Cognitive Interventions for Anxiety 211
tions. Most clients will be able to produce the “most dreaded outcome” and the “most
desired outcome” with little difficulty. The alternative, more realistic or probable out-
come will require considerably more prompting and guidance from the therapist. A
good alternative view should have the following characteristics:
- Be clearly distinct from the catastrophic interpretation.
- Have a better fit with the facts and reality of the situation.
- Be amenable to empirical evaluation.
A client with OCD described as his primary obsession various disturbing sexual
thoughts about being gay. Although he was embarrassed by his apparent homophobic
reactions, nevertheless he continued to feel intensely anxious whenever situations trig-
gered questioning thoughts about his sexual orientation. His catastrophic interpreta-
tion was “What if these frequent thoughts about being gay means that I am a latent
homosexual. I will then have to divorce my wife and move in with a gay lover.” His
most desired outcome was “Never to have thoughts about being gay and have absolute
certainty that I am 100% heterosexual.” The more probable alternative explanation was
“My frequent thoughts about being gay are not due to some latent homosexual orienta-
tion but rather to my overreaction to these thoughts because the thoughts represent a
violation of my personal moral standards.” Notice that the alternative interpretation is
a polar opposite to the catastrophic explanation. Whereas the anxious view is “These
thoughts may be caused by an unconscious homosexual orientation,” the alternative
explanation is “These thoughts are caused by a faulty response that stems from an
extreme aversion to a homosexual orientation (i.e., homophobia).” Evidence gathering
and empirical hypothesis testing are more effective when the alternative view and the
catastrophic explanation are polar opposites. In this way the results from such exercises
will be incontrovertible evidence for the alternative and against the catastrophic conclu-
sion.
Table 6.3 presents examples of catastrophic interpretations, desired outcomes, and
alternative explanations that may be found in specific anxiety disorders. The goal is to
work with the client in generating credible alternative explanations that are subjected
to empirical verification. With practice the client can learn to replace the catastrophic
interpretation with the alternative explanation, thereby reducing the exaggerated threat
appraisals and associated subjective anxiety.
Clinician Guideline 6.13
Remediation of anxious thinking requires the discovery of more realistic alternative inter-
pretations that can replace exaggerated threat- related appraisals. The most effective alterna-
tives for countering automatic anxious thoughts and beliefs are those that offer a more bal-
anced, evidence-based perspective that is clearly distinct from the anxious schemas.Empirical Hypothesis- Testing
One of the most important interventions for cognitive change is behavioral experimen-
tation or empirical hypothesis testing. First introduced in the cognitive therapy manual