"Thank you, James, for that," said Bob, the counsellor. So in a nutshell, you had had an MRI to see if you had a tumour. I believe this was because of a sudden loss of hearing?"
"That's right, Bob. I had seen an ENT specialist to help me with my sudden hearing loss in my right ear which miracalously had healed itself. My specialist said I had dodged the bullet and that sudden hearing loss usually means permanent hearing loss if not caught in time. He gave me his business card and he told me to phone hime immediatley if it were to happen again. Anyway, my ENT (Nose, Ear and Throat) specialist, Dr. Smith, wanted to check to see if there was another possibility for the cause of the sudden hearing loss besides the common inner ear viral infection."
"And there was no tumour; however, you did realize that in being inside the MRI machine which is like a long tube open at both ends is that you felt claustrophobic and started to feel anxious."
That's right, Bob. What saved me is that I could tilt my head back and see the rest of the room and half-way through the procedure, the operator brought me out for a minute before putting me back inside. Of course, there are these earphones where the operator can talk to you, too. It is a noisy machine.
"So you survived it, but you did not like it. Yes, I am afraid that I"d be quite anxious, too. Like you, I'd feel very uncomfortable being in the tube. That must have been very difficult for you.
So how can we help you today, James?"
"Well, I have another health issue, my prostate. My specialist suggested a measurement of the size of the prostate and also to check for any cancer growth. I had answered, "No problem." Then he said, "How are you with MRI's". I felt immediately worried and concerned, but said, "I can manage." So, he gave me a date and a time. I put the time and day on my calendar and then forgot about it. Then the week before the MRI date, I started to think a little about my first very uncomfortable experience with the MRI machine. Instead of dealing with it, I would quickly stuff the fear away. This happened daily until the night before the MRI procedure."
What happened that night, James?
"Bob, I woke up in a panic. My heart was pounding as if it were going to jump out of my chest. I jumped out of bed and immediately wanted to run. I wanted to run away from my fear. How crazy is that?"
" That must have been very scary. Who wouldn't want to run as fast as one could to escape it. Of course, the fear would come with you. So, James, how did you handle it?
"Well, Bob, I used the Burns Daily Mood Log as you had taught me and as we had used together on other occasions."
"Go on. I'm listening, James."
"Well, as I just said, I did as you had shown me with that other probem I had worked on. First of all, I wrote down the situation: My Fear of the MRI machine. Then I circled all my negative feelings with their relative strength plus my goal on how much I'd like to reduce those negative emotions.
unhappy at 70% strong with the goal to reduce it to 0%
anxious, worried, panicky, nervous, frightened at 100% strong with the goal to reduce it to 0%
inferior, defective, incompetent at 100% with the goal to reduce it to 0%
alone at 80% with the goal to reduce it to 0%
foolish, humiliated, self-conscious at 80% with the goal of 0%
pessimistic at 60% with goal 0%
frustrated, stuck at 100% with goal of 0%
upset, resentful, angry at 90% with goal of 0%
overwhelmed at 100% with goal of 0%
ashamed at 60%
"Well, James. I can understand your feeling that way. If you are prone to claustrophobia and you are faced with being put into a confined space, who wouldn't have those emotions. So what were your negative thoughts, by the way?"
"Okay, Bob, here they are:
First negative thought: I'm going to die. 90% True
Second negative thought: I won't be able to breath. 80% True
Third negative thought: I'll get stuck. 85% True
"So, James, I presume you went on to find out if there were any cognitive distortions in those thoughts?"
"Yes, I did, Bob. As you had previously explained, it is difficult to think when one is feeling extremely anxious about a medical procedure. This means my thoughts would be not as accurate as I'd like them to be, being so anxious and all.
First, I put the 10 cognitive distortions in front of me. Then I took each thought to see if there were any distortions in any of them.
10 Cogntive Distortions (David Burns MD)
All-or-nothing thinking. You look at things in absolute, black-and-white categories.
Overgeneralization. You take one single event and you generalize it to your entire life.
Mental filter. You dwell on the negatives and ignore the positives or vice versa.
Discounting positives. You insist your positive qualities don't count or vice ver
Jumping to conclusions. You jump to conclusions not warranted by the facts by:
a) Mind-reading. You assume that people are reacting negatively to you.
b}Fortune-telling. You predict that things will turn out badly.
6. Magnification or minimization. You blow things way out of proportion or shrink them.
7. Emotional reasoning. You reason from your feelings: “I feel like an idiot, so I must be one.”
8. Should statements. You use “shoulds,” “shouldn'ts,” “musts,” “oughts,” and “have tos. ”Selfdirected “Shoulds” cause feelings of guilt, shame, depression and worthlessness. OtherDirected “Shoulds” cause feelings of anger and trigger interpersonal conflict. World-Directed “should” lead to feelings of frustration and entitlement.
