Anxiety
Anxiety
Human anxiety—empirical generalizations
Anxiety—an integrative point of view
There is no single problem of anxiety. Different theorists and different experimental investigators have tackled various aspects of a broad complex of phenomena, all of them summarized under the unifying conceptual category of anxiety. Anxiety has variously been considered as a phenomenal state of the human organism, as a physiological syndrome, and as a theoretical construct invoked to account for defensive behavior, the avoidance of noxious stimuli, and neurotic symptoms.
Historical background. The role of anxiety in the study of personality has been peculiarly a child of the twentieth century. The eighteenth-century and nineteenth-century precursors of modern psychology were first of all concerned with the rational aspects of human personality development, and it was not until the work of Alexander Bain (1859) that motivational concepts became important in speculations about complex human behavior. Thus, with the exception of such precursors of modern existential philosophy and psychology as Kierkegaard (1844), historically there was little central concern with the problem of anxiety.
However, negative, aversive, and unpleasant emotions have been the concerns of modern thinkers. Anxiety has not only been considered as the negative emotion par excellence in the theoretical writings of psychological theorists; but, even apart from its prototypical status as a negative emotion, it became generally the central emotional concept of many theoretical treatments in psychology. Anxiety was emotion.
On the whole, anxiety has remained the child of the psychologist, the problem of the individual. While philosophers, anthropologists, and sociologists have at various times taken the psychologist’s notion of anxiety and speculated about its social and cultural antecedents, the major contributions in the area of anxiety have been those of psychologists.
The following schema briefly recapitulates the various theoretical and empirical concerns that have collectively come to be known as the problem of anxiety.
The three faces of anxiety. Three general rubrics describe various emphases within the problem of anxiety: antecedent, organismic-hypothetical, and consequent conditions. While this triad can be conceptually delimited, there are, as will be obvious, borderline problems that defy any simple categorization.
Antecedent conditions. In the first instance, there has been a continuing interest in the antecedent conditions that give rise to the anxiety phenomenon. Practically all workers in the field have, at one time or another, been concerned with the stimulus that elicits anxiety. What is it in the environment that gives rise to the experience of anxiety or to the behavior that is symptomatic of anxiety? With the notable exception of the existentialists and some psychoanalytic writers, considerations of these conditions have usually viewed anxiety as an acquired emotion, rarely found until the organism has gone through some learning experiences. As an acquired emotion, it is often distinguished from the fear aroused by a threatening or noxious event, and it is usually reserved for those learned conditions that signal or cue the impending occurrence of tissue injury or some other threat to the integrity of the organism.
Organismic conditions. The second set of conditions that is subsumed under the problem of anxiety is the hypothesized or observable state of the organism. While a theoretical purist can easily postulate the anxiety state as a hypothetical theoretical device with explanatory functions only, most notions about the phenomenon have, in addition, assumed some physiological or specifically autonomic arousal state. Those who have taken a specific position in this regard have usually assumed that the experience of anxiety is accompanied by some measurable level of sympathetic nervous system discharge. While there has been some speculation whether this discharge shows a specific pattern for the emotion of anxiety, generally it has been assumed that while the discharge may be specific to the individual it is likely not to be specific to the emotion. On the other hand, the autonomic processes involved have frequently been ignored, and, while some state of the organism has been postulated, its specific empirical referents have not necessarily been investigated. This position is particularly true of the concept of anxiety used by learning theorists in the United States. Even they, however, have at times spoken about specific proprioceptive (i.e., internal) cues associated with the anxiety state.
Consequent conditions. The consequent, experiential, or response aspects of anxiety have probably shown the widest variety of definition and emphasis. It can be assumed that the experience of anxiety falls into a general category of conditions, all of which occur consequent to some prior event or state of the organism; that is, some event must act upon receptors to be experienced. The subjective experience of anxiety is accessible only through the report of the human observer; as such, it is a behavioral, consequent event and falls into the same category as other behavioral and verbal consequences of some real or hypothetical anxiety state. One major group of anxiety theorists, the existentialists, has concerned itself primarily with these experiential correlates. In addition to what the anxious human being says about himself, the problem of anxiety deals with the effect of the various antecedent and intervening states on practically all aspects of his behavior. Apart from the effect of anxiety on neurotic or other pathological behavior, anxiety has been studied as it affects early learning, child rearing, adult acquisition of normal aversions and apprehensions, motor behavior, complex problem solving, and so forth (cf. Cofer & Appley 1964). Anxiety has also been defined in terms of expressive behavior, general level of activity, and a whole class of diagnostic behavioral and physiological symptoms.
