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Description: CBT is a first-line treatment for panic disorder, social anxiety, phobias and OCD. Yet despite its efficacy, it can require a substantial amount of client time, discomfort, and cost, which can lead to treatment refusal, dropouts and lack of engagement. Preliminary studies are now exploring the efficacy of briefer treatments for anxiety disorders and OCD. We will start with a short review of these results and on rapid gain, including published data on this model. Then we will explore a method of initiating treatment, which is engagement-oriented versus compliance-oriented, that encourages clients to adopt a simple yet paradoxical mindset that is manifest through provocative strategies after session 1 that generates positive change before session 2. We will outline the treatment strategy, step-by-step, and illustrate each stage with brief, professionally-videotaped segments of therapist-client interaction in the first two sessions of treatment with two different clients. First will be a woman with claustrophobia, panic attacks, and fear of flying and, second, a man with severe OCD. The treatment protocol—built out of whole cloth within the first session—directs the entire therapy process. The principal goal is to induce clients to adopt a long-term self-help protocol to voluntarily, purposely and aggressively seek out and embrace uncertainty and anxiety moment-by-moment as their ticket out of suffering. Attention will focus on how the clinician presents the paradigm in a manner persuasive enough to counter the dread of symptoms and their feared consequences.

Reid WilsonTrainer:  Reid Wilson, Ph.D is Associate Clinical Professor of Psychiatry at the UNC School of Medicine and directs the Anxiety Disorders Treatment Center in Durham and Chapel Hill. Dr. Wilson has dedicated his 30-year career to developing self-help strategies for the anxiety disorders. He is the author or co-author of four self-help books, including Don’t Panic: Taking Control of Anxiety Attacks (Harper), Stop Obsessing!: How to Overcome Your Obsessions and Compulsions(Bantam), the newly-released Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children (HCI Books), and its free companion e-Book, Playing with Anxiety: Casey’s Guide for Teens and Kids. Dr. Wilson volunteers as the expert for WebMD’s Anxiety & Panic Community. His free self-help website – – serves 500,000 visitors per year. He designed and served as lead psychologist for American Airlines’ first national program for the fearful flier.  Dr. Wilson served on the Board of Directors of ADAA for 12 years and served as Program Chair of the National Conferences on Anxiety Disorders from 1988-1991. He has offered trainings throughout the world in the treatment of anxiety. Dr. Wilson has received the Jerilyn Ross Clinician Advocate Award for his outstanding advocacy for patient education and care, training, and research.

Learning Objectives: 

At the completion of this program, participants will be able to:

  1. Defend the importance of altering perception, as opposed to utilizing technique, to help clients with anxiety disorders.
  2. Guide a client in logically dismantling the common dysfunctional frames of reference of an anxiety disorder or OCD.
  3. Construct with a client a new, internally-consistent paradoxical frame of reference.
  4. Explain how to use reappraisal to activate “approach” emotions toward anxious uncertainty during exposure.
  5. Teach a client how to activate that new frame of reference moment-by-moment while engaging in threatening situations.
  6. Teach a client how to use both motivational and instructional self-talk cues to enhance exposure.


The possibility of rapid gain in treatment; Detachment, paradox & frame of reference shift in generalized anxiety; The four strategies (Step back, Want it, Step forward, Be cunning); Framing up the action; The opening moves

Shifting the focus UP; Establishing the contract & addressing beliefs; Challenging distortions; The shoulder shrug & the hand wave; Interoceptive exposure; Moment-by-moment goals; Voluntarily choosing the experience: “I want this”

Debriefing homework; Two forms of self-talk: motivation & commands; Establishing their new principles; Challenging safety behaviors; Elevating a competing emotion


Some references: 

Wilson, R.R.  (2009). Don’t Panic: Taking Control of Anxiety Attacks, 3rd Edition, New York: Harper.

Wilson, R., Neziroglu, F., Feinstein, B., & Ginsberg, R. (2014). A New Model for the Initiation of Treatment for Obsessive-Compulsive Disorder: An Exploratory Study, Journal of Obsessive-Compulsive and Related Disorders, 3, 332-337.

Wilson, R. (2010) Playing with the Moment: A Frame Theory in Anxiety Treatment, In Burns, G.W. Happiness, Healing, Enhancement: Your Casebook Collection for Applying Positive Psychology in Therapy. Hoboken, NJ: John Wiley & Sons.


3-per-page with note space  or  handouts (with 6 slides per page)

Clinical Institute at the University of North Carolina at Chapel Hill School of Social Work

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