by Jennifer Martin Rieck, LCPC
I once had a close relationship with someone who chronically dreaded impending financial ruin without any evidence of such an event occurring. No amount of reassurance or presentation of evidence to the contrary soothed this person’s discomfort and no amount of money in the bank, I predicted, would ever change this person’s constant daily anxiety around money. It seemed baffling to me at the time. Since that time, I have had a client whose anxiety was through the roof because of concerns that excessive government involvement regarding COVID vaccinations, and requirements for vaccinations, might result in financial ruin for individuals who refused the vaccine. She feared that refusal of the vaccination could result in a loss of her job and restricted access to her money. I have had other clients who have had general, or very specific, medically related concerns. Some clients experience anxiety and dread that they will get a specific and terminal illness, like cancer, while other clients seem to experience a new concern almost daily related to somewhat benign symptom, either real or imagined. The commonality in all of these cases is that the anxiety isn’t grounded in evidence. The feeling of dread and anxiety, and the chronic worrying, is never alleviated by a test, or a review of financial assets, or any amount of reassurance from therapists, doctors, or loved ones. The cycle of feeling impending doom, seeking reassurance, failing to find it, spiking anxiety, and an inability to relax or enjoy life, just keeps repeating for these clients.
What is Schema and Schema Therapy?
I practice a particular type of therapy or counseling known as Schema Therapy. Schema Therapy is a relatively new form of therapy that developed out of the more broadly known therapy called Cognitive Behavioral Therapy (CBT). Cognitive Behavioral Therapy is one of the more researched and scientific types of therapy on the market today, focused heavily on the interaction of thoughts, behaviors, and feelings. The idea behind CBT is that the interaction between thoughts, behaviors, and feelings can be explored in such a way as to allow for a direct manipulation of one variable, which inevitably results in a change in the others. Often, the sequence of interaction goes as follows: someone has a thought, which leads to a feeling, which results in some sort of unwanted behavior, which is an attempt to deal with the feeling. If we can look beyond the unwanted behavior to the feeling that drove the behavior, and then identify the thought that caused the feeling, then we can work directly on challenging the thought. Very often, challenging and changing our thoughts can lead to diminished uncomfortable feelings and subsequently extinction of unwanted behaviors.
Schema Therapy operates on a similar assumption as CBT, but rather than looking at very specific thoughts, Schema Therapy looks at broader thought categories, or what are called Early Maladaptive Schemas. These are thought patterns that are often developed during childhood and that are used to categorize and make sense of incoming information. We all develop schemas throughout our early life as a way to process our experiences and to make sense out of, and predict, future experiences. In fact, it is suggested by Cognitive Consistency Theory that individuals often go through life looking for experiences that fit with the schemas that they already have. This predictability makes people more comfortable and makes life seem more organized. However, when we persistently operate out of schemas that are maladaptive, meaning that they made sense in our childhood and often helped us to understand and function in our family of origins but are harmful to us later in life, we often fall into repetitive cycles of re-experiencing painful and triggering events. For example, someone who experienced being physically or emotionally abandoned by a caregiver during childhood is very likely to re-experience abandonment by friends or partners later in life due to insecure behaviors, such as constantly seeking reassurance or fearing being apart from their friend or love one. Eventually these behaviors drive away significant others and, to the person with a high Abandonment Schema, simply reconfirms the belief that they will always be abandoned in the end. Someone with a high Abandonment Schema may prematurely jump out of, or sabotage, relationships due to the pervasive sense that they will be abandoned. Because they want to prevent themselves from having to go through another painful abandonment, they end the relationship first, thereby confirming that what they know to be true is true and reconfirming to them that the abandonment is inevitable.
