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Social Explanations of Anxiety Disorders

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

Biological and psychological vulnerabilities help to explain why some people are more likely than others to develop an anxiety disorder. Nonetheless, you may be wondering, how is it possible that different people come to fear different things? More specifically, what accounts for the different ways people anxiety? For example, why do some people come to experience social situations as extremely frightening, while others may be unaffected by social situations, but are deathly afraid of bridges? Our early social experiences can account for some of these differences. Through the observation of others, a child might focus her anxiety on certain types of objects, and/or certain situations. These social influences represent a third type of vulnerability in the biopsychosocial model. In fact, these social influences may account for the many different types of anxiety disorders.

A key concept in understanding the role of social experiences in the development of anxiety disorders is the social learning theory (SLT). According to Albert Bandura (1977), the principal founder of SLT, individuals learn new ways of thinking and/or behaving by observing how other people think and behave. Unlike the more traditional view of "behaviorism"that suggests people learn a behavior because of direct experience. If a behavior is rewarded people learn to increase that behavior. If a behavior is punished, people learn to discontinue that behavior. In contrast to this behavioral learning theory, SLT proposes people can learn how to behave vicariously, without ever having direct experience with a particular situation themselves. Instead, individuals are able to learn how to respond to a particular situation simply by observing how others respond. This concept, that learning can take place without any direct experience, has important implications for the formation of anxiety disorders. It helps to explain the many different ways that people experience anxiety.

According to SLT, people with anxiety disorders may have learned to be anxious through prior contact with other people. Other people may have communicated, via their actions or the information they provided, that certain situations or objects are dangerous and subsequently must be avoid at all costs. For instance, some people with Social Phobia were taught (directly or indirectly) that it was extremely important to receive the approval of other people. For example, a child may watch her parents getting ready for a visit from Grandma. During these preparations, she observes her parents becoming highly anxious. She overhears her parents arguing about the impending visit. Then, her usually friendly parents become very formal and stilted in front of Grandma. In addition, her parents have carefully instructed her about what she can, and cannot, say to grandma with the threat of punishment for any misbehavior. Her observations before and during grandma's visit may cause this child to learn social interactions stressful. In her experience, social gatherings are not opportunities for rewarding and enjoyable experiences. Instead, social experiences represent potentially threatening and risky situations. As a natural outcome of these learning experiences, a Social Phobia may develop. Similarly, some people with Panic Disorder may have learned at a young age that any unexplained bodily sensation signals a dangerous or dire illness. This can occur simply by observing the way family members behave. As you can see, the way early role models handled their own anxiety may directly, or indirectly, teach a child to respond in a similar manner. This will influence whether that child will subsequently experience his or her own anxiety.

Therefore, through exposure to these early learning experiences, people may come to "mimic" the anxious behaviors of others. SLT suggests that this learning can take place simply through observation. Therefore, people may learn to avoid certain objects or situations without ever having any independent knowledge or experience. As such, they have no opportunity to form their own beliefs or opinions about the accuracy of the information they were provided. It is irrefutable. Therefore, the avoidance of objects or situations that are feared by caregivers is nearly guaranteed. Although a large portion of social learning stems from direct interaction with caregivers, social learning may also occur through the observation of other influential role models. These role models may include actors and actresses, musical artists, prominent business people, politicians, etc. This influence may be exerted through a variety of mediums, such as television, movies, and videogames.

The social environment provides a guide for coping with anxiety. Additionally, the social environment is a key factor in the development of certain beliefs about oneself and one's abilities. Thus, the social environment influences our cognitive appraisals. This heightens the key role that social influences have in the development of an anxiety disorder. Likewise, the social environment can greatly influence whether or not individuals believe they are capable of recovery in the here-and-now, regardless of their past experiences. Indeed, in CBT treatment for anxiety disorders, the therapist becomes an important, new role model in the therapy participant's social environment. The therapist expresses confidence in the participant's abilities. The therapist models helpful or adaptive behaviors. The therapists also support the participant's efforts to apply these new behaviors in their daily life. Thus, while social learning may contribute to the development of an anxiety disorder, it also facilitates recovery from an anxiety disorder.