FEARED COGNITIONS
Feared cognition is the primary basis of phobia and OCD according to the theories of psychology. We also call it as underlying fear structure and imagined feared consequences which constitute the bottom layer of the problem in a Two Layer Conceptualization. While dealing with phobia/OCD, we must identify and enlist the feared cognition. To illustrate the range of feared cognition in various disorders, I am presenting the list of feared cognitions seen in various phobia and OCD. One of the distinguishing features of feared cognition is the use of future tense/future orientation in the internal dialogue of the affected person. It can be easily identified and enlisted.
A student during upcoming examination may experience severe anxiety reactions with following underlying fear structure:
1. fear of going blank
2. fear of forgetting
3. fear of failure
4. fear of embarrassment
5. fear of humiliation
6. fear of loss of self-esteem
7. fear of humiliation of parents
8. fear of career loss
9. fear of not able to manage things after failure
10. fear of ridicule by the rival etc.
The objects of fear in dog phobia could be exposure to a dog in various circumstances like on street, many dogs together, crossing roads while dog is there, diseased dog, barking dog, sound of barking dog etc. Such an exposure would activate body-mind reactions leading to the avoidance of streets and places in which an encounter with a dog is anticipated. The underlying fear structure could consist of following:
1. fear of dog bite
2. fear of helplessness if dog bites
3. fear of loneliness
4. fear of not able to defend oneself
5. fear of not able to hit the dog if it bites etc.
6. fear of the pain from dog bite
7. fear of catching rabies
8. fear of injections treatment if dog bites
An adult person had come to me last week for two sessions of drill therapy for sexual OCD. While writing this chapter he just came to me for third session. He reported significant reduction in the fears elicited by sexual images and thoughts for religious idols and family members. I tested by asking him to imagine all those thoughts of sex with family members and religious idols. He remained comfortable and did not report any distress.
Now his mind now got focused on excessive thoughts and health concern that run into his mind triggered by somatic sensations of heaviness in chest. A brief enquiry yielded following underlying fear structure. I recommended drill for these statements.
1. Fear of elevated levels of blood pressure
2. Fear of fainting spells
3. Fear of uncontrolled speech which might contain abusive language
4. Fear of seizures
5. Fear of vomiting
6. Fear of trembling
7. Fear of stiffness in limbs
8. Fear of mental illness
9. Fear of heart attack
10. Fear of unspecified disease
Lizard phobia is one of the most common phobias particularly in females. More than fear it involves feelings of disgust. In an affected person it can escalate to a very high level and can potentially affect most spheres of life. It is reported by affected persons that they have modified their place of living in a manner to shield the entry of lizard in the house by installing thick nets, installing glasses on the walls so that it cannot creep. Interestingly, one lady reported that she asked only two things from her prospective husband – (a) whether he is afraid of lizards (b) whether he smokes. She was concerned to the extent that if her husband would also have the fear of lizard, then there might be no one to help her out in case any lizard creeps in. Lizard phobia contains following structure:
Objects of fear: lizard, anything that resembles lizard, pictures of lizard, videos of lizard, places that reminds of lizard, lizard skin, the pattern on lizard skin, inside mouth of lizard
Body-Mind Reactions: trembling, shakiness, accelerated heartbeat, breathing difficulty, wringing hands, sweating, Goosebumps, restlessness, irritability, disgust, fear, helplessness, nausea feeling
Safety Behaviors: Running away from places having lizard, removing lizard, asking someone to remove lizard, sealing windows and rooms by installing nets or glasses.
1. Fear of getting jumped on body
2. Fear of getting unconscious
3. Fear of dying
4. Fear of unknown harm
It is very easy to identify underlying fear structure by asking simple questions like what scares the affected person when exposed to the objects of fear. The imagined feared consequences need be listed in detail which would form the basis of cognitive drill therapy.
1. People have considered me idiot
2. People have come to know that I am a psychiatric patient
3. People have lost faith in me
4. People have come to know that I do not even know very simple things
5. People have begin to show disrespect to me
6. I have become a strange person
7. All my respect is gone
8. I am feeling ashamed in front of others
9. People are doubting my skill and knowledge
10. People are thinking about me
11. I have been insulted
12. People are ignoring me
13. I have failed to perform to the level of people’s expectations
14. I have become a laughing stock
15. I have become worthless in the eyes of others
16. People are rejecting me
17. I have failed in social life
18. People are finding fault in me
19. People are taking me casually
20. People have become dissatisfied of me
21. People have become irritated of me
22. People are getting surprised how bad I am
23. Others are repenting for inviting me to speak
24. Others are getting bored of me
25. Others are having disgusting feelings towards me
26. I have become blank before others
27. Others are considering me as a coward
28. Other drill statements can be drafted in similar manner.
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