cause and effect of anxiety essay

The Causes of Anxiety

Reviewed by Psychology Today Staff

The true cause of anxiety is being a human being, gifted with the capacity to imagine a future. As a mental state of apprehension about what might, or might not, lie ahead, anxiety reflects uncertainty about future circumstances, whether regarding one’s own health, job, or love life, or climate change or a downturn in the economy. It can be triggered by events in the real world—an upcoming doctor’s visit, relationship conflict, a rent increase—or generated wholly internally, through thoughts of real or imagined threats (not knowing what to say when the boss calls on you in a meeting).

Occasional bouts of anxiety are entirely normal and one of the unavoidable costs of being alive; anxiety alerts us to danger, compels our attention, and urges us to make necessary preparations to protect ourselves. But sometimes worries intensify or persist, endlessly caroming through the brain without engaging problem-solving mechanisms, or overwhelming them, and impairing the ability to function. Many factors can contribute to prolonged rumination—worry, the cognitive component of anxiety— over uncertain outcomes.

On This Page

• What are the most common causes of anxiety?
• Can stress bring on anxiety?
• Why are rates of anxiety increasing?
• What is the difference between fear and anxiety?
• Is anxiety ever good?
• Who is prone to anxiety?
• Do genes cause anxiety?
• Can uncertainty cause anxiety?
• Does personality play a role in anxiety?
• What biological factors influence anxiety?
• Are there risk factors for anxiety?
• What happens in the brain with anxiety?
• Why does anxiety so often occur with depression?

Anxiety is a response to uncertainty and danger, and the trigger can be almost anything, or nothing in particular, just a generalized, vague sense of dread or misfortune. High on the list of anxiety-generating situations is having to give a talk or presentation or being called on in class, where people risk loss of social standing by being judged negatively.

People can feel anxious because their neural circuitry has become so sensitized it perceives threat where it doesn’t exist. Too, there are substances—caffeine is one—and medications that stimulate the same physical sensations as anxiety. People differ in their susceptibility to anxiety, as a result of their biological makeup, their parental inheritance, their own life history, personality factors, and the coping skills they acquire or cultivate.

Anxiety and stress are intimately related; anxiety is a reaction to stress. Anxiety is the name we give to the internal sensations of warning generated by the body’s reaction to a mental or physical threat. The sensations are set in motion by the stress response (or fight-or-flight) system, whose job is to alert us to and protect us from danger. Without waiting for us to make a conscious assessment of any danger, it swiftly sends out chemical warning signals, such as cortisol and adrenaline, to various organs. The physical discomfort of anxiety is like a bodyguard ; its job is to protect us by jolting us into action. But it can persist and, by altering the function of neural circuits in the brain, overwhelm the ability to exert rational control.

Anxiety in its several forms, including phobias and social anxiety, is the most common mental health disorder in the U.S. Population-based surveys indicate that about a third of adults in the U.S. will grapple with disabling anxiety at some point.

High as the number is, there is some—and sometimes conflicting—evidence that the prevalence of anxiety (and depression as well) is increasing, especially among the young. Several factors are thought to be responsible for a rise in prevalence. In general, as the middle class erodes, there is growing economic uncertainty for much of the population. The high cost of health care also creates a burden of chronic worry about getting sick. In addition, a lack of coping skills, emotion regulation skills notably among them, is said to be making younger people vulnerable to a number of mental health disorders, particularly anxiety and depression.

Social media are singled out for their especially pernicious effect on young teens, because they introduce a means of constant social comparison and, through it, self-doubt—and that self-doubt drives further social media use , with compounding negative effects. In addition, dating and mating practices are far less structured than in past eras, and digital forms of communication create so much ambiguity that young people are often clueless about where they stand in romantic relationships . Ambiguity typically breeds anxiety.

Anxiety differs from fear in several important ways. Fear is a response to present danger; it is usually highly focused, attached to a very specific thing or circumstance, and meant to mobilize fast action. Anxiety doesn’t require an external stimulus; it is a response to real or imagined future threat, and it is typically more diffuse, setting in motion the need for constant vigilance in anticipation of some calamity. Fear is contagious, marked by characteristic features—widened pupils, pale skin —that signal others to be afraid. Anxiety is highly subjective. While anxiety shares some of the physiological signs of fear—heightened awareness and fast heart rate, similarly set off by the hormones of the stress response—it carries a heavy cognitive load of worry, a form of rumination about what might possibly go wrong in the future.

Anxiety is the reason your ancestors survived, enabling you to be reading these words now. Anxiety reflects the sensations that are triggered in body and brain in response to perceiving a threat; they’re intended as an alarm, to jolt you into paying attention and taking appropriate action to head off possible danger. In short, anxiety protects you. But the system is built to err on the side of caution, which is why we feel anxious even in the absence of a real threat. The sensitivity of the alarm can be reset by traumatic experience so that it is always on. Further, the threats can be wholly invented by your own imagination—thoughts of ways any situation could possibly go wrong. Neither flaw in the system diminishes the value of anxiety—to keep you alive.

To a large degree, people who are prone to clinical depression are also vulnerable to clinical anxiety. The conditions have many features in common . Chief among them is a history of adverse childhood experience, such as abuse or neglect. The reason is that maltreatment can indelibly alter the stress system so that it is hypersensitive to danger and reacts with an outpouring of alarm signals that overwhelm the capacity for emotion processing. Scoring high on the personality trait of neuroticism also inclines an individual to anxiety. Neuroticism reflects a tendency to respond to stressful experiences most readily and intensely with negative emotions and to perceive threats where they do not exist. In addition, people who lack the skills of emotion regulation are vulnerable to anxiety; they can be easily overwhelmed by situations that create uncertainty or stir any negative feelings.

No one has ever identified an “anxiety gene,” and it is unlikely that one will ever emerge; anxiety proves to be a complex condition that arises through many pathways. Some studies estimate that the heritability of generalized anxiety is no more than 30 percent. As with the transmission of depression-prone styles of thinking, families lastingly shape their children by many means. For example, the adults may display and, by the power of repeated example, silently pass on to their children skills for coping with the kinds of emotionally disruptive experiences that can trigger anxiety—or they may become disorganized and unable to function by such experiences. Nevertheless, studies indicate that genes lay a foundation for anxiety primarily by contributing to the personality trait of neuroticism, characterized by volatility of the negative emotion system. It is observable in the readiness to perceive the negative aspects of challenging situations and to react to them with negative emotions.

Uncertainty doesn’t cause anxiety but it creates breeding grounds for anxiety, and the rise of uncertainty in much of public (jobs, national security, pandemics) and private (relationships) life may be one reason why anxiety has become the most prevalent mental health condition today. Worry, the cognitive component of anxiety, is activated by the mere possibility of a bad outcome—and for many modern concerns, possibility can almost never be ruled out entirely. But of course, possibility does not equal probability. Anxiety with its payload of worry can be seen as an attempt to avoid uncertainty —to dispel the discomfort it creates. The better approach, say experts, is to learn to tolerate some uncertainty and recognize that most of life is not black or white but shades of gray.

There is a type of personality consistently associated with anxiety—those who exhibit the trait of neuroticism . One of the so-called Big Five personality traits, it describes a broad tendency to respond to experience with negative emotions and to be roiled by them. In study after study, neuroticism predicts susceptibility to both anxiety and depression and, to a lesser degree, all other mental disorders. Scientists believe that neuroticism reflects emotional reactivity that is especially attuned to threat. Some facets of neuroticism —perfectionism stands out—are virtually free tickets to anxiety. Perfectionists may seem like they’re on a path to success but in fact they are driven by a desire to avoid failure; as a result, much of their mental life is devoted to worrying about mistakes they could possibly make and imagining dire consequences of those mistakes..

The state of a person’s health, past or present, plays a large role in triggering anxiety. Those with chronic conditions such as diabetes or heart disease are at risk of constant worry about getting sick or sudden death. In fact, having a heart attack is known to raise the risk of health anxiety by 20 to 30 percent. People with breathing problems such as asthma or who have severe allergies to common substances may live with chronic worry about exposure to triggering substances. Some people are highly sensitive to internal body sensations—interoception—and may devote so much mental energy to monitoring, say, their heartbeats that every variation becomes a source of doubt and concern. A large number of people—in some estimates, as many as 20 percent of the population—are said to be highly sensitive; having a low threshold of nervous system arousal, they overrespond to both internal and external stimuli and can be easily overwhelmed emotionally. Their reactivity is linked to the personality trait of neuroticism, one of the strongest risk factors for anxiety.

There are multiple factors that create vulnerability to anxiety under stressful circumstances. On a purely psychological level is the ability to manage negative emotions. People lacking emotion regulation skills are at heightened risk of both anxiety and depression. Having a history of adverse life experiences during childhood , such as intense maltreatment or bouts of serious illness, also predisposes people to anxiety. It doesn’t change the makeup of genes but it can permanently alter their level of activity so that that the brain is constantly on the lookout for and perceiving potential threats. Perhaps the strongest risk factor for anxiety is having the personality trait of neuroticism. It denotes the degree to which the negative affect system is readily activated. People high in trait neuroticism are dispositionally inclined to find experiences distressing and to worry.

Neuroimaging studies reliably show changes in brain function among those who experience chronic anxiety, and they involve dysfunction of connectivity among areas of the brain that work together to orchestrate emotional response. Under normal circumstances the brain region known as the amygdala flags threats and, in an act of protection, sends out a signal to many parts of the brain. The stress response system kicks in immediately, preparing the body for action. On a slower track, signals travel to the prefrontal cortex, the so-called thinking brain, where the threat can be evaluated and, if needed, action planned to ameliorate any potential danger. But in anxiety, often because the amygdala has been sensitized by early adverse experience, it overresponds, overwhelming the capacity of the PFC to rationally assess and manage any threat, however remote or hypothetical.

Researchers have recently identified a tiny brain region known as the BNST, the bed nucleus of the stria terminalis, as a major node in brain circuits of anxiety . About the size of a small sunflower seed, it is considered an extension of the amygdala. Its primary function is to monitor the environment for vague, psychologically distant, or unpredictable threats—say, imagining that you’ll stumble badly and embarrass yourself when you give that upcoming talk. And when activated, it sends out alarms prompting alertness and hypervigilance to potential danger—the hallmarks of anxiety.

Depression and anxiety share much in common—they both derive from overresponsiveness of the negative affect system, the distinguishing feature of the personality trait of neuroticism. People with the trait of neuroticism tend to react to experience most readily and most strongly with negative emotions, such as irritability, anger, and sadness. Many of the same brain regions malfunction in both conditions, most notably the amygdala (overactivated) and prefrontal cortex (underactivated). But there are important differences. Anxiety is an alarm intended to energize people to avoid possible future danger they sense; depression shuts people down when they feel overwhelmed, disinclining them to ongoing activity and focusing their attention on losses and other negative experiences in the past. Stress can trigger both responses. And anxiety itself can lead to depression. In fact, nearly 70 percent of people who suffer from depression also have anxiety, and 50 percent of those with anxiety have clinical depression.

Anxiety is often treated by cognitive restructuring and distraction methods. But when it is intense, try to notice and understand bodily sensations and ride out anxious distress.

Mindstorms like meltdowns and shutdowns are common experiences, especially for neurodivergent people. Here are five strategies for getting through one or providing support.

Two studies published last year cast doubt on the power of positive thinking and avoiding negative emotions. Why?

When our minds get stuck, it can be an incredibly painful experience. Here are four strategies to break free.

The challenges of coping with a friend’s suicide.

According to a 2019 study, over 11% of young people have a diagnosable mental disorder. These disorders accounted for about 20% of all disease-related disability in this age group.

Are you criticizing yourself too much?

The secret to success is not concealing the effort it takes.

When do relationships become imbalanced and what can we do about it?

Anxiety rarely just "goes away," and it can get progressively worse. Knowing the myths surrounding anxiety can help the sufferer and their friends better address it.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Teletherapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Therapy Center NEW
• Diagnosis Dictionary
• Types of Therapy

Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

• Coronavirus Disease 2019
• Affective Forecasting
• Neuroscience

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Social context and the real-world consequences of social anxiety

1 Department of Psychology, University of Maryland, College Park, MD 20742 USA

Kathryn A. DeYoung

2 Department of Family Science, University of Maryland, College Park, MD 20742 USA

4 Department of Center for Healthy Families, University of Maryland, College Park, MD 20742 USA

Samiha Islam

Allegra s. anderson.

7 Department of Psychological Sciences, Vanderbilt University, Nashville, TN 37240 USA

Matthew G. Barstead

3 Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD 20742 USA

Alexander J. Shackman

5 Department of Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD 20742 USA

6 Department of Maryland Neuroimaging Center, University of Maryland, College Park, MD 20742 USA

AUTHOR CONTRIBUTIONS

Associated Data

Social anxiety lies on a continuum, and young adults with elevated symptoms are at risk for developing a range of debilitating psychiatric disorders. Yet, relatively little is known about the factors that govern the hour-by-hour experience and expression of social anxiety in daily life.

Here, we used smartphone-based ecological momentary assessment (EMA) to intensively sample emotional experience across different social contexts in the daily lives of 228 young adults selectively recruited to represent a broad spectrum of social anxiety symptoms.

Leveraging data from over 11,000 real-world assessments, results highlight the central role of close friends, family members, and romantic partners. The presence of close companions is associated with enhanced mood, yet socially anxious individuals have smaller confidant networks and spend less time with their close companions. Although higher levels of social anxiety are associated with a general worsening of mood, socially anxious individuals appear to derive larger benefits—lower levels of negative affect, anxiety, and depression—from the presence of their closest companions. In contrast, variation in social anxiety was unrelated to the amount of time spent with strangers, co-workers, and acquaintances; and we uncovered no evidence of emotional hypersensitivity to less-familiar individuals.

Conclusions

Collectively, these findings provide a framework for understanding the deleterious consequences of social anxiety in emerging adulthood and set the stage for developing improved intervention strategies.

INTRODUCTION

Socially anxious individuals are prone to heightened fear, anxiety, and avoidance of social interactions and situations associated with potential social scrutiny ( Alden and Taylor 2004 , Heimberg et al. 2014 ). In addition to heightened negative affect (NA), socially anxious individuals tend to report lower levels of positive affect (PA) ( Kashdan and Collins 2010 , Anderson and Hope 2008 , Kashdan et al. 2011 , Geyer et al. 2018 ). Social anxiety symptoms lie on a continuum and, when extreme, can become debilitating ( Rapee and Spence 2004 , Craske et al. 2017 , Kessler 2003 , Lipsitz and Schneier 2000 , Katzelnick et al. 2001 , Stein et al. 2017 , Conway et al. 2019 , Krueger et al. 2018 , Ruscio 2019 ). Social anxiety disorder is among the most prevalent mental illnesses; contributes to the development of other psychiatric disorders, such as depression; and is challenging to treat ( Mathew et al. 2011 , Schneier et al. 1992 , Stein et al. 2017 , Craske et al. 2017 , Acarturk et al. 2009 , Rodebaugh et al. 2004 , Neubauer et al. 2013 ). Relapse and recurrence are common, and pharmaceutical treatments are associated with significant adverse effects ( Gordon and Redish 2016 , Batelaan et al. 2017 , Spinhoven et al. 2016 , Scholten et al. 2013 , Scholten et al. 2016 , Bruce et al. 2005 , Rhebergen et al. 2011 ). Yet the situational factors that govern the momentary experience and expression of social anxiety in the real world remain incompletely understood. To date, most of what it known is based on either retrospective report or acute laboratory challenges ( Afram and Kashdan 2015 , Alden and Wallace 1995 , Beck et al. 2006 , Buote et al. 2007 , Crişan et al. 2016 ).