While these three general classes of variables— antecedent, organismic, and consequent—provide a general overview of the extent of the problem of anxiety, they are, like most categories in the behavioral sciences, hardly mutually exclusive. Various conditions may at various times shift from an organismic to a consequent state, or even from a consequent to an antecedent, as, for example, when anxious behavior becomes the cue for further anxiety. Quite understandably, several writers on the problem have stressed the importance of different aspects of this triad. When the learning theorist is dealing with anxiety, he is dealing primarily with antecedent-consequent relations; when the existentialist speaks of anxiety, he is concerned primarily with the experience of anxiety and possibly with some organismic state, whereas he has relatively little concern with antecedent conditions of learning.
With these general considerations in mind, three major theoretical positions will be given a brief exposition, followed by a summary of known and stable empirical findings, a general unifying statement on the problem of anxiety, and an exposition of pathological anxiety.
Theoretical positions
Psychoanalytic theory
While much has been written about the development of, and changes in, the psychoanalytic concept of anxiety, the major position, even after several decades, remains Sigmund Freud’s own set of statements. Nothing attests better to the complexity of the problem of anxiety than Freud’s concern with an adequate theory of anxiety. In no other area did he change his point of view as dramatically as he did toward the origins and mechanisms of anxiety, in fact presenting two theories on the topic.
Freud’s early theory of anxiety, generally stated in 1917 (Freud 1916–1917), was relatively straightforward and part of the general energy system of psychoanalytic theory. Anxiety was defined as transformed libido. The transformation occurs as a result of repression, which distorts, displaces, or generally dams up the libido associated with instinctual impulses. This transformation-of-libido or “damming-up” theory of anxiety suggests that whenever the organism is prevented from carrying out an instinctually motivated act, whether through repression or through some prevention of gratification, anxiety will ensue. Such anxiety may, of course, then serve as a motive for a symptom that in turn functions to terminate or completely prevent the subsequent occurrence of anxiety. This theory was amended in 1926 when Freud published Inhibitions, Symptoms and Anxiety. The new position was restated in the New Introductory Lectures on Psychoanalysis in 1933 and in general remained his final statement on anxiety.
The second theory reversed the relationship between repression and anxiety. Although Freud tended to maintain the possibility of both kinds of relationships, the second theory added the possibility that repression occurs because of the experience of anxiety. To Freud, this was the more important possibility. In this context, anxiety becomes a signal from the ego. Whenever real or potential danger is detected by the ego, this perception gives rise to anxiety and in turn mobilizes the defensive apparatus, including, of course, repression. Thus, because of the impending danger from unacceptable or dangerous impulses, the unpleasantness of anxiety produces the repression of the impulses, which in turn leads the organism out of danger.
Avoidance of overstimulation. It should be noted that a central concept in both of Freud’s theories of anxiety is the notion of the avoidance of overstimulation. Whether libido is dammed up by not executing some instinctual act or whether the ego signals impending stimulation that cannot be adequately handled, in both cases the anxiety anticipates an impending situation for which no adequate coping mechanism is available to the organism. The ultimate unpleasantness is overstimulation, including pain, and the anxiety in both theories signals or anticipates this prototypical state. Thus, Freud derives the origin of anxiety from the prototype of overstimulation. Such a derivation is necessary at least for the second theory, which presupposes cognitive, perceptual actions on the part of the ego. Here anxiety is learned; it is acquired as a function of past experience. It is in this sense that the psychoanalytic theory of anxiety, including its several revisions, has never abandoned the first theory, which describes the development of “automatic” anxiety. In the second theory, anxiety is derived from “automatic” anxiety; in the first theory, all anxiety is “automatic.”
Antecedent and organismic conditions. The origin of “automatic” anxiety is traced by Freud into the very earliest period of life, the birth trauma and the immediate period thereafter. Emphasis on the helpless infant as well as on the birth trauma as the origin of the anxiety state places him apart from Rank (1924), who relies solely on the birth trauma as the source of anxiety.
