Cognitive Therapy of Anxiety Disorders

256 ASSESSMENT AND INTERVENTION STRATEGIES

can be used for this purpose. This form can be completed when clients engage in expo-
sure homework assignments or when they prevent maladaptive coping during spontane-
ous, naturally occurring anxiety episodes. Although the form collects data on anxiety
levels and urge to engage in the “prevented response,” the cognitive therapist should
always probe for clients’ cognitions about response prevention and safety- seeking behav-
ior when reviewing the form.

Clinician Guideline 7.6

Preventing maladaptive coping behavior and other forms of safety- seeking responses is an

important component of cognitive therapy that promotes exposure to information that dis-

confirms the client’s faulty threat and vulnerability beliefs.

DireCteD behavioral Change

As previously discussed, individuals with anxiety disorders often exhibit problematic
behaviors that require modification or they may present with behavioral deficits that
actually contribute to their anxious state. An individual with social phobia may have
performance deficits in interpersonal and communication skills, although Antony and
Swinson (2000b) remind us that most people with social anxiety have better interper-
sonal skills than they think. However, social behavioral performance deficits may also
be evident in other anxiety disorders. It can occur in the person with panic disorder
and agoraphobic avoidance who has shunned social settings for many years, or the
individual with chronic OCD who might avoid others because of obsessions of doubt
or contamination. Moreover, individuals with PTSD often have significant social with-
drawal and other interpersonal difficulties (Turner, Beidel, & Frueh, 2005). In such
cases a skills- training component might be included in the treatment plan.
Directed behavioral change refers to intervention strategies that teach individu-
als how to change specific behaviors in order to improve their personal effectiveness
at home, at work, and in interpersonal relations. In the anxiety disorders behavioral
change strategies typically focus on improving prosocial skills, assertiveness, or verbal
and nonverbal communication (see Antony & Swinson, 2000a, 2000b, for further dis-
cussion). Table 7.4 presents the steps normally involved in behavioral change interven-
tions.

table 7.4. therapeutic elements in Direct

behavioral Change interventions

••Didactic instruction or psychoeducation

••Modeling specific behaviors

••Behavioral rehearsal

••Corrective feedback and reinforcement

••In vivo homework assignments

••Self-monitoring and evaluation