Cognitive Interventions for Anxiety 207
ditures. Both (1) and (5) were marked as significant advantages of the new perspec-
tive. In terms of disadvantages, Jeremy wondered (1) if he might end up with a smaller
investment account because he is saving less money, and (2) he would be prepared for a
narrower range of future financial losses. Overall, Jeremy agreed that the disadvantages
of the anxious thoughts about saving and the advantages of adopting a more moderate
view were clearly evident.
The therapist was able to use the cost– benefit analysis in future sessions by remind-
ing Jeremy to think about “the consequences of anxious thinking about savings” and
the benefits “of thinking about moderate savings.” In particular, whenever Jeremy
engaged in anxious worry about his finances, the therapist reminded him to “remember
the cost– benefit form, and what you are doing to yourself by worrying about saving for
the ultimate financial disaster.” “Based on the cost– benefit analysis, how can you think
about saving that will lead to less anxiety?” Again clients are reminded that repeatedly
thinking in terms of cost– benefit analysis whenever they engage in anxious thinking is a
useful tool for weakening the fear program and diminishing their anxiety.
Clinician Guideline 6.10
Cost– benefit analysis is a cognitive intervention that teaches clients to take a pragmatic
approach by examining the immediate and long-term advantages and disadvantages of
assuming exaggerated threat, or alternatively, of adopting a more realistic perspective. The
therapist uses guided discovery and homework assignments to help clients achieve a full
realization of the heavy costs associated with “assuming the worst” and the benefits derived
from a more realistic alternative perspective. Clients can use this insight to counter their
anxious thoughts and beliefs.Decatastophizing
A third cognitive intervention that can be especially useful for most anxiety disorders
involves having the client “hypothetically” confront his dreaded catastrophe or the
worst that could happen. Beck et al. (1985, 2005) provided an extensive discussion
of the use of decatastrophizing to modify exaggerated threat appraisals and beliefs.
Craske and Barlow (2006) describe castatrophizing as “blowing things out of propor-
tion” (p. 86) and decatastrophizing as “imaging the worst possible outcome and then
objectively judging its severity” (p. 87). They note that catastrophizing involves thinking
about outcomes that are entirely unlikely to happen, even impossible (e.g., “I could get
a mental illness by coming in close proximity to a homeless person”), or exaggerating
events that are highly unlikely (e.g., “People will notice I am nervous and think I am
mentally unstable”), or jumping to an extreme conclusion from a minor event (e.g., “If
I make a mistake on this form, it will be completely invalidated and I won’t receive my
long-term disability benefits”).
Decatastrophization is an effective intervention when it is clear that catastrophic
thinking is apparent in the client’s threat and vulnerability appraisals. It is a particu-
larly useful approach when dealing with the cognitive avoidance evident in pathologi-
cal worry (Borkovec et al., 2004). Decatastrophizing confronts cognitive avoidance by
encouraging the client to face the imagined catastrophe and its associated anxiety. This