Anxiety Research Paper

Outline

I. Definition

A. The Nature of Emotion

B. Dimensions of Emotion

C. Threat Meaning and Anxiety

II. Theories

A. Conditioning

B. Cognitive

C. Biological

D. Genetic and Evolutionary

E. Diathesis-Stressor

F. Animal Models

III. Measurement

A. Indicators

B. Psychometrics

IV. Epidemiology

A. Anxiety Across the Life Span

B. Gender Differences

C. Cross-Cultural Perspective

V. Pathological Anxiety

A. Definition

B. Expression versus Suppression of Anxiety

C. Control of Anxiety

D. Classification of Anxiety Disorders

E. Treatment

VI. Summary

VII. Bibliography

I. Definition of Anxiety

A. The Nature of Emotion

There has been much argument among philosophers, psychologists, and other theoreticians about the nature of emotion itself. Our approach here derives from the contemporarily influential idea that emotions are functional states. That is, emotions are states of the organism that can best be understood according to their functions. According to this idea, understanding the function of a state is a good start toward understanding whether that state is emotional in nature.

According to this conceptualization, anxiety is any state that serves a particular function or purpose. What function does anxiety serve? It has become conventional in psychology to construe anxiety as a state that serves to escape or avoid danger. Mobilization of an organism to take actions to avoid harm can be a function that enhances survivability. This is our working hypothesis about the function of anxiety. Another idea that has garnered empirical support is that the function of anxiety is to warn others about danger, particularly via facial expressions. Both of these views constitute theories of the nature of anxiety, and are subject to continuing investigation and development or decline, depending on the accumulation of relevant evidence.

B. Dimensions of Emotion

Some researchers have argued that a limited number of basic emotions exist that cannot be analyzed into more fundamental emotions. These include anger, fear, sadness, disgust, and joy. Other emotions are said to be combinations of these basic emotions. For example, it has been suggested that anxiety can be conceptualized as a combination of fear, guilt, and anger.

Another approach is to analyze emotions according to their position along certain basic dimensions. Watson and Tellegan have proposed one dimension anchored by excitement/elation at one point and drowsy/dull at the other and another dimension anchored by distress/fear at one end and relaxation/calm at the other. These dimensions of positive and negative affectivity are hypothesized to encompass a variety of emotions. Particular emotions are usually depicted as points mapped onto the two-dimensional space. In this model, anxiety is characterized by excess negative affect. Another example of a dimensional approach is Mehrabian and Russell’s three orthogonal axes: (1)valence (pleasant vs. unpleasant); (2)arousal (excited vs. relaxed); and (3) dominance (controlling vs. controlled).

C. Threat Meaning and Anxiety

Because our approach is to view anxiety as a state that serves to escape or avoid danger, an essential element of an anxiety state must be a perception of danger by the organism. Note that there need not be any actual danger, but only the perception of danger. The sense of danger could be very specific, like “there is a tiger about to tear out my esophagus,” or rather vague, like “something seems to be wrong.” We call this sense of danger “threat meaning” and think that it must be part of any state that counts as anxiety. Unless there is some perception of danger by the organism, it is hard to make sense of anxiety as a state whose function is to mobilize the organism to escape or avoid danger.

Cognitive psychology experiments have well established that there are both conscious and unconscious perceptual processes, and that perception of danger can be unconscious. Thus, a person could perceive danger but not be consciously aware of this “threat meaning.” It follows that an anxious person may or may not recognize a perception of danger involved in the anxious state.

II. Theories of Anxiety

A. Conditioning

Mowrer’s two-stage theory for the acquisition and maintenance of fear and avoidance behavior has greatly influenced thinking about anxiety. According to the two-stage theory, a neutral event comes to trigger anxiety if it has been experienced along with an event that itself causes anxiety. Furthermore, it is supposed that anxiety can be conditioned not only to physical events, such as snakes and spiders, but also to mental events, such as thoughts and images. This is the first stage: a process called classical conditioning whereby neutral stimuli are associated with danger cues. Once fear of a previously neutral situation is acquired in this way, methods of escape or avoidance are attempted, and successful methods are learned and maintained. This learning to escape and avoid is the second stage of the hypothesized two-stage process: instrumental, or “operant,” conditioning.

