82 COGNITIVE THEORY AND RESEARCH ON ANXIETY
- Specificity is more likely when researchers focus on thought content that character-
izes each of the disorder subtypes (see Table 3.2) rather than more general forms of
apprehensive thought. Moreover, cognitive content- specificity may be more apparent at
higher levels of symptom severity or in clinical groups that present with greater diag-
nostic homogeneity (e.g., pure anxiety disorder groups). Failure to find specificity in
the anxiety disorders could reflect the inadequacies of the measures employed, espe-
cially if self- report questionnaires are used that underrepresent the more specific forms
of cognition associated with the anxiety subtypes. Also, the high rate of comorbidity
between anxiety and depression has complicated efforts to investigate level of specificity
in pathognomonic processes. Cognitive specificity research would be advanced if inves-
tigators compared “pure” (single- diagnosis) anxiety and depression groups using spe-
cialized instruments of negative thought content. Until then, much remains unknown
about the parameters of cognitive content- specificity in anxiety.
Clinician Guideline 3.6
Clinicians should use thought records, diaries, and other self- monitoring forms to obtain a
“real-time” assessment of the automatic thought and image content that intrudes into con-
scious awareness during fear activation. Specific themes of threat and danger will provide
valuable diagnostic and assessment information for constructing a case formulation of the
anxiety disorder.Hypothesis 7. Ineffective Defensive Strategies
Highly anxious individuals will exhibit less effective immediate defensive strategies for
diminishing anxiety and securing a sense of safety relative to individuals experiencing
low levels of anxiety. In addition, highly anxious individuals will evaluate their defensive
abilities in threatening situations as less effective than nonanxious individuals.
Hypothesis 7 focuses on the final consequence of threat mode activation (see Figure
2.1). It is proposed that fear activation involves an automatic defensive response that
is aimed at immediate reduction or avoidance of fear and the reinstatement of safety.
This rapid response system is not an effortful intentional coping response but instead a
fundamental biologically based adaptational system that is triggered when the organ-
ism encounters a potentially life- threatening situation (Öhman & Mineka, 2001). The
adaptational value of fear is partly due to its ability to trigger an immediate defensive
response.
Fear has evolved to deal with situations involving physical danger that are poten-
tially life- threatening and so primitive alarm reactions may be effective for external
dangers. However, they are less useful, even counterproductive, for the more abstract,
protracted, and internally oriented threats that characterize the anxiety disorders. Beck
et al. (1985, 2005) proposed that two automatic behavioral defensive systems can be trig-
gered by threat. The first is an active, energic system involving mobilization (e.g., fight,
flight) in response to danger. The second is a more passive, anergic system that involves a
stereotypic immobility response (e.g., fainting). Craske (2003) presented a threat immi-