The Cognitive Model of Anxiety 53
Wilson & MacLeod, 2003). Because the orienting mode in nonclinical individuals does
not show the heightened sensitivity to negative stimuli, the anxiety program is less often
activated in nonclinical than in clinical individuals.
When the anxiety program is activated in nonclinical individuals, we propose quali-
tative differences in primal threat mode activation compared with anxious patients. Non-
clinical individuals are less likely to exhibit a preconscious attentional bias for threat,
and so their initial appraisals of threat are less exaggerated and more appropriate to the
situation at hand. In normal anxiety, threat appraisals will more accurately reflect the
consensually recognized threat value associated with internal or external situations. For
example, the panic disorder patient misinterprets chest pain as a heart attack, whereas
the nonclinical individual might interpret the chest pain as only remotely indicative of
heart disease and instead more likely due to recent strenuous physical activity.
In normal anxiety states, activation of the threat mode does not have the same nega-
tive processing effects that are evident in the anxiety disorders. For example, autonomic
arousal will be perceived as uncomfortable but not dangerous. Thus nonclinical persons
are more likely to view their aroused state as tolerable and not requiring immediate
relief. Furthermore, both automatic and more strategic attentional processes are not as
narrowly focused on threat, so nonclinically anxious individuals make fewer cognitive
errors as they process both the threatening and the nonthreatening aspects of a situa-
tion. The automatic reflexive inhibitory behaviors aimed at self- protection (fight/flight,
escape) that are so prominent in the anxiety disorders are delayed in nonclinical states.
This gives opportunity for more elaborative and strategic cognitive processes to recon-
sider the situation and execute a more adaptive, controlled response. The end result is
that even during times of anxiousness, nonclinical individuals will have fewer and less
salient intrusive and uncontrollable automatic thoughts and images of threat.
Secondary Elaborative Cognitive Processing in Normal Anxiety
The greatest differences between clinical and nonclinical anxiety are evident in the sec-
ondary, strategic controlled processes responsible for the persistence of anxiety. For the
clinical individual further elaboration results in a persistence and even escalation of
anxiety, whereas the same processes result in reduction and possible termination of the
anxiety program for the nonclinical person.
One of the most important differences at the elaborative phase is that nonclinical
individuals have a more balanced understanding of their personal strengths and coping
resources whereas clinical individuals tend to focus on their weaknesses and deficien-
cies. In nonclinical individuals this leads to high self- efficacy and expectancy of a suc-
cessful or positive outcome. For individuals with anxiety disorders, negative evaluation
of their coping resources intensifies a sense of personal vulnerability and helplessness.
Second, we expect that nonclinical individuals are better able to recognize and
comprehend the safety cues in a situation compared to those with anxiety disorders.
This will allow them to arrive at a more complete understanding of their circumstances
and a more realistic assessment of its threat potential. Third, the nonclinical individual
will have greater access to constructive mode thinking so that initial threat apprais-
als can be reevaluated in the light of more rational, evidenced-based reasoning. In the
anxiety disorders, this type of rational, reflective thought is blocked by the hypervalent
threat schemas.