The Cognitive Model of Anxiety

This is a simplified version of Beck’s revised (generic) cognitive model of anxiety (1997;2010;2012), based on his distinction between three main stages of the anxiety response: initial perception of threat, automatic responses to threat, and deliberate attempts to cope with threat. 

Try to answer the questions below to help formulate an understanding of how your anxiety might function and be maintained.

1. Recognition of Anxiety Triggers

These are the initial events that evoke anxiety, they are typically events perceived as threatening, however, sometimes internal events such as certain physical sensations or disturbing thoughts or memories may evoke the initial anxiety response.  The initial attention (“orientation”) to possible signs of danger is influenced by pre-existing predispositions (“anxiety schemas”) that can lead to biased perception and interpretation of events and subsequent distortions in the appraisal of the situation, etc.

• What external situations or events appear to trigger your anxiety?
• Do you become anxious in response to any bodily sensations?
• Do any initial memories, thoughts, urges, or images trigger the anxiety?

2. Automatic Responses

2.1. Fearful Thinking (Automatic Thoughts & Core Threat Appraisal)

These are estimates (“appraisals”) of the probability and severity of perceived threat and other automatic thoughts and images that occur immediately in response to the trigger event and help to explain subsequent reactions.

• When anxious, what are you most afraid might happen?  (“Core threat appraisal”)
• When anxious, how catastrophic does that possible outcome seem (0-100%)?
• When anxious, what do you think is the probability of it happening (0-100%)?
• Do you have any other immediate thoughts or images that might trigger distress in this situation?

2.2. Anxiety-Mode Symptoms (Fight-Flight-Freeze-Faint Response)

This is referred to as activation of the “anxiety mode” and consists of the symptoms or automatic responses to interpreting a situation as threatening.

• What initial emotions do you feel?  How strong are they (0-100%)?
• Do you experience any immediate physical sensations in response to the initial trigger?  (Sweating, trembling, heart racing, faintness, etc.)
• Do you experience any automatic muscular responses (inclinations or inhibitions)?  (Tension, freezing, clamming up, etc.)

3. Deliberate (“Strategic”) Responses

3.1. Coping Responses

These are subsequent, slightly more deliberate responses, which involve attempts to cope with the situation both mentally and physically.  Although these strategies may help temporarily they often cause more problems in the longer-term.

• To what extent do you try to seek safety by doing things to protect yourself?  (Seeking reassurance, clinging on to people or objects, etc.)
• To what extent do you try to solve the problem at a practical level?
• To what extent do you try to escape the situation or somehow avoid aspects of it?  (Averting gaze, leaving quickly, etc.)
• To what extent do you continue to focus your attention on things that concern you?  (Preoccupation with bodily sensations, imagining what you look like, etc.)
• To what extent do you consciously worry about things?  (Extended “what if?” thinking, excessive planning, mental problem-solving, etc.)
• What thoughts do you have, in that situation, about your ability to cope or sense of vulnerability? (“Coping appraisal”)
• How successful are your attempts to cope  with the situation (0-100%)?

3.2. Attempts to Control Anxiety

When the perceived threat cannot be overcome, people typically resort instead to trying to combat their anxious thoughts and feelings by blocking them, distracting themselves, etc.  Because this doesn’t change the initial appraisal of threat or alter the external situation, it often backfires and makes the problem worse in the longer-term.

• Do you do anything, in that situation, to try to control or avoid disturbing feelings?  (Blocking feelings, using drugs or alcohol, etc.)
• Do you do anything, in that situation,  to try to control or suppress anxious thoughts?  (Thinking positively, distraction, etc.)
• How successful are your attempts to control your thoughts and feelings (0-100%)?

Comments

The basic cognitive model of anxiety proposes that the things we do to try to cope with a perceived threat may help us feel better temporarily but often maintain (perpetuate) anxiety over the longer-term.  Deliberate responses such as mental and physical attempts to cope with the problem or subsequent attempts to try to combat anxious thoughts and feelings can make things worse in several ways.  Mainly, they are based upon an initial appraisal that the situation signals a highly probable threat of quite severe harm, which may have been an automatic (unconscious) exaggeration of threat.

For example, someone with a dog phobia may find that the sight of a dog triggers their automatic appraisal that they are likely to be attacked and severely harmed (something they may only believe when anxious and not at other times).  This may cause automatic “anxiety mode” symptoms such as shaking, sweating, heart racing, gripping their own body with fear, and freezing  still, etc.  They may try to cope by escaping from the situation as quickly as possible, focusing on their bodily sensations of anxiety, and seeking help from other people, etc.    They may become frustrated because they realise these attempts to cope aren’t working very well.  Finally, they may resort to attempts to suppress their thoughts and feelings, e.g., trying to think courageously, forcing themselves to relax, etc.  However, insofar as none of these strategies actually modify the initial appraisal that they are likely to be attacked by a dog, they may help mask the problem temporarily but are unlikely to genuinely overcome the phobia in the longer-term.  In the case of a phobia, by definition, fear is excessive or irrational, and the situations feared are actually harmless in reality.  (It might be rational to escape if there really was a high probability of a dog severely attacking you but, of course, that is not a phobia.)