Cognitive Therapy of Anxiety Disorders

110 COGNITIVE THEORY AND RESEARCH ON ANXIETY

attributional style literature showing that reduced perceived control over past negative
events may have an even stronger relation to depression than to anxiety. A negative or
pessimistic attributional style refers to the belief that the cause of past loss and fail-
ure can be attributed to internal, global, and stable or enduring personal deficiencies
(Abramson, Seligman, & Teasdale, 1978). A negative attributional style can be viewed
as a diminished sense of past control. There is now considerable evidence that negative
attributional style is a cognitive- personality vulnerability for depression (for reviews,
see Alloy et al., 2006; Sweeney, Anderson, & Bailey, 1986; e.g., Hankin, Abramson,
& Siler, 2001; Metalsky, Halberstadt, & Abramson, 1987). However, studies that have
examined the specificity of the negative attributional style reveal that it is also apparent
in anxiety, though to a lesser degree, (e.g., Heimberg et al., 1989; Johnson & Miller,
1990; Luten, Ralph, & Mineka, 1997).
Perceived reduction in control over potentially threatening outcomes appears to be
an important factor in the anxiety disorders, especially if there is elevated uncertainty
about the threat (Alloy et al., 1990; Moulding & Kyrios, 2006). However, the necessary
longitudinal research has not been conducted to determine whether there is an enduring
belief in diminished personal control over threat that is a distal contributory factor to
anxiety. Nevertheless, there is sufficient evidence to conclude that low perceived control
is a contributor to anxiety, although it is probably a nonspecific cognitive- personality
factor found in both depression and anxiety.

Clinician Guideline 4.2

Include assessment of perceived control over threat in the case formulation. Two aspects

of control are important to assess in anxiety: (1) clients’ perceived control over emotional

responses, especially symptoms of anxiety; and (2) clients’ evaluations of their ability to

manage anticipated threats related to their primary threat concerns. The ACQ can be help-

ful when assessing perceived control of anxiety.

life event preCipitants of anxiety

Diathesis– stress models have been proposed for anxiety that explain disorder onset
in terms of an interaction between negative life events and a preexisting vulnerability
diathesis (e.g., Barlow, 2002; Chorpita & Barlow, 1998). A life event, situation, or cir-
cumstance that is evaluated as a potential threat to one’s survival or vital interests can
activate an underlying vulnerability that will lead to a state of anxiety. This underlying
diathesis can involve personality predispositions like high negative emotionality, trait
anxiety, anxiety sensitivity, and a chronic sense of diminished control, as well as more
specific cognitive vulnerabilities such as hypervalent threat schemas and heightened
sense of personal weakness and ineffectiveness (see discussion below).
There is evidence that an excess of negative life events is associated with the anxi-
ety disorders. In a large population-based twin study, the occurrence of high- threat life
events was associated with a significant increase in risk of developing a pure general-
ized anxiety episode (e.g., Kendler, Hettema, Butera, Gardner, & Prescott, 2003). In
a retrospective study of life adversity and onset of psychiatric disorders in over 1,800