Cognitive Therapy of Anxiety Disorders

Cognitive Interventions for Anxiety 185

and severity of threat, the person’s actual ability to cope with the situation, and whether

it is more realistic to assume safety rather than danger. This latter perspective can only

be achieved by helping clients abandon their maladaptive safety- seeking practices and

focus on aspects of the anxious situation that denote safety. Interventions such as cogni-

tive restructuring and empirical hypothesis testing are used to achieve this modification

in anxious thoughts, beliefs, and appraisals.

A focus on the modification of threat appraisals has always been at the heart of

cognitive therapy for anxiety (e.g., D. M. Clark, 1986b; Wells, 1997). Beck et al. (1985,

2005) state that cognitive restructuring teaches clients to replace questions about “why”

they are feeling anxious with “how” they are making themselves feel anxious (i.e.,

appraisals of threat). Recent cognitive behavioral treatment manuals for the anxiety dis-

orders have also emphasized the use of cognitive interventions to modify threat apprais-

table 6.1 illustrative examples of threat, vulnerability, and safety appraisals associated
with the anxiety Disorders

Anxiety
disorders

Threat probability

appraisals

Threat severity

appraisals

Perceived

vulnerability

estimates

Biased safety

estimates

Panic
disorder

“I’m having difficulty

breathing; I’m not

getting enough air.”

“What if I can’t

breathe and suffocate

to death?”

“I can’t handle this

feeling of not being

able to breathe;

it is a terrifying

experience.”

“No one is around

to help me. I’m so

far from a hospital. I

need more oxygen.”

Generalized
anxiety
disorder

“I just know that I’m

going to do poorly in

the job interview.”

“I’ll make such a

fool of myself; the

interviewers will

wonder why I ever

applied for this job.

I’ll never find a good

job.”

“I never interview

well. I become so

anxious that I lose

my concentration and

end up rambling all

over the place.”

“Job interviewers are

just looking for an

excuse to reject you.

Besides they have

already made up their

mind not to hire you

before you start the

inter view.”

Social phobia “People are looking
at me and notice that
I ’m shaky.”

“They’ll wonder

what’s wrong with

me; does she have a

mental illness?”

“I can’t cope

with these social

situations; I get too

an x ious.”

“I can’t conceal my

anxiety from others;

how could anyone not

see that I’m anxious.”

Obsessive–
compulsive
disorder

“I have a terrible

feeling that I didn’t

turn off the stove.”

“If I did leave the

stove burner on, it

could start a fire.”

“I am prone to

making mistakes,

being forgetful, and

so could easily leave

the burner on.”

“I don’t have an

accurate memory of

turning it completely

off. I need to check

and concentrate hard

on whether the knob

is completely off.”

Posttraumatic
stress
disorder

“I have to avoid

situations that remind

me of the trauma

because I will have

intrusive recollections

of what happened to

me.”

“I feel so helpless,

alone, and frightened

when I have these

intrusive thoughts

and memories of the

ambush. It’s almost

as bad as when I was

under fire.”

“I’ve got to stop

having these intrusive

thoughts and

flashbacks of the

ambush. And yet I

can’t control them;

they’ve taken over my

life.”

“The only time I can

forget is when I’m

drinking. There is

no escape from the

memories even when

I’m asleep.”