Research by Barlow, Clark, and Beck shows that anxiety is maintained by a predictable sequence of events. The cycle begins with a trigger — internal or external — and continues through interpretation, physical sensations, and behavioural responses.
The cycle typically follows this pattern:
This loop strengthens over time unless new learning occurs. It interacts closely with the threat system and anxiety sensitivity.
Triggers can be external (situations, people, environments) or internal (thoughts, memories, sensations). Internal triggers are especially powerful because they are harder to avoid and often linked to interoceptive awareness.
Common triggers include:
The interpretation of the trigger determines whether anxiety escalates. Catastrophic interpretations — described extensively in Clark’s cognitive model — turn harmless sensations or situations into perceived threats.
Examples include:
These interpretations are shaped by core beliefs and cognitive distortions.
Once the threat system activates, the body produces physical sensations — racing heart, tight chest, dizziness, heat, shaking. These sensations are uncomfortable but not dangerous. They become frightening when misinterpreted, especially in people with high anxiety sensitivity.
Anxiety pulls attention toward threat. This attentional narrowing is well-documented in research by Beck and Barlow. It increases hypervigilance and makes sensations feel stronger, similar to the processes described in hypervigilance.
Behaviour is the final — and most powerful — maintaining factor. Avoidance, safety behaviours, and reassurance seeking provide temporary relief but reinforce the belief that the trigger was dangerous. This is the core mechanism behind avoidant coping and avoidance loops.
Evidence-based approaches such as CBT and Cognitive Behavioural Hypnotherapy interrupt the cycle by targeting each stage:
These methods are supported by research from Barlow, Craske, Clark, and Alladin.