Cognitive Therapy of Anxiety Disorders

(sharon) #1

Vulnerability to Anxiety 109


ished sense of personal control is an individual difference variable that may be acquired
through childhood experiences of stifled independence, limited exploration, and high
parental protection. As a result of repeated experiences of uncontrollable or unpredict-
able events throughout early and middle childhood, the individual develops low per-
ceived control over life circumstances and perhaps increased neurobiological activity in
the behavioral inhibition system (Barlow, 2002; Chorpita & Barlow, 1998). According
to Barlow, these beliefs of low personal control constitute a personality diathesis that
interacts with negative or aversive life events to trigger anxiety or depression.
It has been long recognized that a decrease in perceived control is associated with
anxiety and that lower control over a threatening event can increase estimates of the
probability of danger and personal vulnerability (Chorpita & Barlow, 1998). Beck et
al. (1985, 2005) recognized that fear of losing control is a prominent cognitive feature
found in many anxiety states. Barlow and colleagues (Barlow, 2002; Chorpita & Bar-
low, 1998) note that the perception that threatening events occur in an unexpected,
unpredictable fashion is part of a diminished sense of personal control over aversive
events. However, there is a lack of direct support for a specific association between
chronic diminished control and anxiety (see Barlow, 2002; Chorpita & Barlow, 1998).
In fact there has been a long research tradition in locus of control, learned helplessness,
life event appraisals, and attributional style that recognizes a role for perceived control
in depression (e.g., Abramson, Metalsky, & Alloy, 1989; Alloy, Abramson, Safford, &
Gibb, 2006; Hammen, 1988). Alloy et al. (1990), for example, stated that a generalized
tendency to perceive negative events as uncontrollable is a distal contributory cause of
depression.
Alloy and colleagues further proposed a helplessness– hopelessness theory that iden-
tifies certain key cognitive processes that underlie the high comorbidity between anxiety
and depression (Alloy et al., 1990). According to the theory, anxiety is experienced when
individuals expect to be helpless in controlling important future events but are uncer-
tain about their helplessness, whereas this anxiety turns to hopelessness and depression
when the future negative outcomes become certain. Unfortunately, research on the role
of a cognitive style of diminished control for negative outcomes in anxiety, and its prob-
able connection to depression, is limited (Chorpita & Barlow, 1998). This state of affairs
is partly due to the lack of sensitive measures of perceived uncontrollability of threat.
To rectify this situation, the 30-item Anxiety Control Questionnaire (ACQ) was devel-
oped to assess perceived control over anxiety- related symptoms, emotional reactions,
and external problems and threats (Rapee, Craske, Brown, & Barlow, 1996). The ACQ
has good internal consistency, 1-month test– retest reliability, and moderate correlations
with anxiety and depression symptom measures (see also Zebb & Moore, 1999).
There is fairly consistent empirical evidence of a close association between anxiety
and diminished sense of control over outcomes. In a panic disorder study agoraphobic
avoidance was greatest in those who had high anxiety sensitivity and low ACQ percep-
tion of control (White, Brown, Somers, & Barlow, 2006). Likewise Hofman (2005)
found that anxiety in social phobia persists because individuals have low perceived
control over emotions and bodily sensations when exposed to social threat (see also
McLaren & Crowe, 2003; Rapee, 1997, for similar findings).
Despite evidence of an association between diminished sense of control over poten-
tially threatening outcomes and anxiety, there is a significant body of research from the

Free download pdf