The Development and Maintenance of Anxiety Disorders
Up to this point, this article has discussed anxiety in a more general sense. In order to gain a better understanding of anxiety disorders, we now turn our attention to how the biological, psychological, and social forces converge to create the formation of an anxiety disorder. We will also introduce certain behavioral learning mechanisms which function to both develop, and to maintain anxiety disorders once they are formed.
As previously mentioned, the flight-or-flight response is our body's automatic fear reaction when we are faced with an actual threat in our present environment. Under these circumstances the fear response represents a "true alarm" because there is a real and present danger we must either fight against, or escape from. In this case, our fear response is considered adaptive and appropriate.
We may also experience false alarms. During a false alarm our bodies kick into the flight-or-fight mode in order to prepare us for action, just as it would during a true alarm. However, unlike the circumstances that trigger a true alarm, there is nothing in the immediate environment that represents an actual threat; i.e., there is no clear and present danger. So, the "DANGER-DANGER" alarm is going off but for no apparent reason. When the fear alarm is triggered, without an immediate threat or environmental "cue," the resulting response is called an uncued panic attack. Because there is no discernable reason for the panic attack, people often describe these panic attacks as "coming out of the blue."
Although these uncued panic attacks seem to come out of the blue, their occurrence is not as random as previously thought. Research suggests that these unexpected fear responses, (or uncued panic attacks), are often triggered by some form of underlying life stressor. Examples of life stressors include: separation and loss, relationship problems, new responsibilities, a family member's illness, drug reactions, pregnancy, and/or school and work issues (Bourne, 2000). Interestingly, life stressors do not necessarily need to be "negative" in content. Indeed, "positive" stressors such as a job promotion, planning a marriage, and having children may also contribute to the level of stress that may precipitate an initial, uncued panic attack.
You will recall from our discussion of the biological explanations of anxiety that during a fight-or-flight episode, our body is physically preparing for some immediate, protective action. Under the situation of a "true alarm" the chemicals that are released to respond to this demand (such as the release of adrenalin) will be discharged, or used up, as the body runs or fights; much like a car burns up its fuel, particularly at high rates of speed. However, under a "false alarm" condition these additional chemicals are not required: the body does not need to run or fight, it merely needs to "idle." Therefore, these chemicals remain active in the body with no quick or easy way of getting rid of them, thereby producing the unpleasant physical sensations that are associated with panic attacks. These sensations include all the physical symptoms that occur when the fight-or-flight response is activated (racing heart, accelerated respiration, perspiration, digestive upset, dizziness, etc.) Subsequently, the fight-or-flight response is not helpful at this point because there is no real threat. Instead, the person is just left feeling physically and emotionally fearful, and highly uncomfortable.
Unfortunately, because there is no obvious explanation for the physical and mental symptoms the individual is experiencing during a "false alarm" (uncued panic attack), these symptoms are misinterpreted as a sign, or "cue" that something is terribly wrong: "I'm having a heart attack," or "I must be going crazy." In other words, these symptoms are misinterpreted to mean "I must be in danger." And by now we know when the mind believes there is a real and present danger, it prepares the body for fight-or-flight, and so a vicious cycle gets set up. As this cycle continues, exhaustion will eventually occur. Just like a car, the body does not have an unlimited supply of fuel.
Because people do not usually recognize the connection between a life stressor and the initial, uncued panic attack, they will search for a cause of the attack, in an effort to avoid a repeat experience. In an effort to try and find a reason for the panic attack, people may come to associate the place or event where the panic attack occurred as the "cause." For instance, if someone experiences an panic attack in a grocery store, they may come to believe the grocery store "caused" the panic attack and may thus seek to avoid the grocery story at all cost; not wishing to experience another attack. Because they believe the grocery store caused the attack, merely thinking about the need to shop for groceries may prompt another panic attack. This type of panic attack is called a cued panic attack because the grocery story now serves as a cue, or signal of danger. In this respect, anxiety has been learned through a behavioral learning process called classical conditioning which is discussed in the next section.