Cognitive Interventions for Anxiety 201
ering, cost– benefit analysis, decatastrophizing, identifying cognitive errors, generating
alternatives, and empirical hypothesis testing.
Evidence Gathering
This intervention involves questioning clients on the evidence for and against their belief
that a threat is highly probable and will lead to severe consequences. Evidence gather-
ing is the sine qua non of cognitive restructuring (Beck et al., 1979, 1985, 2005) and
has been variously labeled verbal disputation, logical persuasion, or verbal reattribution
(Wells, 1997). After identifying a core anxious thought or belief and obtaining a belief
rating on the thought, the therapist asks the following questions:
••“At the time when you are most anxious, what is happening that convinces you
the threat is highly likely to occur? Is there any evidence to the contrary, that is,
that the threat is not likely to occur?”
••“When you are feeling most anxious, what evidence is there that the outcome will
be so serious? Is there any contradictory evidence that the outcome may not be as
bad as you are thinking?”
••“What makes the evidence for your anxious thinking believable?”
••“Do you think you might be exaggerating the probability and severity of the
outcome?”
••“Based on the evidence, what is a more realistic or likely estimate of the prob-
ability and severity of the worst that might happen?”Appendix 6.2 provides an evidence- gathering form that can be used with clients.
The therapist and client first write down the primary anxious thought or belief that
characterizes an anxious episode. The client then provides probability and severity esti-
mates based on how he feels during anxiety episodes. Using the Socratic form of ques-
tioning, the therapist probes for any evidence that supports such a high probability and
severity estimate of outcome. Although Appendix 6.2 is limited to six entries, additional
pages may be necessary to fully document the evidence supporting the anxious thought
or belief. After writing down all the supporting evidence, the therapist then asks for evi-
dence that suggests the probability and severity estimates may be exaggerated. Normally
the therapist has to take more initiative in suggesting possible contradictory evidence
because anxious individuals often have difficulty seeing their anxiety from this perspec-
tive. Once all the evidence against the anxious thought or belief has been recorded the
client is asked to rerate the likelihood and severity of the outcome based solely on the
evidence.
Individuals will sometimes protest, saying “Yes, but when I’m anxious it feels like
the worst is going to happen even though I know it probably won’t happen.” The cogni-
tive therapist should remind the client that “evidence gathering” is simply one approach
out of many that can be used to deactivate anxiety. Whenever the client feels anxious,
what has been learned from evidence gathering can be used to lower threat probability
and severity appraisals to a more realistic level, thereby countering a major factor in the
escalation of subjective anxiety. The following clinical example illustrates an evidence-
gathering approach with a 27-year-old traveling salesperson who suffered from panic
disorder and mild agoraphobic avoidance.