As part of an on-going prospective-longitudinal study focused on individuals at risk for the development of mood and anxiety disorders, we used smartphone-based ecological momentary assessment (EMA) to intensively sample momentary levels of negative and positive affect in the daily lives of 228 young adults. Subjects were selectively recruited from a pool of 6,594 individuals screened for individual differences in dispositional negativity (i.e., negative emotionality), the tendency to experience more intense, frequent, or persistent levels of depression, worry, fear and anxiety—including social anxiety ( Shackman et al. 2016 , Hur et al. in press ). This ‘enrichment’ strategy enabled us to examine a broader spectrum of social anxiety symptoms than alternate approaches, such as convenience sampling. Because EMA data are captured in real time (e.g., Who are you with? ), they circumvent the biases that can distort retrospective reports, providing insights into how emotional experience dynamically responds to moment-by-moment changes in social context ( Lay et al. 2017 , Barrett 1997 , Csikszentmihalyi et al. 2013 , Shiffman et al. 2008 ). We focused on young adulthood because it is a time of profound, often stressful developmental transitions (e.g., moving away from home, forging new social relationships; Hays and Oxley 1986 , Alloy and Abramson 1999 , Arnett 2000 , Pancer et al. 2000 ). In fact, more than half of undergraduate students report overwhelming anxiety, with many experiencing the first onset or a recurrence of anxiety and mood disorders during this period ( Stein et al. 2017 , Global Burden of Disease Collaborators 2016 , Auerbach et al. 2016 , Auerbach et al. in press, Lipson et al. in press, American College Health Association 2016 ). In particular, those with elevated levels of social anxiety tend to experience substantial distress and impairment and are more likely to develop psychopathology ( Merikangas et al. 2002 ).

We were particularly interested in understanding how the momentary emotional experience of socially anxious individuals varies as a function of social context. Emotion is often profoundly social ( Fox and Shackman 2018 ). For instance, emotional experiences are routinely shared and dissected with friends, family, and romantic partners ( Rime 2009 ). Humans and other primates routinely seek the company of close companions in response to stressors, and increased social engagement promotes positive affect ( Shackman et al. 2018 , Cottrell and Epley 1977 ). Indeed, there is abundant evidence that close companions play a critical role in coping with stress and regulating negative affect ( Bolger and Eckenrode 1991 , Buote et al. 2007 , Coan and Sbarra 2015 , Marroquin 2011 , Myers 1999 , Zaki and Williams 2013 , Wade and Kendler 2000 , Kendler and Gardner 2014 , Ramsey and Gentzler 2015 , Reeck et al. 2016 ). Yet, many of these beneficial effects appear to be disrupted in socially anxious individuals ( Alden and Taylor 2004 ).

We began by testing whether social anxiety is associated with the amount of time allocated to different social contexts (e.g., with close companions) and whether this reflects the number of self-reported confidants. Social avoidance is diagnostic of social anxiety disorder, is a key component of dimensional measures of social anxiety, and contributes to functional impairment and reduced quality of life ( Liebowitz 1987 , APA 2013 , Beidel et al. 1999 , Strahan and Conger 1999 , Turner et al. 1986 ). Among community samples, adults with elevated levels of social anxiety are less likely to have a close friend and more likely to be unmarried by mid-life ( Davidson et al. 1994 ). They are also more likely to be lonely ( Lim et al. 2016 ). Recent work using unobtrusive, smartphone-based global positioning system (GPS) data provides additional evidence suggestive of social inhibition and avoidance ( Boukhechba et al. 2018 ), demonstrating that socially anxious university students spend significantly less time at ‘leisure’ (e.g., gymnasiums, pubs, cinemas, and coffee shops) and ‘food’ (e.g., restaurants, food courts, and dining halls) locations during peak hours in the evening. Socially anxious students also spent more time at home or off-campus (e.g., parents’ home), particularly on weekends, and visited fewer locations overall, suggesting a more restricted range of activities (see also Chow et al. 2017 ). Whether this pattern reflects generalized avoidance, specific avoidance of socially ‘distant’ individuals (e.g., strangers, acquaintances), or a lack of confidants remains unknown.

Next, we used a series of multilevel models (MLMs) to understand the interactive effects of social anxiety and the social environment on momentary affect. This enabled us to test whether socially anxious individuals experience heightened NA and attenuated PA in the presence of distant others, as one would expect based on laboratory studies of semi-structured and unstructured interactions with unfamiliar peers and researchers ( Kashdan et al. 2013b , Kashdan and Roberts 2004 , Kashdan and Roberts 2006 , Kashdan and Roberts 2007 , Heerey and Kring 2007 , Crişan et al. 2016 , Coles et al. 2002 , Creed and Funder 1998 , Meleshko and Alden 1993 ). Likewise, EMA research indicates that children with social anxiety disorder experience diminished PA in the presence of distant others ( Morgan et al. 2017 ). Whether this pattern is evident in adults is, as yet, unknown.

Using a MLM approach, we also tested two competing predictions about the consequences of close companions. One possibility is that socially anxious individuals derive increased emotional benefits (e.g., lower levels of NA) from close companions. Consistent with this view, the presence of a friend has been shown to normalize behavioral signs of anxiety and reduce negative self-thoughts in socially anxious adults exposed to an experimental speech challenge ( Pontari 2009 ). Likewise, diary studies suggest that spousal support plays a key role in dampening negative affect among patients with social anxiety disorder ( Zaider et al. 2010 ) and EMA studies suggests that the presence of close companions is associated with disproportionately enhanced PA in children with social anxiety disorder ( Morgan et al. 2017 ) and adults with elevated levels of dispositional negativity ( Shackman et al. 2018 ). More broadly, a variety of work suggests that individuals with low levels of psychological well-being and patients with depression reap larger emotional benefits from positive daily events ( Rottenberg 2017 , Lamers et al. 2018 , Grosse Rueschkamp et al. in press ). Although socially anxious adults often show symptoms of depression and anhedonia, it is unclear whether similar benefits extend to this population.

A competing possibility is that socially anxious individuals fail to capitalize on available socio-emotional support. Indeed, socially anxious individuals tend to be less emotionally expressive, disclosing, and intimate with companions ( Cuming and Rapee 2010 , Meleshko and Alden 1993 , Sparrevohn and Rapee 2009 , Vernberg et al. 1992 , Williams et al. 2018 ). They perceive themselves as receiving less social support ( Torgrud et al. 2004 , Cuming and Rapee 2010 , La Greca and Lopez 1998 ); perceive their friendships to be of a lower quality ( Rodebaugh 2009 , Rodebaugh et al. 2015 ); are less satisfied with friends, family, and romantic partners ( Stein and Kean 2000 , Wong et al. 2012 , Starr and Davila 2008 ); and are prone to emotional neediness and overreliance ( Davila and Beck 2002 , Darcy et al. 2005 ). Perhaps as a consequence, socially anxious individuals report elevated levels of interpersonal conflict ( Cuming and Rapee 2010 ) and, among patients, marked impairment of interpersonal relationships ( Wittchen et al. 2000 , Rapaport et al. 2005 , Olatunji et al. 2007 , Stein et al. 2017 ). Collectively, these observations motivate the prediction that socially anxious individuals derive smaller emotional benefits or even costs (e.g., higher levels of NA) from close companions.

Discovering the situational factors associated with the real-world experience of social anxiety is important. The identification of potentially modifiable targets, such as social context, has the potential to guide the development of improved intervention strategies.

As part of an on-going prospective-longitudinal study focused on individuals at risk for the development of internalizing disorders, we used well-established measures of dispositional negativity (often termed neuroticism or negative emotionality; Shackman et al. 2016 , Shackman et al. 2018 ) to screen 6,594 young adults (57.1% female; 59.0% White, 19.0% Asian, 9.9% African American, 6.3% Hispanic, 5.8% Multiracial/Other; M = 19.2 years, SD = 1.1 years). Screening data were stratified into quartiles (top quartile, middle quartiles, bottom quartile) separately for males and females. Individuals who met preliminary inclusion criteria were independently recruited from each of the resulting six strata. Approximately half the subjects were recruited from the top quartile, with the remainder split between the middle and bottom quartiles (i.e., 50% high, 25% medium, and 25% low). Given the typically robust relations between measures of dispositional negativity and social anxiety— R 2 = .25 in the present sample—this ‘enrichment’ strategy allowed us to examine a relatively wide range of social anxiety symptoms without gaps or discontinuities. All subjects were first-year university students in good physical health and access to a smartphone. All reported the absence of a lifetime psychotic, bipolar, neurological, or developmental disorder. Given the focus of the larger prospective-longitudinal study on risk for the development of mental illness, all subjects reported the absence of current alcohol/substance abuse, suicidal ideation, internalizing disorder (past 2 months), and psychiatric treatment. To maximize the range of psychiatric risk, subjects with a lifetime history of anxiety and mood disorders were not excluded, consistent with prior work (Alloy, Abramson et al. 2000). At the baseline laboratory session, subjects provided informed written consent, were familiarized with the EMA protocol (see below), and completed the social anxiety and social network assessments. Beginning the next day, subjects completed up to 8 EMA surveys/day for 7 days. All procedures were approved by the University of Maryland Institutional Review Board and the sample does not overlap with that detailed in prior work by our group ( Shackman et al. 2018 ).

Two-hundred and forty-two subjects completed the baseline assessment and EMA protocol. Fourteen subjects were excluded from analyses: 2 withdrew and 12 (~5%) failed to complete >39 survey prompts (70% compliance). The final sample included 228 subjects (51.3% female; 62.7% White, 17.5% Asian, 8.3% African American, 4.9% Hispanic, 6.6% Multiracial/Other; M = 18.76 years, SD = 0.35 years).

Power Analysis

Sample size was determined a priori as part of the application for the award that supported this research (R01-MH107444). The target sample size ( N ≈ 240) was chosen to afford acceptable power and precision given available resources (Schönbrodt & Perugini, 2013). At the time of study design, G-power 3.1.9.2 ( http://www.gpower.hhu.de ) indicated >99% power to detect a benchmark medium-sized effect ( r = .30) with up to 20% planned attrition ( N = 192 usable datasets) using α = .05 (two-tailed).

Social Anxiety

At baseline, the self-report version of the Liebowitz Social Anxiety Scale (LSAS) was used to quantify social anxiety ( Liebowitz 1987 ). Subjects used a 0 ( none ) to 3 ( severe ) scale to rate the amount of fear and anxiety they typically experience in response to 24 everyday situations (e.g., going to a party , meeting strangers , returning goods to a store , speaking up at meeting ). They used a 0 ( never ) to 3 ( usually ) rating scale to rate frequency of avoiding the 24 situations. Social anxiety was quantified by summing the 48 responses. As shown in Figure 1 , LSAS scores were approximately normally distributed ( M = 41.7, SD = 22.0, Range = 1–121, α = .95) and somewhat higher than that previously reported in large university convenience samples (N = 856, M = 34.7, SD = 20.4; Russell and Shaw 2009 ) 1 , 2 .

Social anxiety was assessed at baseline using the self-report version of the Liebowitz Social Anxiety Scale (LSAS). The two highest cases were not excluded because they are sensible—given the nature of the scale and the sample—and because they did not exert undue statistical leverage ( Hoaglin and Iglewicz, 1987 , Hoaglin et al., 1986 ). Exploratory analyses indicated that the exclusion of these cases did not meaningfully alter the results (not reported).

Social Network Size

At baseline, the number of close companions was measured using an item ( How many people do you know where you have a close, confiding relationship and can share your most private feelings? ) from the modified Kendler Social Support Inventory (MKSSI; Spoozak et al. 2009 ). Single-item measures of social network size are routinely used in epidemiology research (e.g., Kendler et al. 2005 , Kocalevent et al. 2018 , Van Lente et al. 2012 ). The resulting descriptive statistics ( M = 5.6, SD = 4.1, Range = 0 – 30) are broadly consistent with the results of past work focused on confidant networks in university students ( Sarason et al. 1983 , Freberg et al. 2010 ) and friendship networks in community-dwelling adults ( Wang and Wellman 2010 ).

EMA Procedures

SurveySignal ( Hofmann and Patel 2015 ) was used to automatically deliver 8 text messages/day to each subject’s smartphone. On weekdays, messages were delivered every 1.5 to 3 hours ( M = 115 minutes, SD = 25) between 8:30 AM and 10:30 PM. As in prior work by our group ( Shackman et al. 2018 ), weekday messages were delivered during the ‘passing periods’ between regularly scheduled university courses to maximize compliance. On weekends, messages were delivered every 1.5 to 2.5 hours ( M = 99 minutes, SD = 17) between 11:00 AM and 11:00 PM. Messages were delivered according to a fixed schedule that varied across days (e.g., the third message was delivered at 12:52 PM on Mondays and 12:16 PM on Tuesdays). Messages contained a link to a secure on-line survey. Subjects were instructed to respond within 30 minutes (Latency: Median = 2 min, SD = 7 min, Interquartile Range = 9 min) and to refrain from responding at unsafe or inconvenient moments (e.g., while driving). A reminder was sent when subjects failed to respond within 15 minutes. During the baseline laboratory session, several well-established procedures were used to maximize compliance ( Palmier‐Claus et al. 2011 ), including: (1) delivering a test message in the laboratory and confirming that the subject was able to successfully complete the on-line EMA survey, (2) 24/7 technical support, and (3) monetary bonuses. Base compensation was $10, with $20 bonuses for ≥70% and ≥80% compliance, respectively ( Total = $10-$50). In the final sample, EMA compliance was acceptable ( M = 87.9%, SD = 6.2%, Minimum = 71.4%, Total = 11,224) and unrelated to social anxiety, p = .77.

Current NA ( afraid, nervous, worried, hopeless, sad ) and PA ( calm, cheerful, content, enthusiastic, joy, relaxed ) at the time of the survey prompt was rated using a 0 ( not at all ) to 4 ( extremely ) scale. Subjects also indicated their current social context ( “At the time of ping, who was around?” ): alone, close friend(s), family, friend(s), romantic partner, acquaintance(s), co-worker(s), and/or stranger(s). Composite measures of NA and PA were computed by averaging the relevant items ( α s > .92). To enable follow-up assessments of generality, composite anxiety ( afraid, nervous, worried ) and depression ( hopeless, sad ) facet scales were computed ( α s > .88). Building on prior work by our group and others ( Shackman et al. 2018 , Diener and Seligman 2002 ), friends, close friends, family, and romantic partners were re-coded as ‘Close’ companions. Acquaintances, co-workers, and strangers were re-coded as ‘Distant’ companions. This approach is conceptually similar to the distinction between ‘strong’ and ‘weak’ social connections ( Granovetter 1973 ). Analyses indicated that assessments completed in the presence of a mixture of Close and Distant companions (8%) showed intermediate effects and are omitted from the report.

Analytic Strategy

The overarching aim of the present study was to understand the joint explanatory influence of Social Anxiety (LSAS) and Social Context (EMA) on real-world Affect (EMA-derived NA, PA). In all cases, hypothesis testing employed a continuous measure of Social Anxiety.

