Cognitive Therapy of Anxiety Disorders

Empirical Status of the Cognitive Model 83

nence model in which increased proximity and detection of a threat is associated with a
corresponding state of autonomic arousal in preparation for fight or flight.
Figure 3.4 summarizes the behavioral, cognitive, and safety- seeking processes
involved in the automatic defensive reaction elicited by threat mode activation.

Behavioral Escape and Avoidance

Escape and avoidance behavior is so prominent in anxiety states that it is included as
one of the cardinal DSM-IV diagnostic features of social phobia, PTSD, specific phobia,
and panic disorder (APA, 2000). Furthermore, attempts to ignore, suppress, or neutral-
ize obsessions in OCD and the ineffective control of worry in GAD can be considered
examples of escape responses in these disorders. Escape and avoidance responses are
so closely associated with subjective fear that their occurrence is taken as an important
marker of fear expression (Barlow, 2002).
Behavioral, biological, and emotion theories of fear are almost universal in their
agreement that an automatic escape and avoidance response is part of fear activation
(Barlow, 2002). Various defensive reactions such as withdrawal (flight, escape, avoid-
ance), attentive (freezing) or tonic (unresponsive) immobility, aggressive defense, and
deflection of attack (appeasement or submission) are associated with fear arousal in
all animals including humans as a means of protection against danger (Marks, 1987).
Active avoidance of fear stimuli, which has been demonstrated in numerous animal and
human aversive conditioning experiments, is known to have reinforcing effects because
it is associated with the avoidance of punishment (Gray, 1987; Seligman & Johnston,
1973). Avoidance learning, then, is resistant to extinction because it terminates expo-
sure to punishment (the aversive stimulus) and engenders a sense of control over the

Threat Mode

Activation

Automatic Behavioral Response

fAvoidance

fEscape

fImmobility

Automatic Cognitive Response

fAttentional avoidance

fDistraction

fThought Suppression

Automatic Safety Seeking

fActive responses to restore

personal safety

figure 3.4. The automatic defensive response system associated with threat mode activation.