Cognitive Interventions for Anxiety 191
provided in a manner that clients can readily understand and apply to their own situ-
ation. And third, the cognitive treatment rationale should be clarified so that clients
will fully collaborate in the treatment process. In our experience clients who terminate
therapy within the first three to four sessions often do so because they have not been
educated into the cognitive model or they fail to accept this explanation for their anxi-
ety. Either way, educating the client begins at the first session and will be an important
therapeutic ingredient in the early sessions.
Table 6.2 presents the main themes that should be addressed when educating the
client about the cognitive approach to anxiety. We briefly discuss how the therapist can
communicate this information to clients in a comprehensible manner.
Defining Anxiety and Fear
Clients should be provided with an operational definition of what is meant by fear and
anxiety from a cognitive perspective. Based on the definitions in Chapter 1, fear can be
described as perceived threat or danger to our safety or security. Clients ca n be asked for
examples of when they felt fearful and what the perceived danger was that characterized
the fear (e.g., near accident, waiting for results of medical tests, threatened with violence
or aggression). It should be pointed out that even thinking about or imaging worst-case
scenarios can elicit fear. Again examples of imagined fears could be discussed. In the
same way anxiety can be described as a more complex, prolonged feeling of unease or
apprehension involving feelings, thoughts, and behavior that occurs when our vital
interests are threatened. Whereas fear is usually momentary, anxiety can last for hours,
maybe even days. Given the ubiquitous nature of computers and information technology
in modern society, most people will readily understand if anxiety is described as analo-
gous to “a computer program that gets turned on, takes over the operating system,
and won’t quit until it is deactivated or turned off.” Throughout treatment, we find it
useful to refer to “activating and deactivating the fear program” and the importance of
“turning off the fear program” in order to eliminate anxiety. The therapist should be
asking the client for personal examples of fear and anxiety in order to reinforce a full
understanding of the concepts. This will ensure that client and therapist have a common
language when talking about experiences of anxiety.
table 6.2. primary elements of educating the Client into the Cognitive
model and treatment of anxiety
Themes emphasized when educating the client
••Define anxiety and the role of fear
••The universal and adaptive nature of fear
••Cognitive explanation for inappropriate activation of the anxiety program
••Consequences of inappropriate activation of anxiety
••Escape, avoidance, and other attempts to control anxiety
••Treatment goal: turning off the anxiety program
••Treatment strategies used to deactivate the anxiety program
••The role of other approaches to anxiety reduction (e.g., medication,
relaxation, herbal remedies)