Cognitive Interventions for Anxiety 205
Th e r a p i sT: I understand but the more you practice correcting the anxious thoughts and
appraisals, the more automatic the whole process becomes and the better you will
get at using this technique to reduce your anxiety. Would you like to give this a try
with a homework assignment?
cL i e nT: Sure, let’s give it a try.
[Note: If the client had difficulty utilizing evidence gathering in response to in vivo anxi-
ety episodes, the therapist could have the client imagine panic situations and practice
countering the anxiety with contradictory evidence.]
Clinician Guideline 6.9
Teach clients how to gather evidence for and against their appraisals of heightened probabil-
ity and severity of threat related to their anxious concerns. Threat probability and severity
estimates are recalculated solely on the basis of the evidence that is generated. Evidence gath-
ering can be an effective method of challenging exaggerated anxious thinking by encourag-
ing the anxious person to shift from affect-based appraisals (i.e., ex- consequentia reasoning:
“I feel anxious, therefore I must be in danger”) to evidence-based appraisals of a situation.Cost– Benefit Analysis
In anxiety disorders cost– benefit analysis is a particularly versatile and effective inter-
vention because individuals are already focused on the consequences of their thoughts
and feelings. The therapist helps the client consider the question “What is the conse-
quence, the advantages and disadvantages, of holding this particular belief or perspec-
tive in regards to my anxiety?” (see Leahy, 2003). Wells (1997) noted that cost– benefit
analysis can also improve motivation for treatment. After identifying a core anxious
thought, belief, or appraisal, the therapist can pose the following questions:
••“From your experience, what are the immediate and long-term consequences of
embracing this anxious thought?”
••“Are there costs and benefits, or advantages and disadvantages to believing in the
anxious thought?”
••“What immediate and long-term effect does this thinking have on your anxi-
ety?”
••“If you had a different outlook on your anxiety, what would be the costs and
benefits?”The therapist can use the Cost– Benefit Form in Appendix 6.3 to conduct a cost–
benefit analysis on an anxious thought or belief. The anxious thought is first recorded.
Then, using guided discovery, the therapist explores the immediate and long-term
advantages and disadvantages of accepting the anxious thought. Clients are asked to
circle the consequences, both positive and negative, that are really important to them.
Next an alternative way of thinking about the anxious situation is considered and the