Cognitive Interventions for Anxiety 203
yet it doesn’t help makes me convinced something is terribly wrong. If all of this was
just bad nerves, shouldn’t it go away when I breathe more slowly?Th e r a p i sT: Okay, a third piece of evidence for the anxious thinking is “controlled
breathing doesn’t make the suffocation feelings disappear.” Is there anything else?
cL i e nT: As I mentioned previously, I have very vivid memories of my uncle grasping for
breath. He had a long battle with emphysema which in the final stage of the disease
left him unable to breathe. It was a most horrifying way to die.
Th e r a p i sT: So the fourth evidence for the anxious thought is “memories of an uncle
who eventually died from suffocation because of emphysema.” Is there any other
evidence for your anxious thoughts about suffocation?
cL i e nT: No, that pretty well covers it.
Th e r a p i sT: Now let’s look for evidence that does not support the view that you are at
high risk of dying from suffocation. Can you think of any?
cL i e nT: This is much harder to do. Huh.... I suppose one thing is that I haven’t died yet.
I mean I’ve had these suffocation feelings for months and yet I’m still here.
Th e r a p i sT: Have you come close to death? For example, did you ever almost pass out,
turn blue, or were paramedics ever called to provide you with oxygen?
cL i e nT: No nothing like that. I’ve never had any tangible signs that I’m dying from suf-
focation.
Th e r a p i sT: Let’s write that down as evidence against your anxious thought on this first
line in the right-hand column of the form: “I’ve never experienced any tangible
medical signs that I am dying from lack of oxygen.” Can you think of anything
else?
cL i e nT: Well, my family doctor has ordered various medical tests and I have seen spe-
cialists but they all say I am healthy. They say my respiration system is fine.
Th e r a p i sT: So a second piece of evidence against the anxious thought is that “I am
physically very healthy as far as can be determined by medical science.” Is there
any other evidence?
cL i e nT: I can’t think of any.
Th e r a p i sT: Well, how hard is it to stop breathing? How long can you hold your breath?
Let’s try it. [Therapist times client on length of breath holding.]
cL i e nT: That was really hard, even though I tried not to breathe, eventually I couldn’t
help myself. I had to breathe.
Th e r a p i sT: Exactly, breathing is an automatic response. It is very difficult to stop
breathing, even when you try your very best. Because breathing is such an auto-
matic physiological response, people rarely just stop breathing spontaneously for no
apparent reason. Have you ever heard of that happening to someone?
cL i e nT: No, I haven’t.
Th e r a p i sT: So let’s write that down as the third piece of evidence against your anxious
suffocation thought: “Breathing is such an automatic physiological response it is
exceedingly rare to suddenly, unexpectedly stop breathing for no apparent rea-
son.” Can you think of any other contrary evidence?