Cognitive Interventions for Anxiety 195
Treatment Goal
In keeping with our metaphor of fear as “a computer program,” the therapist introduces
the treatment rationale by explaining the goal of cognitive therapy in terms of “deac-
tivating or turning off” the fear program by deliberately and intentionally engaging in
activities that will “override” or “counter” fear and anxiety. The therapist should refer
to Figure 6.1 and indicate that the fear program can be deactivated by intervening at all
the different steps that contribute to the persistence of anxious symptoms. Clients could
be asked to provide examples of their own success in deliberately overcoming an initial
fear. It is also important to question the client about treatment expectations in order to
elicit any misconceptions that could undermine the success of cognitive therapy.
There are a number of common faulty misconceptions about treatment that might
need addressing. First, treatment can not permanently shut down fear. The goal is not
to eliminate anxiety totally (if that was even possible) but to help clients develop effec-
tive ways to override the fear program when it is inappropriately activated. Second, the
experience of anxiety will feel more natural, whereas efforts to reduce anxiety will seem
much more difficult. This is because the former is an automatic response to perceived
threat and the latter requires a much more deliberate, effortful response. This does not
mean that intentional responses to anxiety are not powerful enough to deactivate fear
and reduce anxiety. What it does mean is that repeated experiences with these effort-
ful responses will be needed in order to improve their efficiency and effectiveness. And
third, the objective of cognitive therapy is not to teach people more effective ways to
“control their anxiety.” Instead cognitive therapy focuses on helping individuals develop
a more “accepting attitude” toward anxiety rather than a “combative (i.e., controlling)
attitude.” When thoughts like “I can’t let these anxious feelings continue” are replaced
with “I can allow myself to feel anxious because I know I’m exaggerating the threat and
danger,” then the intensity and persistence of anxiety are greatly diminished (Beck et
al., 1985, 2005).
Treatment Strategies
Clients should be provided with a brief description and rationale for the intervention
strategies that will be used to “turn off” the fear program and diminish their anxious
feelings. The therapist should explain that a greater understanding of one’s anxiety
through education and the self- monitoring of anxious episodes are important interven-
tions in cognitive therapy of anxiety. These components of treatment help counter the
unexpected and unpredictable nature of anxiety.
The therapist explains that a second class of cognitive therapy interventions focuses
directly on changing anxious thoughts and beliefs. This is accomplished by learning to
critically question whether one’s initial apprehensive thoughts are an accurate appraisal
of the situation and then replacing these anxious interpretations with a more realistic
way of thinking. Specific behavioral experiments are designed that will help the client
develop a less anxious way of thinking. The therapist should emphasize that developing
new ways of thinking about their anxious concerns is an important part of treatment
because it directly targets the automatic apprehensive thoughts that give rise to anxious
symptoms (refer to Figure 6.1).
A third category of cognitive therapy interventions deals with behavioral responses
and coping strategies that may contribute to the persistence of anxiety. Escape, avoid-