Diathesis-Stress in Action

Clinicians and researchers have developed many ideas about generalized anxiety disorder, phobias, panic disorder, and obsessive-compulsive disorder. At times, however, the sheer quantity of concepts and findings makes it difficult to grasp what is really known about the disorders.

Overall, it is fair to say that clinicians currently know more about the causes of phobias, panic disorder, and obsessive-compulsive disorder than about generalized anxiety disorder and social anxiety disorder. It is worth noting that the insights about panic disorder and obsessive-compulsive disorder—once among the field’s most puzzling patterns—did not emerge until clinical theorists took a look at the disorders from more than one perspective and integrated those views. Today’s cognitive explanation of panic disorder, for example, builds squarely on the biological theorists’ idea that the disorder begins with abnormal brain activity and unusual physical sensations. Similarly, the cognitive explanation of obsessive-compulsive disorder takes its lead from the biological position that some people are predisposed to having more unwanted and intrusive thoughts than others do.

It may be that a fuller understanding of generalized anxiety disorder and social anxiety disorder awaits a similar integration of the various models. In fact, such integrations have already begun. Recall, for example, that one of the new-wave cognitive explanations for generalized anxiety disorder links the cognitive process of worrying to heightened bodily arousal in people with the disorder.

Similarly, a growing number of theorists are adopting a diathesis-stress view of generalized anxiety disorder. They believe that certain individuals have a biological vulnerability toward developing the disorder—a vulnerability that is eventually brought to the surface by psychological and sociocultural factors. Indeed, genetic investigators have discovered that certain genes may determine whether a person reacts to life’s stressors calmly or in a tense manner, and developmental researchers have found that even during the earliest stages of life some infants become particularly aroused when stimulated (Burijon, 2007; Kalin, 1993). Perhaps these easily aroused infants have inherited defects in GABA functioning or other biological limitations that predispose them to generalized anxiety disorder. If, over the course of their lives, they also face intense societal pressures, learn to interpret the world as a dangerous place, or come to regard worrying as a useful tool, they may be candidates for developing generalized anxiety disorder.

In the treatment realm, integration of the models is already on display for each of the anxiety disorders and for obsessive-compulsive disorder. Therapists have discovered, for example, that treatment is at least sometimes more effective when medications are combined with cognitive techniques to treat panic disorder and when medications are combined with cognitive-behavioral techniques to treat obsessive-compulsive disorder. Similarly, cognitive techniques are often combined with relaxation training or biofeedback in the treatment of generalized anxiety disorder—a treatment package known as a stress-management program. For the millions of people who suffer from these various anxiety disorders, such treatment combinations are a welcome development.