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The Maintenance of Anxiety Disorders: Maladaptive Coping Strategies

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.

Now that we understand how anxiety disorders may originate, it is quite sensible to wonder, "Why don't people just get over it?" The answer to this very sensible question rests upon the way people attempt to cope with anxiety symptoms. There are both adaptive and maladaptive ways to cope with anxiety. Adaptive methods improve functioning, while maladaptive methods do not. Unfortunately, many of the maladaptive coping strategies are highly effective in reducing symptoms, at least in the short-term. Unfortunately, the result is to increase dysfunction by maintaining and strengthening the disorder.

For example, one type of coping strategy is called sensitization. A person using this type of coping strategy seeks to learn about, rehearse, and/or anticipate fearful events. This serves as a protective effort to prevent these events from occurring in the first place. These efforts result in hyper-vigilance and obsessive worrying. This type of coping strategy is commonly observed in people with Generalized Anxiety Disorder. Children with Separation Anxiety Disorderworry about the well-being of their attachment figure, or worry that something may happen to keep them from being reunited, such as getting lost.

Another type of coping strategy is the use of safety behaviors. This refers to coping strategies where people come to rely on something, or someone, as a means of coping with their excessive anxiety. This may be demonstrated by an exuberant amount of time and energy seeking reassurances of safety, or repeated reassurances that some disastrous consequence will not befall them. Examples of common safety behaviors include: shopping only when accompanied by someone else; carrying around medication "just in case;" refusing to drive unless someone talks with them on the cell phone while driving (Ironically, this is hardly a safe behavior!). In addition, people with Panic Disorderoften refuse to go certain places without being in the presence of their "safety person." Likewise, children with Separation Anxiety may refuse to go to school or go to bed for fear of being separated from their attachment figure.

But by far, the most common coping strategy is called anxious avoidance. This coping strategy refers to the avoidance anxiety-provoking situations. Unfortunately, if a person does not confront the feared situation, and instead avoids it, their fear will mostly likely be maintained. An avoidance coping strategy serves to maintain anxiety disorders because the person never has the opportunity to learn that they can tolerate their anxiety. Likewise, they cannot have new experiences that would allow them unlearn the faulty beliefs they have come to associate with the situation.

Unfortunately, the strategy of avoidance is successful in the sense it temporarily "takes away" the unpleasant experience of anxiety. Through a learning process called operant conditioning the person learns to avoid the negative experience of anxiety. According to the principles of operant conditioning, a behavior that serves to remove an unpleasant consequence (in this case, the reduction or elimination of anxiety symptoms) will cause that behavior to increase. In other words, the reduction in symptoms will cause avoidance to occur again. This is called negative reinforcement. Negative reinforcement means the removal of something (negative) that causes an increase in a behavior (reinforcement). To make matters worse, avoidance eliminates opportunities to learn how to tolerate, to master, or to overcome the fear-producing situation. For more information about operant conditioning, please refer to the section on Behavioral Learning Theory and Associated Therapies.

Let's use an example to illustrate the powerful effect of negative reinforcement. Suppose Maria, who has Social Phobia, receives an invitation to a party. The moment she receives the invitation, Maria will begin to feel anxious and worry about the party. Next, she may begin to think, "Nobody will like me. I'll probably do something embarrassing." These thoughts and feelings are highly unpleasant and uncomfortable. However, if she decides to avoid the party by not attending, her anxiety level will immediately decrease. This is because she has eliminated the threat (the party) by deciding not to go. Since her anxiety decreased by avoiding the anxiety-provoking situation, her coping strategy (avoidance) is negatively reinforced by the removal of these bad feelings. She has now "learned" that avoidance is a highly effective coping strategy that eliminates the unpleasant feelings of anxiety. Therefore, the next time Maria confronts a similar anxiety-provoking situation, she is quite likely to use the same method that worked so well before (i.e., avoidance). Although in the short-term this strategy may reduce her anxiety, in the long-term it only interferes with her ability to overcome her fear. Avoidance behaviors deprive individuals of the opportunity to learn that their fears are unwarranted; or at very least, that they are capable of effectively coping with the situation. The result of this maladaptive coping strategy is Maria will remain socially isolated and unable to enjoy the many rewards of social relationships. While the principles of operant conditioning can serve to maintain an anxiety disorder, these same principles form the basis for some very effective treatments. These treatments are discussed in the Behavioral Learning Theory and Associated Therapies Section.

A strategy similar to avoidance is one of escape. This strategy is often used by people with panic attacks and phobias. Likewise, selective mutism can be considered a child's version of escape. More specifically, when we encounter an anxiety-producing situation our attention begins to shift. We become overly focused on the signs of threat. This narrowing of attention causes our subjective feelings of anxiety to rise. Our desire to escape the situation increases. However, if we do not remain in the panic-producing situation long enough, we can never discover that anxiety will naturally subside on its own. This is called habituation and is more thoroughly discussed in the Behavioral Therapy Section.

All of these coping strategies interfere with the person's ability to unlearn, or break apart, the paired association between the situation and the associated anxiety symptoms. Therefore, these are maladaptive strategies as they serve to maintain the disorder.