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COGNITIVE PSYCHOTHERAPY: COGNITIVE MODEL OF ANXIETY

COGNITIVE PSYCHOTHERAPY: COGNITIVE MODEL OF ANXIETY

According to Weishaar and Beck (1986), anxiety disorders are seen as the result of excessive functioning or malfunctioning of normal survival mechanisms.  As in the case of depression, symptoms reflect the operation of specific systems: cognitive; affective; behavioural; motivational and psychological.  The basic mechanisms for coping with threat are the same for a normal person as an anxious person: decisions are made quickly and physiological responses prepare the body for escape or defence.  These responses will be similar whether the threat is danger or in a social situation.  Whereas the normal reaction to a threat would be in relation to its danger, that of the anxious person would be excessive, based on a faulty evaluation of that threat.  People normally learn through experience what poses a threat and what does not.  This is reality testing.  Those who suffer from anxiety fail to learn from this reality testing, and people who panic seem to have no positive feedback from previous experiences.  They expect to panic in a situation when they have panicked there once only, out of hundreds of occasions without panicking, so cognitive reasoning is ignored.  In anxiety the cognitive content revolves around danger and the person is likely to maximise the risk of harm and minimise his ability to cope.  The anxiety is also very likely to lead to the prophesy being fulfilled and this will therefore reinforce the anxiety.

In anxiety, the cognitions will trigger physiological reactions.  When a person feels nervous, the autonomic nervous system comes into play and the person prepares for fight or flight.  In extreme cases the person may be “tongue-tied” or “glued to the spot”, which will further exacerbate the problem.  The function of the autonomic nervous system is to prepare the individual to cope with danger by regulating the temperature, blood supply and metabolism.  If there is no real danger, then any reaction is pointless and counterproductive.  It is made even worse by the fact that as no danger actually exists, the person cannot test reality by developing and applying active coping skills.

By changing the maladaptive cognitions to realistic formulations the individual can test these against reality, thus proving their validity and so change his schemata to be functional.  This will lower the person’s anxiety and when the mechanism is understood, the individual can practice acting as his own therapist.

Depression is often seen with anxiety, and although some behaviourists would advocate treating the secondary depression with medication while dealing with the anxiety, in cognitive therapy the dysfunctional thoughts can be countermanded whether they lead to anxiety or depression.

The anxiety may be free-floating or generalised.  It can be specific, leading to phobias, which lead to avoiding behaviours.  In essence, the reactions that are evoked in phobias and the cognitive distortions in the thinking are similar to those in other forms of anxiety.  The mechanisms behind phobias are more in question.  The behaviourists, according to Wolpe (1969), see phobias in terms of classical conditioning so that a previously neutral stimulus becomes linked to the anxiety due to its physical proximity to the feared object.  In cognitive terms it is seen, not as linked fear of the object but, as fear of reacting with anxiety in the presence of an object which intrinsically is not frightening.  In fact, these perspectives are not mutually exclusive.  Wolpe’s position looks at the early learning end and aims to let a change in cognitions follow from a behavioural change.  The cognitive position focuses on the derived thoughts from the faulty learning (now faulty thinking) and aims at changing the thoughts and behaviour at the same time by reality testing.

There are several ways in which phobias appear to be acquired.  They could refer to real but unlikely events, they could result from childhood fears or trauma, or even from vicarious learning from significant others.

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