Psychosocial mechanisms

Data from twin studies suggest that at least 70 per cent of the variance in liability to GAD comes from environmental factors. (23> Several such factors have been implicated.

Stressful life events

Several studies have found an association between stressful or traumatic life events and GAD. In a subset of participants in the Epidemiologic Catchment Area Study, men who reported experiencing four or more stressful life events during the preceding year were more than eight times as likely to meet DSM-III criteria for GAD than those reporting three or fewer stressful life events. (43> The experience of even one very important unexpected negative event was associated with a threefold increase in GAD in both men and women. A variety of stressors have been associated with increased risk of GAD, including early parental death, (44> rape or combat/4.5' and chronically dysfunctional marital and family relationships.(46)


There is an extensive literature on the influences of early environmental factors on the development of anxiety and other negative emotions in children (for an integrative review, see Chorpita and Barlow(47)). Attachment theory holds that parents or other consistent caregivers serve an important function in a child's development by providing a protective and secure base from which the child can operate. Disruption of this base is hypothesized to lead initially to anxious apprehension and dependency and, if the disruption is severe, subsequently to withdrawal and depression.

An important aspect of a healthy parent-child relationship is its ability to foster in the child a sense of control over events. According to Chorpita and Barlow, (47> an individual who lacks sufficient early experiences of control may develop a general perception of personal inefficacy which may predispose him or her to chronic negative emotional states such as GAD. Two aspects of parenting appear to be important in providing a child with opportunities to experience control: responsiveness to the child's efforts at engagement and encouragement of the child to explore and manipulate the environment. A parenting style characterized by excessive control of the child's environment (overprotection) coupled with a lack of warmth and responsiveness toward the child would deprive the child of such opportunities and thus, theoretically, could contribute to the development of anxiety.

Consistent with this theory, mothers of anxious preschool children were found to be more critical and intrusive and less responsive to their children than mothers of non-anxious children/48» In addition, adults who rated their parenting as more protective and less caring had higher trait anxiety scores than other individuals surveyed.(49) A similar pattern was found to distinguish patients meeting DSM-IIIR criteria for GAD or panic disorder from controls. (50> One hypothesis is that the relationship of these early parenting experiences to the subsequent development of anxiety (or depression) is mediated by the early formation of cognitive vulnerability best described as a sense of uncontrollability regarding future events in one's life ( Fig,, d)-7

Barlow Panic Modelk

Fig. 4 Model of the development of vulnerability for anxiety and depression. BIS, behavioural inhibition system (28); HPA, hypothalamic-pituitary-adrenal axis. (Reproduced with permission from B.F. Chorpita and D.H. Barlow (1998). The development of anxiety: the role of control in the early environment. Psychological Bulletin, 124, 3-21.) Copyright © 1998 by the American Psychological Association. Reprinted with permission.

Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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