Case 5 information processing
1. Cognitive model of anxiety disorders?
- Cognitive models of emotional disorders
- Cognitive Models of Panic Disorder
o catastrophic misinterpretations of bodily sensations lead to an upward spiral of
anxiety and increased autonomic responses that lend further credence to the alarming
interpretations
o negative interpretations of somatic symptoms are higher in PD than in other anxiety
disorders
o perceived inability to cope with or control panic is related to the severity of panic
attacks
- Cognitive Models of Social Phobia
o the key process in social phobia is self-directed attention triggered by social
situations, together with a corresponding withdrawal of adaptive attention to positive
external cues. Social phobics are said to generate and attend to a negative self-
impression based on their prior beliefs, feelings, and self-image. Subsequent self-
evaluation of social performance is then driven by this negative self-impression, rather
than by external feedback from others
o socially anxious individuals typically assume negative reactions from others, but at
the same time fail to effectively encode actual social feedback.
o social anxiety is associated with enhanced imagery of feared outcomes, such as
images of oneself blushing or appearing ridiculous
- Cognitive Models of Post-Traumatic Stress Disorder
o Underlying assumption: the extreme emotion experienced at the time of trauma leads
to a powerful but unusually disorganized memory representation encoded in
fragmented, sensory form.
o the dual representation model suggests that memories are encoded in two systems, one
reportable (verbally accessible memory; VAM) and the other not (situationally
accessible memory; SAM). Traumatic experiences are predominantly stored within
SAM, and thus are not well integrated with reportable memories in VAM, but are
easily accessed by trauma-linked sensory cues, leading to intrusive images or
flashbacks.
- Cognitive Models of Generalized Anxiety Disorder
o worry consists of repeated negative thoughts about possible threat, in a predominantly
verbal form, perhaps originating in avoidance or coping attempts
o worry content in GAD groups is less concrete, and individuals with GAD are less
tolerant of the uncertainty about outcome inherent in worry
o According to the meta-cognitive model, the critical difference between pathological
and normal worry lies less in worry frequency per se, as in the beliefs held about
worry. Worriers meeting criteria for GAD endorse positive beliefs (e.g., worry helps
me to cope), as well as more negative beliefs (e.g., worry is uncontrollable and
harmful to health)
o GAD groups report more negative beliefs about worry than do other anxious groups is
consistent with the possibility that excessive “worry about worry” is characteristic of
GAD
- Differences between depressive and anxious people
o Depressed more late attention to mood congruent stimuli while anxious people have
an early attentional bias
- Albert Ellis’s rational-emotive behavior therapy (REBT) suggested that emotional dysfunction
is the consequence of irrational beliefs that are unempirical or unrealistic and/or contain a
“should” or “must” that is unhelpful for an individual to achieve his or her goals and to feel
good.
1
,- symptom stress: a type of secondary stress experienced by individuals as a consequence of
appraising their symptoms in a negative way, e.g., someone with
- an anxiety disorder may get angry at themselves for feeling anxious in a particular situation.
- Beck suggests that fear and anxiety experienced by individuals with anxiety disorders in
specific situations are the consequence of threat appraisals, which are in turn due to
dysfunctional threat-related schemas. In addition, these authors suggest a number of
behavioral and cognitive processes that are thought to maintain threat-related beliefs,
assumptions, and appraisals. This generic cognitive model of anxiety disorders has been
refined and updated over the years.
- Appraisal
o Appraisal of situations: excessive fear and anxiety are the consequence of exaggerated
threat appraisals in neutral, innocuous, or only mildly threatening situations
o Primary appraisal: the immediate appraisal of a situation as threatening (in
comparison to, e.g., positive, neutral, or challenging)
o Secondary appraisal: an individual’s perception of how well he or she will be able to
cope with this threat
o Reappraisal: appraisals are not static but are updated as the situation unfolds, changes
is previous appraisals.
o individuals with anxiety disorders overestimate the probability as well as the costs of
harm. Moreover, they show biased safety estimates and underestimate their own
probability to cope with danger/harm. Also, researchers suggested that deficits in
cognitive emotion regulation, especially the employment of reappraisal, play a role in
anxiety disorders.
o Appraisal of symptoms: threat appraisals in anxiety disorders often also concern the
very symptoms of anxiety or other thoughts, feelings, and bodily sensations,
prominent in panic disorder but also in GAD, PTSD and OCD.
o Despite a large amount of evidence, the cognitive appraisal hypothesis of anxiety
disorders has also been subject to strong criticism: the heavy reliance on self-report,
the assumption that controlled processes, such as conscious appraisal, are solely
responsible for fear responses to situations
- Schemas
o underlying cognitive structures that have developed in response to earlier experiences
and that can be activated by matching trigger. When activated, these schemas are
proposed to lead to matching conscious appraisal of situations and also guide
information processing on a more automatic level.
o Beliefs are global and unconditional in nature (e.g., “I am worthless”).
