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A Causal Systems Approach to Anxiety Disorders

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Clinical Handbook of Anxiety Disorders

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Symptoms are at the heart of psychiatric illness. Clinically, this is readily apparent; patients tend to seek help regarding symptom-level difficulties such as chronic worry, severe anxiety, or panic attacks. As mental health clinicians, we aim to understand and ameliorate these psychiatric symptoms. In this chapter, we review a recently developed framework for conceptualizing mental disorders that centers on symptoms and the plausible causal relations among them (Borsboom D, World Psychiatry 16:5–13, 2017; Borsboom D, Cramer AOJ, Annu Rev Clin Psychol 9:91–121, 2013). We then apply this framework to anxiety disorders, considering how a causal systems approach might be used to better understand, diagnose, and treat patients with anxiety. Throughout, we address how conceptualizing mental disorders in this way may be especially useful in understanding individual differences in the development and maintenance of psychiatric illness and in tailoring therapeutic interventions to better fit the needs of individual patients.

This manuscript was supported by a National Institute of Mental Health Career Development Award (1K23MH113805-01A1).

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References

  1. Borsboom D, Cramer AOJ. Network analysis: an integrative approach to the structure of psychopathology. Annu Rev Clin Psychol. 2013;9:91–121. https://doi.org/10.1146/annurev-clinpsy-050212-185608.

    Article  PubMed  Google Scholar 

  2. Borsboom D. A network theory of mental disorders. World Psychiatry. 2017;16(1):5–13. https://doi.org/10.1002/wps.20375.

    Article  PubMed  PubMed Central  Google Scholar 

  3. van den Hout M. Psychiatric symptoms as pathogens. Clin Neuropsychiatry. 2014;11(6):153–9.

    Google Scholar 

  4. Kim NS, Ahn WK. Clinical psychologists’ theory-based representations of mental disorders predict their diagnostic reasoning and memory. J Exp Psychol Gen. 2002;131(4):451–76. https://doi.org/10.1037/0096-3445.131.4.451.

    Article  PubMed  Google Scholar 

  5. Frewen PA, Allen SL, Lanius RA, Neufeld RWJ. Perceived causal relations: novel methodology for assessing client attributions about causal associations between variables including symptoms and functional impairment. Assessment. 2012;19(4):480–93. https://doi.org/10.1177/1073191111418297.

    Article  PubMed  Google Scholar 

  6. Beck AT, Clark DA. An information processing model of anxiety: automatic and strategic processes. Behav Res Ther. 1997;35(1):49–58. https://doi.org/10.1016/S0005-7967(96)00069-1.

    Article  CAS  PubMed  Google Scholar 

  7. Jones JC, Barlow DH. The etiology of posttraumatic stress disorder. Clin Psychol Rev. 1990;10:299–328. https://doi.org/10.1016/0887-6185(90)90024-4.

    Article  Google Scholar 

  8. Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997;35(8):741–56. https://doi.org/S0005-7967(97)00022-3 [pii]

    Article  CAS  Google Scholar 

  9. Behar E, DiMarco ID, Hekler EB, Mohlman J, Staples AM. Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications. J Anxiety Disord. 2009;23:1011–23. https://doi.org/10.1016/j.janxdis.2009.07.006.

    Article  PubMed  Google Scholar 

  10. Cramer AOJ, Waldorp LJ, van der Maas HLJ, Borsboom D. Comorbidity: a network perspective. Behav Brain Sci. 2010;33:137–93. https://doi.org/10.1017/S0140525X09991567.

    Article  PubMed  Google Scholar 

  11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington; 2013. https://doi.org/10.1017/CBO9781107415324.004.

  12. Borsboom D, Cramer AOJ, Schmittmann VD, Epskamp S, Waldorp LJ. The small world of psychopathology. PLoS One. 2011;6(11):1–11. https://doi.org/10.1371/journal.pone.0027407.

    Article  CAS  Google Scholar 

  13. Boschloo L, Van Borkulo CD, Rhemtulla M, Keyes KM, Borsboom D, Schoevers RA. The network structure of symptoms of the diagnostic and statistical manual of mental disorders. PLoS One. 2015;10(9):1–12. https://doi.org/10.1371/journal.pone.0137621.

    Article  CAS  Google Scholar 

  14. McNally RJ. Can network analysis transform psychopathology? Behav Res Ther. 2016;86:95–104. https://doi.org/10.1016/j.brat.2016.06.006.

    Article  PubMed  Google Scholar 

  15. Goekoop R, Goekoop JG. A network view on psychiatric disorders: network clusters of symptoms as elementary syndromes of psychopathology. PLoS One. 2014;9(11):1–47. https://doi.org/10.1371/journal.pone.0112734.

    Article  CAS  Google Scholar 

  16. Heeren A, Jones PJ, McNally RJ. Mapping network connectivity among symptoms of social anxiety and comorbid depression in people with social anxiety disorder. J Affect Disord. 2018;228:75–82. https://doi.org/10.1016/j.jad.2017.12.003.

