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Summary: The Development and Maintenance 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.

The biopsychosocial model proposes there are multiple, and inter-related causes of pathological anxiety. These can be roughly categorized into three main groups: biological causes, psychological causes, and social (environmental) causes. The biological factors include a genetic vulnerability to stress, and the body's natural and adaptive responses to environmental threats. Psychological vulnerabilities may result from early learning experiences. From these experiences, certain dysfunctional beliefs may develop over time. The social factors refer to a type of learning that occurs via the observation of important role models. Social learning may account for the different ways people experience anxiety.

It becomes clear that the development of an anxiety disorder is quite complex. Fortunately, the solution for people suffering from these disorders is not nearly so complex. In other words, although our biology and prior life experiences may have contributed to the development of a disorder, they do not determine our ability to resolve anxiety disorders in the present. This is discussed more in the treatment section.

The biopsychosocial model provides a useful framework for understanding the origins of anxiety disorders. However, it does not adequately explain why these disorders remain active. We illustrated how biological and psychological vulnerabilities can cause a person to become easily excitable in the presence of life stress. This can result in the occurrence of an initial "false alarm" (or uncued panic attack). Subsequently, through a process called paired association, the anxiety experienced during this initial episode becomes associated with the unpleasant symptoms of the body's fight-or-flight response, and/or the situation that precipitated the panic attack. Therefore, the previously neutral situation becomes a conditioned stimulus, capable of triggering a cued panic attack.

We reviewed several maladaptive coping strategies. We emphasized that although these coping strategies may be helpful in the short-term, these strategies ultimately result in the maintenance of the anxiety disorder. The most common coping strategy, called anxious avoidance, is highly reinforcing by quickly reducing anxiety symptoms. However, it serves to prevent future opportunities that enable a person to learn to overcome the fearful situation. In order for the anxiety to naturally subside on its own (called habituation), a person must encounter the anxiety-provoking situation. If people do not expose themselves to the anxiety-provoking situation, avoidance only serves to maintain their anxiety symptoms. This is because they do not have the opportunity to confront their anxious feelings, and cannot challenge their faulty beliefs about the situation.

Research evidence is accumulating that supports the basic ideas presented thus far. However, some areas of anxiety disorder research remain theoretical, and await further confirmation. Specially, it is difficult to specify exactly which biological, psychological, and social factors combine to cause a specific anxiety disorder. Meanwhile, research continues to increase our understanding of the different factors that are associated with the development and maintenance of specific anxiety disorders. For example, psychological variables such as an individual's perception of their ability to control events, or their perception of their problem-solving abilities, are key components in the manifestation of Generalized Anxiety Disorder. Social factors such as peer pressure, and the subsequent importance of "fitting in," set the stage for developing a disorder such as Social Anxiety Disorder (Social Phobia). As investigation continues into each of these important areas of research, our understanding of anxiety disorders will be expanded. As such, treatment approaches will be further refined.

At this point you may be wondering why the need for defining different anxiety disorders in the first place. Wouldn't it just be easier to use the term "pathological anxiety" to describe anxiety that interferes with a person's functioning? Although the anxiety disorders share common factors, there are certain characteristics considered unique to each disorder. In the future, clinicians and researchers may decide it is more beneficial to focus on a general factor, as opposed to individual disorders.