Empirical Status of the Cognitive Model 79
Clinician Guideline 3.5
The idiosyncratic meaning of anxious symptoms (i.e., the significance of heightened anx-
iousness) must be assessed and treated with cognitive restructuring as part of the interven-
tion for reducing primal threat mode activation.Hypothesis 6. Elevated Disorder- Specific Threat Cognitions
Anxiety will be characterized by an elevated frequency, intensity, and duration of negative
automatic thoughts and images of selective threat and danger in comparison to nonanxious
states or other types of negative affect. Furthermore, each of the anxiety disorders is
characterized by a particular thought content relevant to its specific threat concerns.
One of the conscious phenomenal manifestations of primal threat mode activation
is the frequent and repeated intrusion into conscious awareness of automatic thoughts
and images related to the specific fear concerns of the individual. There is, in fact, a
very large empirical literature that has demonstrated a preponderance of harm, threat,
and danger cognitions and images in panic disorder (Argyle, 1988; McNally, Hornig,
& Donnell, 1995; Ottaviani & Beck, 1987); GAD (Beck, Laude, & Bohnert, 1974;
Hibbert, 1984); social phobia (Beidel, Turner, & Dancu, 1985; Hackmann et al., 1998;
Turner, Beidel, & Larkin, 1986); and OCD (Calamari & Janeck, 1997; Janeck & Cala-
mari, 1999; Rachman & de Silva, 1978; Rowa et al., 2005); as well as posttrauma-
relevant threatening intrusions in PTSD (Dunmore, Clark, & Ehlers, 1999; Mayou et
al., 2001; Qin et al., 2003; Steil & Ehlers, 2000). This “softer version” of Hypothesis 6,
then, has been well documented in the empirical literature.
The more controversial aspect of Hypothesis 6 is the “strong version” predicting
that each of the anxiety disorders will show a specific cognitive profile, and that this
profile will distinguish anxiety from other negative emotional states. Table 3.2 presents
the automatic thought content that characterizes each of the anxiety disorders.
There are two aspects to the “specificity” question in this hypothesis. First, to what
extent is anxiety distinguishable from depression, with the former characterized by
thoughts of harm and danger whereas the latter is distinguished by thoughts of loss and
failure? And second, is there a specific cognitive profile that characterizes each of the
anxiety disorder subtypes?
Cognitive Specificity: Distinguishing Anxiety from Depression
The content- specificity hypothesis states that “each psychological disorder has a distinct
cognitive profile that is evident in the content and orientation of the negative cogni-
tions and processing bias associated with the disorder” (Clark et al., 1999, p. 115). The
content or orientation of the automatic thoughts and processing bias that characterizes
anxiety states focuses on the possibility of future physical or psychological threat/dan-
ger and the sense of increased personal vulnerability or lack of safety. In depression the
predominant cognitive theme concerns past personal loss or deprivation. In fact, global
hopelessness as well as hopelessness about specific life problems is significantly greater
in major depression than in GAD (Beck, Wenzel, Riskind, Brown, & Steer, 2006). The