The Biopsychosocial Model of Anxiety

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The biopsychosocial model can help you understand  why some people shift from normal, healthy anxiety to disordered anxiety.

Why are some people much more anxious than others? And what causes anxiety disorders? What makes some people feel anxious when they’re actually safe?

Well, the cause of an anxiety disorder is actually quite complicated. It’s not a disease with a single origin. There are a lot of factors that go into play. In this post, we’ll talk about how the bio-psycho-social model applies to understanding anxiety. 

Let’s Start With Biology

First, the stuff you’re born with. Anxiety disorders run in families, heritability estimates show that with Generalized Anxiety Disorder, genes play a contributing factor around 25-35% of the time. But what does that mean? There isn’t a single gene or set of genes associated with anxiety disorders, it’s connected to a lot of physical differences, and we’ll go into that, but one thing to know is that genes can get turned on or off based on life experiences, so a traumatic childhood might be more likely to turn on physical changes that show up with anxiety disorders. Again, biology, psychology and our environment all interplay in really fascinating ways. So back to biology…

Brain structure is the obvious physical difference. For people with anxiety disorders, there’s often an increased blood flow in the amygdala (The area associated with fear) and the amygdala is sometimes larger than that of people without anxiety. Researchers have also found higher ratios of gray matter to white matter.  In panic disorder there’s a decreased metabolism in the brain and decreased blood flow between the two sides of the brain

There is also some indication that the part of the brain responsible for internal monitoring, the Insula, may be more active in people with anxiety. This part of the brain scans your body for how you’re feeling, for signs of pain or signs of anxiety. Someone who is highly sensitive and highly attuned with their body’s signals may have a deep sense of intuition, or a powerful sense of empathy or a deep ability to be aware of their emotions around art or music, but if they have a fear based reaction to their internal signals- that can make them very sensitive to any physical symptoms of anxiety and develop unhealthy avoidance of those sensations. 

This biological predisposition towards anxiety is not usually disordered- anxiety serves a function and our society needs more sensitive people and less sensitive people in order to function well. We need Neurodiversity, as this is called. We need slightly anxious caregivers who keep the toddlers away from cliffs, and really un-anxious warriors to protect the village. 

Chemical Differences

There are chemical differences too, but it’s not as simple as just “low serotonin” as commonly believed. An overactive adrenal gland can make physical symptoms of anxiety more intense. Hyper or hypo thyroid can also cause anxiety symptoms.  

And other physical conditions can increase or decrease one’s resilience to stress. And some of these are things you are born with- your ability to sleep well, to absorb nutrients (and your decision to prioritize sleep or nutrition). Physical illnesses can decrease resilience, so for example if you get cancer, that’s going to initially decrease your emotional resilience. So can conditions like inflammation or allergies.  

Researchers have found evidence of biological changes in people with anxiety, but it’s a chicken and egg type problem– brain changes can contribute to anxiety, but anxiety also can contribute to brain changes. 

Your physical brain is built to adapt to how you think, it adapts to your experiences. This is called neuroplasticity. For example, if you constantly catastrophize, your body will probably have more adrenaline and cortisol. And research shows that when anxiety is treated with CBT, changing how you think, the amygdala can decrease in size. You can physically change your brain by how you think. 

And that takes us to the psychology of anxiety. Your brain is wired to learn. It adapts physically and psychologically to our experiences and how we think about our experiences. So if you’re attacked by a dog as a child, your brain wires you to be more alert to the dogs around you and to quickly fire off an anxiety response about dogs to prevent you from interacting with them. Your brain develops this emotional memory to keep you safe…but sometimes it overdoes it a little and you end up being hypervigilant all the time.

But, remember, anxiety isn’t as much about actual danger, as it is about perceived danger. The thoughts we have of danger trigger a real physiological response in our body. If we think – “I’ll never succeed. Or everyone must be making fun of me. I must avoid anything that makes me anxious.” That’s going to keep us anxious.  Vs. thinking “I’m going to keep trying and learning, I’ll probably be able to succeed, but even if I don’t, it’s worth trying.” I can allow myself to feel emotions including anxiety but choose my actions”. This is a much more resilient way of thinking. And it regulates our nervous system and rewires our brain to be less anxious. 

