Cognitive Therapy of Anxiety Disorders

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34 COGNITIVE THEORY AND RESEARCH ON ANXIETY


structures, processes, and products involved in the representation and transformation
of meaning based on sensory data derived from the external and internal environment”
(D. A. Clark et al., 1999, p. 77).
Anxiety, then, is the product of an information- processing system that interprets
a situation as threatening to the vital interests and well-being of the individual. In this
case a “threatening” meaning is generated and applied to the situation. The central-
ity of threat meaning- assignment (i.e., information processing) is nicely illustrated in
an example provided by Beck et al. (1985, 2005). Most individuals could easily walk
across a plank that is 6 inches wide without fear, if it were placed 1 foot off the ground.
However, raise the plank 100 feet off the ground, and most individuals would become
intensely afraid and refuse to walk the plank. What accounts for the different emotional
experiences in these two situations is that individuals evaluate walking a plank 100 feet
above the ground as highly dangerous. They also doubt whether their balance could be
maintained, and might actually experience dizziness and unsteadiness should they ven-
ture a few inches onto the plank. Although the plank is at different heights, their abil-
ity to elicit fear or anxiety depends on the perception of danger. Likewise perceptions
of danger are central to clinical states of anxiety. The cognitive model views clinical
anxiety as a reaction to an inappropriate and exaggerated evaluation of personal vulner-
ability derived from a faulty information- processing system that misconstrues neutral
situations or cues as threatening. This is entirely consistent with the definitions of fear
and anxiety proposed in Chapter 1. Based on the concept of vulnerability, Figure 2.1
illustrates the structures, processes, and products of the information- processing system
that are involved in the experience of anxiety.


Clinician Guideline 2.1
Correcting faulty appraisals of threat and secondary appraisals of vulnerability is a funda-
mental approach in cognitive therapy considered necessary for the reduction of anxiety.

Automatic and Strategic Processing


The cognitive model readily acknowledges that both automatic and strategic processes
are involved in anxiety (see Beck & Clark, 1997). Table 2.1 presents the defining char-
acteristics of automatic and strategic or controlled processing first outlined in Beck and
Clark (1997).
At the cognitive level, automatic processing in anxiety has been most clearly dem-
onstrated in the preconscious attentional bias for threat- related stimuli evidenced in
emotional Stroop and dot probe experiments (Macleod, 1999). Findings from implicit
memory tests suggest the presence of an automatic memory bias for negative informa-
tion in anxiety disorders (Coles & Heimberg, 2002; Williams et al., 1997). Classical
conditioning research has demonstrated the acquisition of conditioned fear responses
(e.g., a skin conductance response) to masked fear- relevant stimuli presented outside
conscious awareness, indicating that fear learning can occur as an automatic, precon-
scious process (Öhman & Wiens, 2004). LeDoux’s (1996) research has documented the
acquisition of auditory fear responses in rodents via the subcortical thalamo– amygdala
pathway that bypasses the higher cortical centers for thinking, reasoning, and con-

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