Anxiety Cognitive Formulation: Facing Fears in Finding Nemo

We’re continuing the theme of CBT formulations with this month’s Psy Fiction post… with a little help from a Disney Pixar classic, Finding Nemo! We’re diving into one of the longitudinal CBT formulations for anxiety, starring Nemo’s dad Marlin as our ‘case study’! Being a parent is a tough gig… and it seems being a Clown Fish is no exception… so let’s explore this dad’s anxiety a bit further…

CBT Formulation Model for Anxiety

What is anxiety?

Anxiety is a normal adaptive response. It is what we feel when we are worried, tense or afraid – particularly about things that are about to happen, or which we think could happen in the future (Mind).

Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about starting a new school, having job interview, or being told that you are going to be Darla’s new pet…

During times like these, feeling anxious can be perfectly normal. But some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives. (NHS)

Characteristics of anxiety can include restlessness, trembling, poor concentration, sweating, heart palpitations, shortness of breath, sleep difficulties, and irritability. These responses can be attributed to the body’s ‘fight or flight’ response. (If this is a new topic and you want more details on the symptoms of anxiety, you can find this from Mind here.)

Anxiety is considered a mental health issue when:

• the anxiety level exceeds the reality of potential danger
• it features excessive fear, vigilance in preparing for perceived danger, and/or lasts for a long time
• it results in negative behavioural changes such as avoidance e.g. avoiding situations that make you anxious.
• it causes significant distress and negatively impacts one’s day-to-day life

What is the cognitive formulation model for anxiety?

This post is going to focus on a longitudinal formulation model for anxiety.

As already mentioned, there are lots of different formulation models for different presentations. For anxiety, there are ‘problem-specific’ CBT formulation models which focus on specific forms of anxiety – some of which we have already covered in Psy Fiction e.g. for Iron Man’s Panic or Harry Potter’s PTSD.

We have also covered the general Longitudinal Formulation in a previous Game of Thrones post, which was originally developed for individuals with depression. In contrast, the present formulation model is a specific longitudinal formulation model for anxiety, developed by Beck (2005) and Wells (1997… no relation to moi…):

This cognitive theory of anxiety suggests that anxiety stems from having maladaptive ‘schemas‘ which develop through early life experiences. These schemas are similar to ‘core beliefs’ which have been discussed in a previous post. Schemas can be seen as the cognitive frameworks which we develop to help us to understand the world.

The model suggests that individuals who suffer from elevated anxiety are likely to have schemas which focus on danger, i.e. they interpret life experiences through a lens of expecting the world to be dangerous. These maladaptive ‘danger schemas’ are activated by ‘critical incidents’, which are trigger incidents that reflect dangerous situations, e.g. being approached by Bruce the shark asking you to come to his party, may trigger your ‘danger schema’….

In this theory, when danger schemas are activated by critical incidents, it triggers ‘negative automatic thoughts’ (NATs – these are discussed in more detail in the previous Shrek post). These are surface level cognitions, which represent the core underlying ‘danger schemas’.

Schema activation also introduces ‘cognitive biases’ in information processing. Thus, events are interpreted in a way that is consistent with the schema, resulting in negative beliefs and appraisals being maintained. Examples of cognitive distortions include ‘overgeneralisation’, where a conclusion based on an isolated event is applied to all situations, and ‘catastrophizing’ which involves predicting the worst possible outcome of a situation.

This can result in both Fight or Flight driven physiological anxiety symptoms (e.g. feeling faint or rapid breathing) and behavioural responses to reduce danger (e.g. safety behaviours and avoidance). Although these reduce feelings of anxiety in the short term, it can prevent challenging the danger schemas and NATs, which maintains the anxiety symptoms.

This model underpins Cognitive Behavioural Therapy (CBT) for anxiety.

Marlin’s Anxiety Formulation

We’re focusing our formulation on the start of the movie, where we get a glimpse of Marlin’s past experiences, examples of his anxious thoughts, as well as the anxiety provoking situation of his son Nemo starting school for the first time. If you haven’t seen Finding Nemo or struggling to remember the details – here’s a few snippets for some context!

Marlin can come across as a bit of an anti-social and irritable ol’ clown fish, whose over-protectiveness can be annoying to others, particularly Nemo! Marlin sometimes comes across as a bit of a know-it-all about the ocean to his son, and doesn’t allow Nemo any independence. One could therefore jump to conclusions and think that this is just Marlin’s personality and he’s not doing very well at this parenting lark… but maybe we can use formulation to delve a bit deeper to understand his behaviour in a different way…?

*Remember! Formulation is moving away from “what’s wrong with you” to “what happened to you and how are you coping with those experiences?”

