Anxiety, fear, anguish, fear, panic; They are all terms used to refer to the same basic process: the body reacts to defend itself. What many people ignore is that this process is normal, healthy and essential for our health.
Why then does it make us suffer? Why does a reaction biologically and psychologically intended to protect us turn against us? Why does anxiety become pathological?
Anxiety is not always pathological. On the contrary, it constitutes a healthy and normal emotion in many situations. When there is some danger, when we are at risk, then the brain triggers a set of defensive mechanisms aimed at preserving our integrity. The subjective emotional experience of such a defensive reaction is what we feel as anxiety or fear.
Part of its adaptive value also lies in its unpleasant nature: we want to put an end to anxiety and, to do so, we must get out of the dangerous situation in which we find ourselves. Now, we also know that anxiety is one of the emotions most linked to psychopathology; bringing a lot of suffering and discomfort.
Anxiety is not always pathological
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Pathological anxiety is exaggerated with respect to the objective threat that triggers it, manifesting itself with activation symptoms that prepare the organism for a defensive action against a danger that does not exist. On a cognitive level, specific thoughts occur that overvalue the risk; they usually take the form of more or less specific concerns depending on the case. On a physiological level, the activation of the sympathetic branch of the autonomic nervous system increases, generating reactions such as tachycardia, sweating, and muscle tension. In the motor system, avoidance and escape responses occur, which leads to abandoning anxiety-triggering environments or enduring them with great discomfort.
Why is all this happening? Why does an emotional system evolutionarily selected to protect us become a weapon against ourselves? Simply put, why does anxiety become pathological? Answering these questions could fill several libraries…
Today we can raise the debate on at least two broad levels. One, that of neurosciences, seeking to objectify both the qualitative and quantitative differences of the neural systems and subsystems in charge of defensive processing. Another, more characteristic of Psychology, and in particular of Cognitive Behavioral Therapy; the functional, dealing with finding what relational patterns between the individual and his or her environment lead to lasting pathological anxiety reactions. Of course, the interrelation between both spheres is extremely interesting and complex.
We will deal with the discussion in the second area, on the other hand, more related to clinical work with patients who suffer from some form of pathological anxiety.
Initiation factors: ways by which anxiety becomes pathological
The most widespread way by which anxiety becomes pathological is what is generically called traumatic. Simply put, a person acquires a pathological fear reaction because an association is established between a neutral event with another that represents a real threat. The process is one of the particular cases of classical conditioning initially described by Ivan Pavlov.
For example, a person traveling by car on the road has an accident with a serious threat to life. From that moment on, he develops a specific phobia; traveling in cars on the road will make him afraid, so much so that he will no longer be able to do it. Although the traumatic route of acquiring irrational fears is valid, research indicates that it accounts for a maximum of 47 or 48% of cases of specific phobias; That is to say, more than half of these paintings have some other origin. On the other hand, there are no conclusive data about how much the traumatic pathway could explain the appearance of other pathological forms of anxiety, such as those presented in Generalized Anxiety Disorder or Agoraphobia.
A second way by which people acquire pathological fears consists of learning by observing models or Modeling, studied in detail by the prominent psychologist Albert Bandura. In humans, this process occurs in two different ways.
There are no conclusive data about how much the traumatic pathway could explain the appearance of other pathological forms of anxiety.
On the one hand, direct observation of a person who suffers from some form of pathological anxiety can lead the observer to acquire the same or a related fear, particularly if the latter is found in childhood. The simplest cases are those in which children end up suffering from the same phobias as their parents.
For example, if a young child watches his mother react with fear when interacting with strangers, he is more likely to copy this pattern and, over the years, develop some form of social anxiety. The tense face, a broken tone of voice, subtle avoidance behaviors, among other signs of fear that the mother inadvertently sends to her child when interacting with unknown people; They give the child the idea that strangers can be dangerous. This lays the foundation for, together with other factors, the development of a Social Anxiety Disorder.
