Transcription
Hello, I am Dr. Steve Johnson, and today I want to work on a very common and sometimes very difficult to treat condition. And that is, how do we help clients who repeatedly perceive overwhelming threat within their lives? So, let's jump into it and begin with a little bit about brain function.
We know that the brain functions to perceive patterns within the environment, especially patterns of seeming threat. And this is for obvious reasons. Perceiving threat is vital to self-preservation and has been historically, and the survival of the individual as well as the species.
Well, this is an important brain function. The brain consistently makes mistakes in attributing threat to the environment. Again, the function of the brain is primarily survival over embracing truth or experiencing happiness in any, any, any of those more positive emotions.
So, where is the problem? Well, one, if the brain perceives in the environment a threat, and there is a real threat, the bodily ex- the body experiences physiological arousal to better address the threat and therefore to survive. So, that's a good outcome. Two, if the brain perceives a threat in the environment, and there actually is no threat, the body again experiences physiological arousal, the production of cortisol, as well as experiences stress, often in the form of anxiety. I mean, this is okay if experienced occasionally, but if this is frequent and over a long period of time, there can be major resultant health problems such as cardiovascular problems, propensity to stroke, diabetes, suppression of the immune system, and all the diseases that can result from that. And then thirdly, if the brain perceives an environmental threat, and there are actually resources within the environment or helpful kind of opportunities, those uh resources and opportunities may not be present in the consciousness of the individual.
So, the problem that arises there is when the brain erroneously perceives threat, especially overwhelming threat, that um, that are at least threefold: one, the needless experience of anxiety and the associated unhealthy behaviors, and I'm going to cover that a little bit in more detail later. And two, the health problems due to that elevated cortisol over a long period of time. And then the third one is overlooking the helpful resources and opportunities that exist within the environment, um, that exist even in the presence of real threat, but may not be able to be used. So, these are three kind of responses that are rather important.
Well, how can we address these problems with Rational Emotive Behavioral Therapy? Well, one step toward addressing this problem of the mismatch of the brain to how to act within the world is to do a thorough and accurate conceptualization of emotions, especially with anxiety and fear, but you know, all other emotions. But this is really important when the client is reporting anxiety or fear or a constant worry.
The REBT conceptualization of emotion involves the following steps: one, uh, to help the client identify the meaning the client attributes to the environment, to events and situations, or said somewhat differently, help the client interpret the event and situation, uh, at least understand how the client is interpreting the event or the situation. In our REBT, this process of attributing meaning or interpreting events to situations is called inferring or forming an inference about the environment. In anxiety, the meaning or the interpretation of the situation or the event is that there is a significant threat within the environment. To what? The threat? To what is always important to ask. It is a threat to what? Well, perhaps to life, a threat to what is valued in one's life, one's health and comfort, one's financial state, one's meaning and purpose in life.
Two, two, um, the second part, excuse me, of the conceptualization of emotions is to identify the dysfunctional disturbance-producing beliefs that inhibit one's attainment of one's, you know, desired life goals, you know, such as connecting with others and experiencing of peace and happiness, and educational goals, professional goals, spiritual goals of all sorts. Uh, the dysfunctional beliefs associated with anxiety would tend to be among the following, and this is not an exhaustive list: one, this threat must not occur. My life would be horrible if the threat occurred. I would be a loser or weak if I permit the threat to take place. The threat would be unlivable. If the life would be unlivable if the threat did occur. If the inferred threat is someone or some institution, they would, they might be seen as evil or unforgivable or useless or whatever.
Finally, we want to identify in the conceptualization of emotion the behavioral potential of that emotion, which in the case of anxiety or worry, what our fear is, uh, avoidance. Just think about it. If you are anxious about something or a possible situation in the future, we would tend to be avoidant. In the face of that, avoidance is tricky and it can take many, many different forms, and it's really important when we're assessing to look at the form that avoidance takes in this particular client and for this particular context.
Let me just give some examples. Uh, procrastination is a form of avoidance where there's often the threat of failure. Drug abuse, substance abuse, or, uh, any kind of substance or even behaviors can be problematical, and often this is because the individual has inferred a threat of discomfort. They don't like what it feels like for certain conditions, and they want to get rid of that feeling. They want to avoid that feeling. Or irresponsibility can be because we, uh, infer a threat, uh, to, uh, of doing the wrong thing or dishonesty, the threat of the negative consequence of disapproval if we tell the truth about what we did or didn't do. Gaming, internet, TV kind of addictions, behavioral addictions, maybe the threat of something unwanting, unwanting, uh, unwanted to occur within the environment, and this would be a way to avoid by distraction.
