Exposure alone though may not be adequate in ensuring cognitive change. Social phobics, for example, get a lot of exposure across their lives but their fears remain. The instruction to expose onself to the situation triggering one's fears needs to be allied with the additional instruction to drop, and even reverse, safety-seeking manoeuvers that prevent cognitive change (see Clark, D. "Anxiety Disorders: Why they persist and how to treat them". In Behaviour Research and Therapy Vol. 37 pp S5 - S28). Also of importance is the need to shift inflexible and intense self-focused attentional processes. Attentional Training may help (see Adrian Wells) as well as the instruction to deliberatley shift one's attention out onto the actual situation if appropriate. A central cognitve task is to teach the client how to stop worrying. So rather than targeting individual negative thoughts or worries, the therapy needs to target this morbid, perseverative STYLE of cognition that continues to generate a sense of threat(Again see A. Wells).This task requires a metacognitive perspective that views cognition strategically as coping repertoirs supported by explicit and implicit metacognitions.
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