210 ASSESSMENT AND INTERVENTION STRATEGIES
to conclusions, tunnel vision, nearsightedness, emotional reasoning, and all-or- nothing
thinking. Error identification should be introduced by first going over thought records
produced in the session and discussing cognitive errors that are apparent in the client’s
anxious thinking. This can be followed with a homework assignment in which clients
record examples of thinking errors taken from their everyday experiences (use Appendix
5.6). After this exercise the therapist encourages clients to incorporate error identifica-
tion into a cognitive strategy utilized whenever they engage in anxious or worrisome
thinking.
Taylor (2000) describes an inductive reasoning approach that can be very useful
in countering the erroneous thinking style that leads to exaggerated threat appraisals.
Through the use of Socratic questioning and a guided discovery approach, the therapist
explores with the client how a particular situation or symptom can lead to a dreaded
outcome. For example, a client could be asked how tightness in the chest could cause a
heart attack, or how lying down prevents such heart attacks. A person with PTSD who
becomes anxious when remembering a past trauma could be asked how such recol-
lections increase the likelihood of present danger or a future trauma. Individuals with
repugnant sexual obsessions could be asked to explain how such thoughts would lead
to committing a sexual offense, or a person with social phobia could explain how a
nervous feeling would lead to public humiliation. By engaging in this form of inductive
questioning, the therapist is provided material that can be used to highlight the cogni-
tive errors in anxious thinking that lead to faulty conclusions about threat and personal
vulnerability.
Clinician Guideline 6.12
Clients learn to identify the cognitive errors and faulty inductive reasoning that character-
izes an anxious thinking style. This intervention helps clients develop a more critical stance
toward their automatic anxious thoughts.Generating an Alternative Explanation
D u r i n g p e r io d s of h e i g ht e n e d a n x i e t y, a n i n d iv idu a l’s t h i n k i n g i s of t e n e x t r e m e ly r i g id a n d
inflexible, with a narrow focus on the perceived threat or danger (Beck et al., 1985, 2005).
Clients will often recognize that their anxious thinking is irrational but the strong emo-
tional charge associated with the thoughts makes them difficult to ignore. Thus searching
for alternative explanations for anxious situations can be extremely difficult. Repeated
practice with the cognitive therapist coaching the client in generating alternative explana-
tions to a variety of anxious situations will be necessary before this skill generalizes to
naturalistic anxious situations that occur outside the therapy setting. It may be necessary
to present the alternative as a tentative possibility that the client is encouraged to at least
entertain as another way to understand a situation (Rouf, Fennell, Westbrook, Cooper,
& Bennett-Levy, 2004). At the same time, learning to produce less anxious alternative
interpretations is a critical component of cognitive therapy for anxiety because clients
need credible explanations that replace their catastrophic interpretation.
The Alternative Interpretations Form in Appendix 6.4 can be used as a within-
session therapeutic tool or a homework assignment for generating alternative explana-