For Freud (1926), the experience of anxiety— as distinct from its antecedents or consequences or as a theoretical state—has three aspects: (1) a specific feeling of unpleasantness, (2) efferent or discharge phenomena, and (3) the organism’s perception of these discharge phenomena. In other words, the perception of autonomic arousal is associated with a specific feeling of unpleasantness. As to the primitive occasions for this anxiety experience, Freud is frequently hazy. While, on the one hand, he considers the predisposition toward anxiety as a genetic mechanism ([1916–1917] 1952) at other times he considers anxiety as arising from separation from the mother, castration fears, and other early experiences. He considers the specific unpleasant experience of the anxiety state as derived from the first experience of overstimulation at the time of birth. He says that the birth experience “involves just such a concatenation of painful feelings, of discharges and excitation, and of bodily sensations, as to have become a prototype for all occasions on which life is endangered, ever after to be reproduced again in us as the dread or ‘anxiety’ condition” (Freud [1916–1917] 1952, p. 344). Thus, it is possible that some of the discussions that have arisen out of several interpretations of Freud’s theory of anxiety have confused the specific experience of anxiety derived from the physiological make-up of the organism and the birth trauma with the conditions that produce or threaten unmanageable discharge. The conditions that produce such an anxiety state are, in addition to the birth trauma, separation or loss of the mother, with the attendant threat of overstimulation due to uncontrollable impulses and threats, and castration fears with similar consequences. Thus, where Rank places both the affect and the prototypic antecedent conditions at the period of birth, Freud lets the organism inherit or learn the affect at birth, but also adds other specific conditions that elicit it later on in early life. On this basis it is reasonable to claim, as Kubie (1941) does, “that all anxiety has as its core what Freud has called ‘free floating anxiety.’” In other words, given the initial affect of anxiety that a child either genetically or experientially brings into the world, specific anxieties and fears are then situationally developed out of this basic predisposition.
In this context, the various types of fears or anxieties that Freud discusses are not different in their initial source of the affect but, rather, differ in the specific conditions that give rise to them. They are fear, where anxiety is directly related to a specific object; objective anxiety (Realangst), which is the reaction to an external danger and which is considered to be not only a useful but also a necessary function of the system; and neurotic anxiety, in which the anxiety is out of proportion to the real danger and frequently is related to unacceptable instinctual impulses and unconscious conflicts.
Freud’s notion that anxiety is brought about when the ego receives those external or internal cues that signal helplessness or inability to cope with environmental or intrapsychic threats is mirrored in Karen Horney’s position that basic anxiety is “the feeling a child has of being isolated and helpless in a potentially hostile world” (Horney 1945, p. 41). For Horney, primary anxiety is related eventually to disturbances of interpersonal relations, initially those between the child and significant adults. A similar position is taken by Harry Stack Sullivan, who relates both parental disapproval to the development of anxiety and the inadequacies, irrationalities, and confusions of the cultural pattern to its elicitation.
In summary, the psychoanalytic position not only treats anxiety as an important tool for the adequate handling of a realistically threatening environment, but it also relates anxiety to the development of neurotic behavior. The “cultural” psychoanalysts then go on to stress the social environment at large, while Freud sees the basic anxiety mechanisms in the very early mother separation and castration fears. In all cases, however, anxiety is related to the inability of the organism to cope with a situation that threatens to overwhelm him, the absence of adequate acts to deal with environmental or intrapsychic events. As Freud phrased it in one of his later formulations, “anxiety . . . seems to be a reaction to the perception of the absence of the object [e.g., goal]” (Freud [1926] 1936). With the object absent, no action is possible and helplessness, i.e., anxiety, ensues.
Learning theory
The theoretical position taken by most representatives of modern learning or behavior theory is derived generally from the work of I. P. Pavlov and J. B. Watson. The two major positions are those of C. L. Hull and B. F. Skinner, although neither of these two men themselves have worked extensively on the problem of anxiety. Most of the work on anxiety, within the framework of learning theory, has been carried out by representatives of the Hullian school. While most of their experimental work has involved lower animals, the “conditioning” concept of anxiety has been extensively applied to complex human behavior (cf. Dollard & Miller 1950).
As Mowrer (1960) has shown, the role of anxiety for learning theory is derived mainly from the attempts to explain the nature and consequences of punishment. In the case of punishment, the application of some painful or noxious event following the performance of a response inhibits or interferes with the performance of that response on some subsequent occasion. Similarly, when an organism avoids a situation, it is, through the operation of some mediating mechanism, precluding the occurrence of a noxious or painful event. The nature of this mediating mechanism, learning theorists contend, is what is commonly called fear or anxiety.
