I sat with a young man recently who believed he could not face the anxiety of going to school..
A little background… A young man is his later teens, attending a local high school, in his junior year. Some family history of anxiety. Was very close to a friend, a childhood friend, who, during the summer, moved away with his family. “These two were like twins.”, his mother’s description of how close her son and this friend were. His friend was very outgoing, smart, capable, etc. The young man I sat with had used his friend’s social self-confidence to deal with/avoid his own social anxieties.
The young man had started this school year well. He reported he quickly began feeling fear/anxiety as the first week progressed but he tried to ignore it. It gradually became stronger. By the start of the second week, he refused to go to school because of the anxiety.
His parents brought him in to see me.
Part of what we have done as we have worked together is examine his thoughts/thinking patterns. I had him identify specific spots in the school/moments in his day when his anxiety was at it’s worst. Then, I had him verbalize the thoughts he has when he experiences these spots/moments. Finally, I had him tell me what he does when he thinks these beliefs…namely, refuse to go to school.
I defined the moments/spots as “Activating Events (A), the thoughts he has when he encounters them as “Beliefs” (B) and what he does after thinking his beliefs as “Consequences” (C). A + B = C. We encounter things (events, situations, feelings, even thoughts) in our day. We have thoughts or believe certain things about these events/situations. This then causes us to do or react in certain ways.
For example: (A) He sees his classroom doorway. (B) He believes if he walks through it, he will be hit with a sea of faces, looking at him, thinking poorly about him. (C) He decides to not go to school. A+B=C.
What to do…
I had him list the beliefs he has upon walking into the classroom and seeing his classmates look at him:
1. “They will think I am weird.”
2. “They will make fun of me.”
3. “I will feel embarrassed.”
4.” They won’t want to see me, wish I would have not come back to school.”
Then we examine each one. How rational are these beliefs? Have you ever encountered a situation like this before and still did what you needed to do anyway? If so, what happened…did what you feared (irrational beliefs) come true or did the situation turn out differently. Even if your beliefs are true, i.e., even if kids would think you are weird, are you weird?; Have you thought that of a kid before and later you found out they were in fact, not weird and you felt empathy for them or you befriended them?; etc.
Other examples of this examination: Have you ever been made fun of before and you lived? Have you ever been embarrassed to do something, but did it anyway? How did it work out? Has a friend ever been out of school for a while and when they came back, did you welcome them or wish they had stayed out of school?
The point is to examine the thought rationally and help the person to see the falseness of their beliefs. This, then, unlocks their ability to act differently in the situation.
I did a couple other interventions with him, along the same line. I asked him to call some of his friends and ask them what they would think if he walked into class the next day. I had him tell his friends the people he thought would think badly about him upon seeing him walk into class and what they thought about that and what he could do about that. I asked him to ask one of his friend accompany him to class or all of his classes, inconspicuously. I asked him to think of what he would say to himself and what his parents would say to him when he mustard-ed the courage to walk into class. I told him of the irrational thoughts I’ve struggled with and how I overcame them. I had his parents tell him of the irrational thoughts they have struggled with. I did some in-office activities also, designed to elicit common fears and confront them.
The principles I use in this case are from Rational-Emotive Therapy, popularized by Albert Ellis. Simply, we are bothered/paralyzed/inhibited/limited by, not events in our lives, but rather by the beliefs we have of events in our lives. Change the beliefs and we change our behavior/reactions to these events.
More later….