It has been argued that Mowrer’s theory is too simple to account for fear acquisition and maintenance. For example, it fails to account for the disproportionately high frequency of certain fears (e.g., snakes and spiders) among humans, compared to, say, phobias about electric sockets. It also does not explain the particular ease with which some fears, like taste aversions, are learned and maintained. A useful addition to the two-stage theory is the theory of biologically prepared learning, that hypothesizes that certain conditioned learning is especially easy because of evolutionary developments in the nervous system that have had survival advantages. Although preparedness theory is a plausible elaboration of two-factor theory, its experimental exploration has yielded equivocal results.

Despite the limitations of the basic two-stage theory, it maps well onto certain observations about the maintenance of phobic avoidance and escape. Specifically, it is generally consistent with the common observation that confrontation with phobic situations has been found to provoke reports of distress and elevated cardiac and electrodermal activity, and withdrawal from the situations leads to temporary relief.

Another influential theory of anxiety emphasizes the anxiogenic role of uncontrollability and unpredictability. Accordingly, unpleasant events feel much worse and have more lasting effects if they are unpredictable and uncontrollable.

B. Cognitive

These theories postulate that what people think influences how they feel. For example, Beck and his colleagues have hypothesized that unrealistic expectations and attitudes, represented as cognitive “schemas,” predispose a person to emotional distress. A limitation of this sort of cognitive theory is that it does not specify what expectations and attitudes distinguish different emotions, such as fear versus anger or sadness.

Another type of cognitive theory supposes that certain styles of thinking, for example, overestimating of threat, are involved in pathological anxiety, and that the perception of threat is an important determinant of anxiety. For example, Watts and his colleagues have argued that the way people pay attention to, remember, and interpret threat-relevant information is a crucial determinant of anxiety. Furthermore, different emotions may be associated with different types of information processing bias, for example, anxiety with attentional bias, and sadness with memory bias.

C. Biological

Biological theories of anxiety emphasize the role of the nervous system in anxiety. Anxiety is routinely construed as a stress reaction, and it is generally understood that environmental stressors affect physical well-being. Hans Selye introduced the concept of a General Adaptation Syndrome(GAS)to describe physical reactions to stressors. Accordingly, there are three phases in the reaction to stress. During the first phase, the alarm reaction, the activity in the autonomic nervous system increases. In the second stage, resistance, some physiological adaptation occurs, but if the stressor persists, other physiological reactions ensue, such as ulcers and atrophy of the thymus. Finally, in the third phase, exhaustion, irreversible damage or death may result if the source of stress is not removed.

Other researchers have emphasized the importance of interpretation of events in the environment. For example, Lazarus suggests that interpretation of threat is as important as the triggering event in causing stress. For example, it has been suggested that stress occurs when a situation is appraised as exceeding the individual’s adaptive resources.

The above theories of stress often refer to neuroanatomical structure that may be involved in the stress reaction. Jeffrey Gray’s theory postulated that the nervous system has subsystems serving different functions, and that there is a subsystem called the “behavioral inhibition system” whose prime function is to inhibit behavior in certain situations (e.g., novel situations, aversive situations). Gray has argued that the effects of certain anti-anxiety substances such as alcohol, and of lesions of certain brain areas (e.g., septohippocampal system) that reduce anxiety support this theory. Furthermore, Gray suggested that individual differences in anxiety stem from differences in the activation of the behavioral inhibition system and that these differences are determined genetically.

D. Genetic and Evolutionary

As noted earlier, anxiety is believed to have survival value because it prepares the organism to avoid harm. While the avoidance of threat is essential for survival, chronic anxiety can involve hypervigilance and exaggerated perception of the number and severity of dangerous environmental stimuli. Such hypervigilance could impede, rather than enhance, the organism’s survivability, by interfering with essential activities.

If this genetic advantage is passed on to one’s offspring, then anxiety should be especially prevalent in relatives of anxious individuals. Genetic and family studies have found some support for this notion. For example, elevated levels of panic have been found in relatives of individuals with panic disorder. Another way of understanding genetic influence is through comparisons of identical (monozygotic) twins, who have identical genetic makeup, and dizygotic twins, who have similar upbringing but different genetic makeup. The method is to compare their concordance for anxiety, that is, to compare the number of each type of twin pair who both have anxiety. Such concordance is higher in monozygotic twins.

