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Friday, February 13, 2009


When a fearful or threatening event is perceived, humans react innately to survive: They either are ready for battle or run away (hence the term "fight-or-flight response").

The nature of the acute stress response is all too familiar. Its hallmarks are an almost instantaneous surge in heart rate, blood pressure, sweating, breathing and metabolism, and a tensing of muscles. Enhanced cardiac output and accelerated metabolism are essential to mobilizing for fast action.

This explanation is thought to be in part a cause for anxiety disorders. Yet over the past decade, the limitations of the acute stress response as a model for understanding anxiety have become more apparent.

The first and most obvious limitation is that the acute stress response relates to arousal rather than anxiety.

Anxiety differs from arousal in several ways: First, with anxiety, the concern about the stressor is out of proportion to the realistic threat. Second, anxiety is often associated with elaborate mental and behavioral activities designed to avoid the unpleasant symptoms of a full-blown anxiety or panic attack. Third, anxiety is usually longer lived than arousal. Fourth, anxiety can occur without exposure to an external stressor.

Cognitive factors, especially the way people interpret or think about stressful events, play a critical role in the etiology of anxiety. A decisive factor is the individual's perception, which can intensify or dampen the response.

One of the most salient negative cognitions in anxiety is the sense of uncontrollability. It is typified by a state of helplessness due to a perceived inability to predict, control or obtain desired results. These are among the factors considered as causes of anxiety disorders such as acute stress disorder.

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
  • Anxiety and Its Disorders: The nature and treatment of anxiety and panic (Guilford Press)
  • Journal of Consulting and Clinical Psychology
  • American Journal of Psychiatry
  • Journal of Anxiety Disorders
  • Journal of Traumatic Stress
  • Journal of Clinical Psychiatry
  • War Psychiatry: Textbook of Military Medicine
  • Journal of the American Academy of Child and Adolescent Psychiatry
  • National Institute of Mental Health
  • National Center for PTSD
  • Department of Health & Human Services