The Biopsychosocial Model: Causes of Pathological Anxiety
So what causes anxiety and anxiety disorders anyway? According to Edmund Bourne (2000), author of the highly popular The Anxiety & Phobia Workbook, it is not uncommon for people, even professionals, to offer single-cause explanations of anxiety disorders. For example, many people will often offer simplistic explanations of anxiety disorders such as: 1) brain imbalances, 2) traumatic episodes from childhood, or when all else fails, 3) the catch-all "blame it on the parents." While each of these explanations does have some merit, the fact is, there does not appear to be any one single cause. Anxiety disorders are actually the result of multiple biological, psychological, and social factors that all interact to create and maintain these disorders.
According to one of the leading anxiety experts, David H. Barlow (2002), anxiety and the development of anxiety disorders can be explained by what is referred to as the biopsychosocial model. 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 environmental or social causes. When psychologists use the word "environment," they mean all the things that are happening around us, and this word typically references our life experiences, particularly social interactions with other people such as caregivers, family members, etc. Theoretically, people develop an anxiety disorder when they possess both biological and psychological "vulnerabilities," in conjunction with a social environment that sets-off, triggers, and strengthens these vulnerabilities.
The biological aspect of the biopsychosocial model refers to the body's physiological, adaptive responses to fear. It also refers to the genetic traits, and brain functioning that we "inherit." More specifically, what is passed down is a genetic vulnerability that is expressed as a "personality type" (Bourne, 2000). This personality type describes a person who is more reactive, more sensitive, and/or more easily excitable in the presence of stress.
Although we may be born with a biologically determined, heightened sensitivity to stress, this fact alone is insufficient to create an anxiety disorder. The psychological factors in the biopsychosocial model refer to our thoughts, beliefs, and perceptions about ourselves, our experiences, and our environment. These cognitive patterns affect our perceived sense of control over our environment, and affect the way we assess and interpret events in our environment as either threatening or non-threatening.
These thoughts, or cognitions about ourselves and our environment, play a key role in the formation of an anxiety disorder. For instance, one child's mother makes a correction to her son's homework. He interprets this as helpful and indicative of his parent's confidence in his ability to learn. Another child's mother makes a correction to her daughter's homework, and instead of interpreting this as helpful, the daughter interprets this as an indication of her limitations, and her parent's lack of confidence in her abilities, which further strengthens her own lack of confidence in herself.
Previously, we alluded to the fact that one way anxiety develops is from the perceived gap between one's estimated ability to cope with a challenge, and the estimated difficulty of the task itself. From the example of the two children described above, you can imagine how the son might grow up to become a man who has confidence in his skills when faced with a challenging task. Thus, when estimating the perceived gap between his abilities and a challenging task, he will be less likely to experience anxiety. In contrast, the daughter may grow up to be a woman who lacks this self-confidence. When she is faced with a challenging task, she is more likely to experience anxiety because she is likely to over-estimate the perceived gap between her abilities and the task itself. Thus, because of these differences in their psychological make-up, the daughter would at greater risk for developing an anxiety disorder.
According to Barlow (2002), once the biological and psychological vulnerabilities are in place, an individual may then "learn," from their social environment (such as their family), to focus their anxiety on specific objects, or situations in their environment. Thus, the social component of the model refers to social-environmental factors that may trigger, shape, and strengthen the biological and psychological vulnerabilities. Examples of environmental factors range from stressors that commonly affect everyone, such as the tragic events of 9-11, or the death of a loved one; to more individualized stressors that may not be experienced by everyone, such as financial stress, or pet loss.
Moreover, our social environment includes different role-models that can have a significant influence on any preexisting vulnerabilities. To illustrate the influence of role models in the formation of anxiety disorders, consider adolescent peer groups. These peer groups often contribute strong opinions about what behaviors will help, or hurt, someone's chances of gaining entrance into the "in crowd." Subsequently, by observing how their peers behave, adolescents learn what behaviors and attitudes will help them become accepted, or at least not rejected by their peers. Although a certain amount of concern over peers' opinions is developmentally normal, especially during adolescence, some teens are particularly sensitive to their peers' opinions and have a tendency to become excessively preoccupied with their peers' evaluations. Ironically, this excessive preoccupation interferes with the very relationships and peer approval they are so desperately trying to obtain. Unfortunately for these youth, this preoccupation often results in clinical levels of worry, avoidance behavior, and feelings of anxiety.
Now let's examine the biopsychosocial model in greater detail to more fully understand the biological, psychological, and social causes of anxiety disorders.