We began by testing whether variation in Social Anxiety prospectively predicts the aggregate amount of time allocated to different social contexts. A standard multivariate mediation framework was then used to test whether relations between Social Anxiety and Social Context were statistically attributable, in part, to variation in Social Network Size (e.g., elevated social anxiety → fewer confidants → less time with close companions ) ( Hayes 2017 ), where Size was indexed using the MKSSI. As in prior work by our group ( Stout et al. 2017 ), the significance of the indirect effect (‘mediation’) was assessed using non-parametric bootstrapping (5,000 samples). Although the mediation framework provides useful information, it rests on strong assumptions and positive results do not license causal inferences ( Green et al. 2010 , Bullock et al. 2010 ). Pirateplots were created using the yaRrr package for R ( Phillips 2017 ). Hotelling’s test for dependent correlations was computed using FZT ( https://psych.unl.edu/psycrs/statpage/comp.html ).

Next, a series of MLMs was implemented in SPSS (version 24.0.0.0) with momentary assessments of Affect and Social Context nested within subjects and intercepts free to vary across subjects. Separate MLMs were computed for NA and PA. Level 2 variables (i.e., Social Anxiety) were mean centered.

The equations defined below outline the basic structure of our final MLMs in standard notation ( Raudenbush and Bryk 2002 ). At the first level, Affect during EMA t for individual i was modeled as a function of Social Context:

Alone served as the dummy-coded reference category for primary analyses (as in Equation 1 ). Distant companions served as the reference category for follow-up analyses 3 .

At the second level, the association between Social Context and Affect was modeled as a function of individual differences in Social Anxiety:

Conceptually, this enabled us to test prospective relations between Social Anxiety and Affect, cross-sectional relations between EMA-derived measures of Social Context and Affect, and the potentially interactive effects of Social Anxiety and Social Context. We also explored the impact of incorporating variation in the amount of time allocated to different contexts as a nuisance variable. For significant effects, we examined generality across NA facets (i.e., anxious and depressed mood). As an additional validity check, we confirmed that similar results were obtained when two authors independently analyzed the data using SPSS (J.H.) and R (M.G.B.), respectively.

Momentary Emotional Experience Covaries with Social Context

Consistent with other work in young adults ( Shackman et al. 2018 , Reed W Larson 1990 , Berry and Hansen 1996 ), our sample spent slightly more than half their time with others (Close = 44.1%, Distant = 13.4%, Alone = 42.5%), although there were marked individual differences in the amount of time devoted to each social environment ( Figure 2 ). Individuals who spent more time with close others reported lower average levels of NA ( r = −.14, p = .03) and higher average levels of PA ( r = .31, p < .000). Conversely, those who spent more time alone reported higher average levels of NA ( r = .14, p = .03) and lower average levels of PA ( r = −.28, p < .001), replicating past work (e.g., Diener and Seligman 2002 , Shackman et al. 2018 , Oishi et al. 2007 , Diener et al. 2018 , Rogers et al. 2018 ). The average amount of time spent with distant others was unrelated to average mood ( p s > .20). In sum, individuals who spend more time with close companions report modestly enhanced mood, whereas those who are prone to seclusion show the opposite effect.

Figure depicts the data ( jittered gray points; individual participants ), density distribution ( colored bean plots ), Bayesian 95% highest density interval (HDI; white bands ), and mean ( black bars ) for each social context. HDIs permit population-generalizable visual inferences about mean differences and were estimated using 1,000 samples from a posterior Gaussian distribution

Socially Anxious Individuals Spend Less Time with Close Companions and Have Smaller Confidant Networks

On average, individuals with higher levels of social anxiety spent significantly less time in the company of close companions ( r = −.16, p = .01) and showed a trend to spend more time alone ( r = .13, p = .06), as in prior work ( Afram and Kashdan 2015 , Alden and Taylor 2004 ). A mediation analysis suggested that this reflects reduced access to close companions. As shown in Figure 3 , individuals with higher levels of social anxiety report fewer confidants ( a = −.19, p = .005), consistent with prior work ( Davidson et al. 1994 , Montgomery et al. 1991 , La Greca and Lopez 1998 ). Individuals with fewer confidants were, in turn, less likely to be in the presence of close companions ( b = .31, p < .001) at the time of momentary assessment 4 . Bootstrapped 95% confidence intervals for the indirect effect excluded zero, indicating significant mediation. Likewise, the direct effect of social anxiety on the amount of time spent with close companions was no longer significant after accounting for variation in the number of confidants ( c ’ path in Figure 3 ; p > .10). 5 Notably, social anxiety was not significantly related to the amount of time spent with distant companions ( p = .20), contraindicating a general bias to avoid others. The association between social anxiety and the amount of time allocated to close companions was significantly stronger than that with distant companions, t Hotelling = 2.18, p = .03.

Figure depicts significant mediation models for the amount of time allocated to close companions. Path labels indicate standardized regression coefficients, with c’ indicating the coefficient while controlling for variation in the self-reported number of confidants. Socially anxious individuals report fewer confidants, and individuals with fewer confidants were, in turn, less likely to be in the presence of close companions at the time of momentary assessment.

Social Anxiety is Associated with Diminished Real-World Emotional Experience

MLM analyses demonstrated that social anxiety is associated with reduced quality of real-world emotional experience. Individuals with higher levels of social anxiety report significantly increased NA ( t = 25.2, b = .12, SE = .005, p < .001) and reduced PA ( t = −24.1, b = −.19, SE = .008, p < .001), consistent with past research ( Kashdan 2004 , Kashdan et al. 2013a , Kashdan et al. 2013b , Kashdan and Steger 2006 ) 6 .

The Quality of Momentary Emotional Experience Covaries with the Presence of Close Companions

Relative to seclusion or the presence of distant others, MLM results showed that close companions are associated with lower levels of NA (Alone: t = −.7.51, b = −.09, SE = .012, p < .001; Distant: t = −6.71, b = −.10, SE = .015, p < .001) and higher levels of PA (Alone: t = 15.79, b = .31, SE = .019, p < .001; Distant: t = 15.03, b = .37, SE = .025, p <.001). Relative to seclusion, distant companions are associated with lower levels of PA (PA: t = −2.59, b = −.06, SE = .024, p = .01; NA: p > .30). Results were similar when controlling for variation in the amount of time allocated to different social contexts ( Supplementary Table S1 ). These findings reinforce the conclusion that the quality of momentary emotional experience is positively associated with the presence of close friends, family, and romantic partners.

Socially Anxious Individuals Derive Larger Emotional Benefits from Close Companions

We next considered the joint impact of social anxiety and social context on momentary mood ( Table 1 ). As shown in Figure 4 , the results of this more comprehensive MLM revealed that socially anxious individuals derive larger emotional benefits—indexed by significantly lower levels of NA—from close companions relative to seclusion (Social Anxiety × Close-Alone, t = −2.27, b = −.03, SE = .012, p = .02). In short, individuals with higher levels of social anxiety tend to experience the least intense, most normative levels of NA in the company of friends, family, and romantic partners. This effect remained significant after controlling for the amount of time allocated to different social contexts ( Supplementary Table S2 ) 7 . Other interactions were not significant for NA or PA ( p > .80). That is, social anxiety was not associated with an exaggerated emotional response in the presence of co-workers, strangers, and other distant companions ( Figure 4 and Table 1 ). The same general pattern of results was evident for analyses focused on the anxious and depressed facets of momentary NA ( Supplementary Tables S3 – S4 ).

The deleterious impact of social anxiety on momentary emotional experience critically depends on social context. Individuals with higher levels of social anxiety derive larger emotional benefits—larger decrements in negative affect (NA)—from close companions relative to being alone ( left side of display ). Hypothesis testing relied on a continuous measure of social anxiety. For illustrative purposes, predicted values derived from multilevel modeling are depicted for extreme levels (±1 SD) of social anxiety. Abbreviation—SA: Social anxiety.

The Impact of Social Anxiety and Social Context on Momentary Emotional Experience

Social anxiety lies on a continuum, from mild to debilitating, and young adults with elevated symptoms of social anxiety are more likely to show significant impairment and develop frank psychopathology. The present study provides new insights into the ways in which real-world emotional experience varies as a function of social anxiety and the social environment. Our results demonstrate that the presence of close companions is associated with lower levels of momentary NA ( Figure 4 ), including anxiety and depression. Importantly, individuals with higher levels of social anxiety were found to spend significantly less time with close companions and a mediation analysis suggested that this association is partially explained by smaller confidant networks ( Figure 3 ). Social anxiety was unrelated to the number of assessments completed in the presence of co-workers, strangers, and other distant companions, contraindicating a general social avoidance bias. Although social anxiety was prospectively associated with a diminished quality of momentary emotional experience (i.e., increased NA and reduced PA), MLM analyses demonstrated that individuals with higher levels of social anxiety derive significantly larger benefits—manifesting as lower levels of NA, anxiety, and depression—from the company of close companions ( Figure 4 ). In contrast, socially anxious individuals were not disproportionately sensitive to the presence of distant companions ( Table 1 and Figure 4 ). Indeed, they showed similarly high levels of NA when they were alone. Although social anxiety research and treatment has predominantly focused on responses to novelty and potential threat, our results underscore the centrality of friends, family, and romantic partners. These findings provide a framework for understanding the deleterious consequences of extreme social anxiety and guiding the development of improved intervention strategies.

The present findings extend developmental and laboratory research highlighting the importance of social and interpersonal processes for emotion regulation and mental wellbeing ( Coan and Sbarra 2015 , Zaki and Williams 2013 , Reeck et al. 2016 , Maresh et al. 2013 , Rubin et al. 2018 ). Our observations motivate the hypothesis that the pervasive NA characteristic of socially anxious young adults partially reflects difficulties forming or maintaining close relationships, consistent with work focused on children and adolescents at risk for developing social anxiety disorder ( Shackman et al. 2016 , Markovic and Bowker 2017 , Rubin et al. 2018 , Frenkel et al. 2015 , Ladd et al. 2011 ). With fewer confidants, socially anxious individuals spend significantly less time with close companions and are less frequent beneficiaries of their mood-enhancing effects ( Figures 3 – 4 ). Socially anxious individuals appear to have an intact capacity for social mood enhancement. Indeed, they show lower levels of NA in the company of close companions, in broad accord with work focused on depressed samples ( Rottenberg 2017 ). This model is well aligned with evidence from prospective longitudinal studies which indicate that close friendships and other kinds of social support and intimacy reduce the risk of developing anxiety symptoms in adolescence and early adulthood ( Narr et al. 2019 , Frenkel et al. 2015 , Tillfors et al. 2012 , Teachman and Allen 2007 , Rodebaugh 2009 ). Likewise, among patients undergoing treatment for social anxiety, higher levels of perceived social support are associated with a more favorable prognosis ( Rapee et al. 2015 ).

Naturally, our results do not license causal inferences. We cannot rule out the possibility that reduced access to confidants begets higher levels of social anxiety or, more likely, that these two constructs exert bi-directional effects ( Rubin et al. 2018 ). Likewise, it could be that socially anxious individuals actively seek out the company of close companions when they are experiencing lower levels of NA. Nevertheless, randomized laboratory studies reinforce the conclusion that close companions play a key role in mitigating NA. For example, the presence of a close companion has been shown to normalize negative affect and catastrophic cognitions ( ‘I’m going to die’ ) in anxiety patients exposed to a panic-inducing CO 2 challenge ( Carter et al. 1995 ) and to normalize behavioral signs of anxiety in socially anxious young adults during a videotaped speech challenge ( Pontari 2009 ). Taken with the present results, these observations motivate the hypothesis that friends, romantic partners, and family members serve as a regulatory ‘prosthesis’ for socially anxious individuals.

Relying on close companions is risky. This is particularly true for socially anxious individuals, who tend to experience elevated levels of interpersonal conflict ( Cuming and Rapee 2010 ) and, among patients, profound impairment of interpersonal relationships ( Wittchen et al. 2000 , Rapaport et al. 2005 , Olatunji et al. 2007 , Stein et al. 2017 ). Relationship distress and dissolution reduces or eliminates the possibility of interpersonal emotion regulation and, ultimately, can contribute to the development, maintenance, and recurrence of psychopathology ( Baucom et al. 2014 , Whisman and Baucom 2012 , Rehman et al. 2008 , Marroquin 2011 ). Even in the absence of relationship problems, as young adults transition to full-time employment, marriage, and parenting, social network size begins to decline and more time is spent with distant companions or alone ( Wrzus et al. 2016 , Wrzus et al. 2013 , R. W. Larson 1990 , Sander et al. 2017 , Lansford et al. 1998 )—effects that may be amplified in more recent cohorts, which tend to allocate less time to face-to-face social interaction and experience elevated levels of loneliness ( Twenge et al. 2019 ). Many middle-aged and older adults report that they have no confidant ( McPherson and Smith-Lovin 2006 ), depriving them of the emotional benefits of close companions. This is likely to be exacerbated among individuals with elevated levels of social anxiety, who are less likely to have close friends and more likely to be unmarried by mid-life ( Davidson et al. 1994 , Montgomery et al. 1991 , La Greca and Lopez 1998 ). Extending the present approach to earlier and later developmental periods is an important challenge for future research, and prospective-longitudinal studies are likely to be especially fruitful.

Social anxiety is often cast as an increased sensitivity to scrutiny from others, especially unfamiliar others, which manifests as heightened avoidance, fear (‘phobia’), and anxiety ( American Psychiatric Association 2013 ). The present results underscore the need to broaden this perspective. As indexed by EMA, social anxiety was unrelated to the amount of time spent with distant companions. Moreover, socially anxious individuals did not experience heightened NA in the presence of distant companions ( Table 1 and Figure 4 ). This suggests that, in the absence of clear signs of rejection, scrutiny, or threat, socially anxious individuals tend to show normative emotional responses to distant companions. Another possibility is that hyper-reactivity to strangers is specific to pathological levels of social anxiety or is only evident in a subset of socially anxious individuals. Adjudicating between these accounts represents another important avenue for future research.

From a clinical perspective, these observations suggest that naturally occurring social relationships are a potentially important target for intervention. Existing treatments for social anxiety typically focus on the individual, but our results highlight the value of simultaneously considering the role of close companions and developing supplementary interventions to enhance social connection, acceptance, and support. This could take the form of nurturing social-cognitive skills (e.g., emotional disclosure), cultivating stronger and more frequent ties with existing companions and social networks (e.g., via behavioral activation approaches), or reducing maladaptive thoughts and behaviors (e.g., neediness, overreliance) that promote conflict and rejection ( Masi et al. 2011 , Cacioppo et al. 2015 , Kok and Singer 2017 ). The development of smartphone-based interventions would provide a scalable and cost-effective alternative to more traditional modalities—already, 77% of U.S. adults, and 94% of U.S. adults aged 18–29 own a smartphone ( Pew Research Center 2018 ). Mobile applications may be especially effective for individuals who are unable or unwilling to use traditional care delivery systems and for subclinical presentations of social anxiety that do not warrant resource-intensive treatments ( Ruscio 2019 ). Regardless of delivery method, intervention research would also provide a crucial opportunity for testing the causal contribution of close companions to the everyday experience of social anxiety.

