What are the key factors that contribute to the development and perpetuation of anxiety disorders?

Anxiety disorders are one of the most common mental health conditions, affecting millions of people worldwide. These disorders can significantly impact individuals’ daily lives, making it challenging to carry out normal activities and maintain healthy relationships. While the exact causes of anxiety disorders are not fully understood, there are several key factors that contribute to their development and perpetuation. Understanding these factors is crucial in recognizing and treating anxiety disorders effectively. In this essay, we will discuss the key factors that contribute to the development and perpetuation of anxiety disorders, including biological, psychological, and environmental factors. By exploring these factors, we can gain a better understanding of anxiety disorders and how to support individuals who are struggling with them.

The maintaining causes of anxiety disorders are what tend to keep them going. They involve ways of thinking, feeling, and coping that serve to perpetuate anxiety, panic, or phobias. Much of this workbook is devoted to helping you deal with these maintaining causes. Of the four types of causes we are considering, only the maintaining ones operate in the here and now and are thus the easiest to deal with. The following list of maintaining causes isn’t exhaustive and includes only those that are most obvious. Maintaining causes will be considered in greater detail throughout the rest of this workbook.

Avoidance of Phobic Situations

Phobias develop because it is very rewarding to avoid facing situations that cause you anxiety. As long as you continue to avoid dealing with a phobic situation, activity, or object, the phobia will remain securely in place. Trying to think or reason your way out of a phobia simply won’t work if you continue to avoid confronting it directly. As long as you avoid a situation, you will be prone to worry about whether you can ever handle it.

Overcoming a phobia means that you unlearn certain responses while relearning others. When you finally begin to face the situation, you unlearn both 1) the “fear-in-advance,” the anticipatory anxiety about possibly panicking in the situation, and 2) the avoidance of the situation itself. At the same time, you give yourself the opportunity to learn that you can enter— and remain in—a phobic situation without undue anxiety. You can learn to tolerate and eventually be comfortable in any phobic situation if you approach it in sufficiently small steps. The imagery and real-life desensitization processes discussed in chapter 7 are intended to foster this type of learning.

Anxious Self-Talk

Self-talk is what you say to yourself in your own mind. It is the internal monologue that you engage in much of the time, although it may be so automatic and subtle that you don’t notice it unless you step back and pay attention. Much of your anxiety is created by statements you make to yourself beginning with the words “what if”—for example, “What if I have another panic attack?” “What if I lose control of myself while driving?” “What will people think if I get anxious while standing in line?” This type of self-talk anticipates the worst before it even happens. The more common term for it is simply worry.

Self-talk can also contribute to creating a full-blown panic attack. Such an attack may start off with bodily symptoms such as tightness in the chest and heart palpitations. If you can accept and “flow with” these symptoms without letting them scare you, they will soon peak and then subside. However, all too often you tell yourself such things as “Oh no—I’m going to panic!” “What if I have a heart attack?” “I’ve got to get out of here, but can’t!” “People will think I’m weird if I have to rest or lean on something for a minute because my legs feel weak.” This scare-talk only aggravates the physical symptoms, which in turn produce even more extreme scare- talk, leading to a vicious circle that produces a full-blown panic attack.

The good news is that you can learn to recognize anxiety-provoking self- talk, stop it, and replace it with more supportive and calming statements to yourself. The subject of self-talk is dealt with in detail in chapter 8.

Mistaken Beliefs

Your negative self-talk comes from underlying mistaken beliefs about yourself, others, and “the way the world is.” For example, if you believe that you can’t be safely alone, you will talk yourself and everyone else into assuming that there must always be someone with you. If you truly believe that life is always a struggle, then you will tell yourself that something is wrong when you start to feel better or when others offer you help. A belief that the outside world is dangerous does not promote an attitude of trust or a willingness to take risks necessary to overcome a condition like agoraphobia.

Revamping your basic beliefs about yourself and your life takes more time and work than simply reversing anxious self-talk. Yet to do so will have far-reaching effects on your self-esteem, your willingness to accept imperfections in yourself and others, and your long-term peace of mind. The subject of mistaken beliefs is considered in detail in chapter 9.

Withheld Feelings

Denying feelings of anger, frustration, sadness, or even excitement can contribute to a state of free-floating anxiety. Free-floating anxiety is when you feel vaguely anxious without knowing why. You may have noticed that after you let out your angry feelings or have a good cry you feel calmer and more at ease. Expressing feelings can have a distinct physiological effect that results in a reduced level of anxiety.

As mentioned earlier, anxiety-prone people are often born with a predisposition to be more emotionally reactive or volatile. Yet they often grow up in families where obtaining parental approval takes precedence over expressing their needs and feelings. As adults, they still feel it is more important to attain perfection or always be pleasing than to express strong feelings. This tendency to deny deep emotions can lead to a chronic state of tension and anxiety. It is believed by some that the external danger avoided by the phobic is actually a stand-in for a deeper-lying internal danger: the fear of long-repressed feelings resurfacing. Panic may occur when such feelings “threaten” to break through. For example, if you have a phobia about water, this might be viewed as a stand-in for a deeper-lying fear of denied feelings. Or a fear of ferocious animals might symbolize a deeper- lying fear of experiencing your own anger and the unmet needs from which it flows. In my view, this emotion-based theory of phobias may be at least partially right.

Fortunately, it is possible to learn to recognize and express your feelings more easily and frequently. Excessive ventilation of feelings, especially anger, may not always be productive, yet it is important to at least know what you are feeling and then allow your feelings some form of expression. Doing so will substantially lower your level of anxiety and reduce your tendency to panic.

