Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012
Cognitive theories of anxiety
Theories of anxiety
The fundamental idea is that emotions are experienced as a result of the way in which events are interpreted or appraised. It is the meaning of events that triggers emotions rather than the events themselves. The particular appraisal made will depend on the context in which an event occurs, the mood the person is in at the time it occurs, and the person’s past experiences.
Paul Salkovskis
Behaviourism — with its exclusive focus on those aspects of human life that could be studied in the laboratory — dominated academic psychology in the US and UK for much of the 20th century. But things began to change in 1956 with the advent of the so-called ’cognitive revolution’. Cognitivism aimed to identify and understand the basic processes underlying how human beings think; behaviourism had declined to study thoughts because they aren’t the sort of thing you can observe directly.
The new approach was summarized in the ground-breaking Cognitive Psychology, published by Ulric Neisser (1928—2012) in 1967. Its subject was:
all the processes by which the sensory input is transformed, reduced, elaborated, stored, recovered, and used … Such terms as sensation, perception, imagery, retention, recall, problem-solving, and thinking, among many others, refer to hypothetical stages or aspects of cognition.
To clarify these processes, cognitive psychologists mapped them out using a metaphor drawn from another boom area of the time: computing. Sensory information was depicted as being received by the brain and then processed via a series of binary yes/no steps, just like the flow diagrams on which many computer programs are based. Today, the models are more sophisticated: rather than a linear flow chart, in which a specified part of the brain deals with inputs one at a time, multiple mental processes occur simultaneously and in tandem across a complex, multi-layered ’neural network’.
Cognitivism is now the dominant strand in contemporary psychology. So what does it have to tell us about anxiety?
Perhaps its key insight is that anxiety — like other emotions — arises from our appraisal of a situation. Initially that appraisal, or interpretation, may not be a conscious process; often, it’s a case of ’intuition’. Our senses function as an early warning system, picking up on something potentially important and then passing it on to the more rational, deliberative part of our brains to consider. When we detect a threat we’re not confident we can handle, we feel anxiety. These latter, conscious thoughts about threat are crucial, and they’re what modern psychological treatments for severe anxiety set about changing.
Imagine, for example, that you are woken in the early hours of the morning by a noise downstairs. How you interpret that noise will determine your emotional response. If you decide it’s your cat clattering around, you might feel mild irritation at being disturbed before turning over and going back to sleep. But if you believe it may be the sound of a burglar rather than your pet cat, you’ll almost certainly be gripped by anxiety and lie awake wondering whether you ought to investigate. It’s not the event that determines our emotional state, but rather the way in which we make sense of that event.
The perceived threat can be either external — like the noise in the night — or internal. For example, panic attacks are very often triggered by the mistaken belief that odd but otherwise normal physical sensations — a tightness in the chest, perhaps, or a twinge in an arm — are symptoms of serious illness, such as a heart attack. Indeed, a vicious cycle can be triggered in which the physical manifestations of anxiety (for example, breathlessness, racing heart beat, queasiness) are taken as confirmation of impending collapse or death, which in turn leads to more anxiety. Again, it is the individual’s appraisal of these internal signals that is crucial. This means that if you change your thinking, you can change your emotion.
But why is it that one person interprets a little breathlessness after running up stairs as a sign of imminent death, and another scarcely notices it? Why does one person assume a noise in the night is nothing to worry about, and another find themselves paralysed by anxiety? The answer lies in our preconceptions, ideas, and habitual thought processes — what the founder of cognitive behaviour therapy Aaron T. Beck termed ’schematic beliefs’. These schematic beliefs are forged through our life experiences. And they’re so ingrained and automatic that we’re usually unaware of their existence.
There’s nothing inherently negative about cognitive schemas: they allow us to quickly orient ourselves to the situations in which we find ourselves. But Beck discovered that people with anxiety disorders typically possess unhelpful schematic beliefs about themselves, the world around them, and the future (what’s known as the cognitive triad). For example:
• ’It’s always wisest to assume the worst.’
• ’Trouble can strike at any moment; I must always be ready.’
• ’I’m a vulnerable person.’
• ’I must be in control.’
2. Aaron T. Beck is recognized as the father of cognitive behaviour therapy, the most effective form of treatment for anxiety problems. One of the world’s leading researchers into psychological disorders, he is Professor Emeritus of Psychiatry at the University of Pennsylvania and founder of the Beck Institute for Cognitive Behavior Therapy. Beck has been acclaimed by the American Psychological Association as ’one of the five most influential psychotherapists of all time’
If we believe such things, we’re likely to overestimate the threat facing us, and underestimate our capacity to cope with it.
Anxiety problems, if untreated, can be extremely persistent. But why is this? Anxious people can spend huge amounts of time worrying about events that have never happened to them, and indeed are very unlikely to occur. Why don’t they realize that their anxiety is misplaced? Why don’t they learn from experience?
This is a question that has received a great deal of attention from clinical cognitive psychologists. One of their key discoveries is that people with anxiety problems adopt a range of strategies — known as safety behaviours — designed to prevent the occurrence of whatever it is they fear. So, for example, a person fearful about social situations will seek to avoid them; if this is impossible, they’ll fall back on other techniques such as ensuring they attend with a friend, dress as unobtrusively as possible, and keep a low profile. These safety behaviours may reduce anxiety in the short term, but they prevent us discovering that our fearful thoughts are unwarranted — and thus end up strengthening our anxiety.
Researchers have built on Beck’s work to identify other cognitive biases underlying and sustaining anxiety disorders. Like safety behaviours, patterns of thought and behaviour that seem designed to ward off anxiety only end up tightening its grip. For example, people with anxiety problems are extremely vigilant for possible threats. But because their attention is so focused on potential danger, they tend to overlook those events that don’t fit this rather bleak view of the world. This in turn can lead to an overestimation of the likelihood of danger occurring (psychologists call this threat anticipation) and lots of false alarms — all of which only fertilizes the ground on which anxiety grows.
There’s a tendency to interpret ambiguous events negatively. This is a particular problem given that so many of the situations we encounter are inherently ambiguous, usually because it’s so difficult to know how other people really think and feel. A telling example of this attentional bias was provided by an experiment that asked participants to spell a series of homophones (words that sound identical but have different meanings), for example: die/dye, slay/sleigh, pain/pane, weak/week, and guilt/gilt. The more anxious a participant was, the greater the likelihood that they would opt for the more threatening spelling of the words. People with anxiety disorders are also prey to unsettling or even downright alarming images, rather than thoughts. An individual with social anxiety may possess an entirely inaccurate mental image of themselves when in social situations. Rather than thinking things through rationally, they use instinctive emotional reasoning. David Clark, the leading cognitive psychologist of anxiety, has explained:
It seems as though a mental model of the patient’s observable, social self was laid down after an early traumatic social experience and this model is reactivated in subsequent social encounters.
This matters all the more because research suggests that images exert a much more powerful influence on emotions than do thoughts. As with the other cognitive biases, this susceptibility to mental images enables anxiety to perpetuate and intensify itself.