Anxiety

Definition

In REBT, anxiety is an unhealthy emotional problem (unhealthy negative emotion / UNE) that arises in response to a perceived or anticipated threat to one’s Personal Domain. It is characterized by worry, dread, physical tension, and avoidance.

Anxiety is distinguished from the healthy alternative, concern, by:

• The presence of rigid/extreme attitudes (particularly about threats and self-worth)
• Safety-seeking behaviour and avoidance
• Threat-exaggerating or catastrophic thinking
• Interference with functioning and problem-solving

Core Inference Theme

When anxious, people typically perceive threat to some aspect of their personal domain:

• Threats to self-esteem: failure, criticism, rejection, loss of status
• Threats to safety: uncertainty, loss of control, panic
• Threats to comfort: experiencing discomfort, unpredictability
• Threats to personal integrity: being judged, being exposed

Rigid/Extreme Attitudes Underlying Anxiety

Anxiety is underpinned by a rigid attitude combined with extreme attitudes:

Rigid attitude:

• “I must not fail / be criticized / lose control / experience uncertainty”
• “Threat mustn’t exist in my personal domain”

Extreme attitudes (derived from the rigid attitude):

1. Awfulising: “It would be catastrophic, horrible, unbearable if [threat] happened”
2. Unbearability: “I couldn’t cope if [threat] happened; I would disintegrate or lose capacity for happiness”
3. Devaluation (in ego-based anxiety): “If [threat] occurred, it would prove I’m a failure/worthless”

Behaviours Associated with Anxiety

When anxious, people typically:

• Avoid the threat or situation where it might occur
• Withdraw physically or mentally from the threat
• Seek reassurance from others that the threat is benign
• Check repeatedly on the status of the threat
• Overprepare to prevent or manage the threat
• Neutralise the threat (e.g., through rituals, superstitious behaviour)
• Use safety behaviours (e.g., holding onto something, having someone nearby)

Note: These safety-seeking behaviours maintain anxiety because they prevent the person from discovering that the threat is either manageable or unlikely, or that they can cope without the safety behaviour.

Thinking Associated with Anxiety

Threat-exaggerating thinking:

• Overestimating the probability of the threat
• Underestimating one’s ability to cope
• Catastrophising about consequences
• Ruminating about the threat

Safety-seeking thinking:

• Seeking mental reassurance that the threat is benign
• Distracting oneself from the threat
• Preparing mentally for worst-case scenarios

Both types of thinking are distorted and maintain the anxiety.

Healthy Alternative: Concern

When the same inference theme (threat) is processed with flexible/non-extreme attitudes, the person experiences concern instead:

Flexible attitude:

• “I would prefer not to face this threat, but that doesn’t mean I mustn’t”

Non-extreme attitudes:

1. Non-awfulising: “It would be bad if [threat] happened, but not catastrophic”
2. Bearability: “I could bear it; I wouldn’t disintegrate; I could still experience happiness”
3. Unconditional acceptance (in ego-based concerns): “If [threat] occurred, it would be bad, but it wouldn’t make me a failure or worthless”

Behaviours associated with concern:

• Face the threat without safety-seeking
• Take constructive action to address the threat
• Seek support for coping, not for reassurance that the threat doesn’t exist
• Prepare appropriately without overpreparing

Thinking associated with concern:

• Realistic appraisal of threat probability
• Accurate assessment of coping ability
• Task-relevant thinking focused on dealing with the threat
• Non-ruminative thought processes

Types of Anxiety in Clinical Practice

Windy Dryden identifies several forms, each with particular threat themes:

• Social anxiety: Threat of poor performance or negative judgment in social settings
• Health anxiety: Threat that a symptom is malignant; uncertainty about health status
• Generalised anxiety: Pervasive sense of threat; feeling unsafe; fear of anxiety itself
• Public speaking anxiety: Threat of poor performance or judgment when presenting
• Test anxiety: Threat of failure or going blank
• Panic: Threat of losing control; fear that anxiety itself is dangerous

REBT Approach to Anxiety

The therapeutic process involves:

1. Identifying the specific threats the person is anxious about
2. Identifying the three components of the anxiety response (emotional, behavioural, cognitive)
3. Setting goals around the HNE (concern) and associated functional behaviours and thinking
4. Identifying and examining the rigid/extreme attitudes
5. Developing and strengthening conviction in flexible/non-extreme attitudes
6. Crucially: Surrendering safety-seeking behaviours and facing threats while holding flexible attitudes

This last step is often counterintuitive for anxious clients and requires careful therapeutic work.

Common Clinical Challenges

• Safety-seeking is strongly reinforced: It provides immediate (though temporary) relief
• Avoidance prevents disconfirmation: The person never discovers that the threat is unlikely or manageable
• Perfectionism: Anxiety is often linked to rigid demands about performance
• “Just right” experiences: Some anxious clients engage in compulsive checking or rituals
• Metanxiety: Anxiety about being anxious; fear of panic attacks or loss of control

How Different Frameworks Treat Anxiety

• REBT: Focuses on the rigid/extreme attitudes about threat and self-worth; emphasizes surrendering safety-seeking
• CBT: Focuses on realistic threat appraisal and behavioural experiments; may not explicitly address the philosophical/attitudinal layer
• ACT: Emphasizes acceptance of anxious thoughts/feelings and values-directed action rather than threat elimination
• CFT: May address shame or self-criticism underlying anxiety
• MBCT: Uses mindfulness to observe anxious thoughts/sensations without judgment

Related Concepts

See also: Concern (the healthy alternative), Personal Domain, Inference Theme, REBT, ABC model, Attitude, Healthy Negative Emotions.

Sources

• Windy Dryden: Dealing with Emotional Problems Using REBT: A Practitioner’s Guide (2nd ed., 2024) — Chapter 2: “Dealing with Anxiety”