Psychological Explanations of Anxiety Disorders
Simply having a biological predisposition, or a heightened sensitivity to stress, is not enough to develop an anxiety disorder. As previously mentioned, a person is more likely to develop an anxiety disorder if they are biologically predisposed to anxiety, in conjunction with a psychological vulnerability. Research has identified four important psychological variables that predict a psychological vulnerability to anxiety: 1) perceived control, 2) cognitive appraisals, 3) cognitive beliefs, and 4) cognitive distortions. Let's examine each of these variables in greater detail.
One of the world's leading experts on anxiety disorders is David Barlow, Ph.D.. According to Barlow (2002), people may develop psychological vulnerabilities to anxiety as a result of early life experiences. One such vulnerability is the lack of "perceived control" over stressful life circumstances. While the presence of environmental stressors may set the stage for the development of an anxiety disorder, researchers have found it is not only the actual presence of environmental stressors that create anxiety; but rather, anxiety is greatly determined by a person's perceived ability to control a potentially stressful event. It is important to realize that this lack of control may, or may not be accurate; rather, it is the person's perception about their degree of control that is important.
It is believed that people's perceptions of control are heavily influenced by childhood experiences. When children repeatedly experience a "lack of control," or a sense of unpredictability over the events in their lives, they may come to view the world as unpredictable and dangerous. This world view may lead to feelings of helplessness, and a tendency to expect negative outcomes, no matter how they may try to prevent them. Examples of early life experiences that may influence a person's perception of control include: 1) family dynamics such as parenting style (i.e., overprotective parenting style, and its opposite, under-protective, low-care style), 2) significant life stressors such as loss of, or separation from, primary caregivers, and 3) traumatic experiences such as childhood abuse (physical, emotional, and/or sexual). This is not to say that our psychological trajectory is fixed in childhood and that nothing can be done to change it. Instead, it simply means that early experiences may have contributed to this psychological vulnerability and explains, in part, why some people are more prone to experience anxiety than others
The perceived lack of control extends to a person's experience of their anxiety disorder. People with anxiety disorders often report they have no control over their symptoms and this lack of control is highly distressing to them. This fact may explain why the often good-intentioned attempts by loved ones, to offer reassurance, are often met with doubt by the person with an anxiety disorder.
The term "cognitive appraisal" simply means the way we evaluate and assess a particular environmental event or situation. Cognitive appraisal is a key concept in understanding one's susceptibility to stress and anxiety. According to Lazarus and Folkman (1984), cognitive appraisal is traditionally broken down into two separate types of beliefs. These beliefs are referred to as "primary" and "secondary" appraisals. Primary appraisal refers to an individual's subjective evaluation of a situation in terms of whether or not the situation has any direct relevance to the individual's well-being. Secondary appraisal refers to an individual's evaluation of their ability to cope with that situation.
Primary appraisal can be further broken down into three separate categories including "irrelevant," "benign-positive," and "stressful." An event is considered an irrelevant appraisal when its occurrence does not in any way affect a person's well-being. For example, suppose you are interviewing for a job and have been asked to sit in a waiting room. You look around the room and notice most people are sloppily dressed while you are meticulously groomed in preparation for this important day. You conclude the other people must not be waiting for a job interview; but rather, are in the waiting area for some other reason. This is an irrelevant appraisal; i.e., the other people in the waiting room do not impact your well-being in any way.
A benign-positive appraisal refers to an instance where one's appraisal of an event leads to positive beliefs which actually enhance positive feelings and/or functioning. Returning to our prior example, suppose you are interviewing for a job, but this time when you observe the other sloppily dressed people in the waiting room, you conclude they are job candidates for the same job, and are also waiting to be interviewed. This appraisal might cause you to believe you have a significant advantage over the other job candidates. Your appraisal of this event would be considered benign positive if you thought to yourself, "No problem, I've got this job!" and this extra confidence enabled you to perform well during the interview.
In contrast, a stress appraisal refers to an instance where the occurrence of an event leads to beliefs that forecast harm: either harm in the present, or threat of harm (in the future). Such beliefs will lead to an experience of anxiety. For instance, imagine you are a job candidate again, but this time when you look around the waiting room, and compare your attire to the other candidates, you decide you are the one who is sloppily dressed, while the other candidates appear neat and prepared. This would be considered a stress appraisal if you believed that your sloppiness will likely hurt your chances of getting the job; and as a result, you performed poorly during the interview, because you were highly anxious. From these three examples of a job interview situation, it becomes clear that our primary appraisals about a circumstance will influence whether we experience any anxiety.
Secondary appraisal refers to an individual's appraisal of their ability to cope with the circumstance, which is in part determined by their perceived ability to control, or to influence, the situation. To illustrate, let's consider a child who experiences abuse. Abuse is certainly a childhood stressor. But, not all abused children develop anxiety disorders. Why might this be? It is possible, that one abused child may come to believe that she can control (prevent) the abuse by being a "good girl." This appraisal may serve to protect the child from anxiety as it provides her a perception of control over her environment, and thus may serve as a buffer against developing an anxiety disorder. In contrast, another abused child may appraise her ability to cope with the abuse, and conclude there is nothing she can do to prevent the abuse. Ironically, while her perception about her lack of control is perhaps more accurate, it also puts her at greater risk for developing an anxiety disorder later in life. Therefore, secondary appraisals include people's assessment of their coping skills and abilities (coping resources); i.e., whether or not they have what it takes to successfully rise to the challenge, or to overcome the stressor.