Cognitive Interventions for Anxiety 187
anxious. In fact clients could be asked to exercise as a behavioral experiment to highlight
their different appraisals of physical sensations (see discussion in next chapter). This
type of normalization highlights the situational nature of anxiety and again emphasizes
the client’s ability to cope with anxiety- related triggers when they occur in nonanxious
situations. It also reinforces the cognitive perspective that anxiety arises from appraisals
rather than the actual stimuli that trigger anxiousness. (E.g., “When you are exercising
and you feel tightness in your chest, you attribute this to physical exertion. You expect
to feel tense while exercising. But when you feel spontaneous chest tightness, you attri-
bute this to a possible impending heart attack. You tell yourself something is wrong,
this shouldn’t be happening. So when exercising you interpret chest tightness in a way
that results in no anxiety, whereas when the chest tightness arises unexpectedly, you
interpret the sensations in another way that leads to anxiousness, even panic.”)
Normalizing fear and anxiety is an important objective in cognitive therapy of
anxiety. It not only reinforces the focus on threat appraisals as the source of anxiety, but
it produces a more optimistic attitude toward overcoming anxiety. Clients are reminded
that very often they react to threat in a nonanxious, even courageous manner. As Rach-
man (2006) recently noted, “In specifiable circumstances virtually everyone, including
patients suffering from anxiety disorders, can behave courageously” (p. 7). In cognitive
therapy we remind clients that they often “turn off the fear program” in a variety of
situations not related to their anxiety disorder. The goal of treatment, then, is to build
on their own natural abilities to overcome fear and apply these resources to the anxiety
disorder.
Clinician Guideline 6.4
Normalization of fear and anxiety, an important element of cognitive therapy, is achieved by
emphasizing the universality of threat, the client’s past experiences with anxious cues, and
the situational or variable nature of anxious triggers.Strengthen Personal Efficacy
In cognitive therapy therapeutic interventions do not focus only on modifying faulty
threat appraisals but also on correcting erroneous beliefs about personal vulnerability
and perceived inability to deal with one’s anxious concerns. The cognitive therapist
can construct the client’s vulnerability perspective from the first apprehensive thoughts,
automatic defensive responses, coping strategies, and worries identified in the cognitive
case conceptualization. An important theme that runs throughout the course of treat-
ment is “You’re stronger than you think” when it comes to dealing with the anxious
concerns. Building a greater sense of self- efficacy (i.e., Bandura, 1977, 1989) by struc-
turing experiences and highlighting information that reinforces perceived control or
mastery of the anxiety- related threat are critical elements in cognitive therapy of anxiety
that will help clients override the threat- schema activation.
During cognitive restructuring and empirical hypothesis- testing exercises the cog-
nitive therapist emphasizes the difference between an initial vulnerability estimate and