Empirical Status of the Cognitive Model 99
Researchers have begun to investigate emotion inhibition and its related construct
of experiential avoidance in the anxiety disorders. The latter refers to an excessively
negative evaluation of unwanted thoughts, feelings, and sensations as well as to an
unwillingness to experience these private events, thereby resulting in deliberate efforts to
control or escape from them (Hayes, Strosahl, Wilson, et al., 2004b). In a study compar-
ing Vietnam combat veterans with and without PTSD, those with PTSD reported more
frequent and intense withholding of positive and negative emotions and this tendency
to suppress emotions was specifically associated with PTSD symptomatology (Roemer,
Litz, Orsillo, & Wagner, 2001; see also Levitt et al., 2004, for panic disorder). Experi-
ential avoidance is significantly correlated with a number of anxiety- relevant features
like anxiety sensitivity, fear of bodily sensations and suffocation, and trait anxiety, and
it prospectively predicted daily social anxiety and emotional distress over a 3-week
period (Kashdan, Barrios, Forsyth, & Steger, 2006). Although these findings are pre-
liminary, it would appear that the suppression of emotion may join the suppression of
unwanted thoughts as a maladaptive coping strategy that inadvertently fuels distressing
emotional states like anxiety.
Clinician Guideline 3.10
Anxious individuals rely on certain deliberate and effortful coping strategies as an immedi-
ate compensation for their highly aversive subjective state. Unfortunately, any immediate
relief from anxiety due to worry, avoidance, safety- seeking behaviors, or cognitive/experi-
ential suppression is temporary. Indeed, these strategies actually play a prominent role in
the longer term persistence of anxiety states. Thus effective intervention must redress the
detrimental impact that these maladaptive effortful coping strategies have on anxiety.summary anD ConClusionA review of the research literature relevant to the cognitive model of anxiety (see Figure
2.1) indicates there is mounting empirical support for the role of automatic cognitive
processes in immediate fear activation. This is most evident for Hypothesis 1, where
there is consistent experimental data indicating that fear is characterized by an auto-
matic, preconscious attentional threat bias for moderately intense personal threat stim-
uli presented at very brief exposure intervals. Very little research has been conducted on
the possibility of an automatic attentional processing against safety information (i.e.,
Hypothesis 2), although there is moderate research support for an automatic threat
evaluation process in high anxiety states (i.e., Hypothesis 3).
Hypotheses 4 to 7 focus on various cognitive, behavioral, and emotional conse-
quences elicited by immediate threat mode activation. There is considerable evidence that
anxious individuals overestimate the probability, proximity, and, to a lesser extent, the
severity of threat- relevant information (i.e., Hypothesis 4). There is consistent empirical
evidence that highly anxious individuals misinterpret their anxious symptoms in a nega-
tive or threatening manner (i.e., Hypothesis 5) and that automatic negative thoughts and
images of threat, danger, and personal vulnerability or helplessness characterize anxiety