Our results highlight some additional avenues for future research. To understand the generalizability of our inferences, it will be useful to extend the present approach to larger and more representative samples and to populations with more severe symptoms, distress, and impairment. Future EMA studies may benefit from using larger sampling windows or selectively targeting periods of increased stress or disrupted social intimacy (e.g., transition from high school or university, or from university to full-time work) in order to capture a wider range of social interactions and their association with momentary affect. It will also be helpful to examine the nature and quality of naturalistic social interactions—including momentary perceptions of social connection, emotional support, and conflict—in more detail using either EMA (e.g., context- or event-triggered) or behavioral observations. Developing a clearer understanding of the processes that promote heightened levels of NA during periods of solitude—when both social support and social threat are absent ( Figure 4 )—is also likely to be fruitful ( Shackman et al. 2016 ).

In sum, the present study suggests that close companions play an important role in the momentary experience of socially anxious young adults. The use of well-established techniques for intensive EMA and a relatively large sample selectively recruited from a pool of more than 6,000 young adults increases our confidence in the reproducibility and translational relevance of these findings. These results set the stage for developing improved strategies for treating or preventing the sequelae of extreme social anxiety.

Supplementary Material

Acknowledgements.

The authors acknowledge the assistance of C. Garbin, L. Friedman, R. Tillman, and members of the Affective and Translational Neuroscience laboratory and constructive feedback from four anonymous reviewers and K. Rubin. This work was supported by the National Institutes of Health (DA040717, MH107444) and University of Maryland. Authors declare no conflicts of interest.

ETHICAL STANDARDS

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

DATA SHARING

Raw data have been or will be made available via the National Institute of Mental Health’s RDoC Database ( https://data-archive.nimh.nih.gov/rdocdb ).

1. The mean and dispersion of the present sample is similar to that of unselected individuals drawn from the same university population. For example, exploratory analyses of data collected as part of the University of Maryland Department of Psychology’s on-line survey during the 2015–2018 academic years ( N = 1,596) revealed that among the subset of respondents 18–19 years old, women reported significantly greater social anxiety ( N = 601, M = 46.8, SD = 23.2) than men ( N = 229, M = 40.3, SD = 22.7), t = 3.67, p = .001. When the on-line survey data were adjusted to reflect the percentage of women in the EMA study (51.3%), the resulting weighted distribution ( M = 43.6, Range = 2–122) was similar to the present EMA sample ( M = 41.7, Range = 1–121).

2. For descriptive purposes, depression was assessed using the General Depression subscale of the revised Inventory of Depression and Anxiety Symptoms (IDAS-II) Watson, D., O’Hara, M. W., Naragon-Gainey, K., Koffel, E., Chmielewski, M., Kotov, R., Stasik, S. M. and Ruggero, C. J. (2012) ‘Development and validation of new anxiety and bipolar symptom scales for an expanded version of the IDAS (the IDAS-II)’, Assessment, 19, 399–420.. As expected, levels of depression were somewhat elevated in the present sample ( M = 39.9, SD = 12.8), which corresponds to the 60 th percentile in U.S. normative data Nelson, G. H., O’Hara, M. W. and Watson, D. (2018) ‘National norms for the expanded version of the inventory of depression and anxiety symptoms (IDAS-II)’, J Clin Psychol, 74, 953–968..

3. Similar results were obtained for the model using the log-transformed NA scores as a DV (not reported).

4. The zero-order correlation between self-reported social network size and the proportion of momentary assessments completed in the presence of close companions was r = .29, p < .001.

5. Although the complementary pattern ( elevated social anxiety → fewer confidants → greater solitude ) was evident for a model focused on time spent alone, we refrain from reporting or interpreting it, given the strong dependency between time allocated to close companions vs. solitude. That is, social contexts were mutually exclusive ( Figure 2 ), and most assessments were completed either in the presence of close companions or alone. From this perspective, the results of the ‘alone’ model are almost entirely predictable knowing the results of the ‘close companions’ model.

6. Momentary NA and PA were negatively correlated within momentary assessments ( t = −18.7, b = −.26, SE = .014, p < .001).

7. It also remained significant when controlling for variation in depressive symptoms, indexed using the General Depression subscale of the IDAS-II (Social Anxiety × Close-Alone, t = −2.28, b = −.03, SE = .012, p = .02).

