I use a BioPsychoSocialSpiritual model to explain the development of anxiety disorders. Anxiety disorders and normal anxiety can both be intense emotional experiences, but with anxiety disorders, this intensity is also associated with great suffering and inteference in social, academic/occupational, or general life functioning.
There may be a genetic predisposition to anxiety sensitivity, or in other words, some individuals may have inherited a sensitively wired danger detection system. This sensitivity can lead to a hyperawareness of potential threats along with an intense fight or flight reaction, which may be experienced throughout life or may be triggered by life events or biological events (e.g., pregnancy, childbirth, hormonal changes, medical illness, trauma, etc.)
There may also be an abnormality in the neurons or in the connections between neurons in the brain, and medications that increase available serotonin in the brain are thought to work by stimulating new growth within and between neurons in the brain. It is no longer thought that a lack of serotonin or a "chemical imbalance" is responsible for anxious and depressive symptoms.
Medications are thought to stimulate new growth in the brain which creates a more "plastic" or modifiable neuron, meaning more flexibility in the brain to facilitate new learning and new patterns of thoughts and behaviors. This explains why it can take several weeks for the therapeutic effects of medications are experienced, even though there are immediate side effects from the additional available serotonin.
It is important to note, though, that studies using various neuroimagin techniques have shown that therapy, specifically cognitive-behavioral therapy, has also been associated with changes in brain functioning. It seems as if the changes in the ways in which we interpret and respond to threats are correlated with a "rewiring" of our neurological system.
Medical conditions can also contribute to anxiety symptoms, and therefore, all individuals with excessive anxiety symptoms should be seen by a medical professional to rule out conditions such as heart disease, diabetes, hyperthyroidism, asthma and other respiratory disorders, drug use or withdrawal, or rare tumors.
Anxiety can also be a side effect of medications or drug use or can be the result of poor sleep and nutrition. For some, physical exercise and adequate sleep can change brain and body chemistry enough to make significant changes in emotional functioning. For others, the additional assistance of medications may be beneficial.
Therapy can address biological causes when possible and to dial down the intensity of emotional distress, but there may be limits to the amount of change that can be made to your biological reality. This means shifting your focus to developing skills that allow you to live with and work with the mind and body you have at this time by using your strengths.
Much of the work in therapy is about tolerating, then accepting, then embracing who you are as this anxiety sensitivity also comes with some pretty amazing qualities such as being compassionate, creative, and responsible.
The ways in which people think about their anxiety is a major psychological factor that contributes to the development of anxiety disorders. For example, individuals who think that their anxiety or the physical symptoms associated with anxiety are bad, scary, dangerous, or weak and thus need to be avoided are susceptible to developing an anxiety disorder.
The tendency to overestimate the likelihood of a catastrophic event while also underestimating their ability to cope with such threats can also lead to an overactive anxiety response system.
Core beliefs individuals have about themselves, their world, and their futures can also contribute to the development of anxiety disorders. Overwhelming anxiety can occur when individuals think of themselves as vulnerable or incompetent, the worlds as dangerous, or their future as doomed.
Individuals who tend to avoid or escape from uncomfortable situations are also prone to anxiety disorders in that those particular behaviors strengthen the fears and do not allow the individual to develop confidence in their coping skills.
Certain personality factors can contribute to the general ways in which individuals think and respond (cope) when faced with stressful situations. For example, a perfectionistic personality trait can lead individuals to see anything less than perfect as a threat, or a neurotic personality can contribute to a tendency to interpret situations as negative.
These psychological factors may have developed due to past experiences or there may be a biological predisposition towards these responses types of responses.
All types of psychotherapy address psychological factors that contribute to anxiety. Cognitive behavioral therapy tends to take a direct approach by identifying psychological factors that may be problematic and working to shift those tendencies while also embracing those aspects of yourself that you want to maintain or develop more thoroughly.
Although labeled as a "social" factor, I take this to mean those external factors outside of oneself that either contribute to or mitigate the stress response. Social factors can be related to interactions with family, friends, co-workers, peers, mentors, neighbors, and even strangers.
Children can learn through their upbringing to be fearful and avoid anxiety provoking situations, and generally, to think, feel, and behave in ways that lead to the development and maintenance of anxiety disorders. In addition, those with anxiety disorders may not have been taught how to deal effectively with challenging and painful emotions in general, such as sadness, fear, shame, or loneliness. Childhood experiences at school or with peers can be another social factor that contributes to the development of anxiety.
Stressors in the social environment can also contribute to anxiety, such as an unstable home environment, experiences with racism, childhood trauma, or toxic work/school environment, while strong relationships with close family and friends and a rewarding work/school environment can help ease the pain of anxiety.
Cultural values and beliefs can also play into the ways in which anxiety manifests. In some cultures, the expression of anxiety may be perceived as a weakness and a source of shame. Talking to others about anxiety may also be looked down upon, contributing to social isolation and a weakening in social supports.
In the U.S., perhaps based on capitalistic values, success is often perceived as coming from one's achievements or one's appearances. This can lead to anxiety regarding making mistakes or regarding the way in which one is perceived by others.
A divisive political climate can also trickle down to the individual contributing to a general sense of unease that can also factor into anxiety or stress.
Psychotherapy can address these various social factors by helping you understand their impact on your anxiety and by helping you develop
a strategy to accept or change the factors contributing to distress.
The spiritual component is an important one that influences the entire biopsychosocial system. For some, a connection to a specific religion or a higher power can provide peace and comfort. For others, life is given meaning through nature, relationships, or acts of service to others.
Psychotherapy can help you Identify your purpose and values which can help you tolerate the pain you encounter in life while also helping you to focus on the beauty and purpose in your life. Then you can be motivated not by running away from pain but running towards meaning and purpose.