18 4 ASSESSMENT AND INTERVENTION STRATEGIES
cL i e nT: Well, I don’t really know. I always thought that what made me anxious is that
I tend to say stupid things when I’m around people.
Th e r a p i sT: Let’s see if we can find out more about this. For a homework assignment,
do you have some close friends or family you could ask about whether they have
ever had concerns about saying something stupid in a public setting? It would be
interesting to find out how they appraise or think about these situations that results
in not feeling anxious.
cL i e nT: Yes, I could do that.
Th e r a p i sT: Great! So let’s see whether the way we appraise or think about situations
(e.g., “I will probably say something stupid and everyone will think I’m an idiot”)
is an important cause of anxiety or not. If these appraisals are important, then we
will want to change them as part of our treatment for social anxiety.
Clinician Guideline 6.2
A key element of cognitive therapy of anxiety is teaching clients that the source of persis-
tent anxiety is their biased appraisals of threat. The success of other cognitive interventions
depends on clients’ acceptance of this cognitive or information- processing formulation of
a n x ie t y.Modify Biased Threat, Vulnerability, and Safety Appraisals and Beliefs
In cognitive therapy of anxiety the main objective of cognitive interventions is to modify
overestimated appraisals of threat and personal vulnerability related to the primary
anxious concern as well as change the client’s perspective on the safety aspects of the
situation. Cognitive interventions tend to focus on four key elements of faulty cogni-
tion.
••Probability estimates: What is the perceived threat or danger? Is the client gener-
ating an exaggerated probability estimate of the threat or danger?
••Severity estimates: Is there a biased evaluation of the severity of the perceived
outcome or consequence of the threat?
••Vulnerability estimates: What is the level of perceived personal vulnerability
when in the anxious situation? To what extent are the client’s perceived weak-
nesses exaggerated when anxious?
••Safety estimates: What safety information is being ignored or undervalued, result-
ing in a downgraded estimate of perceived safety in the anxious situation?The faulty appraisals of threat and vulnerability are evident in the automatic appre-
hensive thoughts or images, misinterpretations of physiological arousal, cognitive errors,
dysfunctional defenses and coping strategies, and primary worry symptoms identified in
the case conceptualization (see Appendix 5.11). Table 6.1 illustrates typical appraisals
that are associated with the anxiety disorders.
Once the biased appraisals have been well articulated in therapy, the goal of cogni-
tive interventions is to arrive at a more balanced, realistic appraisal of the probability