Cognitive Psychology: Anxiety Disorders

Anxiety Disorders

An individual in an anxious state gives heightened attention to threat-related cues (MacLeod et al., 1986; Matthews and MacLeod, 1985; Brosschot et al., 1999; Bradley et al., 2000; Fox et al., 2001; Lundh and Oest, 2001; Bradley et al., 1999; Mogg et al., 2000), as such cues are usually particularly salient to the feelings of anxiety; this selectivity process may in turn filter out and discard information not congruent with the anxious mood state. Such a mood-congruent attentional bias helps orient the individual to the source of danger, which may in turn help en-sure that the individual formulates an appropriate response to the threatening situation. To the extent that there is a reasonable goodness of fit between the level of anxious arousal and the level of genuine threat posed to the individual by the environment, the mood-congruence attentional bias serves an adaptive func-tion. When the level of anxiety is consistently incommensurate with the environmental context, however, a state of pathological anxiety ensues.

Barlow’s (1988) anxious apprehension model suggests that pathological anxiety, such as that observed in GAD, may arise from a chronic misapprehension or overestimation of the level of threat posed by a wide array of situations, many of them benign. It is further proposed that, once the anxious arousal of a patient with GAD is triggered by the misappre-hension of threat, there is a narrowing of external attention to the perceived danger, concurrent with a ruminative internal self-focus on negative expectancies regarding the situation’s outcome. Two deleterious consequences of such an attentional bias predictably ensue: 1) the patient disregards or discounts information that could serve to correct the original misappre-hension of threat and 2) the patient’s attentional resources are so thoroughly consumed by the focus on negative expectancies that few resources are available for constructive problem solv-ing and adaptive responding.

A somewhat related cognitive model of pathological anxi-ety has been proposed by Beck and Emery (1985) in the schema theory of anxiety. Central to this theory is the mechanism of cognitive appraisal, with anxiety as the feeling state resulting from the appraisal of threatening stimuli. The appraisal pro-cess, in turn, is believed to be influenced by cognitive structures known as schemata, which consist of stored information ab-stracted from previous experience (Dombeck and Ingram, 1993; Dibartolo et al., 1997). Schema-guided appraisal is held to take place automatically.

Schema theory views pathological anxiety as the result of faulty schemata that lead to habitual, and largely automatic, overappraisal of danger; pathological appraisal often takes place automatically without benefit of the scrutiny that accompanies attentional focus. Accordingly, Beck’s therapeutic approach to ameliorating pathological anxiety involves helping the patient allocate more attentional resources to the appraisal process, as a corrective to faulty schematic processing. Applications from cognitive psychology to the treatment of anxiety disorders are presented in Table 16.1