How we react to anxiety could be just as important as the anxiety itself

The way a person responds to anxious feelings might play an equally important role in the development of clinical anxiety as the severity of the anxiety itself. According to new research published in the Journal of Clinical Psychology, psychological inflexibility is closely linked to whether a person will develop one or more lifetime anxiety disorders. The findings suggest that learning to accept and adapt to anxious feelings could be a useful strategy for mitigating mental health struggles.

From an evolutionary standpoint, anxiety serves a protective function. The emotion prompts individuals to anticipate potential threats and take preemptive action to survive. Running away from a dangerous predator involves fear, but avoiding the places where that predator might hide involves anxiety. Both reactions ultimately promote survival in a hostile world.

Much like a physical smoke detector, the human brain’s threat detection system is designed to sound an alarm to keep a person safe. Biologically speaking, the potential risk of ignoring a smoke detector that occasionally gives false alarms is much greater than the risk of keeping it on alert. The human species would not evolve out of a strategy that has a net survival benefit. Our brains naturally err toward greater threat detection and safety-seeking behaviors.

Despite its evolutionary utility, anxiety can become highly impairing in modern life. A person worried about being fired from a job might spend excessive time checking their work, which paradoxically increases their risk of making errors. This paradox led researchers to investigate whether the transition from normal anxiety to a clinical disorder depends on how a person reacts to those internal warning signals. Max Z. Roberts, a psychology researcher at the University at Albany and Duke University, and his colleagues hypothesized that psychological inflexibility might be a driving factor.

Psychological inflexibility occurs when a person struggles to adapt to difficult thoughts and emotions. Instead of experiencing anxious feelings and choosing how to act based on the situation, an inflexible response typically involves rigid attempts to avoid the discomfort. For example, a person might invariably escape from a social event the moment they feel nervous. Psychological flexibility, on the other hand, allows a person to feel that same nervousness and stay at the event if it aligns with their personal goals.

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This framework treats all anxiety conditions as sharing a common underlying mechanism, rather than viewing them as completely separate diseases. An obsession with cleanliness and an intense fear of heights look very different on the surface. Yet, they both represent functionally similar efforts to avoid perceived threats. Evaluating how a person reacts to these threats could reveal a shared pathway for many different anxiety disorders.

Previous studies have found connections between this rigid avoidance and clinical anxiety, but they often relied on older questionnaires. These older assessment tools had been criticized for confusing inflexibility with general emotional distress. To correct for this overlap, Roberts and his team decided to use a newer, more precise psychological survey to test the relationship between mental rigidity and anxiety.

The researchers first recruited a community sample of 265 adults through social media and professional mental health organizations. These participants completed a series of online questionnaires designed to map out their mental health profiles. The surveys asked participants to rate their anxiety levels over the past week and measure their psychological inflexibility over the past two weeks. Participants were also asked to report any lifetime diagnoses of anxiety or obsessive-compulsive disorders, providing a total count of their conditions.

The research team used statistical models to look for patterns in the collected data. They found that severe anxiety symptoms were associated with a higher likelihood of having an anxiety disorder, which aligned with their initial expectations. Even after mathematically accounting for that symptom severity, psychological inflexibility remained strongly linked to a person’s diagnostic history. The way individuals managed their distress proved to be just as impactful as the distress itself.

For every one-point increase on the psychological inflexibility scale, participants in the community group were nearly three times more likely to report having at least one anxiety diagnosis. The data also revealed an increased likelihood of having multiple distinct disorders simultaneously. This suggested that a person’s reaction to their anxiety contributed independently to their mental health burden.

To verify these patterns, the researchers repeated their analysis with a separate group of 853 undergraduate students. These students were attending a large university in the northeastern United States and completed the exact same battery of online assessments as the community group. Because the student sample represented a different age demographic and educational background, this second analysis allowed the researchers to test the robustness of their theory.

The results from the student group closely mirrored the community sample. Higher psychological inflexibility was once again associated with an increased chance of reporting an anxiety disorder, independent of how severe the students’ recent anxiety symptoms were. While the mathematical effect was slightly smaller in the student group, the overarching pattern remained exactly the same. Across both groups, individuals who reported rigid, avoidant responses to their inner distress were more likely to have a history of clinical anxiety conditions.

The researchers also looked at demographic variables in both samples to see if other factors played a role in diagnostic history. They found that identifying as White, and identifying as female, were independently associated with higher odds of reporting an anxiety disorder diagnosis. These demographic links held up even when the researchers held anxiety severity and psychological inflexibility constant in their statistical models.

The research team noted that a formal diagnosis might reflect access to mental health care, cultural help-seeking tendencies, or clinician bias. A self-reported diagnosis is not always a universally objective measure of who experiences the most psychological suffering. Social and cultural factors likely influence who receives formal medical recognition for their anxiety. This highlights a need to better understand how race and gender intersect with mental health evaluations.

The study relied on data collected at a single point in time through cross-sectional surveys. Because the research did not track participants over several years, the data cannot establish a timeline of events. The researchers cannot definitively say whether psychological inflexibility causes anxiety disorders, or if living with an anxiety disorder causes a person to become more psychologically inflexible. Additionally, the diagnoses were self-reported rather than verified by clinical interviews or medical records.

Future research could involve structured clinical assessments to confirm participants’ diagnostic histories. Medical professionals could also explore whether therapies designed to improve psychological flexibility might effectively treat multiple forms of anxiety simultaneously. Treatments like Acceptance and Commitment Therapy focus on increasing flexible behavior rather than just trying to eliminate anxiety entirely. Reducing the severity of anxiety symptoms and teaching people how to respond flexibly to those symptoms may both represent viable paths toward improving psychological well-being.

The study, “Psychological Inflexibility’s Associations With Lifetime Anxiety Disorders,” was authored by Max Z. Roberts, James F. Boswell, Rhonda M. Merwin, Alicia A. Lucksted, and John P. Forsyth.