244 ASSESSMENT AND INTERVENTION STRATEGIES
controlled escape may be problematic because it could reinforce beliefs that the situa-
tion is fraught with danger, high anxiety is intolerable, and the best response is escape.
For these reasons we believe that encouraging clients to endure exposure sessions until
there is a significant reduction in anxiety will provide the best disconfirmatory evidence
against exaggerated appraisals of threat and personal vulnerability.
Collaboration and Client- Oriented Control
Perceived predictability and control are important for individuals engaged in exposure-
based treatment (Antony & Swinson, 2000a). Consistent with the cognitive therapy
orientation, there should be a strong collaborative atmosphere, with clients directly
involved in setting their exposure homework assignment. Individuals should be assured
that they will never be asked to do something they don’t “want” to do and that the pace
of the exposure treatment is under their own control. Naturally the therapist will be
encouraging clients to challenge themselves, but there should be no hint of a coercive or
heavy- handed approach. Some cognitive restructuring may be necessary before a reluc-
tant client agrees to undertake some aspect of the exposure hierarchy. It may also be
useful to ask the client for an expected timetable for progressing through the hierarchy.
That way the therapist can correct any faulty expectations about speed of progress in
light of the client’s actual pace of exposure treatment.
Antony and Swinson (2000a) noted that some exposure situations will be inherently
unpredictable such as social situations (e.g., the socially anxious client asked to initiate a
brief conversation with work colleagues). In such cases the therapist might have to work
on preparing the client for possible negative outcomes. At other times one might want to
build some unpredictability into later exposure exercises so the client is better prepared
to handle all the vicissitudes inherent in naturalistic daily life experiences.
Safety Signals and Partner- Assisted Exposure
Most behavioral therapists recommend that reliance on safety signals be eliminated
during exposure (e.g., Taylor, 2000: White & Barlow, 2002). Some of these behaviors
can be quite subtle such as the production of automatic responses like tensing or holding
one’s breath. Dealing with safety cues during exposure means that the therapist must
first identify these responses, wean clients off the safety signals by building this into the
exposure exercises, and encouraging the client to refrain from safety seeking (Taylor,
2000). Eliminating safety signals is important in therapy, because their continued pres-
ence is a form of avoidance that undermines disconfirmation of the threat and vulner-
ability beliefs. In the illustrative case example, Maria believed that maintaining a neat
and tidy appearance would guarantee protection against the negative evaluation of oth-
ers. This served a safety- seeking function that was targeted in therapy through cognitive
restructuring conducted concurrently with social situation exposure assignments.
In some anxiety disorders, like agoraphobia, a particular family member or friend
may be a powerful safety cue for the anxious client. When reviewing exposure home-
work, the therapist must always inquire whether the task was completed alone or with
partner assistance. If there is excessive reliance on a partner, this should be built into the
exposure hierarchy so that clients are gradually weaned off their dependence on others
as they progress up the hierarchy. Individuals who can not venture into an anxious situ-