Summary: The Development and Maintenance of Anxiety Disorders

The biopsychosocial model proposes there are multiple, and inter-related causes of pathological anxiety that 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, and certain dysfunctional beliefs that may develop over time. The social factors refer to a type of learning that occurs via the observation of important role models, and may account for the different ways that anxiety is experienced by different people. Thus, it becomes clear that the development of an anxiety disorder is quite complex and has multiple origins. Fortunately, as we will see in the treatment section, 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.

While the biopsychsocial model provides a useful framework for understanding the origins of anxiety disorders, it does not adequately explain why these disorders are maintained in the present. We illustrated how biological and psychological vulnerabilities can cause a person to become easily excitable in the presence of life stress which will often 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 physical symptoms of the body's fight-or-flight response to threat, and/or the situation in which the panic attack occurred. Therefore, the previously neutral situation becomes a conditioned stimulus, capable of triggering a 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 but serves to prevent future opportunities for learning which would enable the person to overcome, or at least tolerate, the fearful situation. In order for the anxiety to naturally subside on its own (called habituation), individuals must come into contact with the anxiety-provoking situation. If people do not expose themselves to the anxiety-provoking situation, their avoidance will only serve to maintain their anxiety symptoms since they never allow themselves the opportunity to confront their anxious feelings, and to challenge their faulty beliefs about the situation.

It is important to mention that although more and more evidence is accumulating to support the basic ideas presented thus far, some areas of anxiety disorder research remain theoretical, and await further confirmation. Specially, at the present time 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, current research in the area of Obsessive-Compulsive Disorder (OCD), implicates specific brain structures such as the basal ganglia, frontal lobes, and certain brain chemicals such as serotonin, in the formation of that disorder. 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. Whereas socially-related factors such as peer pressure, and the subsequent importance of "fitting in," set the stage for developing a disorder such as Social Phobia. As further investigation continues into each of these important areas of research, our understanding of anxiety disorders will be expanded, and our 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? For now, the simple answer is that 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. However, at this point it time, we find it more beneficial to focus on the unique characteristics of each disorder because it allows for more effective communication among professionals, in hopes of understanding these disorders and creating effective treatments for them.

Authors Statement: Established in 1979, the Bio Behavioral Institute is a psychological and psychiatric clinic dedicated to the treatment and research of anxiety and mood disorders. Based in Long Island, NY, USA, the institute serves both a local and international clientele. Our staff have over 40 years of experience treating anxiety and mood disorders and have been at the forefront of scientifically supported treatments for anxiety disorders for many years. We offer a variety of programs provided by a multidisciplinary team of professionals. For more information, please visit us online at www.biobehavioralinstitute.com or view Bio Behavioral Institute and author biographical information on this website.