Cognitive Model of Anxiety applied to Marlin

This formulation demonstrates how Marlin’s early life experiences lead to the development of his ‘danger schemas’, predisposing him to elevated levels of anxiety. These danger schemas are activated during ‘critical incidents’ which may include reminders of past experiences. In this case, Nemo starting school is triggering as it means Marlin will have to leave Nemo alone and therefore not be around to protect him 24/7 as before. Then, the school trip to the drop-off significantly triggers his danger schemas and subsequent anxiety symptoms, as this is a clear reminder of his past experiences.

We see that Marlin generally has many anxious tendencies earlier in the film. For example, he displays compulsive behaviours going in and out of his home to check for danger. He also panics when Nemo falls out the anemone and gets stuck, worrying he has been significantly harmed. You can also see his tendency towards avoidance, saying to Nemo he doesn’t have to go to school (for 5 or 6 years….). All of these anxiety characteristics are then escalated after the critical incidents.

When Marlin sees Nemo at the drop-off, we see a flurry of NATs arising. These are all in line with the cognitive distortions. This negative thinking would then lead to Marlin experiencing physical anxiety symptoms, such as heart palpitations*. We then see Marlin’s behaviour change in response to these difficult feelings, e.g. being more snappy and irritable towards others. He also engages in many safety behaviours, such as avoidance and over-protectiveness. All these feedback into negative thinking styles, leaving his NATs and danger schemas unchallenged.

*I am using some artistic license here as these symptoms are not mentioned in the film but these are common anxiety responses Marlin was likely to be experiencing… although full disclosure I have no knowledge about the neurobiological fear responses of fish… but we are referring to talking fish so maybe we can suspend our belief just this once!

So… is this the whole story?

The above formulation is great at understanding where someone’s anxiety comes from, when it is most likely to be triggered, and how that links to their experience of anxiety in certain situations. It also highlights some of the cycles which maintain the anxiety. The bit which is perhaps missing from the boxes above, is the role of others in anxiety maintenance, as well as the impact someone’s anxiety has on others.

For example, the anxiety-fuelled way in which Marlin responds to Nemo whilst at the Drop-Off, actually contributes to his son swimming away and getting caught. So in a way – in trying to avoid Nemo coming to any harm, Marlin’s over-protective behaviour ends up resulting in his worst fear becoming realised! This can be understood in a simple ‘self-fulfilling prophecy’ formulation model maintenance cycle (Westbrook, Kennerly & Kirk):

For this case, you could therefore use a combination of longitudinal formulation models, as well as using a simple maintenance cycle along side this, in order to fully understand an individual’s anxiety.

Finding Nemo = the best anxiety intervention

Hopefully this formulation helps to more fully understanding Marlin’s “anti-social”, irritable and over-protective behaviour through a more compassionate lens. At the core he wants his son to be safe – but unfortunately, unintentionally his anxiety and safety behaviours push people away and end up confirming his worst fear!

Marlin’s story in Finding Nemo in a way continues along the CBT theme; at each stage in his journey to find Nemo, he engages in exposure to anxiety-provoking situations, he undertakes ‘behavioural experiments’ which show him not everything is as dangerous as he predicts, and he meets others who help to challenge his NATs and danger schemas!

So in the end… Marlin facing and overcoming his anxiety, with a little help from some pals, means he can swim across the ocean and save Nemo! Dad of the Year or what!

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Will be back soon with our next famous formulation. But for now…

That’s all folks!

I would love for you to stay in touch!

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Which star of the silver screen would you like to see a formulation for in the future?

Let me know in the comments below!

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References and additional information:

• Anxiety disorders and phobias : a cognitive perspective, Beck, Emery and Greenberg (2005)
• Cognitive Therapy of Anxiety Disorders: A Practice Manual And Conceptual Guide, Adrian Wells (1997)
• An introduction to Cognitive Behavioural Therapy: Skills and Applications, by David Westbrook, Helen Kennerley and Joan Kirk (2011)
• Safety Behaviours – Information sheet from Get Self Help
• Fight or Flight – Information Sheet from Therapist Aid
• About Anxiety – Mind Charity
• CBT Formulation models – Presentation by Think CBT

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Disclaimer: All original Finding Nemo image and video rights belong to Disney Pixar. Shrek image rights belong to DreamWorks Animation. Other images are referenced. Images and reference to the original films are used in this blog post in the understanding that it falls under ‘fair use’. This is due to the images and reference to the films being used in the context of a commentary/critique of the original material for educational purposes. To my knowledge, the use of images in this post do not deny the owner of income and they are not being used in this context for monetary gain of the user.

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