Cognitive Defusion Strategies for Social Anxiety


Warren Alpert Medical School, Brown University Portland Psychotherapy

Key Points

  1. Cognitive defusion refers to the process of classifying thoughts as just thoughts, and not necessarily facts.
  2. Metaphors, like the infomercials or the email metaphor, can be used to demonstrate that we don’t need to buy into our thoughts, and can choose which ones to prioritize or empower.
  3. Thought suppression exercises can demonstrate that the more we try to push thoughts away, the more powerful they become.

Getting Unstuck

Once we have a sense of values that are important to the client, another ACT process we might move toward is cognitive defusion. Charles reported some difficult thoughts or beliefs that are relevant to his social anxiety. We can become very welded to thoughts that are not helpful to us in terms of living values-based or meaningful lives.

Charles said things like, ”I’m an idiot,” or, “I can’t meet new people.” Those types of thoughts or beliefs are good targets for defusion exercises. A very basic and quick one is to have him restate a thought with the phrase, “I’m having the thought that …” before it. So instead of saying, “I’m an idiot,” Charles can say, “I’m having the thought that I’m an idiot,” and he can say, “I’m having the thought that I can’t meet new people.”

Doing this changes the relationship with thoughts and, again, that’s part of the goal in ACT. We don’t try to get rid of such thoughts, but we can change the way one relates to them, or what happens when they arise.

Not Buying Into It: Mind Infomercials

Another good metaphor for defusion is the idea of an infomercial, a TV commercial for a ridiculous product that everyone knows doesn’t work and is just junk. Yet somehow it can tempt us into a purchase anyway, because maybe we want to believe in it. Our minds can often function in the same way, getting us to buy into certain things and convincing us that they are true or good.

With Charles, the therapist could actually watch an infomercial with him. For example, an ad for a 1990s product called the Flowbee. It was an awful home haircut system that looked like a vacuum cleaner. You can watch it together, and laugh at this very silly product. Then ask him, would you buy that, and why? He will more than likely say no, I would not buy that, and say why not. Then of course he can be asked whether he could take that same approach to thinking himself an idiot. Does he have to buy into that, or the thought that he can’t meet new people?

A study has found that we have 60,000 to 70,000 thoughts per day. That’s a lot of thoughts. We can choose which of those we prioritize, which we give authority to, which we allow to influence our actions. And which we don’t.

Don’t Hit Send: The Email Metaphor

Another metaphor is that of emails. We might ask Charles how many emails he receives each day, and whether he opens every email and reads each one with the same degree of attention. Most people would say no, they open the ones they must or want to read, and ignore the rest. And we can take that same approach to our thoughts, if we choose. The thoughts that are useful can be given more weight. Those which aren’t don’t need to be gotten rid of. We can allow them to be there, but we don’t have to give them power or authority.

There is also a very classic thought suppression exercise which demonstrates that when you try to argue with thoughts, it actually makes them bigger. This is of course, to tell someone not to think of a white bear for a full minute. You can even start a timer. If you ask a client how successful they were, naturally they had thought of one as soon as they were given the instruction. It neatly demonstrates the principle that the more we try not to think of something or push thoughts away, the more it gives them power, and the more they rebound and grow bigger.

Compare this approach to what Charles worked on with his former therapist. With traditional or other forms of therapy, if a client thinks they are an idiot, you might provide evidence for them that they’re not, and try to convince them of a different self-belief. We’ve established that it’s very difficult not to think something. So in ACT, using cognitive defusion, we ask a client whether such a thought helped them move toward a life worth living, or made that life smaller. If the latter, then maybe they don’t need to give that thought so much credence anymore.

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Cognitive Defusion Strategies for Social Anxiety

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