Our brains are also wired to learn on a deep level through observing others. So if you have parents who are terrified of dogs, you’re more likely to develop a fear of dogs. If you see someone fall off a cliff and get injured, you’ll be more likely to develop a fear of heights. This is the social aspect of anxiety. Again, the brain’s built-in self preservation. But your brain’s ability to learn this stuff goes both ways, experiences can teach you to decrease anxiety too. So if you get a friend who has a dog and you interact with that dog every day and pet it and come to love it, your brain will learn “See, dogs can be safe after all” and that fear will go away. So our family and societal culture can directly impact our relationship with anxiety. 

Initiating vs. Maintaining Causes

But here’s the thing, we sometimes feel helpless when we believe that past trauma has “made” us anxious. And while trauma and our experiences can be the situation that initiates our anxiety, it isn’t the thing that maintains our anxiety. Our anxiety in the present moment is determined by our thoughts and perceptions and behaviors in the present moment. We are going to talk about this a ton throughout this course, so bear with me here. 

There is something that you’re doing that is making your anxiety hang around in the present moment. What maintains anxiety are the messages that you send to your brain about safety and danger.  A lot of times people think that the reason they are anxious is because of an experience they had. But the maintaining causes of anxiety are the maladaptive strategies we built around our anxiety. Basically how we cope with anxiety keeps us anxious. 

I’ll give you a quick example. Let’s say that when you were in middle school, you blurted out something in class and everyone laughed at you. You felt ashamed and embarrassed. Now, to prevent that from ever happening again, you constantly worry about every social situation, you constantly ruminate on how you handled social situations, all in an attempt to prevent yourself from ever doing something embarrassing again. But each time you worry, you create the perception of danger in your mind, which triggers the anxiety response. Each time you ruminate about what you said, you create the perception of danger in your mind. You actively feed your social anxiety through your attempts to avoid it. In this course you’re going to learn how to replace the things that are keeping you anxious with actions that will help you be more confident. 

The Biopsychosocial Model

OK, so that’s the bio-psycho-social model. 

Let’s play with this for a minute, twins with the exact same genes and the exact same home environment that is moderately abusive, one may develop PTSD and the other may not. What’s the difference- one got psychological support as an adult, to change how they thought about themselves, to stop blaming themself for the abuse, and thereby was able to develop healthy relationships in the future, while the other felt a lot of shame, continued to believed she wasn’t worthy of love and kept dating jerk-wad guys who continued to abuse her. Without support, her thoughts and actions maintained her trauma. I know this is an oversimplification, but when we break down problems into small pieces, many of the pieces are treatable. 

Or let’s change it up, two siblings, with different genes, same family, same psychological support, but one sibling has a more sensitive temperament, a mutation in the MTHFR gene that makes it hard to metabolize folate and is just tired all the time, and an undiagnosed milk allergy which makes her feel sick, tired and in pain all the time. The one without the milk allergy is able to rise above depression, the one who feels sick all the time gets overwhelmed, just doesn’t have the energy to go hang out with friends, stays inside and gradually develops depression. 

Or twins who both have the MTHFR gene,  but they were separated at birth. They both have access to psychological support and utilize positive thinking and healthy coping skills. One grows up in a perfectionist, high achieving, stressful home. The other grows up in a super chill hippy home. One develops anxiety, the other doesn’t. But the one who developed anxiety, she learned it from her environment. If you learn it, you can unlearn it. And you can also treat the folate deficiency, and avoid milk and all the sudden, life doesn’t feel so overwhelming. 

And in those other scenarios, you can treat the trauma, you can repair your nervous system, you can unlearn the faulty thinking and learn to love yourself. 

There’s a gazillion different ways to imagine how all the different factors contribute to mental health, but here’s the super important thing- when we see mental health as having many causes when we use the Bio-Psycho-Social Approach, it gives us tons of options to improve our mental health. 

The Bottomline

So here’s the bottom line. When it comes to biological predispositions– no one is going to test you for them– I mean, not usually – no one can tell you what is specifically causing your anxiety symptoms- and how much of it is genetic or psychological. So what’s the takeaway? 

Be gentle with yourself. Practice some self-compassion around your anxiety instead of beating yourself up with it. Can you develop a good relationship with your unique traits? In the next video we’re going to talk about the amazing gifts that Highly sensitive people have and bring to our society. 

Accept what you can’t change, change what you can. There’s a very good chance that you’ll be able to decrease your anxiety, maybe even drastically

And there’s a very good chance that you are among the 95% of people who will experience some anxiety on a regular basis- this is normal and healthy and you can learn to relate to that anxiety, to think of that anxiety in a healthy way so that it no longer bothers you and is no longer disordered. We all have a spectrum of functioning within our biological predispositions, and we can choose to be on the healthy end of that.

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