Empirical Status of the Cognitive Model 93
as the initiation of effective problem solving. In addition, other cognitive strategies aimed
at reducing threatening thoughts, such as thought suppression, distraction, and thought
replacement, are more likely to exhibit paradoxical effects (i.e., rebound, increased negative
affect, less perceived control) in high than low anxiety states.
Worry: A Maladaptive Coping Strategy
As a product of threat mode activation worry has a deleterious impact on the persis-
tence of anxiety by enhancing the perceived likelihood and severity of threat as well as
one’s personal sense of vulnerability or ability to cope. Worry, then, has a dual function
both as a “downstream” consequence of automatic threat processes and a “feedback”
contributor to the persistence of anxiety. This leads to three specific predictions about
worry in the anxiety disorders:
••Highly anxious individuals will have more excessive, exaggerated, and uncon-
trolled worry than those with low anxiety.
••Worry in high anxiety will have a more negative consequence, resulting in greater
threat reappraisal and increased subjective anxiety.
••The worry process in low anxiety is characterized by more adaptive and effective
problem solving, whereas worry in high anxiety is counterproductive.EXCESSIvE, UNCoNTRoLLAbLE WoRRY
Considerable evidence indicates that worry is a prominent feature of all the anxiety
disorders and when it occurs in these clinical states, it is much more excessive, exagger-
ated, and uncontrollable than the worry reported by nonclinical individuals. In a recent
review of cognitive specificity of the anxiety disorders, it was concluded that pathologi-
cal worry is not only evident in GAD but in other anxiety disorders as well, such as
panic disorder and OCD (Starcevic & Berle, 2006). Worry is a prominent feature of
symptom constructs considered common across the anxiety disorders such as anxious
apprehension (Barlow, 2002), negative affect (Barlow, 2000; Watson & Clark, 1984),
and trait anxiety (Spielberger, 1985). Although most studies find that worry is signifi-
cantly more frequent, severe, and uncontrollable in GAD (Chelminski & Zimmerman,
2003; Dupuy et al., 2001; Hoyer, Becker, & Roth, 2001), nevertheless elevated levels are
also present in panic disorder, OCD, social phobia, PTSD, and even depression as well
as subsyndromal states of high anxiety (Chelminski & Zimmerman, 2003; Gladstone
et al., 2005; Wetherell, Roux, & Gatz, 2003). Naturally, the actual content of worry
will vary, with social phobia associated with social evaluative concerns, panic with the
occurrence of panic attacks or some dreaded physical consequence, PTSD with past
trauma or the negative impact of the disorder, and OCD with a variety of obsessional
fears. Moreover, the worry in GAD may be distinguished by concerns about minor daily
matters, remote future events, or illness/health/injury (Craske, Rapee, Jackel, & Barlow,
1989; Dugas, Freeston, et al., 1998; Hoyer et al., 2001). Overall, though, the research
clearly indicates that excessive and maladaptive worry is commonly associated with
states of high anxiety.