Cognitive Therapy of Anxiety Disorders

Cognitive Interventions for Anxiety 193

Consequences of Inappropriate Anxiety

Most individuals with an anxiety disorder are all too familiar with the negative conse-

quences of their anxiety. However, it is important to discuss consequences because hav-

ing “fear of anxiety” is a prominent feature of clinical anxiety (Beck et al., 1985, 2005;

D. M. Clark, 1986b). The therapist can explore with the client whether being “anxious

about being anxious” might actually intensify the clinical disorder by making a person

more sensitive or vigilant for any signs of anxiety (i.e., latter phase in Figure 6.1).

It is important to discuss how anxiety is manifested in the three major response

systems; the physiological, the behavioral, and the cognitive. This should be discussed

in reference to the clients’ own experience of anxiety. Craske and Barlow (2006) provide

a very helpful explanation of the three components of anxiety in their self-help book for

worry called Mastery of Your Anxiety and Worry. They note that a better understand-

ing of the physical, cognitive, and behavioral components of anxiety helps reduce the

mystery and uncontrollability of anxiety and provides a framework for learning ways

to reduce anxiety.

Some discussion of the broader consequences of having anxiety should be incorpo-

rated into educating the client. What effect does anxiety have in the client’s daily life

at work, home, and leisure? Are there restrictions or limitations imposed on what indi-

viduals can do or where they can go? The broader negative impact of anxiety needs to

be emphasized in order to encourage client commitment to the therapeutic process by

helping individuals think in terms of the costs and benefits of change. A consideration

of the “personal burden of anxiety” can also help in the establishment of treatment

goals.

The Role of Avoidance and Safety Seeking

It is useful to ask clients what they think is the most effective way to reduce anxiety.

Although a variety of answers may be given, it should be emphasized that escape and

avoidance (or completion of a compulsive ritual in OCD) ensure the quickest reduction

Experience certain
situations,
information, or cues

Heightened

attention to

threat and automatic

apprehensive

thoughts

[appraisals of threat]

FEAR

ANXIETY

SYMPTOMS

ACTIVATED

Search for safety

and reduction in

anxiety

Preoccupation

with anxiety and

helplessness;

threat reevaluated

Attempts to

control

anxiety

figure 6.1. Diagram of the cognitive model of anxiety for use with clients.