The Psychology of Anxiety

Second Edition

Eugene E. Levitt

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317375210
• Edition: 1
• Topic: Psicología
• Subtopic: Psicología anormal

Originally published in 1980, this title builds on the first edition which provided a comprehensive review and evaluation of theory and research on anxiety at the time. In the time between publications there had been many studies of anxiety phenomena and substantial progress in our conceptual understanding of the nature of anxiety and its measurement. The author incorporates those advances in empirical knowledge and new theoretical insights into this second edition.

The most important and well-documented empirical findings in anxiety research are emphasized throughout the book, but attention is also called to unresolved theoretical issues and problem areas of the time where there was urgent need for additional research. Although much research has been done since, the authoritative analysis of anxiety phenomena that is presented in this book will still be of interest to medical, social and behavioral scientists and personality theorists, and to mental health workers of all disciplines who are engaged in clinical work with emotionally disturbed persons.

1    Introduction

WHY A BOOK ON ANXIETY?

If anxiety could be controlled by biological or social means, fundamental alterations in the organization of our civilization would ensue and the probability of individual happiness would be greatly enhanced.… Anxiety is the most pervasive psychological phenomenon of our time … (Hoch & Zubin, 1950, Foreword).

Anxiety is one of the most important concepts in psychoanalytic theory. It plays an important role in the development of personality as well as in the dynamics of personality functioning. Moreover, it is of central significance in Freud’s theory of the neuroses and psychoses and in the treatment of these pathological conditions … (Hall, 1954, pp. 59–60).

We are not aware of any systematic conception of personality, particularly with regard to its development, which does not give the concept of anxiety a role of great, if not of central, significance (Sarason, Davidson, Lighthall, Waite, & Ruebush, 1960, p. 5).

The importance of anxiety as a powerful influence in contemporary life is increasingly recognized, and manifestations of current concern with anxiety phenomena are ubiquitously reflected in literature, the arts, science, and religion as well as in many other facets of our culture … (Spielberger, 1966a, p. 3).

Anxiety is the official emotion of our time (Schlesinger, 1970, p. 52).

It is difficult to dispute the contention that anxiety is a “pervasive psychological phenomenon” of modern society. The world seems literally to drip with it. It begins in infancy with a fear¹ of the unknown and the yet unexperienced of life, winds its way painfully through countless occurrences, large and small, and concludes with a fear of that unknown which is death. It is not that the emotion itself is of recent origin, or that it is somehow of greater significance today than it has been in the past. Surely fear is as old as human existence and belongs to no particular era or culture.

The capacity to experience fear is an inheritance from our infrahuman ancestors. Among organisms with meager intelligence, it is necessary for survival. If an animal were incapable of fearing the larger, stronger, or more heavily armed predator, or the forest fire, it might never realize the need for disengagement and flight until death was imminent. Emotional experience cues an immediate reaction; in the forest and jungle, there is often no time for deliberation even if the organism were capable of it.

The utility of fear as a survival mechanism decreases as intelligence increases. The need for emotion as a quick trigger for behavior is inversely related to reasoning ability. In the pinnacle of phylogeny—in the maximum in cerebral efficiency, man—fear has lost most of its survival value and has become instead the most serious problem of his existence.

Man no longer urgently needs fear as a protective device, but its strength, its ability to motivate behavior, is no less in us than in unreasoning organisms. This has been perennially recognized by human society, which uses fear in shaping the behavior of its members, especially the young. The trouble is that we do not yet know how to use fear without producing distortion and malignancy. Anxiety is a sort of cunning, malicious golem, which seems to serve us well, at least for a time, but eventually turns and threatens to destroy its creators.

Anxiety is timeless; but only in recent years, with the growth of sophistication in the mental health professions and the behavioral sciences, have we begun to realize its enormous impact on human life. The list of phenomena in which it has been claimed that anxiety plays a role is imposing. Nearly every identifiable form of pathology—psychological, physical, and social—is included. Almost every corner of human endeavor is thought to be affected somehow by anxiety. Thousands of papers and reports of experiments are devoted to it each year in learned journals. Anxiety is not only our official emotion; it is the primary focus of a concerted effort aimed at the improvement, and perhaps the perpetuation, of human life.

