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Cognitive Behavioral Therapy for Phobia
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In the last section, we discussed detecting and exposing anxiety. We discussed three techniques you can use to help your client detect and expose anxiety. The three techniques were analyzing and attacking anxiety by discussing the costs of anxiety, cognitive therapy, and clearing roadblocks to change.
In this section, we will discuss treating phobic conditions. As you know, attempts to treat phobic conditions tend to reflect established methodologies of various health care specialties more than they have addressed the complexity of phobias. I find that the basis for treating phobic conditions in a therapeutic setting often involves providing clients with tools which they can use in everyday life to cope with phobias.
♦ Claire Weekes’ Self-Care Approach
Therefore, this section will briefly outline Claire Weekes’ Self- Care Approach, which uses CBT. Weekes’ Self-Care Approach is comprised of four concepts for coping with phobic conditions. Weekes’ four concepts are face, accept, float, and let time pass. As you read this section, consider your approach to helping clients cope with phobic conditions. How is your approach different? In what ways is your approach similar?
First, let’s discuss Claire Weekes’ Self-Care Approach. For more than 30 years, physician Claire Weekes has pioneered the idea of giving self-care tools to those who suffer from agoraphobia. Her books, which show great understanding and empathy for those suffering from agoraphobia, have brought hope and help to hundreds of thousands of readers in Great Britain, Australia, and the United States. Weekes’ self-care approach is applicable to most phobias. She describes her CBT treatment in the following way:
"My treatment is based first on adequate explanation to the patient of sensitization and nervous symptoms, secondly on teaching the importance of the four concepts—facing, accepting, floating, letting time pass—and finally, on the full explanation of the obstacles met during all stages of recovery and warning of the probable occurrence of setbacks and their treatment. Working this way, many patients need little or no drug therapy. Recovery lies not in the abolition of nervous sensations and feelings (as so many patients believe), but in their reduction to normal intensity."
The Four Cognitive Behavioral Therapy concepts in more detail are:
a. Face—do not run away;
b. Accept—do not fight;
c. Float—do not tense;
d. Let Time Pass—do not be impatient with time.
Do you agree with Weekes’ position on nervous sensations and feelings and with the importance she places on keeping her clients fully informed about the obstacles and setbacks that are part of the recovery process? Behaviorally, the four CBT concepts constitute a useful self-care technique for coping with the experience of panic and anxiety. Facing, accepting, floating, and letting time pass are steps which can establish conditions in which desensitization can occur.The first concept outlined by Weekes, facing, is a skill that may take some time to acquire. Of course, as Weekes makes clear, what clients learn to face are arising thoughts and feelings, not locations or situations. Should a client like Greg retreat from a feared situation instead of facing it, it can benefit him to see his behavior in terms of learning a new skill, not in terms of a life-and-death struggle.
♦ Case Study: Greg
Greg, age 31, suffered frequent panic attacks due to a fear of spiders. When introducing Greg to Weekes’ Self-Care approach, I stated, "If you were learning to ride a bicycle and fell off, it would be reasonable to say, ‘Whoops!’ However, it would not be reasonable to say, ‘Oh, what a terrible person I am! I will never learn how to ride a bicycle!’"
"Another way of looking at it is that even the greatest generals have made strategic withdrawals in order to regroup and replenish their supplies." Greg responded, "So I face it if I can, withdraw temporarily if I must—and don’t feel guilty about it." Think of your Greg. How might your client develop facing skills?
Would you agree that full and complete recovery from a phobic condition can best be ensured by fitting together a self-directed treatment program that is both systematic and comprehensive? What are some differences between your approach and Weekes’? Do you emphasize the importance of understanding the philosophy of helplessness and how it arises in the first place?
Do you feel that clients with phobic conditions, like any chronically anxious client, might benefit from becoming aware of a number of habitual self-defeating ideas and behaviors that lead to poor performance, frustration, resentment, anger, and anxiety?
In this section, we have discussed treating phobic conditions. Our discussion was based on Claire Weekes’ Self-Care Approach. Weekes’ Self-Care Approach is comprised of four concepts for coping with phobic conditions. Weekes’ four concepts are face, accept, float, and let time pass. For more information on Weekes’ approach, consult the Bibliography which accompanies this course.
In the next section, we will discuss successive approximations. Successive approximations consist of setting subgoals, identifying triggers, and implementing the technique through behavior.
Peer-Reviewed Journal Article References:
Battalio, S. L., Glette, M., Alschuler, K. N., & Jensen, M. P. (2018). Anxiety, depression, and function in individuals with chronic physical conditions: A longitudinal analysis. Rehabilitation Psychology, 63(4), 532–541.
Bowler, J. O., Mackintosh, B., Dunn, B. D., Mathews, A., Dalgleish, T., & Hoppitt, L. (2012). A comparison of cognitive bias modification for interpretation and computerized cognitive behavior therapy: Effects on anxiety, depression, attentional control, and interpretive bias. Journal of Consulting and Clinical Psychology, 80(6), 1021–1033.
Consoli, A. J., Blears, K., Bunge, E. L., Mandil, J., Sharma, H., & Whaling, K. M. (2018). Integrating culture, pedagogy, and humor in CBT with anxious and depressed youth. Practice Innovations, 3(2), 138–151.
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.
Goldin, P. R., Ziv, M., Jazaieri, H., Werner, K., Kraemer, H., Heimberg, R. G., & Gross, J. J. (2012). Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder. Journal of Consulting and Clinical Psychology, 80(6), 1034–1040.
Grant, D. M., Nagel, K. M., & Deros, D. E. (2021). Evaluating the influence of cognitive mechanisms on fear expectancies: A commentary on Hilleke et al. (2021). Clinical Psychology: Science and Practice, 28(2), 161–163.
What are four CBT concepts for coping with phobic conditions? To select and enter your answer go to .