76 COGNITIVE THEORY AND RESEARCH ON ANXIETY
were significantly influenced in their danger ratings of hypothetical anxiety scripts by
the presence of anxiety response information.
It is proposed that different aspects of the subjective experience of anxiety will be
perceived as threatening depending on the nature of the anxiety disorder. In some cases
it will be the physiological symptoms that are considered most unacceptable, whereas in
other disorders it is cognitive phenomena (i.e., worry or unwanted intrusive thoughts)
or even the heightened sense of general anxiousness that is perceived as most disturbing.
Whatever the actual focus, it is the state of being anxious that is considered threatening
and intolerable to the person. Table 3.1 presents the specific negative interpretations of
anxiety associated with each of the anxiety disorders discussed in this volume.
Empirical Evidence
Negative interpretation of physiological arousal is a central process in the cognitive model
of panic disorder (see Chapter 8 for further discussion). Questionnaire studies indicate
that individuals with panic disorder are more likely to negatively (even catastrophically)
misinterpret bodily sensations associated with anxiety and to report more distress when
experiencing these symptoms than nonclinical individuals or those with other types
of anxiety disorders (e.g., D. M. Clark et al., 1997; Harvey, Richards, Dziadosz, &
Swindell, 1993; Hochn-Saric, McLeod, Funderburk, & Kowalski, 2004; Kamieniecki,
Wade, & Tsourtos, 1997; McNally & Foa, 1987; Rapee, Ancis, & Barlow, 1988). Also,
experimental research indicates that panic patients are more likely to feel anxious or
even to panic when they focus on induced or naturally occurring bodily sensations
(Antony, Ledley, Liss, & Swinson, 2006; Pauli, Marquardt, Hartl, Nutzinger, Hölzl, &
Strain, 1991; Rachman, Lopatka, & Levitt, 1988; Rachman, Levitt, & Lopatka, 1988;
Hochn-Saric et al., 2004). Together these studies provide a strong empirical basis that a
heightened misinterpretation of physiological arousal is a key process in panic.
For individuals with GAD a focus on the more cognitive symptoms of anxiety will
characterize their negative interpretation of anxiousness. Adrian Wells first noted that
“worry about worry” (i.e., metaworry) is a prominent feature of GAD that distinguishes
high worriers from those who are nonworriers (Wells, 1997; Wells & Butler, 1997;
table 3.1. specific negative interpretations of anxiety associated with each
of the anxiety Disorders
Anxiety disorder Focus of negative interpretation of anxiety
Panic disorder Physiological arousal, specific bodily sensations
Generalized anxiety disorder Subjective experience of worry (“worry about worry”)Social phobia Somatic and behavioral indicators of being anxious in social settings
Obsessive–compulsive disorder Anxious feeling associated with certain unwanted intrusive thoughts,
images, or impulses
Posttraumatic stress disorder Specific physiological and emotional arousal symptoms associated
with trauma-related mental intrusions