Cognitive Therapy of Anxiety Disorders

212 ASSESSMENT AND INTERVENTION STRATEGIES

for depression (Beck et al., 1979), behavioral experiments are planned, structured expe-

riences designed to provide the client with experiential data for and against threat and

vulnerability appraisals or beliefs. The Oxford Guide to Behavioural Experiments in

Cognitive Therapy, the most comprehensive clinical guide to behavioral experimenta-

tion, offered the following operational definition: “Behavioural experiments are planned

experiential activities, based on experimentation or observation, which are undertaken

by patients in or between cognitive therapy sessions” (Bennett-Levy et al., 2004, p. 8).

They are derived from a cognitive formulation of anxiety, and their main purpose is

to provide new information that can test the validity of dysfunctional beliefs, rein-

force more adaptive beliefs, and verify the cognitive formulation. Based on conceptual

considerations, clinical experience, and some empirical evidence, Bennett-Levy et al.

(2004) make a compelling case for behavioral experimentation as the most powerful

therapeutic strategy available to cognitive therapists for promoting cognitive, affective,

and behavioral change.

In the anxiety disorders empirical hypothesis testing usually involves some form

of exposure to a fear situation and a disconfirmatory manipulation that tests the valid-

ity of the anxious appraisal (D. M. Clark, 1986b; Wells, 1997). The most effective

hypothesis- testing exercises are structured so that the outcome of the experiment can

table 6.3. illustrations of Clients’ Catastrophic, most Desired, and alternative explanations that may be
relevant for the various anxiety Disorders
Anxiety disorder Catastrophic interpretation Desired outcome Alternative interpretation

Panic disorder
(lightheaded,
feelings of unreality)

“I’m losing control, contact

with reality. Maybe I am

going crazy and will have to

be hospitalized.”

“I want to always feel

fully conscious and

aware at any moment.”

“Feelings of unreality and

lightheadedness reflect normal

variations in arousal level that

can be affected by a variety of

internal and external factors.”

Social phobia
(observes signs of
increasing anxiety)

“Everyone will notice that

I’m getting anxious and

wonder what is wrong with

me. I’ll end up making a

fool of myself.”

“I want to always feel

perfectly relaxed and

confident in social

set tings.”

“One can feel anxious and

still perform competently in a

social setting. Whether others

observe my anxiety and draw

negative conclusions can not

be known.”

Generalized anxiety
disorder (worry
about finishing
minor daily tasks)

“I will be so worried about

doing chores and errands

that I’ll be completely

paralyzed and have to be

re-hospitalized.”

“I want full confidence

and certainty that I

will accomplish the

daily goals that I set for

myself.”

“Worry will slow me down

and reduce the amount that

I can get done but it doesn’t

have to lead to complete

paralysis and inactivity.”

Obsessive–
compulsive disorder
(fear of mental
contamination or
morphing)

“If I get too close to people

I feel are weird or different,

I will lose my creative

potential.”

“I prefer to avoid all

contact with people

who are different and

threaten my creativity.”

“My creativity has been

hampered by my OCD rather

than by close proximity

to people I perceive as

undesirable.”

Posttraumatic stress
disorder (reaction to
recurrent assault-
related images)

“My inability to suppress

these images means the

PTSD is so bad I will never

be able to function in life.”

“I desire no unwanted

recollections or

memories of the brutal

assau lt.”

“Everyone who has been

assaulted has to live with

disturbing memories while

minimizing their impact on

daily living.”