The Cognitive Model of Anxiety 51
effective problem solving. It is anchored in constructive mode thinking in which the
individual arrives at realistic solutions based on a careful analysis of contradictory evi-
dence. A minimal amount of anxiety may be experienced as the person considers the
possibility of negative outcomes and the consequences of ineffective coping. However,
the anxiety is not based in primal threat mode activation and so, if anything, it serves
to motivate the individual toward action.
For the highly anxious individual worry takes on pathological features that do
not lead to effective problem solving but rather to an escalation of the initial threat
appraisal. Here the worry becomes uncontrollable and almost exclusively focused on
negative, catastrophic, and threatening outcomes. Because of the domination of threat
mode thinking in the anxiety disorders, any constructive aspects of worry are blocked
and the narrow focus on negative outcomes potentiates the appraisal of threat. Thus
worry in the anxiety disorders, especially GAD, can become a self- perpetuating elabo-
rative cycle that intensifies the anxious state and is perceived as confirmation of the
person’s initial appraisal of threat.
Clinician Guideline 2.16
Since worry is a common feature of all anxiety disorders, interventions that focus directly on
worry reduction are a major feature of cognitive therapy of anxiety.Reappraisal of Threat
One outcome of secondary elaborative thinking is a more conscious, effortful reeval-
uation of the threatening situation. In nonanxious states this may result in a dimin-
ished state of anxiety as the person downgrades the probability and severity of
anticipated threat in light of contradictory evidence. Moreover, recognition of safety
features in the environment and a reappraisal of coping strategies may lead to a reduced
sense of vulnerability. In this case elaborative processing can result in a reduction in
a n x iet y.
In the anxiety disorders secondary elaborative thinking is dominated by the threat
mode and so is biased toward confirming the dangerousness of situations. An increased
sense of personal vulnerability is reinforced by this elaborative thinking and the realistic
safety features of the situation are overlooked. Worry and anxious rumination support
the anxious person’s initial automatic appraisal of threat. In this way, secondary elabo-
rative cognitive processes are responsible for the persistence of anxiety, whereas primal
threat mode activation is responsible for the immediate fear response of the anxiety
program.
Clinician Guideline 2.17
Cognitive therapy seeks to help clients process disconfirming evidence that will lead to a
reevaluation of threat as less probable, severe, or imminent.