Together, the various genetic studies point to a component of heritability for anxiety. Notably, however, heritable vulnerability is not absolute: the concordance rate for monozygotic twins is closer to 40% rather than to 100%. This means that genetic makeup provides a limited explanation of vulnerability to anxiety disorder. Furthermore, what seems to run in families is a vulnerability to develop some kind of anxiety, rather than to develop a specific disorder.

E. Diathesis-Stressor

Because of evidence that both person and environment are important in understanding anxiety, it has become commonplace to suggest that an interaction between stressors in the environment with predispositions (or diatheses) in the person cause anxiety. The predisposition could itself be environmentally caused, or it could be inherited. Hypothesized environmentally caused diatheses might be brain injury caused by prenatal hypoxia, or autonomic hyperreactivity stemming from years of child abuse or imprisonment and torture. Some theorists have suggested that individuals inherit predispositions to differing levels of anxiety and that environmental stressors are influential in determining its onset and course.

F. Animal Models

Animals experience distress in threatening situations, and this has been compared to anxiety in humans. For example, when animals are forced to make difficult choices between danger and safety signals, they show agitation, restlessness, distraction, hypersensitivity, muscle tension, and stomach ulcers. This phenomenon has been termed experimental neurosis, and can also be produced by punishment of appetitive behavior, and by long periods of restraint and monotony. There are parallels between disturbances observed in animals who are exposed to unavoidable and unpredictable stressors, and human reaction to extreme harm or threats (e.g., violent assault, physical injury). These similarities suggest that animal models can be useful for studying human reactions to extreme stress. Although animal models do not illuminate every feature of anxiety, they can probably explain some of the more prominent features.

III. Measurement of Anxiety

A. Indicators

Methods of assessing anxiety include interviewing, questionnaires, physiological monitoring, and observations of behavior. These can be used to assess the full range of anxiety, from mild to intense. The primary technique used to assess pathological anxiety is the clinical interview addressing criterion symptoms as specified in DSM-IV or another diagnostic rubric.

An approach to anxiety advocated by Peter Lang holds that it is variously evident in three behavioral systems: semantic (what people report about themselves), physiological (e.g., heart rate, brain electrical activity), and overt behavior (e.g., avoidance), and that there is routinely some dysynchrony among the three systems. The implication of this particular view is that a thorough assessment entails measurement of the three systems.

Measurement of each system has advantages and disadvantages. Self-report indicators of anxiety require introspective description of feelings. An advantage of this indicator is that language can indicate fine nuances of meaning that are less easily accessible in other indicators. Also, self-report provides a relatively economical method of assessment, and can often be done by questionnaire. A disadvantage is that subjects are often inconsistent in their observations of themselves, and the usefulness of their report depends heavily on their limited powers of self-observation.

An advantage of direct monitoring of physiological functioning is that the data do not rely on the self-observational accuracy of the subject, but rather, on the quality of the measurement methods and monitoring equipment. There is a subspecialty of psychology: psychophysiology, which is devoted to psychological theorizing founded in physiological assessment. Disadvantages of physiological assessment are not only the technical burdens, but more fundamentally, the multiplicity of physiological determinants. To put it simply, the bodily organs do not operate just to tell us about anxiety. How much variation in a particular physiological function is irrelevant to anxiety is ambiguous, and complicates any assessment of anxiety via physiology. There is no one physiological response pattern associated with anxiety. For example, heart rate could increase or decrease in response to threat. Note also that with physiological assessment alone, one cannot determine if a heart is pounding because a person is running an Olympic race, running from an assailant, or riding a roller coaster at an amusement park.