There are all kinds of forms that avoidance can take, and these forms of avoidance can really negatively impact health and relationships, even the accomplishment of desired goals, achieving success in life, however the client measures success, the experience of happiness, experiencing life is meaningful and purposeful. So, really, some very negative consequences can arise due to, uh, avoidance behaviors. And this cascade of negative consequences begins with the, um, perception of overwhelming threat in the environment, or the inference that there is a threat, overwhelming threat in the environment. It also, um, is accompanied with forming dysfunctional beliefs about the threat, or if the threat did occur. So, there's not only the inference, the meaning that is given to this situation as a threat, but then we form these dysfunctional beliefs about that threat. And in the case of the anxiety, there can be negative, unhelpful action potential, um, typically in the form of avoidance.
So, what can we do? What can we do within Rational Behavioral Therapy or REBT? Well, one, of course, is to use the ABCDE model, in which we identify the dysfunctional beliefs, dispute those beliefs, and then replace them. And I have discussed this in numerous other, uh, videos on this REBT education and training YouTube channel. So, take a look at that, subscribe, and then you can see all kinds of, uh, videos that I've done on how to handle that issue.
Number two, is, um, the first one was kind of cognitive restructuring when we changed the dysfunctional beliefs that are contributing to the anxiety or directly causing the anxiety and the avoidance behavior. Second, we can employ behavioral techniques such as exposure therapy forms to help the client act against the avoidance. Instead of avoiding, we have them engage in some kind of approach behaviors by first collaboratively working with the client to form clear, measurable approach goals for therapy, rather than avoidance goals that typically are present when a person is attributing overwhelming threat and is trying to avoid it. So, those avoidance goals are going to solidify the anxiety and the, uh, anxiety-associated behaviors, which are not helpful.
However, many REBT therapists fail to do something that can be quite helpful, and that is to use, uh, inferential disputes. Now, we all use the disputes of beliefs, and for good reason, because within the REBT model, beliefs are seen as contiguous to or more directly causing the dysfunctional beliefs, emotions, and even physiological responses. So, of course, we want to work at the level of beliefs. But in the conceptualization of emotion, we look at inferences, and we look at inferences for a very, very good reason, because the inferences, particularly in anxiety, the inference of threat sets the stage for those dysfunctional, uh, beliefs. And so, if we want to do kind of a one-two punch, we want to go after the dysfunctional beliefs through the cognitive restructuring, which involves the disputation of the dis- and replacement of the dysfunctional beliefs. But we also want to remember to address those faulty inferences that, uh, set the stage and would be really helpful if we could change those to something more functional.
So, let's assume that we have a client who is employed in a company that is downsizing, as many companies, uh, have been doing. And this client has been experiencing anxiety about, uh, getting dismissed or getting fired from the company. Well, let's say that the meaning the client is giving to working in the company is that he could get fired. That is possible, or he may even think that it's in actuality, even though it's not there yet, and that this would be, um, an overwhelming threat to him and his family. And as a result of making that kind of interpretation, his work situation is, you know, containing kind of what he perceives as this overwhelming threat. And then he avoids, perhaps, taking on difficult projects for fear of failing and then getting targeted for dismissal.
So, the problem is that the company may be looking for retaining employees who are very proactive in tackling big projects and, um, and, uh, achieve a degree of success that is really needed for this client, for this company that's under pressure. Thus, the client's avoidance of taking on a big project actually increases, uh, his likelihood that he will get fired. So, the anxiety produces behaviors that actually will contribute to the undesired consequence. So, that's not helpful.
So, we want to help that client. So, in REBT therapy with this client, we would help address the client's inferences of overwhelming threat, get that identified, and then his anxiety would be the goal would be to replace that anxiety with some healthy concern about the possibility of getting dismissed or fired, so that he could begin to engage in non-avoidance behaviors. It would actually increase the likelihood of retention at the company, not guarantee. There are no guarantees here, but increase the likelihood, perhaps.
So, how do we then in REBT address the inference, or the interpretation, that there is this overwhelming threat within the environment? Well, there are several things that we can do, and I don't, I can't go into all of them, but I want to highlight some that shows how we can do that and the importance of addressing the inference and how we can combine this with the usual cognitive restructuring of the dysfunctional beliefs. As I say, then we have a one-two punch here for addressing the anxiety.
So, first, we want to help the client see how this interpretation, this perception of overwhelming threat, is unhelpful. That it is really getting in the way of his, uh, life and may actually contribute to the, uh, eventual occurrence of the very thing that he is, uh, is, uh, making himself anxious about. Two, we can help the client overcome this kind of black-and-white inference that, um, that this is, um, that there's an overwhelming threat or there's none at all. And so, we can take, um, an empirical approach here. That's one thing. It's not what we would typically do when we are disputing, uh, beliefs, but sometimes in the disputation of an inference, this empirical approach can be helpful. And so, we want to help them more realistically assess the level of threat. And so, we might put this on kind of a continuum and help the client think through this.