Anxiety as an acquired drive. The conditioning model states that a previously neutral event or stimulus (the conditioned stimulus, or CS), when paired with an unconditioned stimulus (US), which produces a noxious state such as pain, will elicit a conditioned response (CR) after a suitable number of pairings. This conditioned response is what is commonly called fear. In a typical experimental situation, an animal might be placed in a white box
with a door leading to a black box. The floor of the white box is electrified, and the animal receives a shock (US) that becomes associated with the white box (CS). If the animal is then permitted to escape from the shock through the door to the black box, he will eventually run from the white to the black box prior to the application of shock. Learning theorists assert that the fear (CR) conditioned to the white box (CS) motivates subsequent activity. The reduction of the fear—by escape from the CS —thus produces avoidance of the original noxious unconditioned stimulus. Fear—or anxiety—is viewed as a secondary or acquired drive established by classical conditioning. While this basic paradigm has been extensively elaborated, it represents the basic notions about anxiety in modern learning theory.
The Skinnerian point of view has been described by Schoenfeld (1950), who argues against the notion that the organism “avoids” the unconditioned stimulus. He suggests that the organism in fact escapes from a stimulus array that consists of the conditioned stimulus as well as the proprioceptive and tactile stimuli, which precede the unconditioned stimulus. However, this description is not basically divergent from the more general statement that the proprioceptive and tactile stimuli are a conditioned response functioning as a drive [see Learning, article onavoidance learning; CONFLICT, article onpsychological aspects].
Antecedent conditions. Whether avoidance learning is achieved by the mediating effect of the conditioned fear or ascribed to conditioned aversive stimuli, the question still remains open as to the necessary characteristics of the original, unconditioned, noxious, or aversive stimulus. In one of the early statements on conditioned fear, Mowrer (1939) suggested that fear was the conditioned form of the pain response. However, it has been demonstrated that pain cannot be a necessary condition for the establishment of anxiety since individuals who are congenitally incapable of experiencing pain also show anxiety reactions. (For a summary of this argument, see Kessen & Mandler 1961.) In a more general statement about the nature of acquired drives such as fear, Miller (1951) has extended the class of unconditioned stimuli adequate for fear conditioning to essentially all noxious stimuli, and Mowrer (1960) comes close to a psychoanalytic position when he expresses essential agreement with the position that fear is a psychological warning of impending discomfort. However, work with experimental animals has failed to establish unequivocally that fear can be conditioned upon the onset of discomforting primary drives or USs other than those associated with painful stimuli. This failure hampers the generality of the conditioning model.
Organismic conditions. The above evidence becomes important when one considers not only the antecedent conditions for the establishment of fear, which the learning theorists relate to the conditioning paradigm, but also the nature of the mediating response (the CR). A variety of data (for example, Wynne & Solomon 1955) has shown that the development of the anxiety or fear state in animals depends upon an adequately functioning autonomic nervous system. Thus, within the confines of the conditioning model, those writers who have speculated upon the nature of the mediating fear or anxiety state have suggested that it presupposes some sympathetic arousal. It follows from this that fear or anxiety can be conditioned only if the unconditional stimulus also is one that produces such sympathetic or general autonomic effects. To the extent then that a learning theory position assumes emotional, autonomic responses correlated with the fear state, it also suggests that fear necessarily derives only from those primary conditions that in turn are autonomically arousing. Thus, at least as far as such writers as Mowrer are concerned, the threat of discomfort, or rise in primary drives, or overstimulation in general, can only be prototypes for anxiety if, and only if, these states in turn have autonomic components. However, this does not seem to be the case for such divergent states as hunger, thirst, and so forth.
Consequent conditions. As far as the consequences of conditioned fear are concerned, there seems to be general agreement, both theoretical and empirical, that they fall into two general classes. In the first class, fear and anxiety operate as secondary drives and exhibit all the usual properties of drives, serving as motives for the establishment of new behavior. When fear acts as a drive, new responses are reinforced by the reduction of that drive. This response-produced drive is the major emphasis that learning theory has placed on fear or anxiety. In the second class, it has also been recognized that the conditioned fear response or the CER (conditioned emotional response) may in a variety of situations interfere with or suppress ongoing behavior. In this sense, it is of course no different from the general anxiety concept of the psychoanalysts in that behavioral anxiety or preoccupation with anxiety may be incompatible with other behavior or thoughts required from the organism in a particular situation.
Existentialist psychology
The emergence of existentialism from a purely philosophical school to an important influence on psychology has been a phenomenon of the mid-twentieth century. What existentialist thinking has done for psychology is not so much to present it with a new theory in the tradition of well-defined deductive positions that became popular in the early part of the century, but rather to provide it with a wealth of ideas and challenges to conventional wisdom. While a variety of different positions and schools can be discerned within the movement, the problem of anxiety has remained essentially unchanged from Kierkegaard’s pathbreaking formulation, published more than a hundred years ago (1844). For example, Jean-Paul Sartre’s position about the problem of anxiety is, for present purposes, not noticeably at variance with it (1943). Kierkegaard’s central concept of human development and human maturity was the notion of freedom. Freedom is related to man’s ability to become aware of the wide range of possibility facing him in life —possibility in that sense is not statically present in his environment but created and developed by man. Freedom implies the existence and awareness of possibility.
