A Letter from William J. Knaus, EdD
Clients with anxiety and fear will normally have co-existing problems, such as self-worth issues and depression. Cognitive behavioral therapy (CBT) is an evidence-based way to address these conditions. With over forty years of supportive research and over 269 meta-analyses, CBT is the gold standard for treating anxiety.
People with persistent anxieties and fears ordinarily suffer from cognitive, emotive, and behavioral conditions, such as perfectionism, fear of failure, and procrastination. By getting relief from a core cause in one area, your client may automatically become unburdened from another (the transdiagnostic approach). For example, intolerance for tension is a common factor in mixed anxiety and depression. Building tolerance for anxiety can reduce depression.
Clients with multiple problems can profit from a comprehensive CBT approach.
• Perfectionism can extend to a fear of failure and procrastination among those who expect greatness from themselves, and then belatedly make half-hearted efforts to perform. Helping clients break a contingency worth cycle—where worth depends on stellar performances—can reduce perfectionism and a related fear of failure and procrastination.
• Public speaking anxiety can result in your client procrastinating on applying for a desired job. By showing your client how to defuse anxiety thinking, tolerate unpleasant sensations, and practice speaking before groups, your client will have a better chance of getting the job. Following therapy, clients tend to retain these gains and self-improve.
You can help your clients at three levels:
• At a practical level, you use common sense techniques to produce the changes you want to make. For example, you educate your client about the difference between anxiety and fear, and why certain antidotes work better for one than for the other.
• At an empirical level, you help your client test the validity of thoughts that fuel anxiety. Overcoming overgeneralizations can lead to relief. For example, “Everyone will reject me if I make a mistake.” Here is a sample intervention: “What type of mistake would you make that would lead to universal rejection?” The odds are that your client can find exceptions to this belief.
• At a core level, you deal with deeper issues. Your client may have self-doubts and equivocate a lot. Examine the situations that arouse doubts. You might find a contingency worth connection. Clients who see this connection have a direction for change.
Education is an essential part of CBT. Evidence-based crossover manuals give therapists both a reference and an educative tool for clients to use on their own or with their therapist’s guidance. The Cognitive Behavioral Workbook for Anxiety, Second Edition serves this crossover function.