THE APPROACH TO THE SUBJECT

A group of medieval monks, the story goes, were diligently engaged in learned contention about the number of teeth in the mouth of the horse. Finally, one of the monks, doubtless young and unseasoned in the ways of theological disputation, suggested that the argument might be resolved by procuring the nearest horse and examining its mouth. The others were horrified. It is not certain whether they banished the offender from the monastery, turned him over to the Inquisition as a heretic, or simply hushed him up. In any event, it is quite certain that the monks totally rejected the idea of discovering any answers by empirical means.

“Empirical” literally means “by observation,” especially as it refers to natural phenomena. Nowadays, hardly anyone seeks information about nature in venerable books or religious writings, as medieval monks would have done. We moderns obtain our knowledge “from the horse’s mouth.”

Naturalistic observation, while undoubtedly superior to unsupported opinion, even the opinion of an expert, also has its shortcomings. Horses are not all alike, and counting the teeth in the mouth of a single horse would not demonstrate that all horses had the same number. Furthermore, the human eye, ear, and brain, the instruments of observation, are notoriously fallible.

Naturalistic observation, though still the primary data-gathering technique of a few disciplines like astronomy and anthropology, has in turn given way to a superior procedure: scientific method. The word “empirical,” in a parallel fashion, has undergone a transformation of meaning and is now considered to be practically synonymous with “scientific” or “experimental.”

All this is by way of introduction to the statement that this book is an empirical account of anxiety, not a philosophical treatise. Most of the inferences and conclusions about anxiety that will be encountered are derived from scientific experimentation, not from mere observation or expert opinion. This renders the exposition credible, but it does not mean that subsequent pages are crammed full of ultimate, unchallengeable facts. Quite the contrary—behavioral science, a category that includes psychology, sociology, and experimental education, among others, is barely out of its infancy. Its journals abound with reports of experiments that are conflicting, confusing, ambiguous, or difficult to interpret, to say nothing of some that are badly done. Very little about human behavior has been established conclusively. No final words have as yet been written. Some findings are reported more often than others; some appear more logical or reasonable than others; there are many promising trends, and avenues yet to be fully explored.

The Psychology of Anxiety is based upon these findings. A comprehensive collation of all the experiments dealing with anxiety would be of inestimable value to a few scientists, and a hodgepodge of confusion to everyone else. The reader should keep in mind that I have exercised my private discretion in selecting certain ideas and works for inclusion. I take responsibility for varying degrees of emphasis on subject matter throughout the book. My approach is, I believe, properly characterized as scientific, but the text nonetheless is not without some subjective bias.

¹For the absence of distinction between anxiety and fear, see Chapter 2, pp. 6–9.

2 The Terminology of Anxiety

THE PROBLEM OF DEFINITION

In science, states like emotions and most of the words used to describe human personality are constructs. A construct is a broad abstraction, a hypothetical entity that has no actual physical existence but that has proven useful in explaining observable phenomena. It is distinguished from something that has definite physical properties, like a table or a highway, or from an observable act that can be described by such a statement as “He ran down the street.”

These “somethings” are directly manifest; an emotion like anxiety is not. One can dissect a human body and find a heart or brain, but one cannot locate objects that are properly called anxiety, or extraversion, or intelligence.

Constructs are used to explain behavior. We say that a person runs away because he has fear, or that his face reddens because he is angry. We also infer the existence of the emotion itself from these observable manifestations.

Constructs are popularly (but not scientifically) regarded as “things” that are amenable to purely verbal or vernacular definition. Various verbal definitions of anxiety sound very much alike:

… the unpleasure experienced when the object is unknown and the anticipation of being overwhelmed by an internal or external force is present … (Eidelberg, 1968, p. 37).

A painful or apprehensive uneasiness of mind usually over an impending or anticipated ill … (Webster, 1976, p. 51).

Unpleasurable affect consisting of psychophysiological changes in response to an intrapsychic conflict … an uncomfortable feeling of impending danger, accompanied by overwhelming awareness of being powerless, inability to perceive the unreality of the threat, prolonged feeling of tension, and exhaustive readiness for expected danger (Freedman, Kaplan, & Saddock, 1976, p. 1283).

