Today we are going to talk about managing emotions and anxiety through the ACARA system. This technique is usually explained in the third session to anxious patients.


In your sessions, you need to establish a dialogue with your patients. Dr. Malbos suggests starting this session by asking a question: what is an acronym?

An acronym is a word made up of letters and each of its letters refers to a particular word. In our case, each of the letters is in fact a technique that you will teach to your patients.



This is the key point of the whole therapy. Your patients must realize that anxiety is paradoxical. That is, the more they want to control the anxiety, the more it will increase. This is related to the fact that many of your patients are obsessed with the idea of control. They want to control themselves, control their emotions, control their anxiety, control others, control events…etc. But, as you already know, not everything is controllable and sometimes you have to let go. 

The point is that your patients need to understand that they can’t control their anxiety. And that the more they try to control it, the more it will increase. Your patients must make the choice to accept the anxiety. To accept the fact that their hands are sweaty, to accept the increase in their heart rate, telling themselves that the anxiety is there to protect them and that it’s not dangerous.

You have to let the anxiety come, let it be there and let it go. You can put your patients in a situation so that they assimilate this acceptance of anxiety. Tell them that they have to imagine themselves in the street with a young girl having a panic attack in front of them. What will your patients say to this young girl? Ask them. Many patients will probably say, “Calm down, everything is fine,” and they will be wrong! “Calm down” is an appeal to control, which should be avoided if you don’t want to make the situation worse. It is better to say to this girl, “I understand how you feel. Sit down if you want, I’ll stand by you. It’s going to be okay and it’s going to pass.”. This example of the young girl is exactly what patients need to do for themselves. 



If it rains today, will you be able to control the weather or will you accept the weather as it is? A person who is in resistance is going to brace himself, resist and will therefore suffer. Whereas a person who accepts the bad weather will enjoy his day with an umbrella on his head.

Another example of acceptability to avoid suffering is panic surfing. If anxiety was a six-foot Australian wave coming at you, would you stand up to it? No, if you care about your survival at all, you will dive under it and let it pass over your head.



When your patients are anxious, they should measure their anxiety from 0 to 100. “A noisy subway station, sweaty hands, train doors closing behind me, the subway full of people, difficulty breathing: my anxiety level is at 60.” With these measurements, your patient will become aware that anxiety is always temporary. It rises, stagnates, and falls again.



When the patient is anxious, he or she must continue to do what they were doing. Continue washing dishes at the sight of a spider, continue walking to an auditorium. Of course, your patient has the right to move slightly away from the sink or walk more slowly toward the crowd, but he or she should not stop what he or she was doing. Doing relaxation exercises to calm that anxiety is also taking action!

You can’t control your emotions and you can’t really control your thoughts. So ask your patients what is the one thing they can control? It’s behavior, in other words, gestures, actions. Even if your patients are anxious, if they want to keep moving towards the auditorium, physically, they can. Anxiety doesn’t cause as much chaos as they think it does.



There are two rules for your patients. The first is that when they are anxious, they should only do one thing at a time. This avoids distraction, which is not effective in the long run. When we drive, we only look at the road, we concentrate on each of our actions. We don’t talk to the passenger. Yes, it may calm the driver in the short term but not in the long term.



When your patient is in an anxiety-provoking situation, ask them to slow down and break down their every move. Slowing down lowers anxiety and brings back calm. Conversely, rushing will make the anxiety worse.



Your patient simply needs to repeat the steps we just explained. They have to accept the anxiety, that is, not face it. The anxiety is not dangerous, it will pass, I just have to dive under the wave. They must then contemplate the anxiety. That is, measure it and finally realize that it is only temporary. Then they have to act on that anxiety. We only have control over our actions. By slowing them down and jerking them around, I don’t make my anxiety worse.



This is the last letter of this ACARA technique. “Wait for the best” means that your patient should wait for the best. Since his catastrophic thoughts are not realistic (the plane is going to crash, the dog is going to bite me, I’m going to stay locked in the subway, I’m never going to get out of this elevator…etc.) they will never come true. Your patient can only expect the best, that is, what is realistic.

To make sure that your patients do not forget the ACARA method, Dr. Malbos advises them to write it down on a piece of paper and put it in their wallet. That way, if they get into a frightening situation and lose their nerve, they will always have this little card with them.


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