    Article  PubMed  Google Scholar 

  17. Beard C, Millner AJ, Forgeard MJC, Fried EI, Hsu KJ, Treadway MT, et al. Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychol Med. 2016;46:3359–69. https://doi.org/10.1017/S0033291716002300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kendler KS, Zachar P, Craver C. What kinds of things are psychiatric disorders? Psychol Med. 2011;41:1143–50. https://doi.org/10.1017/S0033291710001844.

    Article  CAS  PubMed  Google Scholar 

  19. Coyne JC, Downey G. Social factors and psychopathology: stress, social support, and coping processes. Annu Rev Psychol. 1991;42(1):401–25. https://doi.org/10.1146/annurev.psych.42.1.401.

    Article  CAS  PubMed  Google Scholar 

  20. Kessler RC, Price RH, Wortman CB. Social factors in psychopathology: stress, social support, and coping processes. Annu Rev Psychol. 1985;36:531–72. https://doi.org/https://doi-org.ezp-prod1.hul.harvard.edu/10.1146/annurev.ps.36.020185.002531

    Article  CAS  Google Scholar 

  21. Hebert KR, Fales J, Nangle DW, Papadakis AA, Grover RL. Linking social anxiety and adolescent romantic relationship functioning: indirect effects and the importance of peers. J Youth Adolesc. 2013;42(11):1708–20. https://doi.org/10.1007/s10964-012-9878-0.

    Article  PubMed  Google Scholar 

  22. Persons JB. Cognitive therapy in practice: a case formulation approach. New York: W.W. Norton & Company; 1989.

    Google Scholar 

  23. Hofmann SG. Toward a cognitive-behavioral classification system for mental disorders. Behav Ther. 2014;45(4):576–87. https://doi.org/10.1016/j.beth.2014.03.001.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther. 2012;43(3):666–78. https://doi.org/10.1016/j.beth.2012.01.001.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, Sauer-Zavala S, et al. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiat. 2017;74(9):875–84. https://doi.org/10.1001/jamapsychiatry.2017.2164.

    Article  Google Scholar 

  26. Carney CE, Edinger JD. Insomnia and anxiety. New York: Springer; 2010. https://doi.org/10.1007/978-1-4419-1434-7_3.

    Book  Google Scholar 

  27. Bekhuis E, Schoevers RA, Van Borkulo CD, Rosmalen JGM, Boschloo L. The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology. Psychol Med. 2016;46:2989–98. https://doi.org/10.1017/S0033291716001550.

    Article  CAS  PubMed  Google Scholar 

  28. Heeren A, McNally RJ. An integrative network approach to social anxiety disorder: the complex dynamic interplay among attentional bias for threat, attentional control, and symptoms. J Anxiety Disord. 2016;42:95–104. https://doi.org/10.1016/j.janxdis.2016.06.009.

    Article  PubMed  Google Scholar 

  29. McNally RJ, Robinaugh DJ, Wu GWY, Wang L, Deserno MK, Borsboom D. Mental disorders as causal systems: a network approach to posttraumatic stress disorder. Clin Psychol Sci. 2015;3(6):836–49. https://doi.org/10.1177/2167702614553230.

    Article  Google Scholar 

  30. David SJ, Marshall AJ, Evanovich EK, Mumma GH. Intraindividual dynamic network analysis – implications for clinical assessment. J Psychopathol Behav Assess. 2018;40(2):235–48. https://doi.org/10.1007/s10862-017-9632-8.

    Article  PubMed  Google Scholar 

  31. Fisher AJ, Reeves JW, Lawyer G, Medaglia JD, Rubel JA. Exploring the idiographic dynamics of mood and anxiety via network analysis. J Abnorm Psychol. 2017;126(8):1044–56. https://doi.org/10.1037/abn0000311.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Emma R. Toner & Donald J. Robinaugh

  2. Department of Psychiatry, Harvard University, Boston, MA, USA

    Donald J. Robinaugh

Authors
  1. Emma R. Toner
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  2. Donald J. Robinaugh
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Correspondence to Donald J. Robinaugh .

Editor information

Editors and Affiliations

  1. Department of Psychiatry Massachusetts General Hospital, Boston, MA, USA

    Eric Bui

  2. Department of Psychiatry Massachusetts General Hospital, Boston, MA, USA

    Meredith E. Charney

  3. Department of Psychiatry Massachusetts General Hospital, Boston, MA, USA

    Amanda W. Baker

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Toner, E.R., Robinaugh, D.J. (2020). A Causal Systems Approach to Anxiety Disorders. In: Bui, E., Charney, M., Baker, A. (eds) Clinical Handbook of Anxiety Disorders. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-30687-8_1

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  • DOI: https://doi.org/10.1007/978-3-030-30687-8_1

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-30686-1

  • Online ISBN: 978-3-030-30687-8

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