40 COGNITIVE THEORY AND RESEARCH ON ANXIETY
Automatic and Strategic Processing
We have already considered how automatic and strategic processes are evident at vari-
ous facets of the cognitive basis of anxiety. Automatic processing will be more apparent
in the early primary appraisal of threat involving activation of the primal threat mode,
whereas controlled strategic processing will be more evident at the secondary elabora-
tive phase of threat reappraisal, coping resources, and safety seeking. Given this mix of
automatic and controlled processing, one question that emerges is whether more effort-
ful and voluntary reflection really can have a significant effect on reducing anxiety.
As previously noted, there is considerable empirical evidence from conditioning
experiments that acquired fear responses can be reduced via social transmission of
information (e.g., see discussion by Brewin, 1988). Moreover, information on the pre-
dictability and controllability of future threat, danger, or other negative events deter-
mines in large part the presence or absence of anxious apprehension (Barlow, 2002).
Furthermore, personal and clinical experience supports the assertion that conscious
controlled cognition can have a significant anxiety- reducing effect. In our everyday lives
we have all had experiences of correcting an initial feeling of anxiousness through con-
trolled, effortful, and logical reanalysis of the perceived threat. So experimental and
anecdotal evidence is consistent with the assertion in cognitive therapy that therapeutic
interventions, like cognitive restructuring, that rely on controlled effortful thought pro-
cesses can significantly contribute to anxiety reduction.
The presence of reflexive, automatic cognitive processing in anxiety does mean
that experiential or behavioral interventions, such as direct exposure to the fear stimu-
lus, will be needed in addition to controlled cognitive interventions to reduce anxi-
ety. Exposure-based treatment strategies are important because they enable a deeper,
more generalized and stronger activation of threat schemas and provide opportunities
to gather direct disconfirming evidence against the high threat value initially assigned
by the anxious patient (for related discussion, see Foa & Kozak, 1986). These kinds of
behavioral experiences also become powerful tools for building self- confidence in one’s
ability to deal with the anticipated threat. Chapter 6 discusses cognitive interventions at
the strategic processing level, and Chapter 7 presents various behavioral exercises used
to provide disconfirming evidence for threat.
Clinician Guideline 2.7
Strategic cognitive processing interventions and more behavioral, experiential exercises are
used to modify immediate threat appraisals and reduce heightened states of anxiety.Self- Perpetuating Process
An anxiety episode can last from a few minutes to many hours. In fact some patients
with GAD complain that they are never really free of anxiety. So the persistence of
anxiety must be seen as a vicious cycle or a self- perpetuating process. Once the anxi-
ety program is activated, it tends to be self- perpetuating through a number of pro-
cesses. First, self- focused attention is enhanced during anxiety states so that individu-
als become acutely aware of their own anxiety- related thoughts and behaviors. This