On the other hand, modeling can also be done verbally, that is, through words that narrate anxious reaction patterns to events that are innocuous. As in the previously mentioned case, this process is more likely to occur if exposure to the verbal model takes place during childhood.
For example, a child observes and particularly hears his father worrying about a variety of topics, from money to personal health and safety, but in the absence of clear environmental events that justify the complaints. Thus, for example, while having dinner, sometimes the father spontaneously complains about financial difficulties; others, of the problems of insecurity in the face of crime. At another time, when one of the brothers is a minute late arriving home, he says phrases such as “for God’s sake nothing has happened to him” while emitting signals of anxious activation.
Inevitably, the child exposed to this model is more likely to learn that ambiguous situations constitute a source of danger, thus laying the foundation for the later development of Generalized Anxiety Disorder.
We almost never notice that someone suffers from a phobia of plugs, shoes or knives.
A third possibility for the development of pathological fears comes from the application of Darwinian principles. On the one hand, a simple observation tells us that human fears are not uniformly distributed, which means that people tend to develop fear more easily towards some stimuli than towards others.
Thus, it is common to hear that people are afraid of heights, cockroaches, toads or closed spaces such as a subway or elevator; But we almost never notice that someone suffers from a phobia of plugs, shoes or knives. It is clear that, currently, the latter elements (plugs and knives) carry a greater degree of danger than the former (toads or elevators). However, the defensive anxiety reaction is blind to this fact.
The answer to the question lies in the fact that for millions of years, life on our planet evolved in an environment very different from that of modern humans. In that archaic environment, reacting quickly with fear to some critical stimuli could mean the difference between life and death; Hence, the emotional reaction to events that were once truly dangerous has been facilitated.
Indeed, animals, insects, closed spaces, heights are some of the elements that represented a danger of death for our ancestors. Although today they no longer involve greater risk to our integrity, the brain retains a facility to react defensively towards them. So much so that it represents one of the ways by which anxiety can become pathological.
The strongest hypothesis of this line maintains that we are born with an innate reaction of fear to these evolutionarily prepared stimuli and that through the socialization process, through natural exposure to them in our culture, we lose the initial fear. For example, our instinctive reaction of fear of heights disappears as we approach protected high spaces, such as balconies and windows, while we are restrained by our caregivers. When this natural process of biologically prepared fear extinction fails, then the conditions would be met for the emergence of pathological anxiety.
The previous discussion has briefly reviewed three traditionally proposed pathways for the acquisition of pathological fears: the traumatic episode, modeling, and evolutionary preparation. Now, not everything ends here in terms of the explanation of pathological anxiety. Well, it is not only about asking how a fear is acquired but, and perhaps more importantly, how it is maintained. Having explanations about how pathological anxiety is perpetuated over time can shed a lot of light on possible therapeutic approaches.
Maintenance and modulation factors of pathological anxiety.
There are several factors that can modulate and maintain the pathological anxiety reaction in the long term. It is not our intention to carry out an exhaustive discussion of all of them here, but only to draw attention to the most important one in terms of therapy.
Inevitably, pathological anxiety leads to avoidance and escape behaviors. This is the most relevant critical element when explaining the long-term maintenance of pathological anxiety. For example, if a person suffers from a Simple Phobia, to take the simplest case for explanatory purposes, he will surely try to avoid what he fears or will escape if he has an unexpected encounter with the phobic object. Thus, someone who suffers from a phobia of toads will avoid going to open places and, if they suddenly come across one of these animals, they will try to flee.
Pathological anxiety leads to avoidance and escape behaviors
Well, let’s ask ourselves what would happen if this person carried out an opposite pattern of behavior, that is, approached, perhaps slowly and gradually, the toads and little by little tried to stay close to them instead of avoiding and escaping. What would happen to fear? Definitely, it would decrease until it disappears. This process receives today…