Lack of Assertiveness

In order to express feelings to other people, it is important that you develop an assertive style of communicating that allows you to express yourself in a direct, forthright manner. Assertive communication strikes the right balance between submissiveness, where you are afraid to ask for what you want at all, and aggressiveness, where you demand what you want through coercion or threat. If you are prone to anxiety and phobias, you will tend to act submissively. You avoid asking directly for what you want and are afraid to express strong feelings, especially anger. Often you are afraid of imposing on others; you don’t want to compromise your self-image as someone who is pleasing and nice. Or you are afraid that assertive communication will alienate the one person you feel dependent on for your basic sense of security. The problem with a lack of assertiveness is that it breeds feelings within yourself of resentment and confinement. And resentment and a sense of confinement are notorious for aggravating anxiety and phobias.

It’s possible to learn to be assertive and directly express your wants and feelings. An introduction to this type of communication.

Lack of Self-Nurturing Skills

Common to the background of many people with anxiety disorders is a pervasive sense of insecurity. This is especially apparent in agoraphobia, where the need to stay close to a safe place or safe person can be so strong. Such insecurity arises from a variety of conditions in childhood, including parental neglect, abandonment, abuse, overprotection, or over criticism, as well as alcoholism or chemical dependency in the family. Since they never received consistent or reliable nurturing as children, adult survivors of these various forms of deprivation often lack the capacity to properly take care of their own needs. Unaware of how to love and nurture themselves, they‐ suffer low self-esteem and may feel anxious or overwhelmed in the face of adult demands and responsibilities. This lack of self-nurturing skills only serves to perpetuate anxiety.

The most lasting solution to parental abuse and deprivation is to become a good parent to yourself. Methods for gaining awareness of your needs, healing the “child within,” and becoming more nurturing toward yourself.

Muscle Tension

When your muscles are tense, you feel “uptight.” Muscle tension tends to restrict your breathing. And when your breathing is shallow and restricted, you are more likely to experience anxiety. Tense muscles also help to keep your feelings suppressed, which, as discussed above, can increase anxiety. You may have noticed that when your body is tense, your mind has a greater tendency to race. As you relax the muscles throughout your body, your mind will begin to slow down and become calmer. A founder of systematic methods of relaxation, Edmund Jacobson, once said, “An anxious mind cannot exist in a relaxed body.” Body and mind are inextricably related in anxiety.

You can reduce your level of muscle tension on a consistent basis by maintaining daily programs of deep relaxation as well as vigorous exercise. Either one of these alone can reduce muscle tension, but the combination has an even more profound effect. Detailed guidelines for incorporating relaxation and exercise into your lifestyle are presented in chapters 4 and 5.

Stimulants and Other Dietary Factors

Stimulants such as caffeine and nicotine can aggravate anxiety and leave you more vulnerable to panic attacks. You may not even be aware of their impact until you reduce or eliminate them from your life. In two cases, I have seen panic attacks go away completely when clients eliminated caffeine from their diet (this was caffeine from not only coffee but also tea, cola beverages, and over-the-counter medications). For some people, other dietary factors, such as sugar and food additives, can aggravate or occasionally even cause panic reactions.

The nutrition–anxiety connection has hardly been explored in either popular or technical books on anxiety disorders. Chapter 15 of this book takes a detailed look at this connection.

High-Stress Lifestyle

The role of stress both as a predisposing agent and as a short-term cause of anxiety disorders has been described earlier. It is not surprising that a stressful lifestyle perpetuates problems with anxiety. The frequency of panic attacks and severity of phobias tends to wax and wane depending on how well you cope with the daily stresses of living. Getting a handle on all of the maintaining causes of anxiety discussed in this section—self-talk, mistaken beliefs, withheld feelings, lack of assertiveness, lack of support, muscle tension, and diet—will go a long way toward reducing stress in your life. Other factors associated with stress that are not dealt with in this workbook include time management, Type A personality, and communication. These have been discussed in many excellent popular

books on stress management. I can recommend the following: Guide to Stress Reduction by John Mason and The Relaxation & Stress Reduction Workbook by Martha Davis, Elizabeth Eshelman, and Matthew McKay.

Lack of Meaning or Sense of Purpose

It has been my repeated experience that clients experience relief from anxiety as well as phobias when they come to feel that their life has meaning, purpose, and a sense of direction. Until you discover something larger than self-gratification—something that gives your life a sense of purpose—you may be prone to feelings of boredom and a vague sense of confinement because you are not realizing all your potential. This sense of confinement can be a potent breeding ground for anxiety, phobias, and even panic attacks.

Issues of meaninglessness and purposelessness, and their relationship to psychological well-being, have been dealt with in depth by existential psychologists such as Victor Frankl and Rollo May. Several ways of confronting and working on these issues in your own life.


  1. Which of the following factors do you feel might be helping to maintain your particular difficulty?
  • Avoidance of phobic situations Anxious self-talk
  • Mistaken beliefs Withheld feelings Lack of assertiveness
  • Lack of self-nurturing skills Muscle tension
  • Stimulants and other dietary factors High-stress lifestyle
  • Lack of meaning or sense of purpose
  1. Can you rank these maintaining causes according to how much you feel they influence your condition? Which ones do you feel are most important for you to work on?
  2. Specify three maintaining causes that you would seriously be willing to work on in the next month.
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