Coping with the “What If” of Anxious Thinking (Part 2)

In the previous blog (, I talked about the value of Exposure and Response Prevention (E/RP) often used for OCD. But could E/RP be used for other diagnoses where people struggle with “what if” thinking, such as social anxiety, panic disorder, separation anxiety, and others?
Some authors think that it can be a help. If life is uncertain and if our “what-if” thinking is due to that uncertainty, then it would be logical that exposure and response prevention could help in other areas. For example, if someone has Social Anxiety, they worry about doing or saying something embarrassing or being judged by others for their behavior. They may worry a lot before being with other people or may visibly show their anxiety by blushing or shaking. In extreme situations, they may avoid being with others. All of these behaviors are because they are asking themselves “What if I say something stupid/what if I embarrass myself?” Exposure and response prevention would have that individual not overprepare, and not avoid social interactions, but instead work at being themselves, talking to people, suffering through the worry without trying to control what others think of them.
People with Generalized Anxiety Disorder worry a lot about everyday things: what if I don’t do well in school, what if my boss doesn’t like me, what if my spouse gets sick. They often try to get a lot of reassurance from others or do a lot of checking up to see how things are going. They try to control situations to control their anxiety. By not performing behaviors that try to control situations, and not asking for reassurance, or checking up on others, they will confront the uncertainty of life. They will be able to stop worrying and take action more easily. They will stop trying to neutralize their anxiety and accept the reality of the things they fear, yet go on living their lives.
People who have Panic Disorder worry not only about having panic attacks but when they will occur and what they mean. They often try a lot of techniques to control their worry and avoid situations where they might have a panic attack. Some people constrict their lives out of fear of having a panic attack in front of others. In panic disorder, we want to expose ourselves to the panic, regardless of where the attacks occur, and in fact, be in situations likely to elicit them. Only then will we realize that they will not kill us and that the harm we fear from them (Am I going crazy? Am I going to Die?) did not occur.
There are other disorders in which E/RP can help such as Specific Phobias and Separation Anxiety, even PTSD and Body Dysmorphic Disorder. If you are struggling with “What If” thinking and it is keeping you from living your life fully, please give me a call. Cognitive Behavioral Therapy is a proven way to help with your worries.