258 ASSESSMENT AND INTERVENTION STRATEGIES
difficulty maintaining eye contact. The role play was stopped and the therapist asked
the client “When we were role- playing just now, what was going through your mind?”
The client stated that he was thinking “I am staring at the person; he is going to get
angry if I just keep staring like this.” So, automatically the client would break off his
gaze and look away, which meant that he did not perform the behavioral rehearsal cor-
rectly. Identifying and correcting faulty cognitions that arise in the course of behavioral
rehearsal is an important use of this strategy in cognitive therapy for anxiety.
The effectiveness of any behavioral change intervention will depend on whether
behavioral rehearsal is followed by systematic and repeated practice of these new skills
as in vivo homework assignments. As with any intervention the generalizability and
maintenance of any new learning achieved within session depends on completion of
homework assignments. Individuals should also self- monitor their behavioral home-
work assignments by keeping a record of the situations in which they practiced the new
behavior, their anxiety level, the outcome, and their evaluation of their performance. In
the follow-up session the therapist would review the homework self- monitoring form.
Examples of positive behavioral change would be praised and any problematic cogni-
tions or behavioral responses would be targeted for further intervention.
Clinician Guideline 7.7
Direct behavioral change interventions are often employed in cognitive therapy to address
performance deficits in social functioning that may exacerbate withdrawal and isolation
from others and interfere with the client’s participation in crucial between- session exposure
assignments.relaxation trainingRelaxation training has had a long and venerable history in behavior therapy for anxi-
ety. At one time it was the cornerstone of behavioral treatment for anxiety and consid-
ered critical for inhibiting conditioned anxiety responses (i.e., Wolpe & Lazarus, 1966).
Recently cognitive- behavior therapists have questioned the wisdom and effectiveness
of relaxation therapy for anxiety. White and Barlow (2002), for example, argued that
any behavior that minimizes panic symptoms or provides escape/distraction from these
symptoms would be maladaptive. Teaching individuals to relax via progressive muscle
relaxation or breathing retraining could undermine exposure and be tantamount to
“teaching avoidance as a coping strategy” (White & Barlow, 2002, p. 317). In many
respects relaxation training is also incompatible with the objectives of CT for anxi-
ety. Empirical hypothesis testing of faulty appraisals and beliefs depends on exposure
to anxiety situations in order to gather disconfirming information. If relaxation was
invoked whenever a person felt anxious, then that person would forfeit an opportunity
to learn that the anxious concerns were unfounded. In this way relaxation as an anxiety
management response would undermine the effectiveness of cognitive therapy.
So, is there a place for relaxation training in cognitive therapy of anxiety? We would
only recommend relaxation techniques as an adjunctive intervention if an individual’s