Cognitive Therapy of Anxiety Disorders

54 COGNITIVE THEORY AND RESEARCH ON ANXIETY

A fourth consideration is the quality of worry that occurs at the elaborative phase.
Normal anxiety is characterized by a more controlled, reflective, and problem- oriented
type of worry. The worry of a nonclinical person may lead to the generation of possible
solutions to a particular problem. The pathological worry in the anxiety disorders is
less controllable, more persistent, and more focused on the immediate threat of the situ-
ation. Worry in the anxiety disorders appears to intensify anxiety, whereas the worry
in nonclinical states may motivate an individual to take constructive action. The final
result is that processes at the elaborative phase may lead to diminished threat estimation
in normal anxiety, but to an intensification of the initial threat appraisal in the anxiety
disorders. In this way secondary elaborative cognitive processes are responsible for the
persistence of anxiety in abnormal states but for a controlled management and eventual
reduction of the anxiety program in normal conditions.
The cognitive perspective on normal and abnormal anxiety has direct implications
for the treatment of anxiety disorders. As cognitive therapists, our focus should be on
the elaborative strategic processes involved in secondary reappraisal. Teachman and
Woody (2004) concluded that experimental evidence supports the view that strategic
elaborative processing can override implicit or automatic cognitive processes and behav-
ior. This is the challenge for cognitive therapists

Clinician Guideline 2.18

Shift the secondary elaborative processing and reappraisal in anxiety disorders from one of

threat enhancement to one of threat reduction, as seen in nonclinical states.

hypotheses of the Cognitive moDel

Table 2.6 presents 12 primary hypotheses derived from the cognitive model of anxiety.
Although many other hypotheses can be formulated from the cognitive perspective,
we believe these 12 hypotheses represent critical aspects of the model that provide an
empirical test of its validity. These hypotheses were derived from the central tenets of
the model (see Table 2.2) as well as the two-phase structure outlined in Figure 2.1.
Chapters 3 and 4 provide an extensive review of the empirical support for each of the
hypotheses.

summary anD ConClusion

It is 25 years since the cognitive model of anxiety was first introduced by Beck and col-
leagues (Beck et al., 1985). In this chapter we presented a reformulation of that model,
which incorporates the considerable progress made in our understanding of the cogni-
tive contributors to the pathogenesis of anxiety. The last two decades have represented
an exceptionally productive period of cognitive- clinical research on the anxiety dis-
orders and their treatment. In light of these developments a number of modifications,
elaborations, and clarifications were made to the cognitive model.