023: Scared Stiff — What Causes Anxiety? What’s the Cure? (Part 2)

In this Podcast, David and Fabrice describe four powerful treatment models for anxiety, including

  • The Cognitive Model
  • The Exposure Model
  • The Motivational Model
  • The Hidden Emotion Model

Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger.  And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover.

Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients.

Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever.

Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out!

In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.

3 thoughts on “023: Scared Stiff — What Causes Anxiety? What’s the Cure? (Part 2)

  1. What happens when exposure doesn’t make anxiety go away? When you work a job and experience anxiety every day, despite feeling it & going to work every day for years. When being around people feels terrfying (like being around tigers & bears terrifying) no matter how often you’re with them and around them.

    Many people will post anonymously, because who we are in this instance is irrelevant; asking our questions is what’s important to us for this moment.

    • Hi Anon,

      A good and important question. In the podcasts on anxiety, and in my book, When Panic Attacks, you’ll see that I use more than 50 methods in treating anxiety or any kind of emotional distress, along with four completely different treatment models specifically for anxiety–the motivational, cognitive, exposure, and hidden emotion models. That’s because there is no “one size fits all” in the treatment of depression, anxiety, relationship problems, or habits and addictions. In addition, intentional exposure is radically different from the accidental exposure anxious individuals experience when bumping into a situation that makes them anxious.

      Posting anonymously is A-OKAY!

      I don’t ever throw techniques at problems, like being anxious around people, since that rarely ever works, as you’ve so wisely pointed out. I always work systematically, using TEAM, and of course it is vitally important to pinpoint and write down the Negative Thoughts that trigger the anxiety, or anger, or shame, or whatever the negative emotion happens to be. You can read about how to do this in any of my books, such as the Feeling Good Handbook, or When Panic Attacks, which both have a great deal of information and methods on how to overcome any kind of anxiety, including social anxiety.


  2. Pingback: Another Cool Video for You! The “Niceness” Disease! – Feeling Good

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