Anxiety is intimately tied up with this existence of possibility and potential freedom. The very consideration of possibility brings with it the experience of anxiety. Whenever man considers possibilities and potential courses of action, he is faced with anxiety. Whenever the individual attempts to carry any possibility into action, anxiety is a necessary accompaniment, and growth toward freedom means the ability to experience and tolerate the anxiety that necessarily comes with the consideration of possibility. In modern terms, any choice situation involves the experience of anxiety, and thus for the existentialist position the antecedents of anxiety are, in a sense, the very existence of man in a world in which choice exists.
Kierkegaard endows even the newborn child with an unavoidable and necessary prototypical state of anxiety. However, since the child is originally in what Kierkegaard calls a “state of innocence,” a state in which he is not yet aware of the specific possibilities facing him, his anxiety too is an anxiety that is general but without content. Possibility exists, but it is a possibility of action in general, not of specific choices. The peculiarly human problem of development faces the child as he becomes aware both of himself and of his environment. Possibility and actualization become specific, and anxiety appears at each point where development and individuation of the child progresses; at each point a new choice of possibilities must be faced, and anxiety must be confronted anew.
The consequences of this notion of anxiety are that as the individual develops he is continuously confronted with the unpleasant experience of anxiety and with the problem of mature development in the face of it. It is not only unavoidable as a condition of man; it is, Kierkegaard maintains, actually sought out. “Anxiety is an alien power which lays hold of an individual, and yet one cannot tear oneself away, nor has the will to do so; for one fears, but what one fears one desires. Anxiety then makes the individual impotent” (Kierkegaard [1844] 1944, p. xii). Since anxiety is unavoidable and since it must be encountered if one is to grow as a human being, all attempts at avoiding the experience of anxiety are either futile, or they result in a constricted, uncreative, and unrealistic mode of life. Only by facing the experience of anxiety can one truly become an actualized human being and face the reality of human existence.
Kierkegaard also makes a clear distinction between fear and anxiety. Fear involves a specific object that is feared and avoided, whereas anxiety is independent of the object and furthermore is a necessary attribute of all choice and possibility.
The importance of Kierkegaard, and the existentialist development in general, is not the emergence of testable scientific propositions, but rather the emphasis—found inter alia in some psychoanalytic writings—that anxiety may not be primarily a learned experience derived from past encounters with painful environmental events, but may be a naturally occurring initial state of the organism. Man may in fact be born with anxiety, rather than learn it through experience. While existentialism has not produced any clear definitions of anxiety, apart from appealing to an assumed common phenomenology, it has raised important questions both about the general problem of anxiety and, in the field of psychotherapy, about the proper treatment for those conditions that show pathological effects of anxiety. It is quite clear that a therapeutic attitude that considers anxiety as a normal state is radically different from an attitude that stresses the avoidance of primary and secondary traumata [see Psychology, article on EXISTENTIAL psychology].
Human anxiety—empirical generalizations
Since 1950, when May remarked on the absence of the problem of human anxiety from strictly experimental concerns (1950, p. 99), literally hundreds of studies have been published, using a quantitative, experimental approach to the problem of human anxiety. Many investigations have used the concept of anxiety primarily as an explanatory rather than as a manipulated variable. These studies fall more properly under such rubrics as conflict, stress, frustration, etc. and will not be dealt with here. However, a large body of research has been devoted specifically to anxiety. This rash of experimental investigations was in the first instance instigated by the development of the socalled anxiety scales. The most widely used and influential of these is the Manifest Anxiety Scale, developed by Janet Taylor Spence (Taylor 1953).
Manifest Anxiety Scale
The Manifest Anxiety Scale was originally developed to test some of the implications of the anxiety or fear concept within the general system originated by C. L. Hull. By developing a scale that would order individuals along a continuum of anxiety, it was expected that individuals who had high anxiety scores would exhibit more general drive level than individuals with less anxiety, since anxiety is—within this theoretical position—considered to be a secondary, or acquired, drive.
