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Anxiety-based mental health problems are relatively common, and around 30-40% of individuals in Western societies will develop a problem that is anxiety related at some point in their lives. But why?
Many people would argue that feeling anxious has real benefits—like making us perform effectively in challenging circumstances. Indeed, it is highly unlikely that a common emotion like anxiety would have evolved if it did not have important adaptive benefits. However, for many people anxiety becomes a problem rather than a benefit. So, if the world has shaped anxiety as an effective adaptive tool for us to use, where does anxiety as a disabling experience come from?
We only need to start examining some of the beliefs that anxiety sufferers hold about the world and themselves in order to begin to understand how adaptive anxiety mutates into a mental health problem. For instance, most of the common anxiety disorders are underpinned by a set of dysfunctional beliefs that simply don’t represent the objective reality of the world, and in this sense they might be characterized as ‘delusional’ beliefs.
Of course, the experience of anxiety is not an illusion—especially when it is distressing and disabling. But the cognitions and beliefs that generate it often are. We can look at a selection of anxiety-based disorders to see what this means.
1. When someone is diagnosed with a specific phobia (e.g. spider phobia, height phobia) the phobic trigger usually elicits extreme anxiety and often panic. But individuals with specific phobias usually develop a set of extreme irrational beliefs about their phobia that maintain their anxiety and bear no objective resemblance to the risk of harm that the event or stimulus poses (spider phobia beliefs are a good example here).
2. Panic disorder is another common and debilitating anxiety disorder in which individuals experience regular uncontrollable panic attacks. Most people have experienced a panic attack or two, yet what facilitates the development of individual panic attacks into debilitating regular daily occurrences is an underlying dysfunctional belief that all bodily sensations predict some catastrophic medical event (such as a heart attack or going crazy). Yet a panic attack rarely—if ever—leads to such catastrophic outcomes. The individual’s perception of the risk is massively out of proportion to the reality of what is objectively likely to happen, and acts solely to maintain these repeated panic attacks.
3. One activity that is regularly associated with anxiety is chronic worrying. Indeed, one anxiety disorder - called generalized anxiety disorder (GAD) - has pathological and uncontrollable worry as its cardinal diagnostic feature. So do those with a diagnosis of GAD really have so much to worry about? Probably not. But what such individuals do possess is a set of beliefs that worrying is a necessary and important thing to do—otherwise bad things will happen. This results in the need to worry even about the smallest potential problem —and rough estimates suggest that around 90% of what the chronic worrier worries about is never likely to happen anyway!
4. Obsessive-compulsive disorder (OCD) is an anxiety-related problem in which the sufferer experiences uncontrollable obsessive thoughts and may develop compulsive rituals which function to neutralize the anxiety these obsessions cause (such as compulsive washing or compulsive checking). Once again, this is another anxiety disorder that is underpinned by beliefs about the world that are hugely out of proportion to the objective threat posed by the individual’s fears. For example, the fear of contamination or disease that inhabits the mind of the compulsive washer is significantly out of proportion to the real risk of contamination and out of proportion to the ritualized washing activities the individual needs to perform in order to feel safe.
These are just a few examples of the dysfunctional beliefs about the world that are frequently developed by individuals with anxiety-based problems. Such beliefs do not reflect the reality of the world in terms of the objective risk that the feared objects and events pose to the individual, and act to develop and maintain a range of anxiety disorders. Unfortunately, we know very little at present about how these ‘delusional’ beliefs develop, but we do know that they act to maintain anxiety symptoms, and they do this in a very simple way.
Severe anxiety gives rise to avoidance responses – behaviours designed to ensure the ‘bad things’ related to the anxiety don’t happen or are avoided. What this means in practice is that the dysfunctional beliefs held by anxious individuals are rarely disconfirmed. This is because the sufferer continually avoids situations that might provide information that the threat is not as horrendous as they believe.
Helping individuals with anxiety disorders to challenge and deconstruct their dysfunctional beliefs is a central feature of therapies for anxiety problems, whether this is either an exposure therapy or a more cognitive intervention such as cognitive behavior therapy (CBT). Unfortunately, anyone who has a severe anxiety-based disorder knows how difficult it is to face their fear. But while the fear may be real, the beliefs and cognitions on which the fear is based are usually highly disparate with the objective reality of the world, and dismantling these beliefs and cognitions is equivalent to demolishing the scaffolding that supports the fear and anxiety itself.
