Cognitive Restructuring-Assistance in the Clinical Extinction of Fear and Avoidance

Abstract

Two case studies are presented in which the attempted extinction of negative reinforcement-maintained behavior was unsuccessful because clients were unable to completely stop avoiding the target situations. Clinical treatment was based on the hypothesis that a self-control deficit caused the problem behavior to be maintained because of partial negative reinforcement. In the first case, a male college student experienced considerable anxiety while urinating in public restrooms. He frequently avoided or escaped restrooms with people in them, thus causing a number of secondary problems. The second case was a college female who engaged in an obsessive-compulsive chain in which a catastro-phizing thought set the occasion for engaging in compulsive behavior. The compulsive behavior was taking up a large amount of her time. After unsuccessfully using therapeutic instructions designed to preclude avoidance, systematic cognitive restructuring was used as a way to increase the likelihood clients would follow instructions and discontinue avoidance behavior by decreasing the mediational control of negative and irrational verbal behaviors. Both cases showed that compliance with the extinction instructions was enhanced by combining cognitive restructuring with the treatment program.