Empirical Status of the Cognitive Model 85
egy with an avoidant function, the initiation of the worry process may be a product of
automatic vigilance for threat.
Automatic Safety Seeking
Safety- seeking behavior is an important class of escape and avoidance behavior that
is evident in the persistence of agoraphobia (Rachman, 1984a), panic disorder (D. M.
Clark, 1997; Salkovskis, 1996a), social phobia (Rapee & Heimberg, 1997; Wells &
Clark, 1997), and PTSD (Ehlers & Clark, 2000). Various studies have shown that
increased use of safety- seeking behaviors is related to the persistence of anxiety and
avoidance (e.g., Dunmore et al., 1999; Dunmore, Clark, & Ehlers, 2001; Salkovskis et
al., 1999; Sloan & Telch, 2002; Wells et al., 1995). White and Barlow (2002) reported
that 74% of their patients with panic disorder with agoraphobia engaged in one or more
safety behaviors such as carrying a medication bottle, food/drink, bags, bracelets, or
other objects. In another study individuals with social phobia exhibited more safety
behavior that was associated with increased anxiety and that mediated actual deficits in
social performance (Stangier, Heidenreich, & Schermelleh-Engel, 2006).
Cognitive models of specific anxiety disorders and the few studies that have been
conducted on safety seeking suggest that this form of response may be important in the
pathogenesis of anxiety. However, this research is of limited relevance to Hypothesis 7
because it focuses on safety seeking as a deliberate avoidant coping strategy. Whether
there are more immediate automatic aspects of safety seeking that would make it part
of the immediate defense response is unknown at this time.
Summary
There is overwhelming clinical and laboratory evidence for a fairly automatic escape
and avoidance response in high anxiety, and this responding is part of a characteristic
automatic defensive pattern aimed at protecting the organism against threat and danger.
What is less well known is whether the elimination of escape and avoidance responses
is necessary for the successful treatment of anxiety states. Much less is known about
the more automatic features of cognitive avoidance and safety- seeking behaviors. The
research that has been published has examined these topics in terms of conscious delib-
erate coping strategies aimed at the reduction of anxiety. Thus more research is needed
that directly compares the automatic defensive response of high and low anxious indi-
viduals in terms of its immediate impact on anxiety level and perceived effectiveness as
a direct test of Hypothesis 7. Until this research has been conducted, the empirical status
of the cognitive and safety- seeking aspects of Hypothesis 7 is unknown.
Clinician Guideline 3.7
Relatively automatic and idiosyncratic cognitive, behavioral, and safety- seeking defensive
responses must be identified and targeted for change. A broad perspective on avoidance, one
that recognizes its cognitive and safety- seeking characteristics as part of an automatic rapid
response system to threat, is essential.