We're Not Going to Rikers Today

“We’re not going to Rikers Island today,” I said to an 11am client. “No we are not! We don’t have time for that,” she replied. It’s important to note that this client is not a criminal, there are no outstanding warrants for her arrest and she’s not on the lam. I don’t know the origin of that expression, but it’s relevant here. The client DOES actually struggle with anxiety, occasional panic and distorted cognitions of the  catastrophic type. Catastrophic thinking spin outs are like spray gasoline on a fire, one client described. Cue TV crime drama Law and Order’s opening “bumb bumb” chime and keep reading.

The short of this story is the client’s roommate got a parking ticket over the weekend, and this worried the client for a few reasons. These reasons had no relevance to the parking tickets but in the moment the client’s catastrophic thoughts began to fire away like missles. And, in a few seconds, her thoughts and feelings generated from these thoughts had collided and bonded in a most unhelpful way. All of which created a cognitive and emotional tornado for her. She described her mind feeling like a milkshake in a blender and couldn’t think straight. She felt powerless, panicked, threatened and couldn’t recognize all of this was happening to her in real time, in her own mind. Before she knew it, she was  describing  how she’d have to get on a bus, in the dead of winter and head to Rikers Island to visit her roommate in jail. “What does one pack for such a trip?” she asked. Cue a collective laughter once she stopped her own blender and realized what she’d said.

While one could argue that catastrophic thinking could be entertaining due to a level of extreme exaggeration and a  0-60 approach to conclusion formation, it’s actually quite disruptive and painful to live with as a base of operation.

It’s important to acknowledge that worry is a reasonable and natural reaction to an event but at what point does worry begin to feel all consuming? How well and quickly can we regulate to avoid a full blown spinout? If we do hit a spinout, how do we manage thoughts and feelings, get grounded and back to our baseline? How do we cope?

This client began therapy to help common symptoms of anxiety, all of which she’d been experiencing for years. Symptoms included poor sleep, feeling keyed up, migraines, incessant worry, an inability to trust herself, ruminating, irritability, muscle tension and feeling burnt out in life.

While exploring feelings in therapy, this client noticed the symptoms occurred more days than not in a week, more weeks than not in a month, and more months in a year than she was comfortable with. She has experienced these feelings to varying degrees of intensity since she was an adolescent. She’s now 42 years old.

You might be reading this list of symptoms and identifying with some, or all, but not consider yourself to be anxious. That opinion always belongs to the individual. It’s usually when the symptoms become untenable and begin to compromise the quality of one’s life when someone reaches out for help. Therapy is a great place to learn about the possible ways in which anxiety manifests, to recognize the impact of anxiety on your day to day and to learn strategies to make changes that serve you best.. The ultimate aim is to increase awareness of and insight into triggers and how to manage and cope with them. Integrating them into life as a helpful tool is one way to do that. 

Cognitive Behavioral Therapy (CBT) is one of the most frequently used instruments in a clinician’s toolbox. The aim of CBT is to change our thought patterns, our conscious and unconscious beliefs, our attitudes, and ultimately, our behavior in order to help us face difficulties and achieve goals. CBT is a hands-on approach that requires both the clinician and the client to be invested in the process and willing to actively participate.

Over time, this client was able to increase her level of awareness and insight about triggers, which laid the groundwork for her continued growth. She was able to reflect on and process  unresolved childhood experiences that originally provided a welcome mat for anxiety and unhelpful coping styles that were born many years ago.

Catastrophic style is just one of many types of distorted cognitions.

Filtering: focusing on the negative and ignoring the positive.
Polarized thinking: All-or-nothing thinking and ignoring complexity.
Control Fallacies: Assumes only clothes to blame and assumes only self to blame.
Fallacy of Fairness: Assumes life should be fair.
Overgeneralization: Assumes a rule from one experience.
Emotional Reasoning: “If I feel it, it must be true.”
Fallacy of Change: Expects others to change.
“Shoulds”: Holds tight to personal rules of behavior and judges self and others if rules are broken.
Catastrophizing: Expecting the words case scenario and minimizing the positive.
Heaves’ Reward Fallacy: Expecting self-sacrifice to be rewarded.
Always Being Right: Being wrong is unacceptable and being right supersedes everything.
Personalization: Always assuming self responsibility.
Jumping to Conclusions: Makes assumptions based on little evidence.
Blaming: Assumes everyone else is at fault.
Global Labeling: Extreme generalizations.

Helpful strategies and activities to restructure cognitions and cope used in session and out of session to address distorted thought patterns.

Creating a worry calendar
Journaling and creative writing
Nightmare exposure and rescripting
Play the script until the end exercise
Unraveling distorted cognitions
Cognitive restructuring - reframing negative thoughts
Exposure and response prevention
Interoceptive exposure
Relaxed breathing exercises
Thought stopping
Self-care routines
Reward system and celebration
Radical Acceptance
Mindfulness Practice
Progressive muscle relaxation

For more information and additional readings - Theoretical frameworks: Positive Psychology, Radical Acceptance Theory. Researcher: Dr. Aaron Beck.

As always, this is not clinical or medical advice or treatment. Readers should seek professional help and consult with a doctor if you are concerned about your emotional well-being, health or safety.