182 ASSESSMENT AND INTERVENTION STRATEGIES
acceptable threat and perceived ability to cope. There are six main objectives of cogni-
tive interventions for anxiety.
Shift Threat Focus
One of the first objectives of cognitive interventions is to shift the client’s focus away
from an internal or external situation or stimulus as the cause of fear and anxiety. Most
individuals with an anxiety disorder enter therapy believing that the cause of their anx-
iousness is the situation that triggers their anxious episodes. For example, individuals
with panic disorder believe they are anxious because they have chest pain that could
result in a heart attack, whereas individuals with GAD believe the cause of their anxiety
is the real possibility of negative life experiences in the near future. As a result of this
belief, anxious individuals seek interventions that will alleviate what they consider the
source of the anxiety. The person with panic disorder seeks to eliminate chest pain,
thereby removing the possibility of a heart attack, whereas the person with social pho-
bia may look for signs that he is not being negatively evaluated. One of the first tasks in
cognitive therapy is to guide clients into an acknowledgment that the situational triggers
and perceived possibilities of terrible outcomes is not the cause of their anxiety. This
is accomplished through the cognitive restructuring and empirical hypothesis- testing
interventions that are discussed below.
It is critical that the cognitive therapist avoid any attempt to verbally persuade anx-
ious clients against their anxious threat. This warning against trying to verbally modify
threat content was emphasized by Salkovskis (1985, 1989) for treatment of obsessions.
Thus the therapist must not engage in verbal debates about the possibility of having a
heart attack, suffocating, contaminating others with a deadly germ, making a mistake,
being negatively evaluated in a social setting, being the victim of another assault, or
experiencing some negative outcome in the future. After all, any clever arguments that
can be concocted by the therapist will be immediately dismissed by the client because
mistakes do happen, people can become the victim of disease by contamination, and
even the occasional young person dies from a heart attack. The reality is that threat can
never be eliminated entirely. At best such persuasive debates will only amount to reas-
surance that provides temporary relief from anxiety and at worst the client’s outright
dismissal of the effectiveness of cognitive therapy. Thus it is critical to the success of
cognitive therapy that therapy avoids a direct focus on the client’s threat content.
Clinician Guideline 6.1
Avoid any attempt to use logical persuasion to directly target primary threat content. Such
attempts will undermine the effectiveness of cognitive therapy and result in the persistence
of the anxious state.Focus on Appraisals and Beliefs
The cognitive perspective views anxiety in terms of an information- processing system
that exaggerates the probability and severity of threat, minimizes personal ability to
cope, and fails to recognize aspects of safety (i.e., Rachman, 2006). An important objec-