252 ASSESSMENT AND INTERVENTION STRATEGIES
Implementing Response Prevention
There are a number of steps involved in implementing response prevention. (See also
Rygh & Sanderson, 2004, for a description of response prevention for GAD.)
Identify Maladaptive Coping and Neutralization
In order to implement response prevention, the therapist must first identify the cogni-
tive, behavioral, and emotional responses used to terminate exposure to fear stimuli and
reduce anxiety. The assessment forms in Appendixes 5.7 and 5.9 are quite useful for
this purpose. In addition direct observation of the client during exposure to fear situa-
tions may identify other more subtle automatic safety- seeking responses that should be
addressed in the exposure and response prevention sessions. For example, Maria would
frequently interrupt therapy sessions by asking the therapist if he thought she looked
alright and she would also frequently leave her seat in order to check on her appearance
in the mirror. Response prevention of these safety- seeking responses and their underly-
ing beliefs was an important part of the therapy. In most cases it is helpful to assign
homework that requires self- monitoring of safety- seeking and other coping responses
in order to heighten the client’s awareness of these strategies. Repeated self- monitoring
of one’s anxiety responses and control efforts can help bring fairly automatic processes
under more elaborative, conscious control.
Provide Rationale for Response Prevention
It must be explained to clients why the prevention of maladaptive coping responses
is a critical component of cognitive therapy. Often the rationale for response preven-
tion is presented when educating the client about exposure-based interventions. Rygh
and Sanderson (2004) suggest that a cost– benefit approach can be used in which the
short-term anxiety reduction associated with maladaptive coping and neutralization
responses is offset by the long-term persistence of anxiety. It should be explained that
long-term anxiety reduction will only occur when the underlying faulty appraisals and
beliefs about exaggerated threat and vulnerability are truly modified. The most effective
strategy for changing these attitudes is learning to tolerate anxiety and then letting it
decline naturally.
Preventing maladaptive responses that prematurely terminate anxiety is an impor-
tant part of this treatment approach. The following is a clinical excerpt that illustrates
educating a client with panic disorder on the importance of response prevention.
Th e r a p i sT: Derek, I notice from the behavioral checklist [Appendix 5.7] that whenever
you feel anxious about chest pains you immediately stop all activity, rest, and try to
control your breathing in an effort to relax yourself.
cL i e nT: Yeah, I’ve done this for so long it is kinda automatic now. I keep thinking it is
really important to relax and get control of myself.
Th e r a p i sT: I also notice that on other occasions, when the anxiety gets really bad, you’ll
look on the Internet for medical information, make an appointment with your fam-
ily doctor, or even go to the hospital emergency department. These all look like
ways of seeking reassurance that you are alright and not having a heart attack.