The Manifest Anxiety Scale consists of 50 items from the Minnesota Multiphasic Personality Inventory, all of which are judged to be indexes of high emotionality or anxiety. Typical items are: I am easily embarrassed (if answered “true”); I do not have as many fears as my friends (if answered “false”). Experimental work with this scale bore out the primary prediction: individuals scoring high on this scale (i.e., who are highly anxious) acquire conditioned responses based on aversive unconditioned stimuli much more rapidly than individuals scoring low on the scale. This is certainly the case for eyeblink conditioning, and the evidence is in the same direction for the conditioning of the galvanic skin response. However, these predictions from drive theory do not seem to hold for nonaversive conditioning, and it has been suggested that the anxiety drive measured by the Manifest Anxiety Scale is reactive rather than chronic. In other words, an individual with high anxiety shows anxiety in situations in which there is an element of threat or even conflict, and he apparently does not react with high drive in all situations.
A further prediction from Hullian theory was that individuals with high anxiety should perform better on simple tasks than on complex ones, but that individuals with little anxiety should perform better on complex tasks. This prediction, too, has generally been borne out (Taylor 1956). Finally, even though the scale was not directly constructed to evaluate clinical levels of anxiety, it does show consistently positive correlations with clinical judgments of anxiety in both patient and normal populations.
Test Anxiety Questionnaire
Whereas the Manifest Anxiety Scale concentrated on the drive aspects of anxiety, the other widely used anxiety scale has been more specifically concerned with interfering responses generated by the anxiety state. The Test Anxiety Questionnaire was originally developed by G. Mandler and S. B. Sarason (1952). It consists of 37 graphic scales specifically concerned with the experience of anxiety in test or examination situations. The hypothesis suggested that the more an individual tends to report the occurrence of anxietylike experiences on a questionnaire, the more likely it is that these will occur in any situation that involves examination or test pressures such as potential success or failure, time pressures, and so forth. In contrast to experiments with the Manifest Anxiety Scale, studies of the Test Anxiety Questionnaire have tended to stress rather complex tasks and complex instructions to the subjects. In general, here too the predictions about the interfering nature of anxiety in complex situations have been borne out. Subjects with high anxiety do tend to show interfering or task-irrelevant responses when faced with a task that seems to imply ego involvement or potential failure.
Correlational studies of the two scales have shown a low positive relationship, but the Manifest Anxiety Scale seems to tap more general characteristics of the individual, while the Test Anxiety Questionnaire is more sensitive to situational cues, particularly those that indicate to the subject that he is being tested or examined. Both kinds of scales, however, suggest that anxietylike responses will occur when some cue indicating threat is presented, whether it be an aversive unconditioned stimulus or a test situation. In that sense, the scales are tapping personality differences in the tendency to experience anxiety to a greater or lesser degree.
Finally, J. W. Atkinson has related anxiety, as reported on the Test Anxiety Questionnaire, to a more general system of motivation by using this scale as a measure of a general motive to avoid failure (e.g., Atkinson & Litwin 1960). Attempts of this nature and the general placement of the personality dimension of anxiety within a more general system of motivation (e.g., Spence 1958) are needed to integrate the hundreds of empirical studies that have used the various anxiety scales.
One other important set of experimental studies that have specifically dealt with anxiety has been reported by Schachter (1959). These studies have
shown that affiliative behavior is related to self-reported anxiety. Schachter also demonstrated that the presentation of a fear-arousing situation tended to arouse affiliative needs, such as the desire to be with others. His data suggest that stimuli unrelated to the threat may result in anxiety reduction; flight from trauma or its signals is not the only method of avoiding anxiety.
Anxiety—an integrative point of view
Certain commonalities can be found among the various theoretical views of anxiety, and all of these seem to be fairly consistent with the experiential and experimental evidence available. There is agreement that anxiety, as a mediating, experiential phenomenon, is related to the perception of impending threat, or overstimulation, or unmanageable demands and that it is accompanied by a discharge in the sympathetic nervous system. It seems also fairly well agreed that the consequences of anxiety may, in the face of an aversive event, be motivating in the sense that they make it possible for the organism to avoid the threat or danger more quickly and efficiently. Both learning theory and existential theory, surprisingly, seem to stress the importance of anxiety in making it possible for the organism to handle threatening situations, even though they might disagree about the nature of these threats. It also seems to be generally agreed that anxiety may also interfere with complex, usually cognitive, activities of the organism. There seems to be less agreement on the origin of the anxiety reaction. In psychoanalytic and learning theories the stress seems to be on some early traumatic event, while the existentialists tend to favor anxiety as a built-in characteristic of the human organism. But even here some of the psychoanalytic positions can be read as consistent with the existentialist point of view.
