Cognitive Therapy of Anxiety Disorders

190 ASSESSMENT AND INTERVENTION STRATEGIES

Dysfunctional Avoidance and Safety- Seeking Behavior

An important objective in cognitive therapy for anxiety is the identification and subse-
quent correction of avoidance and maladaptive safety- seeking behavior that contributes
to the persistence of anxiety. As noted in the cognitive case conceptualization, these
safety- seeking strategies can be cognitive or behavioral in nature. For example, clients
with panic disorder might use controlled breathing whenever feeling breathless in order
to avert a panic attack, or the person with social anxiety may avoid eye contact in social
interactions.
Often safety- seeking responses have been built up over many years and may occur
quite automatically. In such cases one can not expect the client to immediately cease
the safety- seeking behavior. Instead the cognitive therapist should challenge the safety-
seeking gradually, first working with the client to understand the role of such behavior
in the persistence of anxiety. Once the client acknowledges its deleterious effects, then
the maladaptive coping can be gradually phased out and substituted with more positive
adaptive strategies. It is likely that this process may have to be repeated a number of
times for anxious clients with multiple avoidant and safety- seeking responses.

Clinician Guideline 6.6

The clinician must address faulty risk appraisals, inhibited processing of safety cues, and

maladaptive avoidant and safety- seeking responses throughout the course of cognitive

therapy of anxiety disorders. Gradually phase out maladaptive safety- seeking responses and

replace them with alternative, more adaptive strategies over an extended period of time.

Cognitive intervention strategies

In this section we present the actual therapeutic strategies that can be used to achieve
the main objectives of cognitive therapy for anxiety. Naturally, these intervention strate-
gies will be modified when used with the specific anxiety disorders discussed in the third
part of this volume.

Educating the Client

Educating clients has always played a central role in cognitive therapy (Beck et al., 1979,
1985, 2005). Today it continues to be emphasized in practically every cognitive therapy
and cognitive- behavioral treatment manual (e.g., J. S. Beck, 1995; D. A. Clark, 2004; D.
M. Clark, 1997; Craske & Barlow, 2006; Rygh & Sanderson, 2004; Rachman, 1998,
2003, 2006; Taylor, 2006; Wells, 1997). The didactic component of treatment may not
only improve treatment compliance but it can also directly contribute to the correction
of faulty beliefs about fear and anxiety (Rachman, 2006).
There are three aspects of educating the client that are important in cognitive ther-
apy for anxiety. First, individuals often have misconceptions about anxiety and so a
discussion of fear and anxiety should be given with reference to the client’s personal
experiences. Second, a cognitive explanation for the persistence of anxiety should be