Anxiety Disorders 249
performance, even if you know the material well. Thus, feeling afraid or anx-
ious can be normal and adaptive. Extreme anxiety, however, is a persistent, vague
sense of dread or foreboding when not in the presence of a feared stimulus (such
as a snake or a plane trip). Such extreme anxiety can arise in response to a high
level of fear of a particular stimulus and is sometimes called anxious apprehension
(Barlow, 2002a). An anxiety disorder involves extreme anxiety, intense arousal,
and extreme attempts to avoid stimuli that lead to fear and anxiety. These emo-
tions, or the efforts to avoid experiencing them, can create a high level of distress,
which can interfere with normal functioning.
The Fight-or-Flight Response Gone Awry
Campbell describes some of the frightening physical sensations he experienced in
this way: “Visualize yourself just sitting back in a chair, relaxing. Suddenly, your
heart starts racing as if you had just run a hundred-yard dash. You break into a cold
sweat. You have trouble breathing. You feel there is nothing you can do to stop all
of these things from happening” (Campbell & Ruane, 1999, p. i). Campbell was
describing the effects of the fi ght-or-fl ight response (also called the stress response;
see Chapter 2), which occurs when an individual perceives a threat. Suppose you
think you see a mugger lurking on a dark doorstep as you are hurrying home, alone,
late at night. Your brain and body respond as if you must either fi ght or take fl ight.
The stress response prepares your body to exert physical energy for an action, either
fi ghting the threat or running away from it. It does not matter whether there is
an actual threat. Your body automatically responds because you perceive a threat.
Your body responds in a number of ways (for a more complete list, see Figure 7.1),
most notably by:
- increasing your heart rate and breathing rate (in order to provide more oxygen to
your muscles and brain),
- increasing the sweat on your palms (a small amount, which helps you grip better —
yet not so much as to make your palms become slippery), and
- dilating your pupils (in order to let in more light and help you to see better).
Your body responds this way even to threats that do not require a lot of physical
energy, such as—for many people—speaking in front of a group of people (or even
thinking about speaking in front of them) or taking a pop quiz. In such cases, your
body gets prepared, but most of the physical preparations aren’t really necessary.
This fi ght-or-fl ight response underlies the fear and anxiety involved in almost
all anxiety disorders. Some people have an overactive stress response—they have
higher levels of arousal during the stress response. Other people may not have an
overactive stress response, but they may misinterpret their arousal during the fi ght-
or-fl ight response and attribute the bodily sensations to a physical ailment. They
might, for instance, interpret an increased heart rate as a heart attack. In either
case, people come to feel afraid or anxious about the physical sensations of the
stress response or the conditions that seem to have caused the response. When their
arousal feels as if it is getting out of control, they may start to feel panic, which is an
extreme sense (or fear) of imminent doom, together with an extreme stress response
(Bouton, Mineka, & Barlow, 2001)—what Campbell experienced sitting in his car
at a stoplight. Some people who become panicked develop a phobia (a term derived
from the Greek word for fear, phobos), which is an exaggerated fear of an object
or a situation, together with an extreme avoidance of the object or situation. Such
avoidance can interfere with everyday life. For instance, at one point, Campbell
avoided crowded rooms because he thought they might bring on the uncomfortable
physical sensations he’d experienced.
Unfortunately, signifi cant anxiety and phobias are not unusual or rare. In the
United States, anxiety disorders are the most common kind of mental disorder
(Barlow, 2002a); around 15% of people will have some type of anxiety disorder in their
Anxious apprehension
Anxiety that arises in response to a high level
of fear of a particular stimulus.
Anxiety disorder
A category of psychological disorders in
which the primary symptoms involve extreme
anxiety, intense arousal, and/or extreme
attempts to avoid stimuli that lead to fear and
anxiety.
Fight-or-fl ight response
The automatic neurological and bodily
response to a perceived threat; also called
the stress response.
Panic
An extreme sense (or fear) of imminent doom,
together with an extreme stress response.
Phobia
An exaggerated fear of an object or a
situation, together with an extreme avoidance
of the object or situation.