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

Section 8
Intervention Strategies Regarding Cognitive Restructuring
in Treatment of Phobias

CEU Question 8 | CEU Test | Table of Contents | Phobias
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs, Nurse CEUs

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On the last track we discussed directing clients.  Methods for directing clients include active affective statements, replacing ‘why’ with ‘how’, experiencing feelings, and fostering honesty.

On the next three tracks we will discuss approaches to cognitive restructuring.  In general, cognitive therapist’s use three basic strategies or questions to help client’s restructure phobic thinking.  Nearly all effective lines of questioning can be broken down to one of three basic approaches to cognitive restructuring.  These three basic approaches are separating fact from fiction, generalizing alternative interpretations, and decatastrophizing.    

#1  Separating Fact from Fiction
First let’s discuss the question of separating fact from fiction.  Clearly, this question pertains to an analysis of faulty logic.  One method is to review the client’s logic in construing his or her experiences. 

For example, 67 year old Edith, had become phobic about taking a written driving exam.  Though she had passed a previous written driving exam, Edith stated, "I’m sure I’m going to fail this time around!"  Edith had already identified the underlying cause of this fear.  When Edith was in school she had failed a test and was punished severely by her father.  The punishment Edith suffered would be considered child abuse by today’s standards.

Think of your Edith.  How might you help her analyze the faulty logic behind her phobia?

Technique:  The Three Column Technique
Edith began to identify her thinking errors by the three column technique.  In the first column, Edith described stimulus which triggered her phobia.  Clearly, Edith’s phobia was test taking.  In the second column, Edith described her automatic thoughts.  For example, Edith wrote, ‘I won’t be able to finish in time.’  And ‘I will fail.’  Edith stated, "I know it sounds dumb, but even thinking about failing makes me start to panic."  In the third column, Edith identified the errors in her thinking. 

In an adaptation of the third column, your client might use the third column to comment on the situation as might an ‘objective’ observer, such as the therapist or a friend.  Through the three column technique, Edith viewed her experience from the vantage point of a neutral ally rather than from that of a predictor of doom. 

Think of your Edith.  Even if initially experienced as an ‘intellectual’ exercise, could this technique with practice take on personal meaning for your client?

Technique #2:  Hypothesis Testing
As you know, much of the homework phobic clients do involves hypothesis testing.  Do you agree with encouraging clients to write out predictions of dire consequences for later evaluation? 

I find that when reviewed at later sessions, these written hypotheses tend to disprove the client’s catastrophic predictions.  As one negative consequence after another fails to occur, the client’s belief in the certainty of impending disaster begins to weaken.  I find that a productive way to conduct hypothesis testing is to test as many maladaptive hypotheses as possible during a client’s session. 

Typically, near the end of the session clients may benefit from discussing or setting up experiments the client runs outside of the session.  During these discussions, I try to foster a no lose attitude regarding the experiments so that the client comes to believe that no matter what the outcome, we will obtain useful data. 

How do you test your phobic client’s hypotheses?  Besides the three column technique and hypothesis testing what ways explore the question of what is the evidence? With your client?

On this track we began to discuss 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 the next track we will continue our discussion on approaches to cognitive restructuring.  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. 

- Jensen, Vicki L.; Hougaard, Esben; Fishman, Daniel B. Sara, A Social Phobia Client with Sudden Change After Exposure Exercises in Intensive Cognitive-Behavior Group Therapy: A Case-Based Analysis of Mechanisms of Change. PCSP: Pragmatic Case Studies in Psychotherapy. 2013, Vol. 9 Issue 3.

Peer-Reviewed Journal Article References:
Bonsaksen, T., Lerdal, A., Borge, F.-M., Sexton, H., & Hoffart, A. (2011). Group climate development in cognitive and interpersonal group therapy for social phobia. Group Dynamics: Theory, Research, and Practice, 15(1), 32–48.

Boswell, J. F. (2013). Intervention strategies and clinical process in transdiagnostic cognitive–behavioral therapy. Psychotherapy, 50(3), 381–386.

Craske, M. G., Niles, A. N., Burklund, L. J., Wolitzky-Taylor, K. B., Vilardaga, J. C. P., Arch, J. J., Saxbe, D. E., & Lieberman, M. D. (2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators. Journal of Consulting and Clinical Psychology, 82(6), 1034–1048.

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 8
What are two techniques for separating fact from fiction? To select and enter your answer go to CEU Test.

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