14 8 ASSESSMENT AND INTERVENTION STRATEGIES
- How does the individual’s more elaborative reappraisal of the situation lead to
an increase in anxiety? - How effective is the individual’s reflective reappraisal in reducing or terminating
the anxiety program?
Assessment of secondary reappraisal is not as difficult as assessment of the imme-
diate fear response because these processes are less automatic and so more amenable
to conscious awareness. Individuals tend to have more insight into these slower, more
deliberate processes that are responsible for the persistence of anxiety. Because cogni-
tive therapy tends to focus on this secondary level, an accurate assessment of elaborative
processes is critical to the success of the intervention. In this section we examine five
domains of secondary processing that should be included in the assessment.
Evaluation of Coping Abilities
Reliance on maladaptive coping strategies and failure to adopt healthier responses to
threat are considered key factors in failed emotional processing in general and the per-
sistence of anxiety in particular (e.g., Beck et al., 1985, 2005; Wells, 2000). One of
the most common distinctions in the coping literature is between strategies that focus
on emotion regulation versus those that focus directly on life problems. Lazarus and
Folkman (1984) originally defined emotion- focused coping as “directed at regulating
emotional response to the problem” (p. 150) and problem- focused coping as “directed
at managing or altering the problem causing the distress” (p. 150). There is now a large
body of research indicating that certain aspects of emotion- focused coping (e.g., rumi-
nation) are related to the persistence of negative emotional states, whereas problem-
focused coping is associated with reduction in negative affect and the promotion of posi-
tive emotion and well-being (e.g., Carver, Scheier, & Weintraub, 1989; see reviews by
Fields & Prinz, 1997; Folkman & Moskowitz, 2004; for discussion of positive aspects
of emotion expression, see Austenfeld & Stanton, 2004 ).
In the present context this distinction between an emotion- and a problem- focused
approach is useful in understanding the persistence of anxiety. Coping responses that
focus on “how can I make myself feel less anxious” are more self- defeating (i.e., lead
to persistence of unwanted anxiousness), whereas coping that is more problem- oriented
(i.e., “I have a real life problem that I must address” ) is more likely to lead to a reduc-
tion in anxiety.
The cognitive therapist should keep this distinction in mind when assessing the cop-
ing responses of anxious clients. To what extent is the client’s coping repertoire domi-
nated by emotion- focused versus problem- oriented strategies? In addition three other
questions on coping must be addressed in the assessment:
- How often does an individual use various maladaptive and adaptive coping
responses when feeling anxious? - What is the client’s perception on the effectiveness of the coping strategies in
reducing anxiety? - Does the client perceive that an increase or persistence of anxiety is associated
with the coping response?