9. Labeling. Instead of saying, “I made a mistake,” you tell yourself, “I am a mistake” or “I'm a loser.”
10. Self-blame and other-blame.
a) Self-blame. You blame yourself for something you weren't entirely responsible for.
b) Personalization. You hold yourself personally responsible for an event not entirely under your control.
c) Other-blame. You blame others and overlook ways you contributed to the problem.
"Well, James. It looks as if you are all set to explain if you found any cognitive distortions or mind traps in your thoughts.
"Sure, Bob ....
Well, in the thought "I'm going to die." I am using the distortion Jumping to Conclusions by Fortune Telling. No one can predict the future. You might guess what might happen, but you CANNOT TELL THE FUTURE. I can't say whether I am going to die or not. That's the first distortion.
Then there is the second distortion: Mental Filter. I am filtering out the positive and holding unto only the negative I am going to die. These machines look for tumours or measure the size of glands. In my case, it is measuring the size of the prostate. If the machine finds something wrong, then that is good news because then we can work at fixing it hopefully. If the machine finds nothing wrong, then we are 'off the hook' which is good news, too.
So, with Mental Filter I was only holding unto the negative and also for Discounting the Positive, I wasn't considering any positive facts or outcomes. I was discounting the positive possibilities that no tumour would be found or a tumour was found (We can remove it!).
Then there was Magnification and Minimization. I was making a big deal out of dying or magnifying death and minimizing the bigger deal of living. These machines can help save lives. These machines are used by thousands of people who have lived because the machine found something or the patients felt wonderfully releaved because the machine found nothing.
Then there is Emotional Reasoning. Just because I am scared of a machine and felt as if I might die iis not fact. Feelings are important; but facts are maybe more important. You can't have one without the other. Emotions have no brains. So it is not a good idea to think with emotions; use your brains and think with facts. That is the wise thing to do. Don't let your feelings run away with your head! Cool down. Take a deep breath and use your head - THINK!
Then there is Other-Blame. I can blame the hospital staff for scaring me or my physician for suggesting the machine in the first place. But it is I who is scaring myself. It is my responsibility to control my anxiety. No one else can do that for me. Of course, it does help to have sympathetic staff and for me to be more honest with my emotions. Still, I own a lot of it, myself. I can't point fingers and not take any personal responsibility. Anyway, I can empower myself by not being a victim and be choosing to be a survivor, a problem solver.
"Well done, James. So now that you found a lot of cognitive distortions in the thought I'm going to die. What is your new positve and realistic thought to make your original thought a lie?
"Well, Bob, my new postive and realisitic thought is: the MRI can help me live by either finding a tumour or not finding a tumour and of course, by measuring the size of the prostate.
"Very good, James! So how true is the original thought - I'm going to die."?
Well. Bob, it isn't true at all! It was a lie I was telling myself and believing and thereby, scaring myself half to death. It is incredible how potent thoughts can be. I can use them to make me brave or anxious. It is often my choice. So, as you say on your website. It isn't what happens to you. It is what you think about what happens to you. "
And how about the others, James?
Well, for I won't be able to breath I found lots of cognitive distortions and my new positive, realistic thought is: The machine stays the same size. It doesn't press down on my chest. There is lots of room for air all around me . Consequently, I have lots of air to breathe, and I can do so by breathing slowly in and slowly out.
For I'll get stuck, well, all the hospitals have back-up generators so the electricity is always there in case of an emergency. Anyway, the staff can slowly pull me out without any electricity needed. I am never at any time 'stuck'!
Also for added measure, I said prayers while I was in the MRI to distract me. I am Catholic so I said the rosary. I guess another person could sing a favourite positive song to themselves as an alternative. Also, I knew I could tilt my head and look out and away form the machine and that could help, too.
Then I went back to my Mood Log and then measured my negative emotions after telling myself the new positive and realistic thoughts on the Burns Mood Log and they had all dropped dramatically mostly to zero.
Then, Bob, after I had finished the Mood Log, I went back to bed and slept like a baby. I went to the hospital also with a positive frame of mind believing that the machine was my friend in the long run. And it was and still is!
James, thank you for sharing. I am sure your story will help other clients dealing with panic attacks. They will soon realize that panic attacks are caused by not dealing with a problem and by the automatic negative thoughts that we tell ourselves. Change your thoughts and you change your emotions. Now, James, that is good news, indeed. Thank you so much!
"Bob, wait a minute. Don't you want to hear the results of the MRI?"
"Oops, sorry, James, that is so important. So ...?
"Well, the prostate has some tumours but they are benign and represent less than 1% of the total prostate. Also, I have a HUGE prostrate which explains the high scores I get with the Gleason score as explained by my specialist. In short, everything looks great apart from the size of the prostate which isn't life threatening but might need some surgery further down the road."
"I am so happy for you, James."