402 TREATMENT OF SPECIFIC ANXIETY DISORDERS
GAD. This can be readily seen during sleep onset, which is commonly associated with a
surge in intrusive anxious thoughts and worry, as individuals with insomnia and GAD
frequently describe a problem with “racing thoughts” (Harvey, 2005). Obviously the
worry-prone individual does not have to intentionally and purposefully try to generate
unwanted thoughts of threat and uncertainty when trying to sleep. Instead this thinking
is experienced as quite spontaneous, unintended, and automatic. The thoughts literally
intrude into conscious awareness against the person’s will and are then very difficult to
control or dismiss (Rachman, 1981). They have a certain adhesive quality and are asso-
ciated with a feeling of apprehension or anxiousness. Wells (2005a) noted that negative
intrusive thoughts often occur in GAD and can be exacerbated by the worry process.
In the current model, we propose that automatic anxious intrusive thoughts involving
uncertain threat play a critical role in triggering the worry process by activating the
maladaptive schemas of threat and vulnerability that characterize GAD.
Automatic Processing Phase
There is now considerable evidence that automatic information processing of threat
occurs in the pathogenesis of GAD. In their review Macleod and Rutherford (2004)
concluded that there is compelling evidence that individuals with GAD selectively attend
to threatening stimuli at the encoding phase and make biased interpretations of threat
when presented with ambiguous information (see discussion below). Thus there is con-
siderable empirical support for an automatic processing phase in GAD.
Schematic Activation
There are three critical elements to the automatic threat processing proposed in Figure
10.1. The first is activation of the cluster of schemas relevant for GAD. In the cognitive
model, intrusive thoughts of uncertainty are both a cause and a consequence of threat
schema activation. We would expect that these thoughts will become more frequent and
salient with sustained activation of the GAD-relevant schemas. The cognitive model
proposes four types of schemas that characterize GAD. These are presented in Table
10.2 along with illustrative examples.
Because GAD and depression are closely related in clinical presentation and diag-
nostic comorbidity, it should be no surprise that the underlying schematic organization
is similar in the two disorders (Beck et al., 1985, 2005). The lower self- confidence and
increased sense of helplessness represented in the general threat and vulnerability sche-
mas share many similarities to the negative self- referent schemas of depression. How-
ever, the schemas in GAD have greater specificity to important personal life goals and
vital interests and, of course, they deal with beliefs about future threats, the “what if’s.”
For example, in our case illustration Rebecca believed she would be criticized at any
moment for not performing well as store manager and she was convinced she was poor
at handling problems with her employees. She did not believe people were generally
critical of her outside the work context nor did she believe that she suffered from poor
social skills. Rather her threat and vulnerability schemas were specific to the work situ-
ation and so she worried excessively about her work performance and whether or not
she was perceived as incompetent.