84 COGNITIVE THEORY AND RESEARCH ON ANXIETY
situation, the latter of which augments fear reduction (for review and discussion, see
Mineka, 1979, 2004). It is not surprising that escape and avoidance responding has
played a prominent role in learning theories of fear acquisition and persistence (for fur-
ther discussion, see Barlow, 2002; Craske, 2003; Öhman & Mineka, 2001; LeDoux,
1996; Marks, 1987).
Phenomenological studies of the anxiety disorders have found that some form of
immediate escape and avoidance is evident in most anxiety states. Escape and avoidance
is more prevalent in high levels of state and trait anxiety (Genest, Bowen, Dudley, &
Keegan, 1990). Most individuals with panic disorder (i.e., 90%) evidence at least mild to
moderate levels of agoraphobic avoidance (Brown & Barlow, 2002; Craske & Barlow,
1988). In social phobia individuals are more likely to engage in subtle avoidance behav-
iors like not giving eye contact or looking away while in social evaluative situations
(Beidel et al., 1985; Bögels & Mansell, 2004; Wells et al., 1995), whereas emotional
numbing, avoidance of trauma- related cues, or foreshortened future are active and pas-
sive avoidance responses in PTSD that reflect attempts to reduce the aversiveness of
reexperiencing the trauma (e.g., Feeny & Foa, 2006; Wilson, 2004). Between 75 and
91% of individuals with OCD have both obsessions and compulsions, the latter being
an active avoidance or escape response (Akhtar, Wig, Varma, Peershad, & Verma, 1975;
Foa & Kozak, 1995). For the vast majority of anxious patients, behavioral avoidance
plays an important role in their daily experience of this negative emotional state.
Cognitive Avoidance: An Automatic Defensive Reaction
Various cognitive processes have been identified as part of the automatic avoidance
response to threat. Attentional shift away from threat stimuli, distraction, thought sup-
pression, and the initiation of worry are all protective cognitive processes that are aimed
at terminating or preventing exposure to threat (Craske, 2003). Ironically, these imme-
diate responses may actually increase accessibility to the very schemas that represent
threat (Wells & Matthews, 2006). Moreover, all of these processes involve a mix of
automatic and more conscious, effortful processing. In this section we consider evidence
for an automatic cognitive avoidance, whereas the more elaborative aspects of distrac-
tion, worry, and thought suppression will be discussed as deliberate avoidant coping
strategies under Hypothesis 10.
An automatic avoidance of threat has been more consistently demonstrated in spe-
cific and social phobias than in GAD and the other anxiety disorders (see reviews by
Bögels & Mansell, 2004; Mogg & Bradley, 2004; e.g., experiment by Mogg, Bradley,
Miles, & Dixon, 2004). As a result it is still unknown whether an automatic attentional
avoidance of threat is a universal feature of all high anxiety states.
If a delayed automatic attentional avoidance of threat does emerge more consis-
tently across the anxiety disorders, then this process could be a key element in triggering
the more conscious, strategic cognitive avoidance responses like distraction, thought
suppression, and worry (see also Mathews & Mackintosh, 1998, for similar view).
Borkovec and colleagues present compelling evidence that worry functions as a cogni-
tive avoidance reaction to threatening information (Borkovec, 1994; Borkovec, Alcaine,
& Behar, 2004; see also Mathews, 1990) that is instigated by the automatic attentional
biases for threat. Although worry is predominantly a conscious effortful coping strat-