Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.
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. These are:
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. Researchers have found the actual presence of stressors alone do create anxiety. 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. Instead, it is the person's perception about their degree of control that is important.
Childhood experiences can heavily influence someone's perceived sense of control. When children repeatedly experience a lack of control over the events in their lives, they may come to view the world as unpredictable and dangerous. This worldview may lead to feelings of helplessness. As a result, they develop a tendency to expect negative outcomes, no matter how they may try to prevent them. Several types of early life experiences can later influence a person's perception of control. One of these is family dynamics, particularly parenting style. An overly protective parenting style can communicate the world is a dangerous place. Furthermore, this parenting style limits a child's opportunity to develop coping skills. Its opposite, an under-protective, low-care style, results in an unstructured, chaotic world filled with stress. Another early life experience affecting perception of control is the loss of, or separation from, primary caregivers. A third type of experience is ongoing trauma 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 can contribute to a psychological vulnerability. It explains, in part, why some people are more prone to experience anxiety than others are.
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. This lack of control is highly distressing to them. This may explain why the well-intentioned attempts of 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 made up of 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. An individual's primary appraisal determines whether the situation has any direct relevance to that person'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 have any affect a person's well-being. For example, suppose you are interviewing for a job. The receptionist asks you 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. You decide they must be in the waiting area for some other reason. This is an irrelevant appraisal. In other words, the other people in the waiting room do not affect 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. These positive beliefs actually enhance positive feelings and/or functioning. Returning to our prior example, suppose you are interviewing for the same job. However, this time when you observe the other sloppily dressed people in the waiting room, you conclude they are job candidates for the same job. All of you are waiting for your interviews. 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. Such beliefs will lead to an experience of anxiety. For instance, imagine you are a job candidate again. However, 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. 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. This appraisal may cause you to perform 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 anxiety.
Secondary appraisal refers to a person's appraisal of their ability to cope with the circumstance. This is partially determined by their perceived ability to control, or to influence, the situation. It is important to recognize that the protective effect afforded by perceived control does not require an accurate appraisal. It is merely the perception of control, even if that perception is illusory. To illustrate, let's consider a child who regularly experiences abuse. Abuse is certainly a childhood stressor. However, not all abused children develop anxiety disorders. Why might this be? It is possible, that one abused child might come to (falsely) believe that she can control, or prevent, the abuse by being a "good girl." This appraisal may serve to protect this child from anxiety as it affords her the illusion that her actions can control the abuse. Thus, it may serve as a buffer against developing an anxiety disorder. In contrast, another abused child may appraise her ability to cope with the abuse differently. She might more accurately conclude there is nothing she can do to prevent the abuse. Ironically, while her perception about her lack of control is 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). In other words, do they have what it takes to successfully rise to the challenge, or to overcome the stressor? The accuracy of the appraisal does not matter.
As the examples above illustrate, a major cause of individual differences in reaction to stressors are the different ways people appraise a particular event (Lazarus and Folkman, 1984). Their cognitive appraisals will in turn affect whether or not they experience anxiety.