Anxiety Disorders: What Causes Them and What Are the Best Treatment Methods?

With 20% of America’s population suffering from one anxiety disorder or another each year, these ailments need to be addressed and treated as effectively as possible. Anxiety causes a significant increase in a person’s risks for other health issues, including substance abuse, heart disease, and more. With such dire statistics, it is immensely important that we take anxiety disorders seriously and utilize the best treatment methods at our disposal – whether developed from the cognitive or behavioral perspective. This paper will analyze why these theoretical perspectives are most relevant to anxiety disorders, which has resulted in the most effective treatment methods, and what could lead to the development of such disorders in the first place.

According to News in Health, anxiety disorders plague 1 in every 5 people in the United States each year, which is approximately 20% of our population. Such disorders can be incredibly crippling to those who struggle with them and include feelings of uncertainty and apprehension, both of which are severe enough to interfere with day-to-day life.

As if that’s not enough, anxiety disorders also increase the risk for a multitude of other medical conditions, including but not limited to: heart disease, depression, diabetes, and substance abuse. generalized anxiety disorder has been a huge part of my life since I was about 10 years old, and I feel that it is important to understand what causes it and what the best treatment methods are, especially within the cognitive and behavioral theories.

Spielman says the cognitive theory “assumes that our thought processes affect the way in which we behave”.

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More specifically, it ascertains that anxiety disorders – especially panic disorder – are acquired through “cognitive misinterpretations of anxiety and other symptoms”. To exemplify the cognitive theory, let’s take a look at how it would explain the symptoms of social anxiety. Persons who suffer with this disorder will frequently underestimate how well they can manage social situations, overestimate how vulnerable they are to the threat at hand, consistently expect negative results from social interactions, and thus overestimate how severe the consequences of such outcomes will be. Additionally, the anxious party will typically focus more on the ways in which the other party could be judging them instead of how the interaction is actually unfolding, thus causing them to make their best effort to avoid interacting with others altogether. The facts displayed in this scenario are excellent examples of how our thought processes and emotions, or cognitions, blow things out of proportion and cause unhealthy levels of anxiety in our brains.

Spielman says that the behavioral theory, on the other hand, “employs principles of learning to help clients change undesirable behaviors”. There are a number of learning mechanisms that can lead to various anxiety disorders – especially a plenitude of phobias – such as classical and operant conditioning. An example of classical conditioning in the behavioral theory would be the Little Albert experiment in the 1920s, when John B. Watson exposed a baby to a white rat. The child was not immediately afraid of the rat, but eventually Watson would make a loud noise with a metal bar behind the child. Seeing the rat while hearing the loud noise conditioned the baby to fear the rat as well. Operant conditioning is when a certain behavior is encouraged or discouraged with either rewards or punishments.

One of the most common treatment methods for anxiety disorders is cognitive-behavioral therapy, otherwise known as CBT. The reason for its popularity lies in how effective it is in alleviating the symptoms of anxiety. CBT has two primary elements regardless of which variation is utilized: helping people assess and alter their antagonistic outlooks on life or specific situations and encouraging them to put themselves in situations that they would typically go out of their way to avoid. This type of therapy is especially helpful when it comes to social anxiety, according to research done over the years, although other treatment methods have also proven to be effective.

Cognitive theory believes that counterproductive thoughts often lead to intense, irrational emotions and “maladaptive behaviors”. Albert Ellis and Aaron Beck developed two very similar approaches to cognitive therapy; Ellis’ is known as Rational Emotive Behavior Therapy. His theory was that negative emotions were a result of “irrational core beliefs,” which is essentially how people feel about the world and themselves at the most simplified level.

Ellis identified what he found to be the three most typical irrational, core beliefs:

1.  I must do well and win the approval of others or else I am no good.
2. Everybody should treat me kindly.
3. Life must be fair. He constructed REBT to use a methodical and candid procedure which allows patients to acknowledge, defy, and swap out the original core beliefs, which are irrational, for ones that are more realistic.

While both Ellis and Beck aim to change the way an individual thinks so that they can breed a more positive behavior and overall healthier mental state, Beck focuses more on our core schema, or a “central assumption about oneself, others, and the world”.

Similarities between Beck and Ellis’ theories are clear to see, especially after knowing Beck’s three primary core schemas:

1.  The world is a dangerous place.
2.  I am unlovable.
3.  I am inadequate.” Cognitive theory has formed the principle that behavioral change will inherently follow the modification of core beliefs and internal distortions.

From a behavioral perspective, people like B.F. Skinner would encourage methods such as operant conditioning. In his studies, Skinner found that behaviors can be learned – and even reversed – by controlling the “reinforcements” and “punishments” produced in the environment. Such reinforcements, or rewards, can enable anxiety disorders to continue. For example, avoidance and escape can provide the reward of alleviating anxious tension and thoughts, or even preventing it altogether, which allow the anxiety disorder to persist as a result of the positive feelings that often result from such actions.

The behavioral perspective has contrived three common treatments for anxiety disorders: exposure therapy, systemic desensitization, and response prevention. Exposure therapy encourages the patient to have contact with the feared stimulus, either imaginative or in real life. Over time, the person should become desensitized to the stimulus that they once feared so deeply once they manage to separate the neutral stimulus from the “fear-inducing” stimulus.