Behavioral measurement entails identifying and quantifying overt behavior that is deemed relevant to anxiety. For example, number of errors during a 5-minute typing test could be used as a performance indicator of anxiety. Distance in feet that a person is willing to approach a dangerous object also could constitute a behavioral measure, as could frequency of eye contact in a social situation. An advantage of direct observation is that it is not subject to inaccuracies of the subject’s interpretation. Disadvantages are that people act very differently in different circumstances, so it is difficult to obtain a representative sampling of behavior, and watching a person during an action often influences the target behavior, so that the observation process itself distorts the obtained behavioral sample.

B. Psychometrics

As mentioned above, individuals are often inconsistent in their observations of themselves, and the usefulness of their reports depends heavily on their limited powers of self-observation. A subfield of psychology called psychometrics concerns the technology of measurement, and includes techniques to enhance the usefulness of self-report data. These methods focus on increasing the consistency, that is, reliability, and accuracy, that is, validity of self-report data, and involve using mathematical statistics to develop selfreport scales. A number of psychometrically sophisticated scales are available to measure anxiety, and many are in the form of questionnaires. Traditional psychometric approaches classify anxiety into state (transitory feelings) and trait (stable personality) attributes.

One method of evaluating the accuracy of an anxiety scale is to compare its results to other measures of anxiety, for example, interview, physiology, and observations of behavior. By assessing various aspects of anxiety, the investigator tries to gauge an emotion for which no single indicator offers a perfect yardstick.

IV. Epidemiology of Anxiety

A. Anxiety across the Life Span

Anxiety can develop at any time in the individual’s life span. However, some fears more especially characterize certain stages of development. For example, fears of heights, of loss of physical support, and of loud noises are common in infancy, but fear of strangers develops between 6 and 12 months.

Jerome Kagan and his colleagues have demonstrated that there are individual differences in the level of anxiety, inhibition, and physiological reactivity that are apparent at infancy. Furthermore, these individual differences may have long-lasting implications for individual development.

From 1 to 3 years of age children develop other fears, including fears of darkness, injury, and animals. Kindergartners develop fears such as separation from parents, bodily harm, animals, and sleeping alone. Later, at elementary school age, common fears include test-taking anxiety, fear related to physical appearance, and illness. Fears common in adolescence include anxiety related to social interactions, physical health, sexual matters, and political and social concerns. In the general population, common fears include, snakes, spiders, heights, flying, blood, and dentists. Anxiety about physical health attains more prominence in the elderly.

B. Gender Differences

Differences exist between men and women in felt anxiety: women report more anxiety. This difference is evident in children as well as in adults. Furthermore, the objects of anxiety differ among the sexes. Environmental, agoraphobic, and animal phobias are more common among women, whereas fears of social situations, bodily injury, and illness are approximately equal among men and women. There are also sex differences in response to interpersonal threat situations, with women more likely to respond with anxiety, and men with anger. This appears related to perception of potential control of the threat by the subject. Other factors, e.g., greater cultural acceptability of reports of distress for women, probably also contribute to observed sex differences.

C. Cross-Cultural Perspective

Although anxiety is common to all cultures its expression varies. For example, as Barlow points out, the introspective interpretation of anxiety is culture dependent. For example, in China, medical treatments of emotional disorders are less successful than they are in Western cultures because of the belief that familial separation is the cause of emotional problems. Furthermore, in the third world countries, somatic symptoms appear to be the prevalent mode of anxious expression. In sum, although there are individuals in all cultures that seem anxious, the foci of anxiety and worry, and the attributions of causes of anxiety, are diverse.

V. Pathological Anxiety

A. Definition

Because everyone feels anxious from time to time, it becomes useful to distinguish normal from pathological anxiety. Disabling anxiety in the absence of any actual danger is clearly pathological. As a rule, if anxiety interferes with routine functioning (e.g., work, social life, leisure) and persists when there is minimal real threat, then it is considered pathological.

B. Expression versus Suppression of Anxiety

Should anxiety be suppressed or expressed? This is a variant of the broader question of whether it is healthier to express or suppress emotions. Although a common response to unpleasant feelings is to try to control them, some theorists have proposed that attempts to suppress negative emotions can result in somatic problems, such as ulcers, asthma, arthritis, urticaria, and so on. Although there is certainly evidence for psychosomatic disease, its existence does not itself imply that emotions should always be immediately and completely expressed. Expressing intense anger at a police officer who is giving you a ticket for speeding, or at an armed combat soldier who confiscates your property, could lead to serious harm. A balanced analysis would weigh the potential disadvantages of a particular expression of anxiety against those of its suppression. An often practical alternative to either expressing or suppressing anxiety might be to identify and eliminate its source.

