Cognitive Interventions for Anxiety 215
other students that indicated they were looking directly at her. Fifteen minutes into the
lecture she would take three to four deep breaths and observe whether anyone noticed
what she was doing. Twenty minutes into the lecture she would try to make her body
shake ever so slightly for a few seconds and observe whether anyone noticed. The thera-
pist and client practiced each of the elements of the experiment: how to record student
reactions and what behavior would constitute a direct look, how to deep breath, and
how to shake ever so slightly. Jodie agreed that this was a “doable exercise” and that it
would be a good test of how much she is noticed in class.
Step 4. Hypothesis Statement
Under item 3 on the Empirical Hypothesis- Testing Form (Appendix 6.5), a specific
hypothesis can be recorded that reflects the client’s predicted outcome of the experi-
ment. The hypothesis would directly reflect the anxious thought or belief stated in item
- The therapist can ask, “Based on your anxious thought [state item #1 here], what do
think will happen when you do this exercise? What outcome would make you feel more
anxious?” In the present case Jodie wrote the following hypothesis on the form “Any-
thing I do in class that is out of the ordinary such as arrive just before the beginning of
the lecture, take deep breaths, or slightly shake will draw attention to myself. Once I
notice people looking at me, I will feel intensely anxious.” Notice that the hypothesis
is derived from the anxious interpretation (i.e., “if I feel nervous in class everyone will
notice me and think I don’t belong in university”) but it is a more specific application of
the threat interpretation to the actual experiment.
Step 5. Record the Actual Experiment and Outcome
Clients should record how they conducted the experiment and its outcome as soon after
completing the exercise as possible. A short description of what was done and its out-
come can be written in the center and right columns on the Empirical Hypothesis-
Testing Form. Often individuals do not conduct an experiment exactly as planned so
a description of what was actually done is important in evaluating the success of the
exercise. However, the actual outcome reported by the client is even more important
when following up on the effects of the behavioral experiment. It is the client’s perceived
outcome that will provide the necessary information for determining whether the exer-
cise had an effect on anxious thoughts and feelings. Thus the outcome recorded on the
form becomes a main focus of therapy when reviewing the assigned homework.
Step 6. Consolidation Phase
The success of a behavioral experiment in large part depends on how effectively the ther-
apist reviews the outcome of the exercise at the following session. Based on information
recorded on the Empirical Hypothesis- Testing Form, the therapist uses a combination of
active listening and probing questions to determine how the exercise was implemented
and the client’s evaluation of the outcome. Rouf et al. (2004) suggest that a number of
issues should be explored including (1) the client’s thoughts and feelings before, during,
and after the experiment; (2) any changes in physical state; (3) evidence that any safety