236 ASSESSMENT AND INTERVENTION STRATEGIES
anxiety (Abramowitz, Franklin, & Foa, 2002; Fava, Zielezny, Savron, & Grandi, 1995;
Feske & Chambless, 1995; Riggs, Cahill, & Foa, 2006). Thus behavioral intervention
strategies are a central therapeutic ingredient of cognitive therapy for anxiety.
Cognitive Perspective on Behavioral Interventions
In cognitive therapy behavioral strategies are employed as interventions for modifying
faulty threat and safety appraisals and beliefs. Thus the cognitive therapist conceptual-
izes behavioral- oriented assignments quite differently from a strictly behavioral perspec-
tive. Instead of viewing behavioral interventions in terms of strengthening inhibition or
habituation of an anxiety response, cognitive therapy views the interventions in terms
of its effect on changing threat- related cognition, which in turn will lead to a reduction
in anxious symptoms. This cognitive reconceptualization of behavioral treatment has
several practical implications for how behavioral interventions are implemented in the
following steps. (See the section on empirical hypothesis testing in the previous chapter
for a discussion of issues relevant to the use of behavioral interventions in cognitive
therapy.)
Rationale
As with any therapeutic intervention, the client should be provided a rationale for the
behavioral assignment that is based on the cognitive model of anxiety presented during
the psychoeducational phase of treatment (see Figure 6.1). There are two essential ideas
about behavioral interventions that should be communicated to clients. First, the cogni-
tive therapist explains that one of the most effective ways to change anxious thinking
is through direct experience with anxiety- provoking situations. In our case example it
was explained to Maria that the experience she gained from exposure to actual social
situations was the most potent way to learn whether other people were evaluating her
as harshly as she imagined.
Second, a cognitive rationale for behavioral interventions should include a discus-
sion of potentially maladaptive behavioral coping strategies. It is explained that modifi-
cation of these coping strategies is an essential component of cognitive therapy. Another
reason for behavioral interventions, then, is the modification of dysfunctional coping
responses and the acquisition of more effective responses that will lead to a reduction
in anxiety.
Identify Target Thought/Belief
The cognitive therapist always introduces a behavioral intervention as a means for
achieving cognitive change. Thus a specific anxious thought, appraisal, or belief is iden-
tified as the primary target for the behavioral intervention. In order for the behavioral
exercise to be effective, the client must be clear on the anxious thought or belief that
is under evaluation by the intervention. For Maria three core beliefs were particularly
critical in her cognitive therapy: “If I happen to meet familiar people, they will consider
that I have little worth or value, that I’m a real failure in life,” “Familiar people will
view me as emotionally unstable because they will remember my ‘crazy’ behavior when