The Cognitive Model Of Anxiety

The cognitive model of anxiety views anxiety as having three components: cognitive, emotional and behavioral. An anxious individual perceives threats in relation to self, the world, or related to the future. The perception of a threat elicits a physiologic reaction, known as a “flight or fight” response, associated with increased pulse, blood pressure, sweating, and an overall sense of high vigilance. For example, a person who is walking down a dark street hears footsteps behind them. Their first thought might be, “someone is following me”, their cognitive appraisal might be, “they’re going to hurt me”. The individual begins to experience increased arousal in response to perceived threat including physiological reactions such as an increased heart rate and sweatiness (fight or flight). The individual may then feel scared (emotional response) and begin running or “freeze” (behavioral response). The cognitive model of anxiety states that an individual’s beliefs impact their perceptions in several crucial ways. First an individual may have the belief that they cannot cope or manage stress effectively and thus would perceive situations that elicit stress or uncomfortable feelings as risky. Also, since anxiety elicits physiological symptoms through cognitions or images, these feelings alone may cause the individual to inaccurately assess a situation as threatening. The perception of a situation as threatening coupled with the person’s belief that they cannot cope with the situation serves to increase feelings of anxiety, and vigilance to “watch out” for threatening stimuli both internally and in the environment. For instance, as people become more vigilant, they become more “tuned in” to internal signs of anxiety (physical sensations such as heart racing, difficulty breathing, sweating, chest pain, numbness) they may make catastrophic interpretations of physical symptoms or of the situations itself. This increased vigilance leads to greater cognitive distortions of both internal and environmental stimuli, thereby increasing anxiety. Furthermore, this cognitive appraisal of internal and external experience may decrease the person’s sense that they could cope and increase the anxiety. The patient with intense anxiety tends to be “hypervigilant” for signs of danger or is preoccupied with “perceived” danger or threat. Therefore he is selectively “tuned in” to looking for signs of danger when it is maladaptive (Freeman, 1990). Because of his preoccupation the patient then is often unable to tend to other tasks and may complain of forgetfulness, lack of recall and ability for self-reflection may be restricted (Freeman, 1990). One of the main goals of cognitive therapy is to help the patient "test" whether a situation that has been "labeled dangerous is actually dangerous" (Beck & Emery, 1985). This is accomplished via exploration of cognitive processes, specifically by: 1) identifying automatic thoughts around the anxiety, 2) examining automatic thoughts, 3) challenging cognitions; and through 4) exposure, whereby the patient will be able to “detach and extinguish the fears that have been erroneously attached to a given situation or object” (Beck & Emery,1985). As the patient is able to identify automatic thoughts, they learn that there is a relationship between the occurrence of automatic thoughts relevant to danger and the anxiety experienced (Beck & Emery, 1985). This is extremely important to demonstrate to anxious parents, who tend to attribute their anxiety solely to external causes.
Some of the specific types of cognitive distortions associated with anxiety include: catastrophizing (predicting a disastrous outcome), selective abstraction (focusing on a single negative aspect of an event while excluding evidence that contradicts this information), personalization (viewing external events as relevant to them), overgeneralization (drawing global conclusions from single or small series of events) and dichotomous thinking (looking at things in "all or nothing terms"). For example, an adolescent with generalized anxiety may have the belief that he is a “failure”. His compensatory strategy then is to do flawless or perfect work. An automatic thought could be, “If I don't get an A on the exam I'm a failure.” Because anxious patients tend to look to external causes for their anxiety, it is often difficult for the anxious patient to identify automatic thoughts. Therefore, socialization to the cognitive model is critical in order for further therapeutic progress to occur.