On that note. Today I’m talking about the Vulnerability to Harm or Illness Schema.
Vulnerability to Harm or Illness
Typical Presentation of the Schema
Most of these patients rely on avoidance or overcompensation to cope with the schema. They become phobic, restrict their lives, take tranquilizers, engage in magical thinking, perform compulsive rituals, or rely on “safety signals,” such as a person they trust, a bottle of water, or tranquilizers. All of these behaviors have the goal of stopping the bad thing from happening.
Heh, in fact, I have a tendency to live like the world IS about to end and I want to do everything I can. Or if the world is going to end then there’s nothing I can do about it, I’m going to go out with my own kind of bang.
Goals of Treatment
The goals of treatment are to get patients to lower their estimations of the likelihood of catastrophic events and to raise their evaluations of their ability to cope. Ideally, patients come to recognize that their fears are greatly exaggerated and, even if a catastrophe did occur, they would be able to deal with it adequately. The ultimate goal of treatment is to convince patients to stop avoiding and overcompensating for the schema, and to face most of the situations they fear.
Strategies Emphasized in Treatment
Patients explore the childhood origins of the schema and trace its pattern through their lives. They count the costs of the schema. Patients explore the changes they would make in their current lives if they were not overly afraid. It is important to spend time building motivation to change. The patient should stay focused on the long-term negative consequences of living a phobic lifestyle, such as lost opportunities for fun and self-exploration; and on the positive benefits of moving more freely in the world, such as a richer, fuller life.
Behaviorally it’s important to face the situations that are feared by undergoing gradual and graduated exposure to phobic situations in homework (try to face it on paper before you face it in real life): Picture entering specific phobic situations and, with the assistance of the “healthy Adult” coping well. Anxiety management techniques such as breathing exercises, meditation, and flash cards help patients cope with the exposure as they go through them.
This sounds easier than it is. It’s been my experience that when you have an irrational fear, you pretty much know it’s irrational. However that doesn’t change how you feel or think or act. So just having someone tell you that what you’re doing is irrational is not going to change anything. And the longer you’ve done a particular coping strategy, the harder it’s going to be to undo all that habit and reform new, healthier, habits. However, that’s what time is for. You take the time. You work on it little by little with someone you can trust.
Special Problems with This Schema
The greatest problem is that people with this schema are too afraid to stop avoiding and overcompensating. They resist giving up their protections against the anxiety of the schema. As we mentioned earlier, mode work can help patients strengthen the healthy part of them that yearns for a fuller life.
Something like that.
*Schema Therapy: A Practitioner’s Guide – Young, Klosko, Weishaar