• Acarturk C, Cuijpers P, Van Straten A and De Graaf R (2009) ‘ Psychological treatment of social anxiety disorder: a meta-analysis ’, Psychol Med , 39 ( 2 ), 241–254. [ PubMed ] [ Google Scholar ]
• Afram A and Kashdan TB (2015) ‘ Coping with rejection concerns in romantic relationships: An experimental investigation of social anxiety and risk regulation ’, Journal of Contextual Behavioral Science , 4 ( 3 ), 151–156. [ Google Scholar ]
• Alden LE and Taylor CT (2004) ‘ Interpersonal processes in social phobia ’, Clin Psychol Rev , 24 ( 7 ), 857–882. [ PubMed ] [ Google Scholar ]
• Alden LE and Wallace ST (1995) ‘ Social phobia and social appraisal in successful and unsuccessful social interactions ’, Behaviour Research and Therapy , 33 ( 5 ), 497–505. [ PubMed ] [ Google Scholar ]
• Alloy LB and Abramson LY (1999) ‘ The Temple-Wisconsin Cognitive Vulnerability to Depression Project: Conceptual background, design, and methods ’, Journal of Cognitive Psychotherapy , 13 , 227–62. [ Google Scholar ]
• American College Health Association (2016) American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2015 Hanover, MD: American College Health Association. [ Google Scholar ]
• American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5) , Washington, DC: American Psychiatric Publishing. [ Google Scholar ]
• Anderson ER and Hope DA (2008) ‘ A review of the tripartite model for understanding the link between anxiety and depression in youth ’, Clin Psychol Rev , 28 ( 2 ), 275–287. [ PubMed ] [ Google Scholar ]
• APA (2013) Diagnostic and statistical manual of mental disorders (DSM-5®) , American Psychiatric Pub. [ PubMed ] [ Google Scholar ]
• Arnett JJ (2000) ‘ Emerging adulthood. A theory of development from the late teens through the twenties ’, Am Psychol , 55 , 469–80. [ PubMed ] [ Google Scholar ]
• Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, Hwang I, Kessler RC, Liu H, Mortier P, Nock MK, Pinder-Amaker S, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Benjet C, Caldas-de-Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, Karam EG, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, O’Neill S, Pennell BE, Scott K, Ten Have M, Torres Y, Zaslavsky AM, Zarkov Z and Bruffaerts R (2016) ‘ Mental disorders among college students in the World Health Organization World Mental Health Surveys ’, Psychol Med , 46 , 1–16. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Auerbach RP, Mortier P, Bruffaerts R, Alonso J, Benjet C, Cuijpers P, Demyttenaere K, Ebert DD, Green JG, Hasking P, Murray E, Nock MK, Pinder-Amaker S, Sampson NA, Stein DJ, Vilagut G, Zaslavsky AM, Kessler RC and Collaborators WW-I (in press) ‘ WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders ’, J Abnorm Psychol . [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Barrett LF (1997) ‘ The relationships among momentary emotion experiences, personality descriptions, and retrospective ratings of emotion ’, Personality and Social Psychology Bulletin , 23 ( 10 ), 1100–1110. [ Google Scholar ]
• Batelaan NM, Bosman RC, Muntingh A, Scholten WD, Huijbregts KM and van Balkom A (2017) ‘ Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials ’, BMJ , 358 , j3927. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Baucom DH, Belus JM, Adelman CB, Fischer MS and Paprocki C (2014) ‘ Couple-based interventions for psychopathology: a renewed direction for the field ’, Fam Process , 53 , 445–61. [ PubMed ] [ Google Scholar ]
• Beck JG, Davila J, Farrow S and Grant D (2006) ‘ When the heat is on: Romantic partner responses influence distress in socially anxious women ’, Behaviour Research and Therapy , 44 ( 5 ), 737–748. [ PubMed ] [ Google Scholar ]
• Beidel DC, Turner SM and Morris TL (1999) ‘ Psychopathology of childhood social phobia ’, Journal of the American Academy of Child & Adolescent Psychiatry , 38 ( 6 ), 643–650. [ PubMed ] [ Google Scholar ]
• Berry DS and Hansen JS (1996) ‘ Positive affect, negative affect, and social interaction ’, Journal of Personality and Social Psychology , 71 ( 4 ), 796. [ Google Scholar ]
• Bolger N and Eckenrode J (1991) ‘ Social relationships, personality, and anxiety during a major stressful event ’, J Pers Soc Psychol , 61 , 440–9. [ PubMed ] [ Google Scholar ]
• Boukhechba M, Chow P, Fua K, Teachman BA and Barnes LE (2018) ‘ Predicting Social Anxiety From Global Positioning System Traces of College Students: Feasibility Study ’, JMIR mental health , 5 ( 3 ). [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, Shea MT and Keller MB (2005) ‘ Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study ’, Am J Psychiatry , 162 , 1179–87. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bullock JG, Green DP and Ha SE (2010) ‘ Yes, but what’s the mechanism? (don’t expect an easy answer) ’, J Pers Soc Psychol , 98 , 550–8. [ PubMed ] [ Google Scholar ]
• Buote VM, Pancer SM, Pratt MW, Adams G, Birnie-Lefcovitch S, Polivy J and Wintre MG (2007) ‘ The importance of friends. Friendship and adjustment among 1st-year university students ’, Journal of Adolescent Research , 22 , 665–89. [ Google Scholar ]
• Cacioppo S, Grippo AJ, London S, Goossens L and Cacioppo JT (2015) ‘ Loneliness: clinical import and interventions ’, Perspect Psychol Sci , 10 , 238–49. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Carter MM, Hollon SD, Carson RE and Shelton RC (1995) ‘ Effects of a safe person on induced distress following a biological challenge in panic disorder with agoraphobia ’, Journal of Abnormal Psychology , 104 , 156–63. [ PubMed ] [ Google Scholar ]
• Chow PI, Fua K, Huang Y, Bonelli W, Xiong H, Barnes LE and Teachman BA (2017) ‘ Using mobile sensing to test clinical models of depression, social anxiety, state affect, and social isolation among college students ’, Journal of medical Internet research , 19 ( 3 ). [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Coan JA and Sbarra DA (2015) ‘ Social baseline theory: The social regulation of risk and effort ’, Curr Opin Psychol , 1 , 87–91. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Coles ME, Turk CL and Heimberg RG (2002) ‘ The role of memory perspective in social phobia: Immediate and delayed memories for role-played situations ’, Behavioural and Cognitive Psychotherapy , 30 ( 4 ), 415–425. [ Google Scholar ]
• Conway CC, Forbes MK, Forbush KT, Fried EI, Hallquist MN, Kotov R, Mullins-Sweatt SN, Shackman AJ, Skodol AE, South SC, Sunderland M, Waszczuk MA, Zald DH, Afzali MH, Bornovalova MA, Carragher N, Docherty AR, Jonas KG, Krueger RF, Patalay P, Pincus AL, Tackett JL, Reininghaus U, Waldman ID, Wright AGC, Zimmerman J, Bach B, Bagby RM, Chmielewski M, Cicero DC, Clark LA, Dalgleish T, DeYoung CG, Hopwood CJ, Ivanova MY, Latzman RD, Patrick CJ, Ruggero CJ, Samuel DB, Watson D and Eaton NR (2019) ‘ A Hierarchical Taxonomy of Psychopathology can reform mental health research ’, Perspectives on psychological science , 14 , 419–436. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Cottrell NB and Epley SW (1977) ‘Affiliation, social comparison, and socially mediated stress reduction’ in Suls JM and Miller RL, eds., Social comparison processes: Theoretical and empirical perspectives , Washington, DC: Hemisphere, 43–68. [ Google Scholar ]
• Craske MG, Stein MB, Eley TC, Milad MR, Holmes A, Rapee RM and Wittchen H-U (2017) ‘ Anxiety disorders ’, Nature Reviews Disease Primers , 3 , 17024. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Creed A and Funder D (1998) ‘ Social anxiety: From the inside and outside ’, Personality and Individual Differences , 25 ( 1 ), 19–33. [ Google Scholar ]
• Crişan LG, Vulturar R, Miclea M and Miu AC (2016) ‘ reactivity to social stress in subclinical social anxiety: emotional experience, cognitive appraisals, Behavior, and Physiology ’, Front Psychiatry , 7 , 5. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Csikszentmihalyi M, Mehl MR and Conner TS (2013) Handbook of research methods for studying daily life , New York, NY: Guilford. [ Google Scholar ]
• Cuming S and Rapee RM (2010) ‘ Social anxiety and self-protective communication style in close relationships ’, Behaviour Research and Therapy , 48 ( 2 ), 87–96. [ PubMed ] [ Google Scholar ]
• Darcy K, Davila J and Beck JG (2005) ‘ Is social anxiety associated with both interpersonal avoidance and interpersonal dependence? ’, Cognit Ther Res , 29 ( 2 ), 171–186. [ Google Scholar ]
• Davidson JR, Hughes DC, George LK and Blazer DG (1994) ‘ The boundary of social phobia: Exploring the threshold ’, Archives of General Psychiatry , 51 ( 12 ), 975–983. [ PubMed ] [ Google Scholar ]
• Davila J and Beck JG (2002) ‘ Is social anxiety associated with impairment in close relationships? A preliminary investigation ’, Behav Ther , 33 ( 3 ), 427–446. [ Google Scholar ]
• Diener E and Seligman ME (2002) ‘ Very happy people ’, Psychol Sci , 13 , 81–4. [ PubMed ] [ Google Scholar ]
• Diener E, Seligman MEP, Choi H and Oishi S (2018) ‘ Happiest People Revisited ’, Perspect Psychol Sci , 13 , 176–184. [ PubMed ] [ Google Scholar ]
• Fox AS and Shackman AJ (2018) ‘How are emotions embodied in the social world’ in Fox AS, Lapate RC, Shackman AJ and Davidson RJ, eds., The nature of emotion. Fundamental questions , 2nd ed., New York, NY: Oxford University Press, 237–239. [ Google Scholar ]
• Freberg K, Adams R, McGaughey K and Freberg L (2010) ‘ The rich get richer: Online and offline social connectivity predicts subjective loneliness ’, Media Psychology Review , 3 , n.p. [ Google Scholar ]
• Frenkel TI, Fox NA, Pine DS, Walker OL, Degnan KA and Chronis-Tuscano A (2015) ‘ Early childhood behavioral inhibition, adult psychopathology and the buffering effects of adolescent social networks: a twenty-year prospective study ’, J Child Psychol Psychiatry , 56 , 1065–73. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Geyer EC, Fua KC, Daniel KE, Chow PI, Bonelli W, Huang Y, Barnes LE and Teachman BA (2018) ‘ I Did OK, but Did I Like It? Using Ecological Momentary Assessment to Examine Perceptions of Social Interactions Associated With Severity of Social Anxiety and Depression ’, Behav Ther . [ PubMed ] [ Google Scholar ]
• Global Burden of Disease Collaborators (2016) ‘ Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 ’, Lancet , 388 , 1545–1602. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Gordon JA and Redish AD (2016) ‘On the cusp. Current challenges and promises in psychiatry’ in Redish AD and Gordon JA, eds., Computational psychiatry: New perspectives on mental illness , Cambridge, MA: MIT Press, 3–14. [ Google Scholar ]
• Granovetter MS (1973) ‘ The strength of weak ties ’, American Journal of Sociology , 78 , 1360–1380. [ Google Scholar ]
• Green DP, Ha SE and Bullock JG (2010) ‘ Enough already about “black box” experiments: Studying mediation is more difficult than most scholars suppose ’, Annals of the American Academy of Political and Social Science , 628 , 200–208. [ Google Scholar ]
• Grosse Rueschkamp JM, Kuppens P, Riediger M, Blanke ES and Brose A (in press) ‘ Higher well-being is related to reduced affective reactivity to positive events in daily life ’, Emotion . [ PubMed ] [ Google Scholar ]
• Hayes AF (2017) Introduction to mediation, moderation, and conditional process analysis: A regression-based approach , 2nd ed, New York, NY: Guilford. [ Google Scholar ]
• Hays RB and Oxley D (1986) ‘ Social network development and functioning during a life transition ’, J Pers Soc Psychol , 50 , 305–13. [ PubMed ] [ Google Scholar ]
• Heerey EA and Kring AM (2007) ‘ Interpersonal consequences of social anxiety ’, Journal of Abnormal Psychology , 116 ( 1 ), 125. [ PubMed ] [ Google Scholar ]
• Heimberg RG, Hofmann SG, Liebowitz MR, Schneier FR, Smits JA, Stein MB, Hinton DE and Craske MG (2014) ‘ Social anxiety disorder in DSM‐5 ’, Depression and Anxiety , 31 ( 6 ), 472–479. [ PubMed ] [ Google Scholar ]
• Hofmann W and Patel PV (2015) ‘ SurveySignal: A convenient solution for experience sampling research using participants’ own smartphones ’, Social Science Computer Review , 33 ( 2 ), 235–253. [ Google Scholar ]
• Hur J, Stockbridge MD, Fox AS and Shackman AJ (in press) ‘ Dispositional negativity, cognition, and anxiety disorders: An integrative translational neuroscience framework ’, Progress in brain research . [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kashdan TB (2004) ‘ The neglected relationship between social interaction anxiety and hedonic deficits: Differentiation from depressive symptoms ’, J Anxiety Disord , 18 ( 5 ), 719–730. [ PubMed ] [ Google Scholar ]
• Kashdan TB and Collins RL (2010) ‘ Social anxiety and the experience of positive emotion and anger in everyday life: An ecological momentary assessment approach ’, Anxiety, Stress, & Coping , 23 ( 3 ), 259–272. [ PubMed ] [ Google Scholar ]
• Kashdan TB, Farmer AS, Adams LM, Ferssizidis P, McKnight PE and Nezlek JB (2013a) ‘ Distinguishing healthy adults from people with social anxiety disorder: Evidence for the value of experiential avoidance and positive emotions in everyday social interactions ’, Journal of Abnormal Psychology , 122 ( 3 ), 645. [ PubMed ] [ Google Scholar ]
• Kashdan TB, Ferssizidis P, Farmer AS, Adams LM and McKnight PE (2013b) ‘ Failure to capitalize on sharing good news with romantic partners: Exploring positivity deficits of socially anxious people with self-reports, partner-reports, and behavioral observations ’, Behaviour Research and Therapy , 51 ( 10 ), 656–668. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kashdan TB and Roberts JE (2004) ‘ Social anxiety’s impact on affect, curiosity, and social self-efficacy during a high self-focus social threat situation ’, Cognit Ther Res , 28 ( 1 ), 119–141. [ Google Scholar ]
• Kashdan TB and Roberts JE (2006) ‘ Affective outcomes in superficial and intimate interactions: Roles of social anxiety and curiosity ’, Journal of Research in Personality , 40 ( 2 ), 140–167. [ Google Scholar ]
• Kashdan TB and Roberts JE (2007) ‘ Social anxiety, depressive symptoms, and post-event rumination: Affective consequences and social contextual influences ’, J Anxiety Disord , 21 ( 3 ), 284–301. [ PubMed ] [ Google Scholar ]
• Kashdan TB and Steger MF (2006) ‘ Expanding the topography of social anxiety: An experience-sampling assessment of positive emotions, positive events, and emotion suppression ’, Psychol Sci , 17 ( 2 ), 120–128. [ PubMed ] [ Google Scholar ]
• Kashdan TB, Weeks JW and Savostyanova AA (2011) ‘ Whether, how, and when social anxiety shapes positive experiences and events: A self-regulatory framework and treatment implications ’, Clin Psychol Rev , 31 ( 5 ), 786–799. [ PubMed ] [ Google Scholar ]
• Katzelnick DJ, Kobak KA, DeLeire T, Henk HJ, Greist JH, Davidson JR, Schneier FR, Stein MB and Helstad CP (2001) ‘ Impact of generalized social anxiety disorder in managed care ’, Am J Psychiatry , 158 , 1999–2007. [ PubMed ] [ Google Scholar ]
• Kendler KS and Gardner CO (2014) ‘ Sex differences in the pathways to major depression: a study of opposite-sex twin pairs ’, Am J Psychiatry , 171 , 426–35. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kendler KS, Myers J and Prescott CA (2005) ‘ Sex differences in the relationship between social support and risk for major depression: a longitudinal study of opposite-sex twin pairs ’, American Journal of Psychiatry , 162 ( 2 ), 250–256. [ PubMed ] [ Google Scholar ]
• Kessler RC (2003) ‘ The impairments caused by social phobia in the general population: implications for intervention ’, Acta Psychiatr Scand , 108 ( Suppl. 417 ), 19–27. [ PubMed ] [ Google Scholar ]
• Kocalevent RD, Berg L, Beutel ME, Hinz A, Zenger M, Harter M, Nater U and Brahler E (2018) ‘ Social support in the general population: standardization of the Oslo social support scale (OSSS-3) ’, BMC Psychol , 6 , 31. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kok BE and Singer T (2017) ‘ Effects of contemplative dyads on engagement and perceived social connectedness over 9 months of mental training: A randomized clinical trial ’, JAMA Psychiatry , 74 , 126–134. [ PubMed ] [ Google Scholar ]
• Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, Simms LJ, Widiger TA, Achenbach TM, Bach B, Bagby RM, Bornovalova MA, Carpenter WT, Chmielewski M, Cicero D, Clark LA, Conway C, DeClercq B, DeYoung CG, Docherty AR, Drislane LE, First MB, Forbush KT, Hallquist M, Haltigan JD, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patalay P, Patrick CJ, Pincus AL, Regier DA, Reininghaus U, Rescorla LA, Samuel DB, Sellbom M, Shackman AJ, Skodol A, Slade T, South SC, Sunderland M, Tackett JL, Venables NC, Waldman ID, Waszczuk MA, Waugh MH, Wright AGC, Zald DH and Zimmerman J (2018) ‘ Progress in achieving empirical classification of psychopathology ’, World Psychiatry , 17 , 282–293. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• La Greca AM and Lopez N (1998) ‘ Social anxiety among adolescents: Linkages with peer relations and friendships ’, Journal of Abnormal Child Psychology , 26 , 83–94. [ PubMed ] [ Google Scholar ]
• Ladd GW, Kochenderfer-Ladd B, Eggum ND, Kochel KP and McConnell EM (2011) ‘ Characterizing and comparing the friendships of anxious-solitary and unsociable preadolescents ’, Child development , 82 , 1434–53. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lamers F, Swendsen J, Cui L, Husky M, Johns J, Zipunnikov V and Merikangas KR (2018) ‘ Mood reactivity and affective dynamics in mood and anxiety disorders ’, Journal of Abnormal Psychology , 127 ( 7 ), 659. [ PubMed ] [ Google Scholar ]
• Lansford JE, Sherman AM and Antonucci TC (1998) ‘ Satisfaction with social networks: an examination of socioemotional selectivity theory across cohorts ’, Psychol Aging , 13 , 544–52. [ PubMed ] [ Google Scholar ]
• Larson RW (1990) ‘ The solitary side of life: An examination of the time people spend alone from childhood to old age ’, Developmental review , 10 ( 2 ), 155–183. [ Google Scholar ]
• Larson RW (1990) ‘ The solitary side of life: An examination of the time people spend alone from childhood to old age ’, Developmental Review , 1990 ( 10 ). [ Google Scholar ]
• Lay JC, Gerstorf D, Scott SB, Pauly T and Hoppmann CA (2017) ‘ Neuroticism and extraversion magnify discrepancies between retrospective and concurrent affect reports ’, Journal of Personality , 85 ( 6 ), 817–829. [ PubMed ] [ Google Scholar ]
• Liebowitz MR (1987) ‘ Social phobia’ in Modern Problems in Pharmacopsychiatry , Karger Publishers, 141–173. [ PubMed ] [ Google Scholar ]
• Lim MH, Rodebaugh TL, Zyphur MJ and Gleeson JF (2016) ‘ Loneliness over time: The crucial role of social anxiety ’, J Abnorm Psychol , 125 ( 5 ), 620–30. [ PubMed ] [ Google Scholar ]
• Lipsitz JD and Schneier FR (2000) ‘ Social phobia. Epidemiology and cost of illness ’, Pharmacoeconomics , 18 , 23–32. [ PubMed ] [ Google Scholar ]
• Lipson SK, Lattie EG and Eisenberg D (in press) ‘ Increased rates of mental health service utilization by U.S. college students: 10-Year population-level trends (2007–2017) ’, Psychiatr Serv , appips201800332. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Maresh EL, Beckes L and Coan JA (2013) ‘ The social regulation of threat-related attentional disengagement in highly anxious individuals ’, Frontiers in human neuroscience , 7 , 515. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Markovic A and Bowker JC (2017) ‘ Friends also matter: Examining friendship adjustment indices as moderators of anxious-withdrawal and trajectories of change in psychological maladjustment ’, Psychiatr Serv , 53 , 1462–1473. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Marroquin B (2011) ‘ Interpersonal emotion regulation as a mechanism of social support in depression ’, Clin Psychol Rev , 31 , 1276–90. [ PubMed ] [ Google Scholar ]
• Masi CM, Chen HY, Hawkley LC and Cacioppo JT (2011) ‘ A meta-analysis of interventions to reduce loneliness ’, Pers Soc Psychol Rev , 15 , 219–66. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mathew AR, Pettit JW, Lewinsohn PM, Seeley JR and Roberts RE (2011) ‘ Co-morbidity between major depressive disorder and anxiety disorders: shared etiology or direct causation? ’, Psychol Med , 41 , 2023–34. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• McPherson M and Smith-Lovin L (2006) ‘ Social isolation in America: Changes in core discussion networks over two decades ’, Am Sociol Rev , 71 , 353–75. [ Google Scholar ]
• Meleshko KG and Alden LE (1993) ‘ Anxiety and self-disclosure: toward a motivational model ’, Journal of Personality and Social Psychology , 64 ( 6 ), 1000. [ PubMed ] [ Google Scholar ]
• Merikangas KR, Avenevoli S, Acharyya S, Zhang H and Angst J (2002) ‘ The spectrum of social phobia in the Zurich cohort study of young adults ’, Biological psychiatry , 51 ( 1 ), 81–91. [ PubMed ] [ Google Scholar ]
• Montgomery RL, Haemmerlie FM and Edwards M (1991) ‘ Social, personal, and interpersonal deficits in socially anxious people ’, Journal of Social Behavior and Personality , 6 ( 4 ), 859. [ Google Scholar ]
• Morgan JK, Lee GE, Wright AG, Gilchrist DE, Forbes EE, McMakin DL, Dahl RE, Ladouceur CD, Ryan ND and Silk JS (2017) ‘ Altered positive affect in clinically anxious youth: the role of social context and anxiety subtype ’, J Abnorm Child Psychol , 45 ( 7 ), 1461–1472. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Myers DG (1999) ‘Close relationships and quality of life’ in Kahneman D, Diener E and Schwartz N, eds., Well-being , NY: Sage, 374–391. [ Google Scholar ]
• Narr RK, Allen JP, Tan JS and Loeb EL (2019) ‘ Close friendship strength and broader peer group desirability as differential predictors of adult mental health ’, Child Dev , 90 , 298–313. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nelson GH, O’Hara MW and Watson D (2018) ‘ National norms for the expanded version of the inventory of depression and anxiety symptoms (IDAS-II) ’, J Clin Psychol , 74 , 953–968. [ PubMed ] [ Google Scholar ]
• Neubauer K, von Auer M, Murray E, Petermann F, Helbig-Lang S and Gerlach AL (2013) ‘ Internet-delivered attention modification training as a treatment for social phobia: A randomized controlled trial ’, Behaviour Research and Therapy , 51 ( 2 ), 87–97. [ PubMed ] [ Google Scholar ]
• Oishi S, Diener E and Lucas RE (2007) ‘ The optimum level of well-being: Can people be too happy? ’, Perspect Psychol Sci , 2 , 346–60. [ PubMed ] [ Google Scholar ]
• Olatunji BO, Cisler JM and Tolin DF (2007) ‘ Quality of life in the anxiety disorders: a meta-analytic review ’, Clin Psychol Rev , 27 ( 5 ), 572–581. [ PubMed ] [ Google Scholar ]
• Palmier‐Claus JE, Myin‐Germeys I, Barkus E, Bentley L, Udachina A, Delespaul P, Lewis SW and Dunn G (2011) ‘ Experience sampling research in individuals with mental illness: reflections and guidance ’, Acta Psychiatr Scand , 123 ( 1 ), 12–20. [ PubMed ] [ Google Scholar ]
• Pancer SM, Hunsberger B, Pratt MW and Alisat S (2000) ‘ Cognitive complexity of expectations and adjustment to university in the first year ’, Journal of Adolescent Research , 15 , 38–57. [ Google Scholar ]
• Pew Research Center (2018) ‘ Mobile fact sheet ’, [online], available: http://www.pewinternet.org/fact-sheet/mobile/ [accessed
• Phillips ND (2017) ‘ YaRrr! The pirate’s guide to R ’, APS Observer , 30 , 22–23. [ Google Scholar ]
• Pontari BA (2009) ‘ Appearing socially competent: The effects of a friend’s presence on the socially anxious ’, Personality and Social Psychology Bulletin , 35 ( 3 ), 283–294. [ PubMed ] [ Google Scholar ]
• Ramsey MA and Gentzler AL (2015) ‘ An upward spiral: Bidirectional associations between positive affect and positive aspects of close relationships across the life span ’, Developmental review , 36 , 58–104. [ Google Scholar ]
• Rapaport MH, Clary C, Fayyad R and Endicott J (2005) ‘ Quality-of-life impairment in depressive and anxiety disorders ’, American Journal of Psychiatry , 162 ( 6 ), 1171–1178. [ PubMed ] [ Google Scholar ]
• Rapee RM, Peters L, Carpenter L and Gaston JE (2015) ‘ The Yin and Yang of support from significant others: Influence of general social support and partner support of avoidance in the context of treatment for social anxiety disorder ’, Behav Res Ther , 69 , 40–7. [ PubMed ] [ Google Scholar ]
• Rapee RM and Spence SH (2004) ‘ The etiology of social phobia: Empirical evidence and an initial model ’, Clin Psychol Rev , 24 ( 7 ), 737–767. [ PubMed ] [ Google Scholar ]
• Raudenbush SW and Bryk AS (2002) Hierarchical linear models. Applications and data analysis methods , 2nd ed, Thousand Oakes, CA: Sage. [ Google Scholar ]
• Reeck C, Ames DR and Ochsner KN (2016) ‘ The social regulation of emotion: An integrative, cross-disciplinary model ’, Trends Cogn Sci , 20 , 47–63. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rehman US, Gollan J and Mortimer AR (2008) ‘ The marital context of depression: research, limitations, and new directions ’, Clin Psychol Rev , 28 , 179–98. [ PubMed ] [ Google Scholar ]
• Rhebergen D, Batelaan NM, de Graaf R, Nolen WA, Spijker J, Beekman AT and Penninx BW (2011) ‘ The 7-year course of depression and anxiety in the general population ’, Acta Psychiatr Scand , 123 , 297–306. [ PubMed ] [ Google Scholar ]
• Rime B (2009) ‘ Emotion elicits the social sharing of emotion: Theory and empirical review ’, Emotion Review , 1 , 60–85. [ Google Scholar ]
• Rodebaugh TL (2009) ‘ Social phobia and perceived friendship quality ’, J Anxiety Disord , 23 , 872–8. [ PubMed ] [ Google Scholar ]
• Rodebaugh TL, Holaway RM and Heimberg RG (2004) ‘ The treatment of social anxiety disorder ’, Clin Psychol Rev , 24 ( 7 ), 883–908. [ PubMed ] [ Google Scholar ]
• Rodebaugh TL, Lim MH, Shumaker EA, Levinson CA and Thompson T (2015) ‘ Social anxiety and friendship quality over time ’, Cogn Behav Ther , 44 , 502–11. [ PubMed ] [ Google Scholar ]
• Rogers AA, Updegraff KA, Iida M, Dishion TJ, Doane LD, Corbin WC, Van Lenten SA and Ha T (2018) ‘ Trajectories of positive and negative affect across the transition to college: The role of daily interactions with parents and friends ’, Dev Psychol , 54 , 2181–2192. [ PubMed ] [ Google Scholar ]
• Rottenberg J (2017) ‘ Emotions in depression: What do we really know? ’, Annu Rev Clin Psychol , 13 , 241–263. [ PubMed ] [ Google Scholar ]
• Rubin KH, Barstead MG, Smith KA and Bowker JC (2018) ‘Peer relations and the behaviorally inhibited child’ in Pérez-Edgar K and Fox NA, eds., Behavioral inhibition: Integrating theory, research, and clinical perspectives , Cham, Switzerland: Springer International Publishing, 157–184. [ Google Scholar ]
• Ruscio AM (2019) ‘ Normal versus pathological mood: Implications for diagnosis ’, Annu Rev Clin Psychol , 15 , 179–205. [ PubMed ] [ Google Scholar ]
• Russell GS and Shaw S (2009) ‘ A study to investigate the prevalence of social anxiety in a sample of higher education students in the United Kingdom ’, Journal of Mental Health , 18 , 198–206. [ Google Scholar ]
• Sander J, Schupp J and Richter D (2017) ‘ Getting together: Social contact frequency across the life span ’, Dev Psychol , 53 , 1571–1588. [ PubMed ] [ Google Scholar ]
• Sarason IG, Levine HM, Basham RB and Sarason BR (1983) ‘ Assessing social support: The social support questionnaire ’, Journal of Personality and Social Psychology , 44 , 127–139. [ Google Scholar ]
• Schneier FR, Johnson J, Hornig CD, Liebowitz MR and Weissman MM (1992) ‘ Social phobia: comorbidity and morbidity in an epidemiologic sample ’, Archives of General Psychiatry , 49 ( 4 ), 282–288. [ PubMed ] [ Google Scholar ]
• Scholten WD, Batelaan NM, Penninx BW, van Balkom AJ, Smit JH, Schoevers RA and van Oppen P (2016) ‘ Diagnostic instability of recurrence and the impact on recurrence rates in depressive and anxiety disorders ’, J Affect Disord , 195 , 185–90. [ PubMed ] [ Google Scholar ]
• Scholten WD, Batelaan NM, van Balkom AJ, Wjh Penninx B, Smit JH and van Oppen P (2013) ‘ Recurrence of anxiety disorders and its predictors ’, J Affect Disord , 147 , 180–5. [ PubMed ] [ Google Scholar ]
• Shackman AJ, Tromp DPM, Stockbridge MD, Kaplan CM, Tillman RM and Fox AS (2016) ‘ Dispositional negativity: An integrative psychological and neurobiological perspective ’, Psychological bulletin , 142 , 1275–1314. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Shackman AJ, Weinstein JS, Hudja SN, Bloomer CD, Barstead MG, Fox AS and Lemay EP Jr. (2018) ‘ Dispositional negativity in the wild: Social environment governs momentary emotional experience ’, Emotion , 18 , 707–724. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Shiffman S, Stone AA and Hufford MR (2008) ‘ Ecological momentary assessment ’, Annu Rev Clin Psychol , 4 , 1–32. [ PubMed ] [ Google Scholar ]
• Sparrevohn RM and Rapee RM (2009) ‘ Self-disclosure, emotional expression and intimacy within romantic relationships of people with social phobia ’, Behaviour Research and Therapy , 47 ( 12 ), 1074–1078. [ PubMed ] [ Google Scholar ]
• Spinhoven P, Batelaan N, Rhebergen D, van Balkom A, Schoevers R and Penninx BW (2016) ‘ Prediction of 6-yr symptom course trajectories of anxiety disorders by diagnostic, clinical and psychological variables ’, J Anxiety Disord , 44 , 92–101. [ PubMed ] [ Google Scholar ]
• Spoozak L, Gotman N, Smith MV, Belanger K and Yonkers KA (2009) ‘ Evaluation of a social support measure that may indicate risk of depression during pregnancy ’, J Affect Disord , 114 ( 1–3 ), 216–223. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Starr LR and Davila J (2008) ‘ Differentiating interpersonal correlates of depressive symptoms and social anxiety in adolescence: implications for models of comorbidity ’, J Clin Child Adolesc Psychol , 37 , 337–49. [ PubMed ] [ Google Scholar ]
• Stein DJ, Lim CCW, Roest AM, de Jonge P, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bromet EJ, Bruffaerts R, de Girolamo G, Florescu S, Gureje O, Haro JM, Harris MG, He Y, Hinkov H, Horiguchi I, Hu C, Karam A, Karam EG, Lee S, Lepine JP, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Ten Have M, Torres Y, Viana MC, Wojtyniak B, Xavier M, Kessler RC, Scott KM and Collaborators WHOWMHS (2017) ‘ The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative ’, BMC Med , 15 , 143. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Stein MB and Kean YM (2000) ‘ Disability and quality of life in social phobia: epidemiologic findings ’, American Journal of Psychiatry , 157 ( 10 ), 1606–1613. [ PubMed ] [ Google Scholar ]
• Stout DM, Shackman AJ, Pedersen WS, Miskovich TA and Larson CL (2017) ‘ Neural circuitry governing anxious individuals’ mis-allocation of working memory to threat’ , Scientific reports , 7 , 8742. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Strahan EY and Conger AJ (1999) ‘ Social anxiety and social performance: Why don’t we see more catastrophes? ’, J Anxiety Disord , 13 ( 4 ), 399–416. [ PubMed ] [ Google Scholar ]
• Teachman BA and Allen JP (2007) ‘ Development of social anxiety: social interaction predictors of implicit and explicit fear of negative evaluation ’, J Abnorm Child Psychol , 35 , 63–78. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Tillfors M, Persson S, Willen M and Burk WJ (2012) ‘ Prospective links between social anxiety and adolescent peer relations ’, J Adolesc , 35 , 1255–63. [ PubMed ] [ Google Scholar ]
• Torgrud LJ, Walker JR, Murray L, Cox BJ, Chartier M and Kjernisted KD (2004) ‘ Deficits in perceived social support associated with generalized social phobia ’, Cognitive Behaviour Therapy , 33 ( 2 ), 87–96. [ PubMed ] [ Google Scholar ]
• Turner SM, Beidel DC, Dancu CV and Keys DJ (1986) ‘ Psychopathology of social phobia and comparison to avoidant personality disorder ’, Journal of Abnormal Psychology , 95 ( 4 ), 389. [ PubMed ] [ Google Scholar ]
• Twenge JM, Spitzburg BH and Campbell WK (2019) ‘ Less in-person social interaction with peers among U.S. adolescents in the 21st century and links to loneliness ’, Journal of Social and Personal Relationships , 36 , 1892–1913. [ Google Scholar ]
• Van Lente E, Barry MM, Molcho M, Morgan K, Watson D, Harrington J and McGee H (2012) ‘ Measuring population mental health and social well-being ’, Int J Public Health , 57 , 421–30. [ PubMed ] [ Google Scholar ]
• Vernberg EM, Abwender DA, Ewell KK and Beery SH (1992) ‘ Social anxiety and peer relationships in early adolescence: A prospective analysis ’, Journal of Clinical Child Psychology , 21 ( 2 ), 189–196. [ Google Scholar ]
• Wade TD and Kendler KS (2000) ‘ The relationship between social support and major depression: Cross-sectional, longitudinal, and genetic perspectives ’, Journal of Nervous and Mental Disease , 188 , 251–258. [ PubMed ] [ Google Scholar ]
• Wang H and Wellman B (2010) ‘ Social connectivity in America: Changes in adult friendship network size from 2002 to 2007 ’, American Behavioral Scientist , 53 , 1148–1169. [ Google Scholar ]
• Watson D, O’Hara MW, Naragon-Gainey K, Koffel E, Chmielewski M, Kotov R, Stasik SM and Ruggero CJ (2012) ‘ Development and validation of new anxiety and bipolar symptom scales for an expanded version of the IDAS (the IDAS-II) ’, Assessment , 19 , 399–420. [ PubMed ] [ Google Scholar ]
• Whisman MA and Baucom DH (2012) ‘ Intimate relationships and psychopathology ’, Clin Child Fam Psychol Rev , 15 , 4–13. [ PubMed ] [ Google Scholar ]
• Williams WC, Morelli SA, Ong DC and Zaki J (2018) ‘ Interpersonal emotion regulation: Implications for affiliation, perceived support, relationships, and well-being ’, J Pers Soc Psychol , 115 , 224–254. [ PubMed ] [ Google Scholar ]
• Wittchen H-U, Fuetsch M, Sonntag H, Müller N and Liebowitz M (2000) ‘ Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study ’, European Psychiatry , 15 ( 1 ), 46–58. [ PubMed ] [ Google Scholar ]
• Wong N, Sarver DE and Beidel DC (2012) ‘ Quality of life impairments among adults with social phobia: The impact of subtype ’, J Anxiety Disord , 26 ( 1 ), 50–57. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Wrzus C, Hanel M, Wagner J and Neyer FJ (2013) ‘ Social network changes and life events across the life span: a meta-analysis ’, Psychol Bull , 139 , 53–80. [ PubMed ] [ Google Scholar ]
• Wrzus C, Wagner GG and Riediger M (2016) ‘ Personality-situation transactions from adolescence to old age ’, J Pers Soc Psychol , 110 , 782–99. [ PubMed ] [ Google Scholar ]
• Zaider TI, Heimberg RG and Iida M (2010) ‘ Anxiety disorders and intimate relationships: a study of daily processes in couples ’, J Abnorm Psychol , 119 , 163–73. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Zaki J and Williams WC (2013) ‘ Interpersonal emotion regulation ’, Emotion , 13 , 803–10. [ PubMed ] [ Google Scholar ]
• HOAGLIN DC & IGLEWICZ B 1987. Fine-tuning some resistant rules for outlier labeling . Journal of the American Statistical Association , 82 , 1147–1149. [ Google Scholar ]
• HOAGLIN DC, IGLEWICZ B & TUKEY JW 1986. Performance of some resistant rules for outlier labeling . Journal of the American Statistical Association , 81 , 991–999. [ Google Scholar ]

