A cognitive model on the theoretical backings of anxiety and depression explores internal sense of control as a dimension of causality. Anxiety can come from an individual's uncertainty on ability to control an outcome (uncertain helplessness). If this uncertainty and lack of control is heightened (certain helplessness), the individual now faces a mixed state of both anxiety and depression. Once the individual has lost all sense of their control in the face of a certain negative outcome (hopelessness). this fosters feelings of depression. This theory suggest a high comorbidity between depression and anxiety.