The Cognitive Model of Anxiety 39
may spend many hours searching the Internet for information that would confirm that
a particular skin rash is benign and not a sign of melanoma. However, in this case the
safety- seeking behavior (i.e., reassurance seeking) may be particularly maladaptive and
a potent contributor to anxiety because the individual fails to find conclusive evidence
to disconfirm the threat attributed to the skin rash. Another form of disconfirmation
bias occurs when the person with panic disorder, for example, engages in controlled
breathing (safety- seeking behavior) whenever he feels tightness in the throat and fears
suffocation. In this case the controlled breathing prevents the person from learning that
the throat sensation will not lead to the catastrophic outcome of suffocation.
Clinician Guideline 2.5
Improved processing of safety cues that disconfirm perceived threats is an important ele-
ment in cognitive therapy of anxiety disorders.Impaired Constructive or Reflective Thinking
During anxious states constructive modes of thinking are less accessible. This means
that slower, more logical and effortful deductive reasoning involving a more complete
and balanced processing of a situation’s threat potential is more difficult to achieve.
This more constructive, reflective approach to threat is under conscious control and
so takes more time and effort because it involves not only a more complete evaluation
of the threat and safety features of a situation, but it also requires selection of instru-
mental behaviors for dealing with anxiety. Beck et al. (1985, 2005) noted that this
constructive mode of thinking may be an alternative anxiety- reduction system to the
anxiety- potentiating, automatic primal threat process. However, this reasoned, elabo-
rative cognitive orientation appears lost to individuals who are intensely anxious. The
predominance of the primal threat mode appears to inhibit access to constructive mode
thinking. Beck (1996) stated that once an automatic or primal mode of thinking is acti-
vated, it tends to dominant information processing until the activating circumstance
disappears.
The relative inaccessibility of constructive thinking contributes to the persistence of
anxiety. Beck (1987) argued that a key factor in the experience of panic is the inability
to realistically appraise (i.e., apply tests, draw on past experiences, generate alternative
explanations) a specific physical sensation (e.g., chest pain) in any way other than from
a catastrophic perspective. It is the existence of impaired reflective thinking that is a key
entry point for cognitive therapy of anxiety. Clients are taught cognitive restructuring
skills as a means of developing a more constructive cognitive perspective on perceived
threat.
Clinician Guideline 2.6
Cognitive therapy seeks to improve access to and the effectiveness of ref lective thinking to
counter immediate faulty threat appraisals.