Treating Philip’s performance anxiety

  As mentioned earlier in this chapter, treatment interventions for this problem focus on Philip shifting his focus of attention on physical and mental symptoms of anxiety from an internal to an external one, challenging and modifying his anxious thinking and dropping his excessive use of safety behaviours. The techniques used to treat Philip’s performance anxiety are outlined below.

SHIFTING THE FOCUS OF ATTENTION

  Philip was so preoccupied with how bad he was feeling when ‘performing’ that he rarely sought any additional information from the reactions of his peers to his presentation. He concluded that if he felt so bad, his performance must be equally bad. However, by shifting his focus of attention from an internal to an external direction, he was able to reduce the confirmatory evidence from his internal state and increase the opportunity to disconfirm evidence from the environment. By scanning his social environment he was able to see that his peers were listening and interested and it took his attention away from all the negative physical and cognitive events that he was experiencing internally.

CHALLENGING NEGATIVE THINKING

  Philip began keeping a record of his thoughts and feelings in a thoughts diary (as described in Chapter 9). By doing so he was able to identify and label the unhelpful thoughts relating to how badly he imagined he would perform in front of his peers. For example, he imagined that he would ‘go to pieces’, ‘shake uncontrollably’, ‘sweat’, ‘blush’, make a ‘complete fool’ of himself and show everyone that he was ‘not up to the job’. He was able to use the techniques outlined in Chapter 9 to challenge his negative thinking and set up behavioural experiments to test out his new predictions. Also, by shifting his attention externally he was able to access external evidence that he could use to weigh up how likely it was that his feared consequences would occur, i.e., that people would notice his anxiety and judge his performance as poor.

DROPPING SAFETY BEHAVIOURS

  Philip dropped his safety behaviours in an incremental way and used behavioural experiments as a way of establishing if his feared outcome would come true or not. For example, he practised speaking more slowly, making more eye contact, wearing less anti-perspirant, drinking less water and wearing tighter clothing to establish if making these changes really did have the catastrophic consequences that he had imagined they would. He found to his surprise that his fears never materialized.

In addition to using the techniques described above, Philip also introduced forms for people to give him feedback about his performance and video recorded a couple of his sessions. Both of these provided further evidence to disconfirm his beliefs about his poor performance since the written feedback given was positive, and from observing himself on video he was able to see himself in the way others did. He also realized that his tendency to avoid situations involving public speaking served to maintain his problem and thus decided to offer to do more presentations in order to confront and overcome his fear. In the short term this was difficult but in the longer term it assisted him to make further progress in terms of building his confidence.