Cognitive Therapy of Anxiety Disorders

266 ASSESSMENT AND INTERVENTION STRATEGIES

Clinician Guideline 7.9

Applied relaxation (AR) is an intensive, systematic, and graded relaxation training protocol

that can be effective in the treatment of GAD, although it may be less effective for other anxi-

ety disorders. AR is a viable alternative to cognitive therapy for GAD when the latter may not

be acceptable to a client.

Breathing Retraining

Training in controlled breathing is considered a form of relaxation that is often included
in relaxation procedures for stress and anxiety (e.g., Bourne, 2000; Cautela & Groden,
1978). Individuals often engage in rapid shallow breathing when in anxious or stressful
situations. Controlled breathing procedures train individuals to become more aware of
their dysfunctional breathing and to replace this with a slower, more paced diaphrag-
matic breathing of approximately 8–12 breaths per minute. This slower, deeper rate of
breathing promotes a greater sense of relaxation, thereby reducing the anxious state. It
is a quick and fairly simple intervention strategy that can give anxious individuals a lim-
ited sense of control over their emotional state. Because breathing retraining has been
used most extensively in CBT of panic disorder, further discussion of this procedure is
presented in the next chapter.

Clinician Guideline 7.10

Controlled breathing is a relatively quick and simple relaxation strategy that can be used to

counter the rapid, shallow overbreathing that often contributes to heightened anxiety. In

recent years clinical research has questioned the therapeutic role of controlled breathing,

particularly in the treatment of panic disorder.

summary anD ConClusion

Behavioral interventions play a critical role in cognitive therapy of anxiety disorders. In
fact it is difficult to imagine an effective cognitive treatment for anxiety that does not
include a significant behavioral component. There is a large empirical literature demon-
strating the effectiveness of exposure interventions in the treatment of all types of fear
and anxiety. When utilized as a therapeutic ingredient of cognitive therapy, exposure-
based exercises provide the most powerful forms of corrective information for the faulty
threat and vulnerability appraisals and beliefs that sustain heightened anxiety. Expo-
sure in the form of empirical hypothesis- testing experiments should be a focal point in
all cognitive therapy interventions offered to treat the anxiety disorders.
Greater attention should be given to response prevention and correction of safety-
seeking cognitions and behaviors in cognitive interventions for anxiety (e.g., D. M. Clark
et al., 1999; Salkovskis, Clark, & Gelder, 1996). Without intervention that directly
reduces reliance on safety- seeking cues and coping responses, it is likely that any reduc-
tion in anxiety will be incomplete and place the individual at high risk for relapse.