Cognitive Interventions for Anxiety 209
if her heart rate was too high. After a number of sessions involving education and less
threatening interventions that focused on her misinterpretation of an accelerated heart
rate, Josie agreed to engage in an imaginal exposure exercise in which she imagined an
accelerated pulse rate that led to a severe heart attack in which she is lying on the ground
grasping her chest, alone and dying. After an extensive evidence- gathering exercise in
which the client and the therapist were able to examine evidence on whether the prob-
ability and severity of the catastrophic outcome was exaggerated or not, an alternative
negative outcome was considered. Josie decided that a more likely very negative outcome
might be chest tightness, a racing heart, followed by severe chest pain. She rushes to an
emergency room and finds out she has had a mild heart attack. An action plan was then
developed on how she would manage the rest of her life knowing that she has a heart
condition. Josie was encouraged to work on the “mild heart attack” plan whenever
she started to catastrophize. Notice that the purpose of this intervention was to reduce
Josie’s fear (and catastrophizing) about heart disease and to increase her perceived abil-
ity to cope if this situation ever occurred.
Clinician Guideline 6.11
Decatastrophizing involves the identification of the “worst-case scenario” associated with an
anxious concern, the evaluation of the likelihood of this scenario, and then the construction
of a more likely moderate distressing outcome. Problem solving is used to develop a plan for
dealing with the more probable negative outcome.Identifying Thinking Errors
Teaching anxious clients to become more aware of the cognitive errors they tend to make
when feeling anxious is another useful strategy in the modification of faulty apprais-
als of anxiety. Highlighting the errors in one’s thinking style reinforces the message to
clients that threat perceptions are inaccurate when people are highly anxious. It encour-
ages a more critical, questioning approach to one’s anxious thinking. Thus it is impor-
tant that clients understand the rationale for identifying and then correcting cognitive
errors. The therapist could use the following explanation:
“Although everyone engages in these erroneous thinking styles from time to time,
these errors are particularly prominent when we are anxious. When we commit
these errors in our thinking they tend to lead to more exaggerated and biased con-
clusions. For example, if I always focused only on the flaws or mistakes in a talk
whenever I gave a public address (tunnel vision error), I would end up concluding
that the talk was terrible and I was a dismal failure. The same thing happens when
we commit these cognitive errors when we’re feeling anxious. They lead us to exag-
gerated and false conclusions about the threat or danger in a situation and our
inability to cope. So learning to identify these errors and correct them is an impor-
tant intervention for reducing anxious thoughts and feelings.”Clients can be given a copy of Appendix 5.6 in order to familiarize themselves with
the six forms of cognitive errors that are common in anxiety: catastrophizing, jumping