Change Password

Your password must have 6 characters or more:.

• a lower case character, 
• an upper case character, 
• a special character 

Password Changed Successfully

Your password has been changed

Create your account

Forget yout password.

Enter your email address below and we will send you the reset instructions

If the address matches an existing account you will receive an email with instructions to reset your password

Forgot your Username?

Enter your email address below and we will send you your username

If the address matches an existing account you will receive an email with instructions to retrieve your username

• April 01, 2024 | VOL. 181, NO. 4 CURRENT ISSUE pp.255-346
• March 01, 2024 | VOL. 181, NO. 3 pp.171-254
• February 01, 2024 | VOL. 181, NO. 2 pp.83-170
• January 01, 2024 | VOL. 181, NO. 1 pp.1-82

The American Psychiatric Association (APA) has updated its Privacy Policy and Terms of Use , including with new information specifically addressed to individuals in the European Economic Area. As described in the Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences.

Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.

The Critical Relationship Between Anxiety and Depression

• Ned H. Kalin , M.D.

Search for more papers by this author

Anxiety and depressive disorders are among the most common psychiatric illnesses; they are highly comorbid with each other, and together they are considered to belong to the broader category of internalizing disorders. Based on statistics from the Substance Abuse and Mental Health Services Administration, the 12-month prevalence of major depressive disorder in 2017 was estimated to be 7.1% for adults and 13.3% for adolescents ( 1 ). Data for anxiety disorders are less current, but in 2001–2003, their 12-month prevalence was estimated to be 19.1% in adults, and 2001–2004 data estimated that the lifetime prevalence in adolescents was 31.9% ( 2 , 3 ). Both anxiety and depressive disorders are more prevalent in women, with an approximate 2:1 ratio in women compared with men during women’s reproductive years ( 1 , 2 ).

Across all psychiatric disorders, comorbidity is the rule ( 4 ), which is definitely the case for anxiety and depressive disorders, as well as their symptoms. With respect to major depression, a worldwide survey reported that 45.7% of individuals with lifetime major depressive disorder had a lifetime history of one or more anxiety disorder ( 5 ). These disorders also commonly coexist during the same time frame, as 41.6% of individuals with 12-month major depression also had one or more anxiety disorder over the same 12-month period. From the perspective of anxiety disorders, the lifetime comorbidity with depression is estimated to range from 20% to 70% for patients with social anxiety disorder ( 6 ), 50% for patients with panic disorder ( 6 ), 48% for patients with posttraumatic stress disorder (PTSD) ( 7 ), and 43% for patients with generalized anxiety disorder ( 8 ). Data from the well-known Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study demonstrate comorbidity at the symptom level, as 53% of the patients with major depression had significant anxiety and were considered to have an anxious depression ( 9 ).

Anxiety and depressive disorders are moderately heritable (approximately 40%), and evidence suggests shared genetic risk across the internalizing disorders ( 10 ). Among internalizing disorders, the highest level of shared genetic risk appears to be between major depressive disorder and generalized anxiety disorder. Neuroticism is a personality trait or temperamental characteristic that is associated with the development of both anxiety and depression, and the genetic risk for developing neuroticism also appears to be shared with that of the internalizing disorders ( 11 ). Common nongenetic risk factors associated with the development of anxiety and depression include earlier life adversity, such as trauma or neglect, as well as parenting style and current stress exposure. At the level of neural circuits, alterations in prefrontal-limbic pathways that mediate emotion regulatory processes are common to anxiety and depressive disorders ( 12 , 13 ). These findings are consistent with meta-analyses that reveal shared structural and functional brain alterations across various psychiatric illnesses, including anxiety and major depression, in circuits involving emotion regulation ( 13 ), executive function ( 14 ), and cognitive control ( 15 ).