Systematic desensitization is another form of exposure therapy which is often much simpler to convince anxiety sufferers to agree to. After being taught relaxation techniques, the affected party would be gradually exposed to whatever it is they are afraid of so as not to overwhelm them. Systemic desensitization allows for the patient to be exposed to their fear in increasingly intense situations until habituation occurs, during which their sensory and behavioral responses to the stimulus dissipate. In response prevention, the individual would simply need to abandon coping methods like avoidance and escape.

After considering all this information, it is my belief that the cognitive theory is superior to the behavioral perspective, although they are relatively similar. Behaviorism seems to discredit the significance of internal criteria, i.e. our personal beliefs, thoughts, perceptions, and more, simply because such cognitions are not necessarily observable or measurable. As someone who struggles with generalized anxiety disorder, cognitive methods of therapy appear to be preferable to those of behaviorism because they aim to confront the reasoning behind my emotions directly instead of forcing me into uncomfortable situations before I truly understand my anxieties enough to face them. I feel that the behavioral theory and its treatment methods can also lead us to view humans as machines that can be manipulated and altered.

If everyone used these methods for treatment, it would reduce the dignity of human beings as a whole. Cognitive treatment methods promote a healthy mind and understanding of why people with anxiety view situations in the ways that they do. People who are utilizing behavioral theory treatments should be mindful of how their treatments affect them and why the affect them in that way, even if it is helpful in the moment.

James Madison University has presented 8 key ethical questions used to evaluate fairness, outcomes, responsibility, character, liberty, empathy, authority, and rights. The questions of fairness, outcomes, and character are the most easily related to the matter of anxiety. To inquire about the fairness of an action, JMU asks, “How can I act equitably and balance legitimate interests?” In regard to anxiety disorders, one could ask, “What needs to be done if I treat people poorly as a result of my anxiety?” and “How understanding do others need to be of my disorder?” In my personal experiences, I know that I have often treated others unfairly as a result of my frustrations with the constant nerves and emotional exhaustion that goes hand-in-hand with it. Others should absolutely be tolerant and understanding of those with anxiety disorders, but it will eventually reach a point where help needs to be sought out in one way or another, for the benefit of the sufferer as well as those around them.

JMU’s second key ethical question addresses outcomes: “What achieves the best short and long-term outcomes for me and all others?” We could use this to elaborate on the previous question and wonder what would happen if someone did get treated for their disorder, as well as how the treatment or lack thereof would impact those around them. In my case, not seeking out medical treatment for my anxiety would have resulted in me continuing to lash out at people when they haven’t done anything wrong. As a result of treatment, instances such as those are much less frequent, and I experience significantly less tension. Finally, JMU asks, “What action best reflects who I am and the person I want to become?” As may be evident by now, each question stems off of the last. This question mostly addresses the inquisition of which methods would be most helpful to overcoming anxiety. As previously stated, I think that using cognitive therapy methods to approach anxiety disorders would be the most effective way to treat the symptoms.

Anxiety disorders can occur for an abundance of reasons, from unintentional conditioning to genetic components in how our cognitions perceive situations. While there is no single best way to treat anxiety disorders, it seems to me that the cognitive perspective has produced the most effective methods over the years, without discrediting the importance of our internal differentia as the behavioral perspective tends to do. The most ethical thing for someone suffering with anxiety to do is seek out treatment; in the long run, it will not only benefit them, but it will also benefit the company that they keep by improving their social relationships.

References

1. Andrew Kukes Foundation for Social Anxiety. (2018). The cognitive theory of social anxiety. Retrieved December 1, 2018, from https://akfsa.org/research/the-cognitive-theory-of-social-anxiety/
2. Jacofsky, M.D., Santos M.T., Khemlani-Patel, S., & Neziroglu, F. (2018). Behavioral learning theory and associated therapies. Retrieved November 20, 2018, from https://www.gracepointwellness.org/1-anxiety-disorders/article/38492-behavioral-learning-theory-and-associated-therapies
3. Jacofsky, M.D., Santos M.T., Khemlani-Patel, S., & Neziroglu, F. (2018). Cognitive theory and associated therapies. Retrieved November 20, 2018, from https://www.gracepointwellness.org/1-anxiety-disorders/article/38497-cognitive-theory-and-associated-therapies
4. Jacofsky, M.D., Santos M.T., Khemlani-Patel, S., & Neziroglu, F. (2018). Operant conditioning. Retrieved November 20, 2018 from https://www.gracepointwellness.org/1-anxiety-disorders/article/38493-operant-conditioning
5. Jacofsky, M.D., Santos M.T., Khemlani-Patel, S., & Neziroglu, F. (2018). Operant conditioning and avoidance learning. Retrieved November 20, 2018 from https://www.gracepointwellness.org/1-anxiety-disorders/article/38494-operant-conditioning-and-avoidance-learning
6. Jacofsky, M.D., Santos M.T., Khemlani-Patel, S., & Neziroglu, F. (2018). Behavioral therapies for anxiety disorders. Retrieved November 20, 2018 from https://www.gracepointwellness.org/1-anxiety-disorders/article/38496-behavioral-therapies-for-anxiety-disorders
7. News in Health. (2016). Understanding anxiety disorders. Retrieved December 1, 2018, from https://newsinhealth.nih.gov/2016/03/understanding-anxiety-disorders
8. Spielman, Rose M. (2017). Psychology. Houston, TX: OpenStax.