Cognitive Model Of Anxiety Disorders

Whereas the cognitive themes in depression are deprivation, defeat, and loss, the cognitive theme in anxiety disorders is danger. Following the continuity hypothesis, anxiety reactions are on a continuum with normal physiologic responses, but are exaggerated reactions to perceived threat. Cognitive therapy views anxiety from an evolutionary perspective, as originating in the flight, freeze, or fight responses apparent in animal behavior. These innate responses to physical danger became less adaptive in humans over the mil-lenia as danger became less physical and more psychosocial in nature.

The cognitive model of anxiety emphasizes the roles of beliefs and interpretations of events in maintaining and escalating anxiety. Anxious cognitions reflect unrealistic perceptions of danger, catastrophic interpretations about loss of control, or perceived negative changes in a relationship. As in depression, there are underlying beliefs, such as, "the world is a dangerous place,'' which make one vulnerable to anxiety. Cognitive distortions support those underlying beliefs and contribute to the overestimation of the probability of a feared event, the overestimation of the severity of the event were it to happen, the underestimation of one's ability to cope with the feared event, and the underestimation of "rescue factors'' such as the presence of people or environmental factors that could help or reduce risk.

The contribution of cognitions to anxiety is exemplified in the cognitive model of recurrent panic. In

Cognitive Therapy this case, the person's catastrophic misinterpretation of his or her own physiology escalates anxiety to the point of panic. The sequence is as follows: a variety of factors (e.g., mild anxiety, caffeine, exercise, excitement) create mild sensations that are interpreted as signs of internal disaster. Consequently, there is a marked increase in anxiety which leads to a further heightening of bodily sensations. This creates a vicious cycle, which culminates in a panic attack. Stress-induced hyperventilation may be part of this cycle if somatic sensations are interpreted as a sign of imminent danger. In the case of panic, the feared stimulus is one's own physiology. Once a person has had a panic attack, he or she becomes hypervigilant to any signs of physiological arousal. One's own physiology becomes the feared stimulus. Treatment, therefore, includes exposure to physical sensations.

Cognitive therapy, which uses cognitive techniques alone or in combination with behavioral techniques, can almost eliminate panic attacks after 12 to 16 weeks of treatment.

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