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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?"
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
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
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
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.
Cognitive Behavioral Therapy in Anxiety Disorders:
Current State of the Evidence
- Otte, C. (2011). Cognitive Behavioral Therapy in Anxiety Disorders: Current State of the Evidence. Dialogues Clin Neurosci., 13. p. 412-421.
Online Continuing Education QUESTION
What are some interventions to assist your client in answering the question
"What's the evidence?" To select and enter your answer go to CEU Answer