152 ASSESSMENT AND INTERVENTION STRATEGIES
Cognitive Coping and the Role of Worry
Excessive Worry
We previously argued that worry in highly anxious individuals is an important con-
tributor to the persistence of anxiety because of domination of threat mode activation
(Beck & Clark, 1997; see Chapter 2). It is a detrimental cognitive coping strategy (see
Chapter 3, Hypothesis 10) that is evident in most of the anxiety disorders, especially
GAD. Thus it is important that the nature, extent, and function of worry be assessed
when developing a case formulation for anxiety.
table 5.3. examples of Constructive responses to anxiety that should be assessed as part
of the Case Conceptualization
Constructive response Clinical questions
Spontaneous exposure •• How often does the client deliberately expose himself to anxiety-provoking
situations?
•• How intense and for how long is the anxiety tolerated before escape occurs?
•• Does exposure occur on a regular basis? Are safety cues present or absent?
•• What is the client’s evaluation of the exposure experience? Is it seen as
reducing her anxiety or exacerbating it?
Self-initiated response
prevention
•• How often does the client inhibit responses that are intended to reduce
anxiety (e.g., a compulsive ritual in OCD)?
•• How hard is it to resist the urge to engage in the anxiety-reduction activity?
•• Does resistance occur on a regular basis?
•• How is the attempt to resist the anxiety-reducing activity evaluated? Is the
resistance viewed as making the anxiety worse or better?Relaxation response •• How often does the client engage in progressive muscle relaxation, controlled
breathing, or meditation in response to anxiety?
•• What is the client’s evaluation of the effectiveness of these strategies in
managing anxiety?
•• Is there any evidence that the client is using relaxation as an escape strategy
because of a fear of being anxious? To what extent is relaxation an adaptive
or maladaptive response strategy for anxiety?
Problem-solving
ability
•• Does the client take a problem-solving approach to the source of anxiety?
(e.g., a student worried about exam failure works on improving study skills)
•• What is the perceived effect of these problem-solving attempts on anxiety
level?
•• Are there any weaknesses to the problem-solving strategy that may undermine
its positive effect on anxiety?Realistic threat
reappraisal
•• Does the client engage in any questioning or reappraisal of his initial threat
appraisal, and if so, how effective is this questioning?
•• Can he practice evidence gathering where he seeks out contrary information
that the threat is not as great as initially thought?
•• Does he ever turn to some form of empirical hypothesis testing where he seeks
out experiences to determine if his fears are realistic or exaggerated?Reappraisal of
personal vulnerability
•• Does the client engage in any form of evidence gathering about her ability to
cope with the threat?
•• Can she recall past experiences of successful coping as a means of readjusting
her initial sense of personal vulnerability?
•• Does she deliberately engage in anxiety-provoking activities to test-out her
vulnerability?