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Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions
Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions

Section 6
Cognitive Restructuring Strategies

CEU Question 6 | CEU Test | Table of Contents | Phobias
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs, Nurse CEUs

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On the last track we began a discussion on approaches to cognitive restructuring.  The first of three approaches that we discussed was separating fact from fiction.  Two techniques for separating fact from fiction are the three column technique and hypothesis testing.

On this track we will continue to discuss approaches to cognitive restructuring.  Our discussion will start with a look at the second basic approach to cognitive restructuring, generalizing alternative interpretations.  We will also three techniques for generating alternative interpretations with the phobic client.  Three techniques we will discuss are generating alternative interpretations, dysfunctional thought records, and enlarging perspective. 

#1  Generating Alternative Interpretations
First let’s discuss generating alternative interpretations.  The phobic client’s closed and limited view of reality excludes more neutral and more realistic interpretations.  A major therapeutic aim is to teach the client to consider possibilities other than his or her dire predictions of what may happen when the client is faced with the feared stimulus

Although therapists use different methods to generate alternative interpretations of phobias, one standard procedure is to have the client write down anxiety producing thoughts and then search for alternative interpretations. 

Do you recall the three column technique from the last track?  By simply using the first two columns, I find it relatively simple to generate alternative interpretations with phobic clients.  How do you model this type of strategy with your phobic clients?  Might a blackboard work as a medium for generating alternative interpretations using the first two steps in the three column technique? 

Consider Ronald, age 43.  Ronald experienced a fear of being fired.  Ronald’s phobia became active at work whenever his boss began to act aloof.  Ronald stated to me, "When he’s acting aloof, I start thinking that he’s avoiding me specifically.  Why would you avoid one of your employees if you weren’t going to get fired?"  Using the first two steps in the three column technique, Ronald generated the following alternative explanations. 

Ronald stated, "I guess my boss is being aloof from everyone and not just me.  Or maybe he dislikes me regardless of what he thinks of my performance.  And even if he does think I’m incompetent or something, the other supervisors around here know I’m not."  Ronald began to lower his anxiety by repeatedly considering these alternative interpretations.  At a later session, Ronald stated, "It seems that these alternative interpretations are almost always more accurate, and definitely more functional than what I’m afraid of." 

Think of your Ronald.  In what ways could you help your phobic client generate alternative interpretations of his fear?

#2 Dysfunctional Thought Records
Dysfunctional thought records can be used in conjunction with the preceding techniques to help phobic clients analyze phobic thoughts.  I find that the dysfunctional thought record can be an integral part of treatment.  Could your client benefit?  If so, you can find a sample record in the work book that accompanies this course.

I find that dysfunctional thought records are most effective if clients create them as soon as possible following a phobic reaction.  Initially clients complete the first three sections of the dysfunctional thought record.  The first three sections are the situation leading to phobia, the emotion felt and degree of emotion, and the automatic thought and degree of belief in the thought. 

Would you agree that this process can help clients learn how to monitor changes in anxiety levels, to recognize automatic thoughts, and to understand their relationship to the specific phobia?  I find that once the client masters these skills, he or she is generally ready to begin providing ‘rational response’ and outcome ratings to complete the dysfunctional thought record. 

An alternative to the dysfunctional thought record form included in the manual for this course is to give the client a notebook to write in.  Would you agree that simply giving a phobic client a notebook can help ensure that he or she does his or her written homework?

#3 Enlarging Perspective
Next, let’s discuss the technique of enlarging perspective.  Would you agree that regarding phobia inducing situations, clients usually take the ‘worm’s eye view’ of the situation?  Clearly, one of the functions of cognitive therapy is to provide the client with a broader perspective on the phobia stimulus. 

For example, Amanda, age 23, was away from home at college.  Amanda had never spent time far from home and had developed a moderate case of agoraphobia, or fear of open spaces.  Amanda stated, "It’s so strange being out of my room!  It’s almost physically painful and I’m afraid that if I go out the pain will last forever!" I attempted to help Amanda broaden her perspective by looking at some of the positive attributes of the homesickness which led to her phobia of leaving her dormitory. 

Together, Amanda and I generated the following list.  Her homesickness was a form of growing pains.  Her homesickness was to teach her how to accept change.  Amanda was inoculating herself against future losses she may have to deal with.  By sticking out the pain instead of going home, she was putting into practice the principle of getting better instead of feeling better.  And because pleasure follows pain, she would likely feel very good when the pain left.  As Amanda began to recover from homesickness, her phobia of leaving the dormitory began to subside as well. 

Think of your Amanda.  Could she benefit from an enlarged perspective?  How might you aid your phobic client in increasing his or her perspective regarding the feared situation or object?

On this track we have discussed three techniques for generating alternative interpretations with the phobic client.  Three techniques we discussed are generating alternative interpretations, dysfunctional thought records, and enlarging perspective. 

On the next track we will discuss finish our discussion regarding approaches to cognitive restructuring.  The focus on this track will be on decatastrophizing.  First we will discuss the technique of decatastrophizing and then discuss coping plans and the point/counterpoint technique.

Peer-Reviewed Journal Article References:
Aderka, I. M., Gillihan, S. J., McLean, C. P., & Foa, E. B. (2013). The relationship between posttraumatic and depressive symptoms during prolonged exposure with and without cognitive restructuring for the treatment of posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81(3), 375–382.

Dryman, M. T., McTeague, L. M., Olino, T. M., & Heimberg, R. G. (2017). Evaluation of an open-access CBT-based Internet program for social anxiety: Patterns of use, retention, and outcomes. Journal of Consulting and Clinical Psychology, 85(10), 988–999.

Mattick, R. P., & Peters, L. (1988). Treatment of severe social phobia: Effects of guided exposure with and without cognitive restructuring. Journal of Consulting and Clinical Psychology, 56(2), 251–260.

Shikatani, B., Fredborg, B. K., Cassin, S. E., Kuo, J. R., & Antony, M. M. (2019). Acceptability and perceived helpfulness of single session mindfulness and cognitive restructuring strategies in individuals with social anxiety disorder: A pilot study. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 51(2), 83–89.

Online Continuing Education QUESTION 6
What are three techniques for generating alternative interpretations with the phobic client? To select and enter your answer go to CEU Test.

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