Anxiety disorders and major depression occur during development, with anxiety disorders commonly beginning during preadolescence and early adolescence and major depression tending to emerge during adolescence and early to mid-adulthood ( 16 – 18 ). In relation to the evolution of their comorbidity, studies demonstrate that anxiety disorders generally precede the presentation of major depressive disorder ( 17 ). A European community-based study revealed, beginning at age 15, the developmental relation between comorbid anxiety and major depression by specifically focusing on social phobia (based on DSM-IV criteria) and then asking the question regarding concurrent major depressive disorder ( 18 ). The findings revealed a 19% concurrent comorbidity between these disorders, and in 65% of the cases, social phobia preceded major depressive disorder by at least 2 years. In addition, initial presentation with social phobia was associated with a 5.7-fold increased risk of developing major depressive disorder. These associations between anxiety and depression can be traced back even earlier in life. For example, childhood behavioral inhibition in response to novelty or strangers, or an extreme anxious temperament, is associated with a three- to fourfold increase in the likelihood of developing social anxiety disorder, which in turn is associated with an increased risk to develop major depressive disorder and substance abuse ( 19 ).

It is important to emphasize that the presence of comor‐bid anxiety symptoms and disorders matters in relation to treatment. Across psychiatric disorders, the presence of significant anxiety symptoms generally predicts worse outcomes, and this has been well demonstrated for depression. In the STAR*D study, patients with anxious major depressive disorder were more likely to be severely depressed and to have more suicidal ideation ( 9 ). This is consistent with the study by Kessler and colleagues ( 5 ), in which patients with anxious major depressive disorder, compared with patients with nonanxious major depressive disorder, were found to have more severe role impairment and more suicidal ideation. Data from level 1 of the STAR*D study (citalopram treatment) nicely illustrate the impact of comorbid anxiety symptoms on treatment. Compared with patients with nonanxious major depressive disorder, those 53% of patients with an anxious depression were less likely to remit and also had a greater side effect burden ( 20 ). Other data examining patients with major depressive disorder and comorbid anxiety disorders support the greater difficulty and challenge in treating patients with these comorbidities ( 21 ).

This issue of the Journal presents new findings relevant to the issues discussed above in relation to understanding and treating anxiety and depressive disorders. Drs. Conor Liston and Timothy Spellman, from Weill Cornell Medicine, provide an overview for this issue ( 22 ) that is focused on understanding mechanisms at the neural circuit level that underlie the pathophysiology of depression. Their piece nicely integrates human neuroimaging studies with complementary data from animal models that allow for the manipulation of selective circuits to test hypotheses generated from the human data. Also included in this issue is a review of the data addressing the reemergence of the use of psychedelic drugs in psychiatry, particularly for the treatment of depression, anxiety, and PTSD ( 23 ). This timely piece, authored by Dr. Collin Reiff along with a subgroup from the APA Council of Research, provides the current state of evidence supporting the further exploration of these interventions. Dr. Alan Schatzberg, from Stanford University, contributes an editorial in which he comments on where the field is in relation to clinical trials with psychedelics and to some of the difficulties, such as adequate blinding, in reliably studying the efficacy of these drugs ( 24 ).

In an article by McTeague et al. ( 25 ), the authors use meta-analytic strategies to understand the neural alterations that are related to aberrant emotion processing that are shared across psychiatric disorders. Findings support alterations in the salience, reward, and lateral orbital nonreward networks as common across disorders, including anxiety and depressive disorders. These findings add to the growing body of work that supports the concept that there are common underlying factors across all types of psychopathology that include internalizing, externalizing, and thought disorder dimensions ( 26 ). Dr. Deanna Barch, from Washington University in St. Louis, writes an editorial commenting on these findings and, importantly, discusses criteria that should be met when we consider whether the findings are actually transdiagnostic ( 27 ).

Another article, from Gray and colleagues ( 28 ), addresses whether there is a convergence of findings, specifically in major depression, when examining data from different structural and functional neuroimaging modalities. The authors report that, consistent with what we know about regions involved in emotion processing, the subgenual anterior cingulate cortex, hippocampus, and amygdala were among the regions that showed convergence across multimodal imaging modalities.

In relation to treatment and building on our understanding of neural circuit alterations, Siddiqi et al. ( 29 ) present data suggesting that transcranial magnetic stimulation (TMS) targeting can be linked to symptom-specific treatments. Their findings identify different TMS targets in the left dorsolateral prefrontal cortex that modulate different downstream networks. The modulation of these different networks appears to be associated with a reduction in different types of symptoms. In an editorial, Drs. Sean Nestor and Daniel Blumberger, from the University of Toronto ( 30 ), comment on the novel approach used in this study to link the TMS-related engagement of circuits with symptom improvement. They also provide a perspective on how we can view these and other circuit-based findings in relation to conceptualizing personalized treatment approaches.

Kendler et al. ( 31 ), in this issue, contribute an article that demonstrates the important role of the rearing environment in the risk to develop major depression. Using a unique design from a Swedish sample, the analytic strategy involves comparing outcomes from high-risk full sibships and high-risk half sibships where at least one of the siblings was home reared and one was adopted out of the home. The findings support the importance of the quality of the rearing environment as well as the presence of parental depression in mitigating or enhancing the likelihood of developing major depression. In an accompanying editorial ( 32 ), Dr. Myrna Weissman, from Columbia University, reviews the methods and findings of the Kendler et al. article and also emphasizes the critical significance of the early nurturing environment in relation to general health.

This issue concludes with an intriguing article on anxiety disorders, by Gold and colleagues ( 33 ), that demonstrates neural alterations during extinction recall that differ in children relative to adults. With increasing age, and in relation to fear and safety cues, nonanxious adults demonstrated greater connectivity between the amygdala and the ventromedial prefrontal cortex compared with anxious adults, as the cues were being perceived as safer. In contrast, neural differences between anxious and nonanxious youths were more robust when rating the memory of faces that were associated with threat. Specifically, these differences were observed in the activation of the inferior temporal cortex. In their editorial ( 34 ), Dr. Dylan Gee and Sahana Kribakaran, from Yale University, emphasize the importance of developmental work in relation to understanding anxiety disorders, place these findings into the context of other work, and suggest the possibility that these and other data point to neuroscientifically informed age-specific interventions.

Taken together, the papers in this issue of the Journal present new findings that shed light onto alterations in neural function that underlie major depressive disorder and anxiety disorders. It is important to remember that these disorders are highly comorbid and that their symptoms are frequently not separable. The papers in this issue also provide a developmental perspective emphasizing the importance of early rearing in the risk to develop depression and age-related findings important for understanding threat processing in patients with anxiety disorders. From a treatment perspective, the papers introduce data supporting more selective prefrontal cortical TMS targeting in relation to different symptoms, address the potential and drawbacks for considering the future use of psychedelics in our treatments, and present new ideas supporting age-specific interventions for youths and adults with anxiety disorders.

Disclosures of Editors’ financial relationships appear in the April 2020 issue of the Journal .

1 Substance Abuse and Mental Health Services Administration (SAMHSA): Key substance use and mental health indicators in the United States: results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, Md, Center for Behavioral Health Statistics and Quality, SAMHSA, 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/NSDUHFFR2017.htm Google Scholar

2 Kessler RC, Chiu WT, Demler O, et al. : Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication . Arch Gen Psychiatry 2005 ; 62:617–627, correction, 62:709 Crossref , Medline ,  Google Scholar

3 Merikangas KR, He JP, Burstein M, et al. : Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A) . J Am Acad Child Adolesc Psychiatry 2010 ; 49:980–989 Crossref , Medline ,  Google Scholar

4 Kessler RC, McGonagle KA, Zhao S, et al. : Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey . Arch Gen Psychiatry 1994 ; 51:8–19 Crossref , Medline ,  Google Scholar

5 Kessler RC, Sampson NA, Berglund P, et al. : Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys . Epidemiol Psychiatr Sci 2015 ; 24:210–226 Crossref , Medline ,  Google Scholar

6 Dunner DL : Management of anxiety disorders: the added challenge of comorbidity . Depress Anxiety 2001 ; 13:57–71 Crossref , Medline ,  Google Scholar

7 Kessler RC, Sonnega A, Bromet E, et al. : Posttraumatic stress disorder in the National Comorbidity Survey . Arch Gen Psychiatry 1995 ; 52:1048–1060 Crossref , Medline ,  Google Scholar

8 Brawman-Mintzer O, Lydiard RB, Emmanuel N, et al. : Psychiatric comorbidity in patients with generalized anxiety disorder . Am J Psychiatry 1993 ; 150:1216–1218 Link ,  Google Scholar

9 Fava M, Alpert JE, Carmin CN, et al. : Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D . Psychol Med 2004 ; 34:1299–1308 Crossref , Medline ,  Google Scholar

10 Hettema JM : What is the genetic relationship between anxiety and depression? Am J Med Genet C Semin Med Genet 2008 ; 148C:140–146 Crossref , Medline ,  Google Scholar

11 Hettema JM, Neale MC, Myers JM, et al. : A population-based twin study of the relationship between neuroticism and internalizing disorders . Am J Psychiatry 2006 ; 163:857–864 Link ,  Google Scholar

12 Kovner R, Oler JA, Kalin NH : Cortico-limbic interactions mediate adaptive and maladaptive responses relevant to psychopathology . Am J Psychiatry 2019 ; 176:987–999 Link ,  Google Scholar

13 Etkin A, Schatzberg AF : Common abnormalities and disorder-specific compensation during implicit regulation of emotional processing in generalized anxiety and major depressive disorders . Am J Psychiatry 2011 ; 168:968–978 Link ,  Google Scholar

14 Goodkind M, Eickhoff SB, Oathes DJ, et al. : Identification of a common neurobiological substrate for mental illness . JAMA Psychiatry 2015 ; 72:305–315 Crossref , Medline ,  Google Scholar

15 McTeague LM, Huemer J, Carreon DM, et al. : Identification of common neural circuit disruptions in cognitive control across psychiatric disorders . Am J Psychiatry 2017 ; 174:676–685 Link ,  Google Scholar

16 Beesdo K, Knappe S, Pine DS : Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V . Psychiatr Clin North Am 2009 ; 32:483–524 Crossref , Medline ,  Google Scholar

17 Kessler RC, Wang PS : The descriptive epidemiology of commonly occurring mental disorders in the United States . Annu Rev Public Health 2008 ; 29:115–129 Crossref , Medline ,  Google Scholar

18 Ohayon MM, Schatzberg AF : Social phobia and depression: prevalence and comorbidity . J Psychosom Res 2010 ; 68:235–243 Crossref , Medline ,  Google Scholar

19 Clauss JA, Blackford JU : Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study . J Am Acad Child Adolesc Psychiatry 2012 ; 51:1066–1075 Crossref , Medline ,  Google Scholar

20 Fava M, Rush AJ, Alpert JE, et al. : Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report . Am J Psychiatry 2008 ; 165:342–351 Link ,  Google Scholar

21 Dold M, Bartova L, Souery D, et al. : Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders: results from a European multicenter study . J Psychiatr Res 2017 ; 91:1–13 Crossref , Medline ,  Google Scholar

22 Spellman T, Liston C : Toward circuit mechanisms of pathophysiology in depression . Am J Psychiatry 2020 ; 177:381–390 Link ,  Google Scholar

23 Reiff CM, Richman EE, Nemeroff CB, et al. : Psychedelics and psychedelic-assisted psychotherapy . Am J Psychiatry 2020 ; 177:391–410 Link ,  Google Scholar

24 Schatzberg AF : Some comments on psychedelic research (editorial). Am J Psychiatry 2020 ; 177:368–369 Link ,  Google Scholar

25 McTeague LM, Rosenberg BM, Lopez JW, et al. : Identification of common neural circuit disruptions in emotional processing across psychiatric disorders . Am J Psychiatry 2020 ; 177:411–421 Link ,  Google Scholar

26 Caspi A, Moffitt TE : All for one and one for all: mental disorders in one dimension . Am J Psychiatry 2018 ; 175:831–844 Link ,  Google Scholar

27 Barch DM : What does it mean to be transdiagnostic and how would we know? (editorial). Am J Psychiatry 2020 ; 177:370–372 Abstract ,  Google Scholar

28 Gray JP, Müller VI, Eickhoff SB, et al. : Multimodal abnormalities of brain structure and function in major depressive disorder: a meta-analysis of neuroimaging studies . Am J Psychiatry 2020 ; 177:422–434 Link ,  Google Scholar

29 Siddiqi SH, Taylor SF, Cooke D, et al. : Distinct symptom-specific treatment targets for circuit-based neuromodulation . Am J Psychiatry 2020 ; 177:435–446 Link ,  Google Scholar

30 Nestor SM, Blumberger DM : Mapping symptom clusters to circuits: toward personalizing TMS targets to improve treatment outcomes in depression (editorial). Am J Psychiatry 2020 ; 177:373–375 Abstract ,  Google Scholar

31 Kendler KS, Ohlsson H, Sundquist J, et al. : The rearing environment and risk for major depression: a Swedish national high-risk home-reared and adopted-away co-sibling control study . Am J Psychiatry 2020 ; 177:447–453 Abstract ,  Google Scholar

32 Weissman MM : Is depression nature or nurture? Yes (editorial). Am J Psychiatry 2020 ; 177:376–377 Abstract ,  Google Scholar

33 Gold AL, Abend R, Britton JC, et al. : Age differences in the neural correlates of anxiety disorders: an fMRI study of response to learned threat . Am J Psychiatry 2020 ; 177:454–463 Link ,  Google Scholar

34 Gee DG, Kribakaran S : Developmental differences in neural responding to threat and safety: implications for treating youths with anxiety (editorial). Am J Psychiatry 2020 ; 177:378–380 Abstract ,  Google Scholar

• Cited by None

• Neuroanatomy
• Neurochemistry
• Neuroendocrinology
• Other Research Areas

• Human Editing
• Free AI Essay Writer
• AI Outline Generator
• AI Paragraph Generator
• Paragraph Expander
• Essay Expander
• Literature Review Generator
• Research Paper Generator
• Thesis Generator
• Paraphrasing tool
• AI Rewording Tool
• AI Sentence Rewriter
• AI Rephraser
• AI Paragraph Rewriter
• Summarizing Tool
• AI Content Shortener
• Plagiarism Checker
• AI Detector
• AI Essay Checker
• Citation Generator
• Reference Finder
• Book Citation Generator
• Legal Citation Generator
• Journal Citation Generator
• Reference Citation Generator
• Scientific Citation Generator
• Source Citation Generator
• Website Citation Generator
• URL Citation Generator
• Proofreading Service
• Editing Service
• AI Writing Guides
• AI Detection Guides
• Citation Guides
• Grammar Guides
• Paraphrasing Guides
• Plagiarism Guides
• Summary Writing Guides
• STEM Guides
• Humanities Guides
• Language Learning Guides
• Coding Guides
• Top Lists and Recommendations
• AI Detectors
• AI Writing Services
• Coding Homework Help
• Citation Generators
• Editing Websites
• Essay Writing Websites
• Language Learning Websites
• Math Solvers
• Paraphrasers
• Plagiarism Checkers
• Reference Finders
• Spell Checkers
• Summarizers
• Tutoring Websites

Most Popular

13 days ago

How Educators Can Reinvent Teaching and Learning With AI

12 days ago

Plagiarism vs Copyright

How to cite a graph, how to cite personal communication in apa, how to cite a dissertation, causes of social anxiety disorder essay sample, example.

