On the last track we discussed managing anxiety with humor.  We examined how humor helps, using humor to cope with anxiety, the ‘Playing with Language’ Technique, and increasing a client’s capacity for humor. 

On this track we will discuss treatment goals for recovery.  Two categories of treatment goals for recovery are behavioral treatment goals and cognitive treatment goals.  As you listen to this track, you might consider using parts of it as a checklist for your client’s progression through therapy.

As you know, recovery from anxiety conditions is not a one-dimensional event.  I find it is a complex experience of a whole, multidimensional human being.  It begins with basic self-care and has physical, behavioral, cognitive, and philosophical dimensions.  This track is a review of treatment goals.  Clearly, treatment goals for your client will vary.  Theses goals have various interrelationships.  In general, the treatment goals on this track are ranked within each category in order of how soon clients can expect to reach them.  A few of these goals that apply only if you suffer from anxiety attacks or agoraphobia.

Would you agree that for a therapeutic setting, behavioral and cognitive goals represent a progression from short-term to long-term goals?

5 Behavioral Cognitive Behavior Therapy Goals
First, let’s discuss behavioral goals. 
1. One of the first behavioral goals in my practice is to increase a client’s ability to cope with fight-or-flight reactions. 
2. Next, I find it productive to focus on increasing a client’s ability to go places and do things without experiencing fight-or-flight reactions. 
3. Assertiveness then increases the client’s ability to tell others what he or she does not need, want, or like. 
4. Following that, assertiveness also increases the client’s ability to tell others what he or she does need, want, or like.  Is one of your treatment goals to decrease the amount of time clients spend feeling guilty, ashamed, or embarrassed? 
5. Finally, decreasing the amount of time a client spends worrying is a sixth behavioral treatment goal.  Think of your anxiety client.  Where in treatment progression does he or she fall regarding these goals?

Cognitive Goals
Next, let’s discuss cognitive goals.  As you know, cognitive goals have to do with gaining control through observation and awareness in the present moment.  The act of calmly observing and understanding conditioned stimuli can eliminate emotionally disruptive effects.  I find it productive to explain to my clients that, in other words, the client can learn to be the "calm observer" rather than the "reactor" in anxiety causing situations.

a. A preliminary cognitive treatment goal is for the client to be able to relax and recognize the external stimuli that trigger fight-or-flight reactions.  Clearly, this first treatment goal can be easily implemented along with the first behavioral treatment goal. 

b. Next, clients can focus on being able to relax and recognize the internal stimuli (thoughts and visceral feelings) that trigger fight-or-flight reactions, including self-diminishing and self-defeating assumptions, beliefs, and attitudes that "trap you in thought," such as the following 8 cognitions.

8 Cognitions
1. The idea that the client is helpless and unfree.
2. The idea that criticism or disagreement by others threatens the client’s survival.
3. The idea that something is fundamentally wrong with the client.
4. The idea that anxiety is a shameful secret.
5. Either-or thinking.
6. What-if thinking.
7. Have-to thinking.
8. If-only thinking.

c. A third cognitive treatment goal is for the client to be able to relax and recognize thoughts and feelings that reflect an attempt to eliminate risk or uncertainty from life through avoidance, concealment, or deception. I find it productive for clients to be able to relax and recognize thoughts and feelings that reflect an unrealistic craving for continuous expressions of love and admiration from others.

d. A final cognitive treatment goal is for the client to be able to accept themselves and to care for themselves as they would for a child or friend.  Think of your client.  How does anxiety prevent him or her from achieving self-acceptance?

Could these treatment goals apply to your practice?
- Ramnerö, Jonas; Jansson, Billy. Treatment goals and their attainment: a structured approach to assessment and evaluation. Cognitive Behaviour Therapist. 2016, Vol. 9, p1-11.

Peer-Reviewed Journal Article References:
Barrenger, S. L., Maurer, K., Moore, K. L., & Hong, I. (2020). Mental health recovery: Peer specialists with mental health and incarceration experiences. American Journal of Orthopsychiatry, 90(4), 479–488. 

Lenehan, P., Deane, F. P., Wolstencroft, K., & Kelly, P. J. (2019). Coherence between goals and therapeutic homework of clients engaging in recovery-oriented support. Psychiatric Rehabilitation Journal, 42(2), 201–205.

Treichler, E. B. H., Cardoso, L., Du, Y., Nungaray, J., Hochberger, W. C., Joshi, Y. B., Sprock, J., Cohen, A. N., & Light, G. A. (2020). Contextualizing the road to recovery: A novel method of assessing outcome trajectories in clinical trials. Psychological Services. Advance online publication.

Online Continuing Education QUESTION 14
What are two categories of CBT treatment goals for recovery? To select and enter your answer go to CE Test.

This CD set has covered such topics as:   watching worries come and go, mirror anxiety, accepting reality, uncertainty training, overriding obsessive anxiety, past redemption, if only’s, assertiveness training, treating phobic conditions, successive approximations, managing anxiety with humor, and treatment goals for recovery.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Teen Self Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship.