The Maintenance of Anxiety Disorders: Maladaptive Coping Strategies
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; but, the end result is to increase dysfunction by maintaining and strengthening the disorder.
For example, one rather extreme coping strategy is called dissociation. This type of coping strategy is often observed in people who have experienced a traumatic event. Dissociation is a coping strategy that is characteristic of Post Traumatic Stress Disorder (PTSD). Dissociation refers to the ability of the mind to separate and compartmentalize thoughts, memories, and emotions. In a sense, the traumatic event, along with all its memories and emotions, are walled-off and separated in the mind so that the traumatic experience never gets a chance to become processed and fully integrated. You might compare this idea to digestion. Imagine what would happen if a piece of spoiled food was ingested. Ordinarily, the body's efforts to digest bad food will result in some unpleasant symptoms. The person might become quite ill for a few days. But after the digestive process is completed, the person returns to normal. Now imagine instead what would happen if the spoiled food was walled-off and blocked from completing the digestive process. This might temporarily delay the physical symptoms of illness, but eventually the food would rot and putrefy causing all kinds of unpleasant digestive symptoms, for a very long time. This is similar to what happens when the mind walls-off, and separates a traumatic experience. In the short term, it enables the person to remain functioning, but dissociation takes its toll in the end, with long-lasting and highly disruptive symptoms. Thus, the coping strategy of dissociation serves to maintain symptoms and is maladaptive.
Another coping strategy is called sensitization. A person using this type of coping strategy seeks to learn about, rehearse, and/or anticipate fearful events in a protective effort to prevent these events from occurring in the first place. These efforts result in hypervigilance and obsessive worrying. This type of coping strategy is commonly observed in people with Generalized Anxiety Disorder, as well as with Obsessive-Compulsive Disorder.
Safety behaviors refer to coping strategies where individuals with anxiety disorders often 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: only shopping 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 Disorder often refuse to go certain places without being in the presence of their "safety person."
But by far, the most common coping strategy is called anxious avoidance. This coping strategy refers to efforts to avoid anxiety-provoking situations at all costs. Unfortunately, if a person does not confront the feared situation, and instead chooses to avoid it, their fear will mostly likely be maintained. An avoidance coping strategy serves to maintain anxiety disorders because the person is never allowed the opportunity to learn that they can tolerate their anxiety; or to 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 repeatedly avoid the negative experience of anxiety but in so doing, eliminates experiences where they could learn to tolerate, to master, or to overcome the fear-producing situation. According to the principles of operant conditioning, a behavior which serves to remove an unpleasant consequence (in this case, the removal of anxiety symptoms) will cause that behavior to increase (will cause avoidance to occur again). This is called negative reinforcement. Negative reinforcement means the removal of something that causes an increase in a behavior (reinforcement). 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. Maria will begin to feel anxious and worry about attending the party, the moment she receives her invitation. Next she may begin to think "Nobody will like me," or "I might do something embarrassing." These thoughts and feelings are highly unpleasant and uncomfortable. However, if she decides to avoid going to the party instead, her anxiety level will immediately decrease because she has eliminated the threat (the party) by deciding not to attend. Since her anxiety decreases by avoiding the anxiety-provoking situation, her coping strategy (avoidance) is negatively reinforced by the removal of these bad feelings. She has now "learned" a highly effective coping strategy which 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 be helpful in reducing her anxiety, in the long-run it would only interfere with her ability to overcome her fear. Again, this is because 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 end result of this maladaptive coping strategy is that 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 and are discussed more thoroughly in Behavioral Learning Theory and Associated Therapies Section.
This same logic holds true for the coping strategy of escape, often used by people with panic attacks and phobias. More specifically, when we encounter an anxiety-producing situation, our attention shifts and we become overly focused on the signs of threat. This narrowing of attention causes our subjective feelings of anxiety to rise, thus resulting in our desire to escape from the situation. However, if we do not remain in the panic-producing situation long enough, we will never discover that given an enough time, anxiety naturally subsides 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.