Ideational Components of Anxiety Neurosis

The relationship between cognitions and anxiety was studied in 32 patients with anxiety neurosis. The thoughts and fantasies associated with the arousal and intensification of anxiety were mainly anticipation of physical harm, such as being violently attacked, being involved in an accident, or becoming sick; and anticipation of psychosocial trauma, ranging from humiliation or rejection in certain circumstances to complete ostracism. The patients' idiosyncratic ideation involved unrealistically heightened expectations of harm; the degree of anxiety was related to the degree of credibility of the fears (to the patient) and severity of the anticipated adversity. Of 24 patients specifically questioned about having visual images, 22 reported having typical fantasies of being in danger prior to and concomitant with their anxiety attacks. Verbal cognitions related to danger were reported in all cases.