Vulnerability to Harm Schema
Vulnerability to Harm Schema, like Abandonment Schema, is likely formed early in life. This schema may come about because someone experienced a painful loss, such as the loss of a friend or loved one to a terminal illness or tragic accident. Due to this loss, the person may feel that the world is unsafe and that tragedy is right around the corner. Alternatively, someone may have had a parent or caregiver who had high anxiety or a high Vulnerability to Harm schema and constantly talked about how unsafe the world was. A parent may have had specific anxiety around money and been extremely frugal as a result. Perhaps they went overboard with emphasizing “playing it safe” or hoarding money, for fear of a future lack of money. Alternatively, a parent might have been obsessed with their or their child’s physical safety, and expressed constant worry over the danger of doing physical activities that could result in harm. Maybe they worried about sickness and attempted to live in bubble to protect themselves, or were overly obsessed with any physical symptom that “could be” something serious. This sort of repetitive conversation or overboard behavior could have planted the message that the child should be constantly on alert to physical signs or symptoms of illness, or that they should avoid any environment where they could potentially become ill. As mentioned earlier, Vulnerability to Harm schema can be very specific or more broad, but either way this schema can be at the core of a person’s high anxiety. It is often focused on a particular aspect of life such as health, money, or death, with a lack of evidence that the anxiety is warranted.
Treatment for Vulnerability to Harm Schema
Treatment for Vulnerability to Harm Schema involves doing work in several different areas, which I will break down into the following categories: Down-regulating the Amygdala, Thought Management, and Behavioral Modification. I will provide techniques and useful tools for each category.
Down-Regulating the Amygdala
Neuroscience has demonstrated that our Amygdala is the part of the brain that really drives the anxious response, therefor, work is needed around training the brain to down-regulate the Amygdala. This is a process that takes some time and requires practice. Any practice that helps the body to calm down,or down-regulate, is beneficial for individuals with generalized anxiety or anxiety due to Vulnerability to Harm schema. Some of the best practices for down-regulating the Amygdala involve deep breathing and breathing exercises. Focus on taking deep breaths, holding the breath, and then breathing out longer than you are breathing in. This ensures that you are exhaling all of the Carbon Dioxide from your lungs. This exercise can be extremely helpful in preventing a sensation of anxiety from escalating into a panic attack. Progressive muscle relaxation techniques can also be helpful to recognize early signs of anxiety and help the body to relax. Starting from the top of your head and working downward through each muscle group, purposely tighten each muscle group, focusing on the feeling of tension the body. After tensing each muscle group, relax the muscle group and focus on the physical sensation of releasing tension. This technique will raise your body awareness. Being mindful about which muscles are tensing up in response to stimulus will enable you to be intentional about relaxing those muscles when you feel anxiety coming on.
Another exercise that I find extremely helpful is to create a go-to relaxation spot in your mind that you will flee to at the first sign of anxiety. For example, I love the water, so when I start to think of something troubling or anxiety provoking I like to immediately go to the beach in my mind. I close my eyes and picture my favorite spot, then I focus on my physical senses. I describe in my mind what it smells like there, what sounds I hear, what the sun feels like on my skin, how the water looks, etc. Our brains are not that great at focusing on more than one thing at once and so this practice can really preoccupy our mind temporarily while we let whatever thought we are having pass, preventing it from escalating into rumination or obsessive worry.
Lastly, mental imagery can also help us here. One thing that I do when I have a nagging thought that comes to mind frequently but serves no real purpose (other than to cause anxiety), is to picture myself on a baseball field as a batter. I like to picture the annoying thought entering my mind from a distance and getting closer and closer, but then visualize myself batting it out of the park before it can land. Next I distract myself long enough to move on to something else. All of these things can be useful for immediately preventing your Amygdala from kicking in and taking over.