Some recent observations on the behavior of the newborn child and some speculations on the inadequacy of the pain experience as the foundation of all of anxiety have resulted in a series of proposals that seem to provide a broad basis for the many different theoretical conceptions. The position in question suggests that some of the psychoanalytic and existentialist assumptions about the origins of anxiety are essentially correct. There is good reason to believe that the newborn infant is, in fact, in a state of variable, spontaneous, and sometimes intense autonomic arousal. This state of arousal is correlated with a general state of infantile distress. It is certainly the case that the newborn infant shows cyclic states of distress that cannot easily be related to antecedent stimulation. It may in fact be the case that the relatively well-regulated autonomic system of the adult is a result of acquired and systematic regulation. In any case, infantile distress can be seen as the prototype of the distress that is later called anxiety, in the absence of specific environmental events, or fear, in the presence of specific stimuli. Given this general cyclical state of distress, it can also be shown that a child can be quieted by a set of environmental or organismic events that have been designated as inhibitors (Kessen & Mandler 1961). Sucking is the best-known and most intensively investigated of these inhibitors. Sucking, rocking, and other activities seem to inhibit or quiet the distress of the child. It is possible that these acts stimulate parasympathetic activity that counteracts the sympathetic discharge. It also appears that with maturation not only these apparently innate inhibitors but a whole class of secondary, probably conditioned, inhibitors also acquires this quieting or anxiety-suppressing property. On the other hand, the removal of these inhibitors or the interruption of any organized activity (Mandler 1964) appears to reinstate the general state of distress or anxiety. This view suggests that from a state of congenitally given autonomic and behavioral distress the child moves into a situation in which more and more acts and events tend to acquire the property to inhibit distress, and their removal tends to reinstate it.
Starting with Kurt Lewin’s work (1935), it has been shown that interruption of well-organized behavior leads to a state of anxiety. Therefore, it is suggested that while, for the young child, there is only a limited repertory of events and behaviors available that will inhibit or control the basic state of distress, any organized activity in the older child and in an adult will do so, and that finally any organized activity serves to ward off the state of distress. Conversely, it might be stated that whenever the organism has no well-organized behavior available to him, he is in a state of distress. Thus, whenever the organism is not able to draw upon some behavior or act that controls his environment, that is, whenever he is in a condition of helplessness, unable to control stimulation or environmental input in general, he will be in a state of anxiety.
This view is consistent with the psychoanalytic tenets on overstimulation and Freud’s statement about anxiety being related to the loss of the object. When either overstimulation threatens or no object (goal) is present, the organism has no behavior available to him and cannot act; therefore he is anxious. As far as the existentialist position is concerned, the state of anxiety occurs, of course, whenever the individual has no way of coping with environmental demands; in other words, no way of confronting possibility, no way of overcoming the anxiety that goes with possibility and freedom. Finally, the noxious, painful unconditioned stimulus of learning theory typically is an event that is unmanageable, represents overstimulation, and disrupts ongoing behavior. When the organism does in fact find a way of coping with this situation by escape, this escape behavior is the way of overcoming helplessness vis-à-vis the noxious stimulus and will appear upon a signal (the conditioned stimulus) prior to the occurrence of the unconditioned stimulus.
Finally, the data on highly anxious individuals suggest that these are people who have very few mechanisms available for coping with helplessness or threat. They are in fact frequently faced with a world in which no behaviors are available for them to inhibit or avoid the threat of helplessness.
Anxiety neurosis
The most important pathological manifestation of the anxiety reaction is seen in the syndrome commonly called anxiety neurosis. While anxiety presumably plays a role in all neurotic disorders, this syndrome has both the overt and the subjective aspects of anxiety as its primary characteristics. The anxiety neurotic is the patient who is incapacitated by continuous and often nonspecific feelings of anxiety. Whereas anxiety in the other neuroses, particularly in the phobias, is aroused by a specific condition or set of internal or external stimuli, in the anxiety neurotic any and all external situations or thoughts may give rise to an anxiety reaction. The patient typically displays signs of apprehensiveness and fearfulness in a variety of different situations, none of which can necessarily be objectively described as threatening or aversive. While the patient may in some cases ascribe specific fearfulness to some stimulus, he will frequently find himself in situations that never before have aroused anxiety and now suddenly acquire the power to do so. Thus, while he may name a long list of thoughts or events of which he is afraid or apprehensive, he will just as frequently describe the general phenomenon of free-floating anxiety, a feeling of distress or apprehensiveness with no specific content.
