, the expected danger will not happen and the panicky feelings will subside.

#3: Focus on and do manageable things in the present. 

When you are in the anxiety-producing situation, it is tempting to concentrate on and react to frightening thoughts and imaginary dangers, most of which are anticipated. This focus on what might happen, as opposed to what is happening, creates a spiral of catastrophic thinking. Point #3 teaches you how to interrupt this process. It guides you toward focusing on concrete, familiar activities in the present, things that you can think about or do that will keep you involved in the here and now and reduce the distressing psychological and physiological sensations. Examples include diaphragmatic breathing, observing reality, talking, writing, singing, counting, and feeling the textures of things around you.

#4 : Label your level of fear from 0 to 10. Watch it go up and down.

To help you discover and better understand what makes your anxiety increase and decrease, you are directed by Point #4 to observe and study changes in your levels of fear. A level of 10 means that the anxiety is perceived as seemingly unbearable (a panic attack), and O means that it is absent. From these observations you begin to realize that your anxiety goes up and down and does not just run wild once it appears. You become aware that there are factors in your life, including your own thinking and activities, that affect the changing levels. As you become familiar with what thoughts or activities increase and decrease your anxiety levels, you will begin to develop a sense of mastery over them.

#5: Function with fear. Appreciate your achievement. 

Experiencing extreme anxiety or panic in a place or situation that poses no real threat or danger is not a reason to leave. It is, instead, an opportunity to practice; a chance to see that you can function in spite of even the most seemingly debilitating feelings of anxiety. Once you truly understand and trust this concept, usually through much hard work and practice, you will no longer be afraid of facing your fears. Your fearful feelings and thoughts will instead become a signal for attending to and accomplishing a realistic, manageable task, rather than avoiding a situation or becoming preoccupied with the uncomfortable feelings. Each time you achieve this, no matter how insignificant the task, you're moving closer to recovery.

#6: Expect, allow, and accept that fear will reappear.

All learning, including learning to change negative thinking and behavior, is an up-and-down process. Therefore, setbacks must be accepted as part of learning, of getting better. Sometimes progress itself brings more difficult goals that can intensify fear. Point #6 tries to prepare you for such setbacks. As you learn to understand and cope with them, your progress will be strengthened and deepened. Every "failure" is a learning opportunity-a chance to grow stronger.

Source: Ross J. Triumph Over Fear. New York, NY: Bantam Press; 1994.

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