Assumptions/rules, on the other hand, are conditional (e.g., “If others see that I am
anxious, they will think I am weak”;) and are sometimes described as the mediating
level between beliefs and negative automatic thoughts.
o Cognitive schemas in individuals with anxiety disorders are thought to be more
negative, more rigid, and less flexible than in controls, whereby the precise content is
disorder-specific
o Results show that when compared to controls, individuals with specific phobia, panic
disorder, social phobia, OCD, and PTSD endorse higher levels of maladaptive beliefs
and assumptions
- Maintenance of cognitive schemas
o Cognitive theories of anxiety disorders suggest that maladaptive schemas and the
resulting exaggerated threat appraisals are maintained by (a) biased information
processing, (b) avoidance and safety-seeking behavior, and (c) engagement in
maladaptive cognitive strategies.
o Information processing: when maladaptive schemas are activated in an individual with
an anxiety disorder this should result in threat-related information being processed
predominantly and safety-related information being less salient in the information-
processing system. In this way, maladaptive schemas are maintained
2
, o Safety seeking behaviour/ safety behaviour: any behaviour that is performed in order
to prevent a feared catastrophe from occurring and/or reduce its impact on the
individual. safety behavior prevents the individual from testing whether her belief is
correct; instead, it is likely that the belief may even be reinforced. safety behaviors
leads to increased levels of anxiety and/or a maintenance of anxiogenic beliefs in
comparison to control conditions
o Dysfunctional cognitive coping strategies
Thought suppression: immediate suppression of thoughts often comes at the
cost of a rebound later on. undesirable side effects: less effective when
employed over longer periods of time, a direct negative effect on mood,
sustains or even increases negative appraisals related to the suppressed
thought
Repetitive negative thinking: e.g. excessive worry in GAD, worry and
rumination are not only an epiphenomenon or a consequence of having an
anxiety disorder but are also a causal factor involved in the maintenance of
anxiety. Mechanisms: engaging in repetitive negative thinking during
negative mood has been found to impair recovery from this very mood, the
content of repetitive negative thinking often matches anxiety patients’
negative beliefs, which means that these beliefs are repeatedly rehearsed,
worry and rumination lead to an increase in schema-congruent intrusive
thoughts and memories, worry and rumination are characterized by a
relatively abstract style of thinking, They have been suggested to be a form of
cognitive avoidance individuals engage in in order to avoid negative imagery,
high levels of emotion or arousal, and/or decisive action
-
3
1. Cognitive model of anxiety disorders?
- Cognitive models of emotional disorders
- Cognitive Models of Panic Disorder
o catastrophic misinterpretations of bodily sensations lead to an upward spiral of
anxiety and increased autonomic responses that lend further credence to the alarming
interpretations
o negative interpretations of somatic symptoms are higher in PD than in other anxiety
disorders
o perceived inability to cope with or control panic is related to the severity of panic
attacks
- Cognitive Models of Social Phobia
o the key process in social phobia is self-directed attention triggered by social
situations, together with a corresponding withdrawal of adaptive attention to positive
external cues. Social phobics are said to generate and attend to a negative self-
impression based on their prior beliefs, feelings, and self-image. Subsequent self-
evaluation of social performance is then driven by this negative self-impression, rather
than by external feedback from others
o socially anxious individuals typically assume negative reactions from others, but at
the same time fail to effectively encode actual social feedback.
o social anxiety is associated with enhanced imagery of feared outcomes, such as
images of oneself blushing or appearing ridiculous
- Cognitive Models of Post-Traumatic Stress Disorder
o Underlying assumption: the extreme emotion experienced at the time of trauma leads
to a powerful but unusually disorganized memory representation encoded in
fragmented, sensory form.
o the dual representation model suggests that memories are encoded in two systems, one
reportable (verbally accessible memory; VAM) and the other not (situationally
accessible memory; SAM). Traumatic experiences are predominantly stored within
SAM, and thus are not well integrated with reportable memories in VAM, but are
easily accessed by trauma-linked sensory cues, leading to intrusive images or
flashbacks.
- Cognitive Models of Generalized Anxiety Disorder
o worry consists of repeated negative thoughts about possible threat, in a predominantly
verbal form, perhaps originating in avoidance or coping attempts
o worry content in GAD groups is less concrete, and individuals with GAD are less
tolerant of the uncertainty about outcome inherent in worry
o According to the meta-cognitive model, the critical difference between pathological
and normal worry lies less in worry frequency per se, as in the beliefs held about
worry. Worriers meeting criteria for GAD endorse positive beliefs (e.g., worry helps
me to cope), as well as more negative beliefs (e.g., worry is uncontrollable and
harmful to health)
o GAD groups report more negative beliefs about worry than do other anxious groups is
consistent with the possibility that excessive “worry about worry” is characteristic of
GAD
- Differences between depressive and anxious people
o Depressed more late attention to mood congruent stimuli while anxious people have
an early attentional bias
- Albert Ellis’s rational-emotive behavior therapy (REBT) suggested that emotional dysfunction
is the consequence of irrational beliefs that are unempirical or unrealistic and/or contain a
“should” or “must” that is unhelpful for an individual to achieve his or her goals and to feel
good.
