Section 9
CD Track #9: Four Specific Interventions for Anxious Thoughts

Table of Contents | NCCAP/NCTRC CE Booklet

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What's the Evidence?
Your anxious client, in the simplest terms, believes, "Something bad is going to happen that they won't be able to handle." According to Beck, all of the cognitive therapist's questions can be broken down to one of these questions:
1. "What's the evidence?"
2. "What's another way of looking at the situation?" and
3. "So what if it does happen?"

I find some clients respond better to one approach than to another. However, I find the clients with the highest success rate develop skill in using all three approaches.

4 Specific Interventions for Anxious Thoughts
Let's look at some specific interventions that help your client answer this question regarding his or her anxious thoughts. We will look at Analysis of Faulty Logic, a Three-Column Technique, Providing Information and Hypothesis Testing.

Intervention #1. Analysis of Faulty Logic
As you know, a standard method is to review the client's logic in constructing his experiences. For example, Ethel, a sixty-seven-year old woman, was extremely anxious about and believed she would fail a written driving exam although she passed a previous one. I led her to concede that there was no evidence that she would fail (other than her thoughts that the second test could be harder that the first), and that she could read the license manual.

When the client recognized that she was "jumping to conclusions," her anxiety subsided sufficiently to allow her to study for the test and, as a result, her anxiety went down even more. When she did pass the exam, I used the success as further evidence of her competence.

Intervention #2. The Three-Column Technique
Clients can identify thinking errors by the three-column technique. In the first column, the client describes an anxiety-producing situation; in the second, his or her automatic thoughts; in the third column, types of errors found in these thoughts. By doing this, the client practices viewing his experience from the vantage point of a neutral ally rather than from that of a predictor of doom. This technique is usually viewed by the client initially as an "intellectual" exercise; however, this exercise with practice, usually takes on personal meaning to the client to help him answer the question "Where's the evidence?"

Intervention #3. Providing Information
Lack of information or erroneous information may increase the client's anxiety. Kelly, a 20-year-old college student, was afraid of going insane regarding stress over grades and assignments. However, she was unaware of the symptoms of schizophrenia. Her fear was alleviated after I explained the difference between hallucination and delusion and the symptoms of anxiety.

When a client exaggerates the actual odds of his experiencing a feared event, the therapist can provide realistic information to enable him to reassess the potential of danger. Thus, point out if a person could die only as a result of a plane crash, he would live to be a million years old; or, if he could die only because of an automobile accident, he would live to be over three thousand years old (Marquis).

Intervention #4. Hypothesis Testing
Probably much of the homework you assign between sessions involves testing hypotheses. As you know, it's best to encourage your client to write out his prediction of dire consequences for later evaluation so as to accumulate a recorded body of data disproving the client's catastrophic predictions. As one negative consequence after another fails to occur, the client's belief in the certainty of impending disaster usually begins to weaken.

Here is a list of hypotheses I've used; compare them with yours.
1. I'm too anxious to even read.
2. I'm too anxious even to make an outline for a speech.
3. I'm too nervous to call and ask for information.
4. I can't even talk to a stranger.
5. I can't do anything when this symptom comes on.
6. I can't make any decisions.
7. I can't think or talk about this -- it's too frightening.
8. I can't do anything to control my anxiety.

I motivate the client into testing the hypothesis by setting up a "no lose" situation, since each test of a hypothesis, no matter what the outcome, provides useful data.

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