Almost everyone agrees that anxiety is an unpleasant-feeling state, clearly distinguishable from other emotional states and having physiological concomitants. In addition to this common core of meaning, however, the term takes on other nuances and shadings of meaning, depending upon the particular theoretical orientation and operational criteria employed by individual researchers (Ruebush, 1963, p. 461).

Apparently, we can say simply that anxiety is very much like fear and thus establish the “common core of the meaning,” a general idea of what is meant by the construct, anxiety. Fear is a universal, personal experience; each of us has an awareness of fear deriving from our own existence. Or we could say, roughly speaking, that it is a complex state characterized by a subjective feeling of apprehension and heightened physiological reactivity.

We all understand the meaning of anxiety in this broad, vague sense, but it will not suffice for the purposes of science. Scientific definitions must be precise, objective, and quantifiable. Vernacular definitions of anxiety are themselves full of abstract constructs requiring definition. Exactly what is meant by “painful uneasiness,” or “unpleasant”? If we attempt to define each of these words, we find ourselves merely adding further constructs, each of which also requires defining.

We could go on forever in this absurd fashion, adding word after word and phrase after phrase in a vain attempt to define the original, single-word construct. Even if the volume of verbiage becomes infinite, we shall not have added much more clear meaning to the word with which we began … (Levitt, 1961, pp. 17–18).

To be scientifically useful, a construct must be defined in terms of acts, not words alone. These acts are what Ruebush calls “operational criteria.” In the experimental situation, anxiety is defined by a response or class of reactions by individuals to a particular stimulus or experimental situation. The experimenter threatens to shock the subject with electricity; the subject begins to sweat, and his pulse rate increases. The threat of shock, the sweating, and the pulse rate together constitute a definition of anxiety. Or the experimenter may ask each subject the standard question, “Are you afraid?” The question and the response, “Yes,” constitute another definition of anxiety.

The range of possible definitions is, in principle, unlimited, and, in practice, very broad. All of them are reasonably encompassed by the abstract, purely verbal definitions of anxiety. No one of these operational definitions is the ultimate definition. Rather, each is a partial definition, a paradigm or typical instance of anxiety. Each experimenter selects his own definition, guided by a “particular theoretical orientation,” or by hunch, whim, previous research, common sense, or personal experience. The important consideration is whether the definition will eventually predict human behavior, and whether it is found to be related to other partial definitions.

The soundest theoretical conceptions are those that are based on research and that usually influence future research. It will pay for us to examine some of the more recent, research-based conceptions of the contruct that is called anxiety.

ANXIETY, FEAR, AND PHOBIA

The idea that anxiety is not a unitary phenomenon is not new. Many clinicians and theorists contend, for instance, that fear ought to be distinguished from anxiety. Two lines of argument underly this decision. One deals with the source of the emotion, the relative specificity of its stimulus. The other is concerned with the emotion’s basis in reality; is the reaction proportionate to the threat of the stimulus?

Source

Psychoanalytic theorists from Sigmund Freud to Rollo May have proposed that anxiety is a vague fear stemming from a source that is unknown to the stricken individual. When the threatening object or situation is identifiable, we should speak of a fear rather than anxiety.

It is agreed by students of anxiety—Freud, Goldstein, Horney, to mention only three—that anxiety is a diffuse apprehension, and that the central difference between fear and anxiety is that fear is a reaction to a specific danger while anxiety is unspecific, “vague,” “objectless” (May, 1977, p. 205).

This view has influenced the training of clinical practitioners for decades. Yet the difference between a specific, conscious fear and what is called “free-floating” anxiety proves difficult to maintain either in theory or practice.

A specific fear, when it occurs, is usually easily identified. The individual who steps from the curb and looks up to find a speeding car bearing down on him knows precisely what is causing his sudden upsurge of anxiety. The psychiatric patient who is suffering from free-floating anxiety feels that “something terrible is going to happen” but does not know what that eventuality will be. Both the specific and the diffuse occur far less often than most anxiety reactions in modern society, which are neither highly specific nor completely diffuse. The mother who worries incessantly about her children’s welfare is afraid of a multitude of occurrences of very different kinds. A man may fear that he will be injured in ...