Being AWARE in Cognitive Therapy for Anxiety

Being AWARE in Cognitive Therapy

Copyright (c) Donald Robertson, 2009-2010.  All rights reserved.

The short handout below is based on the AWARE acronym used by Aaron Beck and his colleagues in their cognitive therapy for anxiety and phobias.  For more information see Beck, Emery, & Greenberg, Anxiety Disorders & Phobias: A Cognitive Perspective (2005).  In his recently-revised manual for treating anxiety, Beck writes,

[T]he objective of cognitive therapy is not to teach people more effective ways to “control their anxiety”.  Instead cognitive therapy focuses on helping individuals develop a more “accepting attitude” toward anxiety rather than a “combative (i.e., controlling) attitude.”   When thoughts like “I can’t let these anxious feelings continue” are replaced with “I can allow myself to feel anxious because I know I’m exaggerating the threat and danger,” then the intensity and persistence of anxiety are greatly diminished. (Clark & Beck, 2010, p. 195)

This self-help advice to clients can precede typical cognitive therapy to modify negative automatic thoughts.  It can also be seen as a “role definition”, describing the best mind-set or attitude for the client to adopt toward their problem at the outset of therapy.  Similar acceptance and self-awareness strategies have been used in hypnotherapy and humanistic psychotherapies for many decades, especially in Gestalt psychotherapy, and are central to the new “third wave” approaches to CBT.

Your First Job: Being AWARE

At the beginning of therapy it helps to start learning a whole new attitude toward your anxiety, which has been summed up in the acronym “AWARE” to help you memorise the instructions.  You can think of this as defining your initial “role” in therapy, or as a kind of job description.  Paradoxically, learning to accept anxiety tends to help overcome it.  People sometimes describe this as stopping “battling against” or “fighting with” their symptoms, taking the pressure off themselves, being non-judgemental, or forgiving themselves for feeling anxious.

  • Accept that your anxious thoughts and feelings are natural.  Allow yourself to feel anxious without becoming annoyed or frustrated with yourself.  Say “hello” to the thoughts and feelings, think of them as being fairly normal, acknowledge the fact that they exist, and adopt a patient attitude toward change.
  • Watch your anxiety from a distance.  Observe your thoughts and feelings non-judgementally, without making strong value judgements about them being bad, or about yourself for having them.  Just imagine you’re observing your thoughts and feelings from a detached perspective, from a distance, without placing too much importance on them.  You are not your thoughts or your feelings; rather you’re the person observing them.  Observe your thoughts and feelings as if they’re transient things, like clouds passing across the sky, instead of becoming absorbed in them.
  • Act despite your anxiety.  Act as if you’ve overcome your fears, act as if you’re in control or you’ve already achieved your goal of getting better.  Reverse your avoidance behaviour and face your fears in steps and stages, dropping any unnecessary signs of anxiety such as gripping objects for safety or averting your gaze from people.
  • Repeat as much as possible.  Keep accepting your anxiety, watching it from a detached perspective, and acting as if you’re better until it becomes second nature and your feelings change.
  • Expect realistic improvement.  Be hopeful and confident but don’t rush things.  Be realistic and expect possible setbacks but see them as temporary, surmountable, and opportunities to improve your coping skills.  Expect that anxiety may return, because it’s human nature, but also expect that you can learn to cope and make more and more progress if you persevere.

In other words, begin by accepting things, watching the symptoms of anxiety without worrying about them, and acting as if you were feeling better already.  To begin with, adopting this mind-set might take some effort and you’ll need to keep reminding yourself to do it, but it soon becomes easier and easier until it has evolved into a habit and something you’ll find yourself doing automatically.  It takes a lot of fuel to get a steam engine to start moving but a lot less fuel to keep it going once it’s started rolling.  It sometimes takes a lot of motivation to begin learning new thinking habits but it takes less and less effort with each attempt – the main thing is to take the first step and get the process started.  So why don’t you begin right now and see what happens if you put the AWARE strategy into practice as often as possible over the next few days or weeks?

Comments

Being AWARE in Cognitive Therapy for Anxiety — 3 Comments

  1. Great post. I especially like the point about accepting your anxious thoughts. “Saying hello” to my anxious thoughts kind of makes me laugh instead of getting frustrated and feeling hopeless.

  2. I have used your AWARE method for the past few years with some success, and it works pretty well if I catch it early. But what if the anxiety hits out of the blue, and reaches anxiety attack mode? It seems almost impossible to calm down and only a Xanex will suffice. Also, there are days my head is so tight and I seem to get these little pains that go from one side of my head to the other by the temple area. Slight headaches. And one more question: Last evening I was so exhausted from trying to control my anxiousness that I went to bed early, only to find out that I couldn’t sleep. I had to take a Xanex again to fall asleep. I hate having to take it. I’m very sensitive by nature and I don’t do well with most meds. But at least this helps me sleep. Is it possible to control anxiety and live without meds? I’m tired all the time.

  3. Hi Joan,

    That’s good, well done on persisting in trying to help yourself in that way. It’s not easy. Sometimes taking Xanax can help but it’s not always the best strategy. Most people can learn to cope with anxiety without medication. Anxiety basically works differently from what we call “panic attacks”, and correct diagnosis is the key to effective treatment, especially where problems continue for some time. You should seek assessment by a clinical psychologist or cognitive-behavioural therapist, with a particular view to establishing what form of anxiety you’re suffering from and whether you’re experiencing actual panic attacks or not.

    http://en.wikipedia.org/wiki/Panic_attacks

    Regards,

    Donald Robertson