Vulnerability to Anxiety 111
community-based young adults, individuals who averaged over six major life events or
potentially traumatic experiences and an accumulating exposure to lifetime adversity
had increased risk of depressive or anxious episodes (Turner & Lloyd, 2004). Stressful
or adverse life experiences have been shown to frequently precede and/or exacerbate
the onset of OCD (i.e., Cromer, Schmidt, & Murphy, 2007), social phobia, panic dis-
order, GAD, and, of course, PTSD (for reviews, see Clark, 2004; Craske, 2003; Ledley,
Fresco, & Heimberg, 2006; Taylor, 2000, 2006). However, one must keep in mind that
many individuals develop an anxiety disorder without experiencing a major negative life
event, and most people who experience life adversities never develop an anxiety disorder
(McNally, Malcarne, & Hansdottir, 2001).
Although there is consistent evidence that life events play an etiological role in
anxiety, it is also apparent that their contribution may be less prominent in anxiety
than they are in depression. For instance, Kendler, Myers, and Prescott (2002) did not
find evidence to support a diathesis– stress model for the acquisition of phobias (see also
Brown, Harris, & Eales, 1996). Thus threatening life events and other experiences of
life trauma and adversity are significant contributors in the pathogenesis of anxiety, but
much remains to be learned about the exact nature of these proximal contributors and
how they interact with the cognitive- personality vulnerability factors for anxiety.
Clinician Guideline 4.3
Given the prominence of threat- oriented stressful events, adversity, and traumatic experi-
ences in anxiety disorders, include a life history in the assessment. The cognitive case formu-
lation should include appraisals of control, perceived vulnerability, and expected outcomes
associated with these experiences.the Cognitive vulnerability moDelIn their original account of the cognitive model of anxiety Beck et al. (1985, 2005)
defined vulnerability as “a person’s perception of himself as subject to internal or exter-
nal dangers over which his control is lacking or is insufficient to afford him a sense of
safety. In clinical syndromes, the sense of vulnerability is magnified by certain dys-
functional cognitive processes” (Beck et al., 1985, pp. 67–68). In this formulation vul-
nerability to anxiety is conceptualized as a predisposition to misinterpret potentially
threatening or novel situations as dangerous and devoid of safety, leaving the individual
in a state of perceived helplessness. In the anxiety disorders only certain types of threat
will activate this underlying cognitive vulnerability. Once activated in a particular situ-
ation, the cognitive- affective program described in Chapter 2 (see Figure 2.1) maintains
the individual in a heightened state of anxiety.
Beck et al. (1985, 2005) focused on two main characteristics of cognitive vulnerabil-
ity. The first is an enduring tendency to misinterpret certain types of threatening or novel
situations as dangerous. The second is a predisposition to perceive one’s self as incompe-
tent, weak, or lacking the personal resources to deal with certain types of threatening or
stressful situations. In the current formulation of the cognitive model, the first feature of
cognitive vulnerability is captured by Hypothesis 12, enduring threat- related beliefs, and