Got Anxiety? Therapeutic metaphors: ‘Drowning in a sea of anxiety’ |

Got Anxiety? Therapeutic metaphors: ‘Drowning in a sea of anxiety’

Barry C. Barmann, Ph.D.
Mary B. Barmann, MFT

Editor’s note

This is the second in a three-part series of columns from the Barmanns concerning the use of clinical metaphors in the treatment of anxiety disorders.

Click here to read Part One.

Metaphors can often serve as a bridge between our concrete world, and more abstract constructs, such as the emotion of anxiety.

We often refer to those who suffer from anxiety disorders as, “what if” thinkers, who behave in “just in case” scenarios. They have a tendency to overestimate the probability of threat, and the severity level associated with it.

These individuals also UNDERESTIMATE their PERCEIVED ability to cope with danger, should it materialize. The use of metaphors represents a convenient method for helping one to better understand a key concept which lies at the core of anxious arousal — threat appraisal.


“Changing one’s patterns of thinking and behaving involves risk. Those with Obsessive-Compulsive Disorder, as well as other anxiety conditions, do NOT like to take risks.”

What is perceived by one person as threatening, may be viewed by another as challenging. Metaphors related to the manner in which a person comes to view a life experience as threatening, as well as their perceived ability to cope with threat, can be an effective means for generating alternative thought patterns, particularly when they result in anxious apprehension.

Let’s take a look at a few clinical metaphors we often use within our clinical practice. Some of these examples target anxiety in general, while others are best used for addressing specific anxiety conditions:

1. Air-Traffic Trainee Metaphor (for Chronic Worry)

When using this metaphor, the patient is asked to imagine they are working on a flight simulator, as two planes on the screen are rapidly moving within close proximity of one another.

The likelihood of threat is judged as low, due to the simulation nature of this task, resulting in little anxiety. However, compare this same situation when occurring during one’s first real (post-training) assignment.

The likelihood of preventing a crash remains good, yet this time the stakes are much higher. Should a mistake transpire, and the planes collide, hundreds of people will die, therefore significantly increasing the severity of the outcome, and subsequent perceived threat of danger.

Realizing that you have the ability to speak directly to each of the pilots for the purpose of altering their routes, increases your perceived coping resources, and thus lowers the degree of perceived threat.

Thus, the more time one takes to gather additional information and reappraise the situation, probabilities of threat decline, and estimates of one’s ability to cope effectively with potential danger increases.

2. Rocking the Boat (for Panic Disorder)

Those with Panic Disorder frequently misinterpret harmless physical sensations (increased heart rate, dizziness, etc.) as a sign of imminent physical catastrophe (death).

Once these individuals learn how to effectively manage this condition, they have a tendency to prematurely discontinue therapy; explaining that they do not want to “rock the boat.”

What the person means is that after having significantly lowered the frequency of their panic attacks, they remain hesitant that continuing with more challenging sessions might result in losing the gains made to date. Prior to therapy, the patient felt that to rock the boat would result in drowning in a sea of anxiety.

However, by remaining in the boat, nothing is learned about the water (it’s depth, temperature, etc.). Now is the time to rock the boat and be tossed into the water.

Without doing so, the person will never have the chance to walk to shore, get on with life, and enjoy the benefits of no longer being stuck in a boat of panic.

3. Insurance Metaphor (for OCD)

Changing one’s patterns of thinking and behaving involves risk. Those with Obsessive-Compulsive Disorder, as well as other anxiety conditions, do NOT like to take risks.

Following a frightening obsessive thought or image, there is a strong need to perform a specific ritual for the purpose of preventing danger associated with the obsession (death of a loved one).

To not perform the ritual is interpreted as a risk too big to take. The insurance metaphor helps to remind the patient that his or her house insurance policy is designed to deal with risk; but not all risks.

The person is then told that the therapist will offer a policy which will cover ALL risks, however the premium is one million dollars! Due to the cost, the patient refuses to purchase the policy.

As is the case with OCD, rituals are performed to lower risks. Unfortunately, OCD comes with a huge price tag — the cost of the amount of time engaging in rituals (sometimes up to 7 hours/day), feelings of exhaustion, the sense of being held hostage, the impact on relationships and happiness, etc.

The costs continue to rise daily, without ever truly lowering risks, no matter how important they may be.

Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit to learn more.

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