406 TREATMENT OF SPECIFIC ANXIETY DISORDERS
employee who was persistently late for work, she would imagine various scenarios of
how she might deal with this problem. She was looking for a “solution” that would
relieve her anxiety, a way of dealing with this problem that would bring her relief, a
sense of safety. However, each scenario she generated was flawed and so the worry only
led to more anxiety and uncertainty rather than to the relief she so desperately desired.
Ultimately the failure to find an acceptable solution, to achieve a sense of relief or safety,
contributed to the perpetual cycle of worry.
The outcome of the cognitive processes illustrated in Figure 10.1 is a heightened
state of general distress. Because the schematic content in GAD deals with general threat
and helplessness, we expect the resulting emotional state to be more mixed or gener-
alized than what is seen in panic disorder or social phobia. Naturally this elevated
anxiousness or distress will feed back into the cognitive apparatus by contributing to
further activation of the GAD schemas. In this way the cognitive basis of GAD is a self-
perpetuating vicious cycle that can be terminated only by intervention at the automatic
and elaborative reappraisal levels.
empiriCal status of the Cognitive moDelA number of hypotheses have been proposed that are germane to the cognitive perspec-
tive on GAD. In the following section we review six hypotheses that are central to the
cognitive formulation presented in this chapter.
Hypothesis 1
Intrusive thoughts of uncertainty about significant goals and important life tasks will elicit
more worry in vulnerable than nonvulnerable individuals.
Over the years various studies have indicated that both intrusive thoughts and worry
are triggered by immediate situations, stressful events, and other current concerns of the
individual. In a review of earlier research on worry Borkovec and colleagues (Borkovec
et al., 1991) concluded that differences in the worry content of children, students, and
the elderly reflect the life circumstances and current concerns of individuals (see also
Mathews, 1990). Moreover, worry may result from a problem situation in which a
sense of security, safety, or certainty has not been attained (Dugas, Freeston, & Ladou-
ceur, 1997; Segerstrom et al., 2000; Woody & Rachman, 1994). In a study comparing
worry in GAD and non-GAD patients, findings indicated that worry about immediate
problems may be more adaptable, whereas worry about highly remote events was more
pathological, distinguishing the GAD from non-GAD sample (Dugas, Freeston et al.,
1998).
In terms of intrusive thoughts, naturalistic and experimental studies indicate that
exposure to a stressful situation will increase the number of negative stress- relevant
intrusive thoughts, especially if individuals engage in worry about the stressor (e.g.,
Butler et al., 1995; Parkinson & Rachman, 1981b; Wells & Papageorgiou, 1995). In one
of the original studies on cognitive intrusions, Parkinson and Rachman (1981a) found
that two- thirds of intrusive thoughts were triggered by an identifiable external stimu-
lus. Thus it is widely recognized that unwanted negative intrusive thoughts and worry