Apart from the subjective feelings that accompany the general anxious state of the patient, he will usually exhibit somatic symptoms, particularly those that are in a milder form associated with the typical normal anxiety reaction. In general, he will show heightened autonomic arousal, cardiac involvement, breathing difficulties, excessive sweating, and so forth. These will frequently be accompanied by skeletal symptoms such as trembling and startle reactions. Both the intensity and the duration of the anxiety attacks may vary. They may range from a continuous feeling of uneasiness and distress to sudden, panicky attacks that may last for minutes or hours.
Since all situations are potentially cues for the anxiety reaction, the patient frequently tends to be immobilized and unable to act or plan over long periods of time.
Relatively little is known about the genesis of this pathological state, although experimental work has shown that the equivalent of the anxiety neurosis may be produced in lower animals by the presentation of unsolvable conflicts. Case histories of anxiety neurotics also generally show their backgrounds as being replete with continuous conflicts coupled with feelings of inadequacy and inferiority. Just as the experimental animal is unable to resolve the conflict between hunger and fear of shock when he has been shocked at the time and place of feeding, so the human is unable to act in the face of two conflicting motives.
For both psychoanalytic theory and learning theory, the conditions that produce the pathological anxiety reaction are seen in the inability of the patient to discriminate threatening from non-threatening events and ideas. From a psychoanalytic point of view, infantile fears and fantasies are kept unconscious but produce an interpretation of danger in a wide variety of otherwise neutral situations. Many different stimuli reactivate childhood conflicts, and the ego, which is otherwise functioning normally, interprets as dangerous a wide variety of different situations. Another possibility is that aspects of parental behavior during early childhood training have produced the tendency to identify many different situations as dangerous.
The somewhat similar interpretation given by learning theory suggests that anxiety neurosis is the result of an overgeneralization of the original conditioned stimuli for the anxiety reaction. Whereas in the normal adult the generalization gradient in conditioning is relatively steep, the anxiety neurotic manifests a very flat generalization gradient from the original conditioned stimuli. The anxiety reaction is elicited by a wide variety of stimuli that may be only vaguely similar to the original conditioned stimulus, with verbal mediators playing an important role in generalizing to new situations. In addition, both learning theory and psychoanalytic theory suggest that the patient not only becomes afraid of the original conditioned stimulus and similar ones, but also the anxiety reaction itself becomes a conditioned stimulus for a new fear reaction, resulting in a vicious cycle of increasing anxiety eventually reaching panic levels.
Both of these positions suggest that the pathological condition of the anxiety reaction is somehow derivable from one or several early nuclear experiences. Another possibility consistent with clinical observation of anxiety neurotics relates the sources of the anxiety reaction to a generalized feeling of helplessness. The anxiety patient will practically invariably describe his subjective state as one of conflict or helplessness. He feels unable to act because he does not know how to act; he vacillates because he does not know what to do; he cannot defend one course of action as preferable to another. Conflict may arise out of the competition of two equally strong reaction tendencies; it may also derive from the fact that no one reaction tendency is, by itself, organized well enough to be executed. In other words, the inability to choose an act, the fear of facing the consequences of an act once chosen, or a general lack of confidence that any behavior could possibly be adaptive or successful may by themselves lead to anxiety. The pathological condition of the anxiety neurotic is thus related to the inability to face choices and to make choices: he is anxious because he is in conflict, and he is in conflict because he is anxious.
Finally, the genesis of the pathological anxiety reaction may not only be derived from an environment that endows a variety of thoughts and events with the label “danger” but may also be related to the individual’s reaction to his physiological responses. One theory of emotion claims that the basic physiological substratum of all emotions is similar (i.e., a sympathetic nervous system reaction) and that the content of the emotion depends on cognitive or environmental factors, suggesting that a combination of physiological readiness and helplessness in view of environmental demands is basic to the problem of the anxiety neurotic (Schachter 1964; Mandler 1962). Such a position would indicate that one of the things the anxiety neurotic may not have learned is adequate labeling of his autonomic responses. In the absence of such adequate labeling or in case of hypersensitivity or hyperattention to such arousal, an individual would be much more likely to experience anxiety whenever faced with a situation in which no adequate response is available. In this sense, the problem of the anxiety neurotic may be exactly opposite to that of the psychopath who experiences too little anxiety (Schachter 1964).
George Mandler
[Other relevant material may be found underDrives; Emotion; Motivation; Psychoanalysis; Stress.]
BIBLIOGRAPHY
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