The Cognitive Model of Anxiety 41
heightened attention to the symptoms of anxiety will intensify one’s subjective appre-
hension. Second, the presence of anxiety can impair performance in certain threaten-
ing situations, such as when the speech- anxious person goes blank or starts to perspire
profusely. Attention to these symptoms could easily interfere with the person’s ability
to deliver the speech.
In the final analysis the anxious person interprets the presence of anxiety itself as
a highly threatening development that must be reduced as quickly as possible in order
to minimize or avoid its “catastrophic effects.” In this case the person literally becomes
“anxious about being anxious.” D. M. Clark and colleagues have developed cognitive
models and interventions for panic, social phobia, and PTSD that emphasize the del-
eterious effects of misinterpreting the presence of anxious symptoms in a catastrophic
(or at least highly negative) manner (D. M. Clark, 1996, 2001; D. M. Clark & Ehlers,
2004). This self- perpetuating characteristic of anxiety, then, indicates that any inter-
vention designed to interrupt the cycle must deal with any threat- related appraisals of
anxious symptoms themselves.
Clinician Guideline 2.8
Correcting misinterpretations of anxious symptoms is another important component of
cognitive therapy for anxiety disorders.Cognitive Primacy
The cognitive model asserts that the central problem in anxiety disorders is the acti-
vation of hypervalent threat schemas that present an overly dangerous perspective on
reality and the self as weak, helpless, and vulnerable (Beck et al., 1985, 2005). From
a cognitive perspective, an initial rapid and involuntary stimulus evaluation of threat
occurs in the early phase of anxiety. It is within this framework that we view cognition
as primary in the acquisition and maintenance of fear responses. Furthermore, because
of the primacy or importance of cognition, we propose that some shift in the cognitive
conceptualization of threat is needed before any reduction in anxiety can be expected.
Without treatment, the repeated appraisal and reappraisal of threat and vulnerability
will lead to a generalization of the anxiety program so that it encompasses a broader
array of eliciting situations.
Clinician Guideline 2.9
Changing the cognitive evaluation of threat and vulnerability is necessary to reverse the gen-
eralization and persistence of anxiety.Cognitive Vulnerability to Anxiety
There are individual differences in susceptibility or risk for anxiety disorders. Indi-
viduals are at increased risk for anxiety because of certain genetic, neurophysiological,