CBT and the "What if's"

Many of my clients come to treatment feeling anxious or upset about issues in their lives.  When they express what’s bothering them, they will often formulate their worries that begins with a “what if…” question.  For example:

• What if I fail my test?

• What if my wife gets mad?

• What if I lose my job?

• What if I get sick?

• What if I can’t do it?

My answer is the same for everyone: There is no right answer to a what if question.  There are thousands of answers to these questions.  Oftentimes people, who ask themselves a “what if..” question, are generally focused on the negative outcomes and rarely recognize the possibility of a positive outcome.  For example, suppose a woman is traveling and is feeling anxious. As she is driving to the airport, she asks herself, “What if I miss my flight?” How many possibilities can you imagine addresses this question?  Off the top of my head, I can imagine anything from simply booking another flight to passing out in the middle of the airport due to stress and anxiety. Because there are so many possibilities,nothing feels resolved and the “what if..” question does nothing but increase the negative feelings the woman started out with.

In the Cognitive Behavioral Therapy (CBT) model, what if questions are very specifically addressed.  This type of thinking is known as a cognitive distortion (CD).  CD’s are thoughts (cognition) that are messed up (distorted). Because they are messed up, they generally create negative feelings like anxiety, anger, or sadness.  We all have thousands of thoughts that pop into our minds every day and invariably, a percentage of those thoughts are distorted.

CBT helps us to identify which thoughts are distorted and which thoughts are truthful.  Recognizing our CDs is the first step toward reducing our negative feelings. CBT teaches us to restructure our CDs to more truthful and rational thoughts.  This ultimately leads to reduced and less intense anxiety, anger or sadness.

So remember… whenever you ask yourself what if… you are experiencing a cognitive distortion and you are likely feeling terrible.  Find a different way to think about and express your worries, and you will be will be able to work through quicker and more effectively.