1
,- symptom stress: a type of secondary stress experienced by individuals as a consequence of
appraising their symptoms in a negative way, e.g., someone with
- an anxiety disorder may get angry at themselves for feeling anxious in a particular situation.
- Beck suggests that fear and anxiety experienced by individuals with anxiety disorders in
specific situations are the consequence of threat appraisals, which are in turn due to
dysfunctional threat-related schemas. In addition, these authors suggest a number of
behavioral and cognitive processes that are thought to maintain threat-related beliefs,
assumptions, and appraisals. This generic cognitive model of anxiety disorders has been
refined and updated over the years.
- Appraisal
o Appraisal of situations: excessive fear and anxiety are the consequence of exaggerated
threat appraisals in neutral, innocuous, or only mildly threatening situations
o Primary appraisal: the immediate appraisal of a situation as threatening (in
comparison to, e.g., positive, neutral, or challenging)
o Secondary appraisal: an individual’s perception of how well he or she will be able to
cope with this threat
o Reappraisal: appraisals are not static but are updated as the situation unfolds, changes
is previous appraisals.
o individuals with anxiety disorders overestimate the probability as well as the costs of
harm. Moreover, they show biased safety estimates and underestimate their own
probability to cope with danger/harm. Also, researchers suggested that deficits in
cognitive emotion regulation, especially the employment of reappraisal, play a role in
anxiety disorders.
o Appraisal of symptoms: threat appraisals in anxiety disorders often also concern the
very symptoms of anxiety or other thoughts, feelings, and bodily sensations,
prominent in panic disorder but also in GAD, PTSD and OCD.
o Despite a large amount of evidence, the cognitive appraisal hypothesis of anxiety
disorders has also been subject to strong criticism: the heavy reliance on self-report,
the assumption that controlled processes, such as conscious appraisal, are solely
responsible for fear responses to situations
- Schemas
o underlying cognitive structures that have developed in response to earlier experiences
and that can be activated by matching trigger. When activated, these schemas are
proposed to lead to matching conscious appraisal of situations and also guide
information processing on a more automatic level.
o Beliefs are global and unconditional in nature (e.g., “I am worthless”).
Assumptions/rules, on the other hand, are conditional (e.g., “If others see that I am
anxious, they will think I am weak”;) and are sometimes described as the mediating
level between beliefs and negative automatic thoughts.
o Cognitive schemas in individuals with anxiety disorders are thought to be more
negative, more rigid, and less flexible than in controls, whereby the precise content is
disorder-specific
o Results show that when compared to controls, individuals with specific phobia, panic
disorder, social phobia, OCD, and PTSD endorse higher levels of maladaptive beliefs
and assumptions
- Maintenance of cognitive schemas
o Cognitive theories of anxiety disorders suggest that maladaptive schemas and the
resulting exaggerated threat appraisals are maintained by (a) biased information
processing, (b) avoidance and safety-seeking behavior, and (c) engagement in
maladaptive cognitive strategies.
o Information processing: when maladaptive schemas are activated in an individual with
an anxiety disorder this should result in threat-related information being processed
predominantly and safety-related information being less salient in the information-
processing system. In this way, maladaptive schemas are maintained
2
, o Safety seeking behaviour/ safety behaviour: any behaviour that is performed in order
to prevent a feared catastrophe from occurring and/or reduce its impact on the
individual. safety behavior prevents the individual from testing whether her belief is
correct; instead, it is likely that the belief may even be reinforced. safety behaviors
leads to increased levels of anxiety and/or a maintenance of anxiogenic beliefs in
comparison to control conditions
o Dysfunctional cognitive coping strategies
Thought suppression: immediate suppression of thoughts often comes at the
cost of a rebound later on. undesirable side effects: less effective when
employed over longer periods of time, a direct negative effect on mood,
sustains or even increases negative appraisals related to the suppressed
thought
Repetitive negative thinking: e.g. excessive worry in GAD, worry and
rumination are not only an epiphenomenon or a consequence of having an
anxiety disorder but are also a causal factor involved in the maintenance of
anxiety. Mechanisms: engaging in repetitive negative thinking during
negative mood has been found to impair recovery from this very mood, the
content of repetitive negative thinking often matches anxiety patients’
negative beliefs, which means that these beliefs are repeatedly rehearsed,
worry and rumination lead to an increase in schema-congruent intrusive
thoughts and memories, worry and rumination are characterized by a
relatively abstract style of thinking, They have been suggested to be a form of
cognitive avoidance individuals engage in in order to avoid negative imagery,
high levels of emotion or arousal, and/or decisive action
-
3