So, is there just overwhelming threat there? It's 100% sure that this negative thing will occur, and that it will be horrible in the individual's life? So, we would say that that's 100% threat, and that's overwhelming threat. Or is it a probable threat? So, there's a greater than 50% likelihood, but certainly less than 100. Or is it just a possible threat? Even less than 50. Or, and this would be even more helpful if we can get the client here, is, yes, there is a, a threat within the environment, probable or possible, and there is also some opportunity. And then scale that. Is there more threat than opportunity? Are they equal? Is there less threat and more opportunity? Or is it largely overwhelming opportunity or resource, uh, because the person has misperceived the threat? So, here we can put this on a scale. And, um, and typically we see in CBT, they would do that even with the with beliefs, and REBT that would not be the approach generally with the beliefs, but I think it can be helpful somewhat in dealing with, uh, inferences.
Okay, then combine that kind of empirical approach with the philosophical approach of REBT when it comes to the dysfunctional beliefs associated with this inference. Right? So, the person is inferring an overwhelming threat, and they're believing that this is terrible, horrible, awful, that they couldn't stand it, life would have no meaning and purpose, etc. Then we would, with the approach when we're dealing with those dysfunctional beliefs, would be, well, let's assume that the threat does occur. So, we go to the worst case, and then we help the client change the dysfunctional beliefs about the eventuality that the worst case does occur. We would see that by doing that, that is the elegant solution.
So, um, we can combine the more realistic approach, empirically based approach, of the inference, and then, uh, attack the, uh, uh, dysfunctionalities associated with, uh, with that. So, using that empirical approach, then we could brainstorm with the client what steps, if any, could be taken to increase the opportunity that might exist within the threat. So, for this client, there is a threat of getting fired, within the, uh, you know, from the company. We may not, we may want to assess how real is that. And even if there is some possibility or probability of threat of getting fired, what is it that the individual can do? Where within that threat are there some opportunities? Well, some of the opportunities may be at, within the, um, within the workplace itself, but some of the opportunities may be in, outside the workplace, in the connections that the individual has, other possible jobs, all of those kinds of things that are not considered when the individual is so highly anxious.
So, we can help them begin to see opportunities and resources in the midst of the threat, but have a more realistic sense of threat to that empirical analysis, and also through the disputation of the associated dysfunctional beliefs in the event the individual does get fired. Um, there may be some, you know, additional interpretations to help change the dysfunctional inferences. Different interventions to help change the dysfunctional inference that occur across various domains of life. And it is really important to look at the inference of threat that this client is making in this situation, but then to open that up to see whether this, that's a theme in this client's life. Do, does this client typically see overwhelming threat in the environment in the different domains? Not only in the workplace, but in interpersonal relationships, in education, in recreation, in, uh, in relationships with particular individuals, etc.
And this is tremendously important. Why is this important? Well, if we shift from this kind of previously attributing threat over multiple domains of life, um, if we, if we have that, if the client has that kind of threat-oriented attitude toward life, or life, or disposition toward life, then they often develop a kind of a cynical, pessimistic, uh, life. Um, they, um, you know, that life form can contribute to dysfunctional emotions, etc. However, if their inferences are improved, and we see, um, the diminution or the elimination of the dysfunctional beliefs, then the individual may have a more optimistic, realistic kind of attitude toward life. And so, looking at inferences of threat across domains of life is going to be tremendously important to see if this is a pervasive attitude that is really going to be getting in the way of this client's, client's life.
Well, once we look at that, then we can zero in on the disputation of the inferential disputation, or disputation of the inferences, but also the cognitive restructuring of the beliefs. And this will help the client to become much more resilient and actually inoculated against emotional disturbance in the future and in other domains of life. So, I hope you found this helpful as one way, one way to look at these dysfunctional inferences of threat that clients make, and sometimes across different domains of life.
I'll be talking more about other kinds of ways that we can help change inferences of individuals to make them more realistic. And, and please don't forget, it is vitally important, uh, in REBT, that we, as therapists, look at those dysfunctional beliefs because they are more contiguous to the dysfunctional emotions, behaviors, etc. So, we're not going to let those go. What we're saying is, let's just do a little more work with the inferences of clients.
So, again, I hope you found this helpful, and I look forward to meeting you again here on YouTube. And if you like these channels, and, you know, I have professors who use these and show them in classes, or individuals that just use them for their own edification or to help improve REBT therapy, if, if you think these would be valuable, then just subscribe to this channel, then you'll get notified when, uh, when we create another one. Thank you, and have a great day.