The next part of healing the Vulnerability to Harm schema involves thought challenging and reality testing. For clients who score really high in Vulnerability to Harm schema, the likeliness of what they dread actually happening is usually pretty much non-existent or extremely unlikely. For instance, people who have an obsession with thinking that every physical sensation or symptom means that they are going to die, are actually acting as if something is likely to happen which is very unlikely to happen. The same is true from someone with a phobia of flying or someone who has a job and an income and has for most of their life, but feels every day that they are going to be bankrupt soon if they aren’t extremely cautious. Clearly, the anxiety and fears that these clients experience aren’t grounded in current reality, though they might have come from a past experience. This is where reality testing is so, so crucial. Stopping ourselves mid-sentence when we are thinking or saying something about our fears, and pointing out what evidence we have to the contrary, is critical in order to challenge the legitimacy of our thoughts. If we don’t do this work then we are actually giving legitimacy and weight to potentially completely unrealistic thoughts. By giving weight and legitimacy to these sticky and unwanted thoughts, we are creating neural pathways in our brains that then get stronger and stronger over time and result in increasing levels of anxiety. It is important to reality test our thoughts by critically evaluating whether there is current evidence to support our worry and recognize that, if not, the feelings may be coming from a Vulnerability to Harm schema.
The good news is that Neuroscience has taught us that if we quit using neural pathways they actually diminish and get smaller over time. This means that there is hope that these perpetual cycles of thoughts leading to worries, leading to anxiety, leading to fight-or-flight responses, and obsessive, unwanted behaviors, don’t have to last forever. Creating self-talk that helps us to self-soothe and calm our bodies, and reassuring ourselves that we are safe and that nothing bad is likely to happen will teach our Amygdala to be less active over time and reduce the frequency of anxious experiences.
Lastly, we have to tackle unhealthy behaviors. For individuals with Vulnerability to Harm schemas, the number one behavioral change that is needed is to stop looking for re-assurance, to stop habitual and impulsive “checking”. This means that for people who are constantly worried about illness, refraining from monitoring their bodies constantly is crucial. Also, refraining from compulsive internet searching for reassurance that their symptoms don’t mean something worse is necessary. For people who are worrying constantly about money, the behaviors that flow out of this type of thinking need to stop. Any habitual checking or planning that perpetuates the belief that potential harm is being prevented because of the checking behaviors must stop. Otherwise, the brain becomes increasingly convinced that by these compulsive behaviors, the threat is alleviated. Instead, when the feeling of impending doom begins to come on, individuals must stop, challenge the reality of the thought, and do whatever they need to do in order to distract themselves from the thought, and practice Amygdala down-regulating. All of these things help our brain learn that we are safe without compulsive checking and create new neural pathways, rather than building up the unhealthy ones that have previously been utilized.
Unfortunately, like all of the Early Maladaptive Schemas, Vulnerability to Harm schema can cause a lot of problems for individuals who score high in it. Clients with this schema struggle with high anxiety and an inability to relax and have fun in their lives, constantly sensing that there is impending doom right around the corner. This constant discomfort keeps individuals from truly living a life of autonomy and choice. Choices become limited, activities and enjoyment restricted. Even relationships suffer as a result of strong Vulnerability to Harm schemas. Often, partners of individuals with high scores in Vulnerability to Harm schema become exhausted from constantly having to reassure their partner or loved one. By proxy, their partner’s lives may become increasingly restricted due to their own anxieties and the relationship may become strained or end. The good news, however, is that there is hope and treatment available for anxiety in general and anxiety due to Vulnerability to Harm schema. In addition to practicing the techniques and changes mentioned above, there are Schema Therapists trained in supporting and encouraging clients to own their schemas and to combat them in helpful ways. Getting treatment doesn’t mean that you will cease to ever feel the impact of your schemas. However, therapy will give you the tools needed to change how you respond to them and to go after a life of emotional and relational health, one that is unrestricted and free!
For more information on generalized anxiety, see Caveman No More: Surviving Modern Day Anxiety.
Any and all client information contained in this blog is merely a fictitious representation used to illustrate recurring themes, topics, and examples of scenarios encountered frequently in therapy sessions and related to the blog content. No real client information is used.