220 ASSESSMENT AND INTERVENTION STRATEGIES
ious thoughts have been identified, the therapist can probe for metacognitive processes
in the following way.
••“When you have this anxious thought (e.g., ‘I’m going to completely blow this
job interview and never find decent work’), what makes this a significant or a
threatening thought for you?”
••“Are you concerned about any negative consequences from having such
thoughts?”
••“Why do you think you keep having these thoughts?”
••“Is it possible to get control over them? If so, which control strategies work and
which ones don’t work for you?”Notice that this line of questioning focuses on how the individual appraises the
experience of having anxious thoughts. In the present example, the client may indicate
that he is concerned that having such anxious thoughts before the interview might make
him even more anxious and more likely to perform poorly. A prominent metacognitive
belief might be “Thinking you’ll blow the interview makes it more likely you won’t get
the job” and “It’s critical to get control of this thinking in order to have a good job inter-
view.” Once such metacognitive beliefs and appraisals have been identified, assessment
should focus on the actual mental control strategies that an individual might employ to
shift attention away from the anxious thinking.
Metacognitive Intervention
Having identified the key metacognitive appraisals and beliefs that characterize the anx-
ious state, the cognitive therapist can employ standard cognitive restructuring strategies
to modify this cognitive phenomenon. Strategies such as evidence gathering, cost– benefit
analysis, decatastrophizing, and empirical hypothesis testing can be used to change
metacognitive processes. The difference is not in the interventions but rather in what
is targeted for change. In our previous discussion these cognitive strategies were used
to directly modify the exaggerated threat and vulnerability appraisals that character-
ize anxious states. In the present discussion these same intervention strategies are used
to modify “thinking about thinking,” that is, the appraisals and beliefs about thought
processes.
To illustrate, an anxious client believes “If I keep thinking I am going to have a car
accident, I’m afraid this way of thinking will actually cause it to happen” (i.e., thought–
action fusion). As a cognitive intervention the client could be asked to examine the
evidence that motor vehicle accidents are caused by anxious thoughts. Inductive reason-
ing could be used to explore how a thought can lead to a physical catastrophe like a
serious motor vehicle accident. A behavioral exercise could be set up in which the client
observes the effects of such thoughts on her driving behavior or that of other motorists.
A survey could be taken among friends, family, and work associates to determine how
many people thought they would have an accident and then experienced a serious car
accident. These cognitive interventions would focus on modifying the metacognitive
appraisals of significance associated with the “accident premonition” so that the indi-
vidual begins to interpret such thinking in a more benign fashion such as “the product
of a highly cautious driver.”