Cognitive Interventions for Anxiety 189
Clinician Guideline 6.5
The therapist focuses on correcting low perceived self- efficacy for anxiety by pointing out
how a discrepancy between predicted ability to cope and actual past outcomes contributes
to anxiety. In addition the therapist adopts a problem- solving approach to expand the cli-
ent’s repertoire of adaptive coping resources and to foster positive experiences to enhance
self- efficacy.Adaptive Approach to Safety
In Chapter 3 we reviewed empirical research indicating that safety- seeking thoughts,
beliefs, and behaviors are important contributors to anxiety. Consequently dealing with
safety- seeking issues is an important theme in CT for anxiety. Three aspects of safety
seeking should be considered in treatment.
Faulty Risk Appraisals
Salkovskis (1996a) noted that threat appraisal that leads to safety seeking is a bal-
ance between the perceived probability and severity of threat, on the one hand, and
coping ability and perceived rescue factors, on the other. Kozak, Foa, and McCarthy
(1988) commented that in OCD danger is assumed unless there is evidence for complete
safety whereas the opposite viewpoint prevails in nonanxious states in which safety is
assumed unless there is valid evidence of danger. The person with panic disorder may
find heart rate increases too risky, or the person with OCD might be convinced that any
observable dirt is a harbinger of disease and destruction. This strategy will confirm the
patient’s fear while disconfirming safety evidence is overlooked.
An important goal of cognitive therapy is to investigate with clients whether they
hold faulty appraisals and assumptions about risk. What, then, constitutes “an accept-
able level of risk”? “Can one eliminate all possibility of risk?” “What effect does this
have on a person’s life?” “Do nonanxious people live with risk”? “How successful have
you been at eliminating all risk and at what cost to you?” These are questions that the
cognitive therapist explores with clients when reviewing their self- monitoring diaries in
an effort to correct maladaptive risk appraisal.
Enhance Safety- Seeking Processing
There are many aspects of anxious situations that signal safety rather than threat, but
the anxious person often misses this information. When reviewing homework assign-
ments, attention can be drawn to safety elements that the client may have ignored or
minimized. Furthermore, anxious clients can be asked to intentionally record any safety
information conveyed in an anxious situation. This safety information can be contrasted
with threat information in order to generate a more realistic reappraisal of the magni-
tude of the risk associated with a particular situation. Throughout treatment the cog-
nitive therapist must be vigilant for biases that minimize safety and maximize threat,
thereby resulting in a threat- oriented information processing bias.