C. Control of Anxiety

Because anxiety can interfere with an individual’s functioning it is sometimes desirable to reduce it. The most established method for reducing excessive fear is by confronting the feared situation. For example, through gradual approach, an individual who is afraid of insects can handle some insects and reduce the fear. The various components of anxiety described above, however, typically change at different rates. Although the person may be handling an insect, and so seem by his or her behavior to no longer be afraid, heartrate may still be elevated, and there may still be a suspicion that the insect is dangerous. This is an example of the often observed desynchrony among different aspects of anxiety. With more practice, the idea of threat and the physical reaction may also change.

Although it is clear that anxiety can sometimes be controlled, it is unclear to what extent vulnerability to develop anxiety can be changed. Some researchers believe that psychological and biological interventions can change vulnerability to anxiety, but this issue remains controversial.

D. Classification of Anxiety Disorders

The Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV), delineates seven specific anxiety disorders. This classification is based on both theoretical and practical considerations, and reflects contemporary thinking. Some theorists have argued that such classifications are too arbitrary, do not reflect “natural” categories, and should be replaced by dimensional descriptive nomenclature. The DSM-IV categories are: Obsessive-Compulsive Disorder, Panic Disorder, Social Phobia, Posttraumatic Stress Disorder, Generalized Anxiety Disorder, and Acute Anxiety Reaction. They differ not only according to the nature of the feared situation (e.g., social situations), but also according to the cluster of associated symptoms.

E. Treatment

Treatments for anxiety disorders often mirror the underlying theories of anxiety discussed above. For example, a clinician who believes that biochemical abnormalities cause anxiety might favor pharmacotherapy with anxiolytic medicine. A clinician who believes that faulty learning or mistaken beliefs are responsible for pathological anxiety might prescribe corrective exercises, for example, facing the anxiety-provoking situation as opposed to avoiding it, or reevaluating the likelihood of danger in a given situation. Certain drug- and learning-based treatments have been studied scientifically and found helpful for various kinds of anxiety. Particular treatments have been found especially helpful for particular types of anxiety, so it is important to obtain a treatment that has been found to match the type of difficulty experienced.

Unfortunately, clinicians sometimes focus too much on the treatments in which they are most expert: a physician tends to prescribe medicine and a psychologist or social worker tends to prescribe psychotherapy. The kind of psychotherapy given sometimes depends more on the kind of psychotherapist (cognitive, behavioral, family, hypnosis, psychoanalytic) than on the kind of treatment that is of established efficacy for a particular type of anxiety. Ideally, a clinician should be familiar with scientific findings on the comparative efficacy of the available treatments for different anxiety problems, regardless of whether that clinician is competent with each treatment, and should guide the anxious person accordingly to choose a treatment of established efficacy. Seekers of treatments for anxiety should be cautious about treatment providers who are unwilling to explain the advantages and disadvantages of alternative treatments, including the strength of the evidence for and against each treatment.

VI. Summary

Anxiety is a routine part of human existence but is incompletely understood. One way of trying to understand it is by what function it serves, for example, to prepare to escape or avoid harm. Many theories about various aspects of anxiety have been proposed, but there is no generally accepted comprehensive explanation. A number of methods of assessing anxiety are available, and each has advantages and disadvantages. The incidence and expression of anxiety varies across age and culture. Anxiety merits treatment if it is severe, persistent, and disabling. Different drugs and psychotherapies have been found helpful for different types of anxiety, and careful consideration of the scientific evidence for each treatment should guide selection.

Bibliography:

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2. Eysenck, H. (1992). Anxiety the cognitive perspective. Hillsdale, NJ: Lawrence Earlbaum Associates.
3. McNally, R. J. (1994). Panic disorder: A critical analysis. New York: Guilford Press.
4. Tuma, A. H., & Maser, J. (1985). Anxiety and the anxiety disorders. Hillsdale, NJ: Earlbaum.