Although the environment we live in definitely has an effect on how people feel, it is important to consider the biological factors leading to social anxiety disorder (SAD). In particular, biologists believe SAD is related to a dysfunction of brain circuits responsible for regulating emotions and the “fight or flight” response center ( WebMD ). There is a brain structure called the amygdala; it is known to play a role in controlling the fear response. If a person has an overactive amygdala, they often display an excessive “fear” type of emotional response; therefore, whenever a situation occurs that can be interpreted as even slightly uncomfortable, a person with SAD will overreact in terms of fear ( Mayo Clinic ). In addition, genetic factors should also be considered when studying the causes of SAD, because social anxiety may occur when it was also present in a first-degree relative: parent, sibling, or child.

Another significant group of factors responsible for the development of SAD is a group of environmental factors, including psychological climates. The first social interactions people make in their lives are usually connected to parents; from them, people learn basic social rules, what is acceptable and what is not, how it is like to be loved and to be ignored, and so on. Based on what happened in their childhood, people construct their personal systems of beliefs, including assumptions on what other people think about them. Commonly, if a child is loved and respected by parents, he or she later assumes that other people treat them in the same way; however, if a child is often criticized, it prevents him or her from developing a sense of personal value, and for such people, it is more difficult to become socially confident ( Overcoming ).

In addition, the way parents deal with different life situations also influences children’s personality. According to Cheryl Carmin, a psychiatrist and director of the clinical psychology training program at the Ohio State University Wexner Medical Center, parents are often responsible for developing social anxiety in a child. “A parent or a significant adult figure may model that it’s appropriate to be anxious in situations where your performance will be evaluated […]. For example, a parent who is commenting on being nervous about a performance review or who tells their child to not be anxious before their first “show and tell” may be priming the child to, in fact, be anxious in that situation. It’s also quite possible that any number of these factors interact,” says Dr. Carmin ( Live Science ).

The reasons why people develop social anxiety are different, but generally they can be divided into two categories: biological and environmental. A biological group of reasons includes dysfunctions in brain work, as well as excessive “fight or flight” reactions. Environmental factors include psychological influences caused by parents on their children, as well as the models that parents provide in the form of teaching their children consciously or unconsciously.

“Social Anxiety Disorder (social Phobia).” Mayo Clinic. N.p., n.d. Web. 09 June 2015. <http://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/basics/causes/con-20032524>

“What is Social Anxiety Disorder? Symptoms, Treatments, & More.” WebMD. WebMD, n.d. Web. 09 June 2015. <http://www.webmd.com/anxiety-panic/guide/mental-health-social-anxiety-disorder?page=2>

“Understanding Social Anxiety and Shyness.” Overcoming. N.p., n.d. Web. 09 June 2015. <http://www.overcoming.co.uk/single.htm?ipg=8622>

Zimmermann, Kim Ann. “Social Anxiety Disorder: Causes, Symptoms and Treatment.” LiveScience. TechMedia Network, 28 Aug. 2014. Web. 09 June 2015. <http://www.livescience.com/45267-social-anxiety-disorder.html>

Follow us on Reddit for more insights and updates.

Comments (0)

Welcome to A*Help comments!

We’re all about debate and discussion at A*Help.

We value the diverse opinions of users, so you may find points of view that you don’t agree with. And that’s cool. However, there are certain things we’re not OK with: attempts to manipulate our data in any way, for example, or the posting of discriminative, offensive, hateful, or disparaging material.

Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

More from Cause and Effect Essay Examples and Samples 2024

Jul 18 2023

How Your Childhood Affects Your Love Style Essay Sample Example

May 28 2023

How does outdoor exercises impact our health and well-being? Essay Sample, Example

Why Video Games are Good for the Brain. Essay Sample, Example

Related writing guides, writing a cause and effect essay.

Remember Me

What is your profession ? Student Teacher Writer Other

Forgotten Password?

Username or Email

How to Write a Cause and Effect Essay: Full Guide

Ever wondered how things are connected in our world? Think of the butterfly effect—where a butterfly's wings in Brazil can set off a tornado in Texas. It's a quirky idea, but it shows how events are intertwined. Writing a cause and effect essay is like unraveling these connections, connecting the dots to reveal how things influence each other and shape our experiences.

In this guide, experts from our paper writing service will explore the concept of causality and share practical tips for creating great cause and effect essays. These essays won't just provide information—they'll leave a lasting impression on your readers.

What Is a Cause and Effect Essay

A cause and effect essay is a form of writing that aims to explore and explain the relationships between different events, actions, or circumstances. The central idea is to investigate why certain things happen (causes) and what results from those occurrences (effects). It's like peeling back the layers to reveal the interconnectedness of events, understanding the domino effect in the narrative of life.

Here's a breakdown of the key components:

• Causes: These are the factors or events that initiate a particular situation. They are the reasons behind why something occurs. For instance, if you're exploring the cause of obesity, factors like unhealthy eating habits and lack of physical activity could be identified as causes.
• Effects: The effects are the outcomes or consequences that result from the identified causes. Following the obesity example, effects could include health issues, reduced quality of life, or increased healthcare costs.
• Connection: The heart of a cause and effect essay lies in demonstrating the link between causes and effects. It's not just about listing events but explaining how one event leads to another in a logical and coherent manner.

When crafting such an essay, you're essentially acting as a storyteller and investigator rolled into one. Your goal is to guide the reader through the web of interconnected events, providing insights into the 'why' and 'what happens next.'

How to Write a Cause and Effect Essay with Easy Steps

Understanding how to write a cause and effect essay is like putting together a puzzle. Here are ten simple steps to help you write an engaging essay that looks into how things are connected.

1. Select a Specific Topic

• Choose a cause and effect relationship that sparks your interest.
• Ensure your topic is focused and manageable for a thorough exploration.

2. Explore Causal Links

• Conduct thorough research to uncover hidden connections and supporting evidence.
• Look beyond the obvious to identify intricate relationships between causes and effects.

3. Craft a Clear Thesis Statement

• Develop a precise thesis that clearly articulates the main cause and the resulting effects.
• Your thesis serves as the roadmap for your essay, guiding readers through your analysis.

4. Organize Chronologically or by Significance

• Structure your essay in a logical order, either chronologically or by the significance of events.
• This organization enhances clarity and helps readers follow the cause-and-effect progression.

5. Utilize Transitional Phrases

• Employ transition words and phrases to ensure seamless flow between causes and effects.
• Clear transitions enhance readability and strengthen the coherence of your essay.

6. Support Arguments with Credible Evidence

• Back up your claims with relevant data, examples, and statistics.
• Strong evidence adds credibility to your analysis and reinforces the cause-and-effect relationships you present.

7. Illustrate Chain Reactions

• Show how a single cause can trigger a chain of effects, and vice versa.
• Illustrate the ripple effects to emphasize the complexity of the relationships.

8. Analyze Root Causes

• Move beyond surface-level explanations and explore the underlying factors contributing to the cause-and-effect scenario.
• Deep analysis adds depth and nuance to your essay.

9. Consider Alternative Causes

• Address potential counterarguments to showcase a comprehensive understanding.
• Acknowledging alternative causes strengthens your essay's overall credibility.

10. Conclude with Impact

• Summarize key points and emphasize the broader significance of your analysis.
• Leave your readers with a thought-provoking conclusion that ties together the cause-and-effect relationships explored in your essay.

Cause and Effect Essay Structure Types

When setting up your essay, you can choose from different structures to make it organized. Let's look at two common types of cause and effect essay structures:

• Block Structure:

The block structure is a clear and organized way to present causes and effects in your essay. Here, you dedicate one section to discussing all the causes, covering multiple causes within each category. After that, you have another section to explore all the effects. This separation makes your ideas easy to understand.

Using the block structure allows you to dive deep into each category, thoroughly looking at causes and effects separately. It's handy when you want to give a detailed analysis and show the importance of each part of the causal relationship. This way, readers can fully grasp each element before moving on.

• Chain Structure:

On the other hand, the chain structure focuses on how events are connected and create ripple effects. It highlights how one cause leads to a specific effect, and that effect becomes the cause of more effects in an ongoing chain. This method is potent for illustrating the complexity of causal relationships.

The chain structure works well when you want to emphasize the sequence of events or deal with intricate cause-and-effect scenarios. It allows you to show how actions trigger a series of reactions, displaying the domino effect that leads to a specific outcome.

Regardless of the structural style you choose, if you require assistance with your academic paper, reach out to us with your ' write my paper for me ' request. Our experienced team is ready to tailor your paper to your specific requirements and ensure its excellence.

Cause and Effect Essay Outline

Creating an effective cause and effect essay begins with a well-structured outline. This roadmap helps you organize your thoughts, maintain a logical flow, and ensure that your essay effectively conveys the causal relationships between events. Below, we'll outline the key components of the essay along with examples:

I. Introduction

• Hook: Start with an engaging statement or fact. Example: 'Did you know that stress can significantly impact your overall health?'
• Background Information: Provide context for your topic. Example: 'In today's fast-paced world, stress has become an increasingly prevalent issue.'
• Thesis Statement: Clearly state the main cause and its corresponding effects. Example: 'This essay will explore the causes of stress and their profound negative effects on physical and mental health.'

II. Body Paragraphs

• Topic Sentence: Introduce the first cause you'll discuss. Example: 'One major cause of stress is heavy workload.'
• Supporting Details: Provide evidence and examples to support the cause. Example: 'For instance, individuals juggling multiple job responsibilities and tight deadlines often experience heightened stress levels.'
• Transition: Link to the next cause or move on to the effects.
• Topic Sentence: Introduce the first effect. Example: 'The effects of chronic stress on physical health can be devastating.'
• Supporting Details: Present data or examples illustrating the impact. Example: 'Studies have shown that prolonged stress can lead to cardiovascular problems, including hypertension and heart disease.'
• Transition: Connect to the next effect or cause.

C. Causes (Continued)

• Topic Sentence: Introduce the next cause in a new cause and effect paragraph. Example: 'Another significant cause of stress is financial strain.'
• Supporting Details: Explain how this cause manifests and its implications. Example: 'Financial instability often results in anxiety, as individuals worry about bills, debts, and their financial future.'
• Transition: Prepare to discuss the corresponding effects.

D. Effects (Continued)

• Topic Sentence: Discuss the effects related to financial strain. Example: 'The psychological effects of financial stress can be profound.'
• Supporting Details: Offer real-life examples or psychological insights. Example: 'Depression and anxiety are common consequences of constant financial worries, affecting both mental well-being and daily life.'

III. Conclusion

• Restate Thesis: Summarize the main cause and effects. Example: 'In summary, the heavy workload and financial strain can lead to stress, impacting both physical and mental health.'
• Closing Thoughts: Reflect on the broader significance of your analysis. Example: 'Understanding these causal relationships emphasizes the importance of stress management and financial planning in maintaining a balanced and healthy life.'

Cause and Effect Essay Examples

To help you grasp cause and effect essay writing with clarity, we have prepared two distinct essay examples that will guide you through the intricacies of both block and chain structures. Additionally, should you ever find yourself requiring assistance with academic writing or descriptive essays examples , simply send us your ' write my research paper ' request. Our expert writers are here to provide the support you need!

Why Wait? Get Your Stellar Cause and Effect Essay Now!

Don't procrastinate – order yours today and let our wordsmiths create an essay that's more captivating than a Netflix series cliffhanger!

Cause and Effect Essay Topics

Choosing a good topic starts with recognizing cause and effect key words. Here are 10 interesting topics that let you dig into fascinating connections and their important consequences:

• The Relationship Between Lack of Exercise and Mental Health in Older Adults
• Effects of Sleep Deprivation on Workplace Productivity
• The Impact of Cyberbullying on Adolescents' Emotional Well-being
• Influence of Social Media Advertising on Consumer Purchasing Decisions
• Consequences of Oil Spills on Coastal Ecosystems
• How Noise Pollution Affects Concentration and Academic Performance in Schools
• The Connection Between Fast-Food Marketing and Childhood Obesity
• Effects of Urbanization on Water Quality in Local Rivers
• The Relationship Between Indoor Plants and Air Quality in Homes
• Impact of Plastic Pollution on Wildlife in Urban Environments
• The Effect of Meditation on Stress Reduction in College Students
• How Increased Screen Time Affects Teenagers' Attention Span
• The Impact of Single-Use Plastics on Marine Microorganisms
• The Relationship Between Smartphone Use and Sleep Quality in Adults
• Effects of High-Fructose Corn Syrup on Metabolic Health
• The Consequences of Deforestation on Local Biodiversity
• Influence of Social Media Comparison on Body Dissatisfaction in Adolescents
• The Connection Between Air Pollution and Respiratory Health in Urban Areas
• Effects of Excessive Gaming on Academic Performance in High School Students
• The Impact of Fast Food Consumption on Childhood Obesity Rates

Final Words

Knowing what a cause and effect essay is and how to write it helps you uncover connections in different topics. With this guide, you can share your ideas in a clear and impactful way.

Meanwhile, if you're in need of a reaction paper example , rest assured we have you covered as well. So, seize this opportunity, put your thoughts on paper logically, and witness your essays leaving a lasting and influential mark.

Let's Turn Those 'What Ifs' into 'A+ Ifs'!

Don't procrastinate when you can cause an effect on your grades right now!

Related Articles

• Grades 6-12
• School Leaders

FREE Poetry Worksheet Bundle! Perfect for National Poetry Month.

137 Intriguing Cause & Effect Essay Topics for Students

Teach critical thinking, logic, and the art of persuasion.

Cause-and-effect essays aren’t just a way to help students strengthen their writing skills. They’ll also learn critical thinking, logic, and the art of persuasion. In addition, they teach students to demonstrate how one thing directly influences another. Coming up with engaging cause-and-effect essay topics can be challenging, but we have you covered. This list of ideas includes a variety of topics that range from social and cultural movements to mental health and the environment.

Science and Environment Cause & Effect Essay Topics

• Describe the effect of urbanization on the environment.
• What is the impact of air pollution on health?
• What are the causes and consequences of plastics on marine life?
• What is the impact of rising sea temperatures on fish and marine life?
• Describe the impact of human behavior on global warming.

• What is the effect of social media on environmentalism?
• What causes volcanic eruptions?
• What causes trees to die?
• What are the effects of gravity?
• Why are plants green?
• Why do trees shed their leaves?
• What causes a species to become endangered?
• What are some of the causes of animals losing their habitats?
• Describe the effect of overpopulation on the environment.
• What are the effects of famine on human population?
• What are the causes and effects of Antarctica floods?
• What are the effects of pollution on the ocean?
• What effect do cars have on the environment?
• Why is it important to manage wildfires?
• What has been the impact of DNA on crime scene processing?

• What are the impacts of deforestation in Brazil?
• What are the effects of GMO foods on human health?
• What are the impacts of immunizations on human health?

Technology and Social Media Cause & Effect Essay Topics

• What are the effects of social media on adolescent development?
• How does technology affect productivity?
• What are the effects of video games on childhood development?
• How do cell phones affect human relationships?
• What are some reasons a teacher might ban cell phones from class?

• What effects do cell phones have on sleep?
• What effects did the invention of the Internet have on technology?
• What were the origins of cyberbullying?
• What are the effects of tablet use on small children?
• How has online dating changed relationships?
• What makes some people less likely to use social media?
• What are the effects of social media on privacy?
• How does the rise of TikTok affect Facebook and Instagram?
• In what ways could social media lead to extremism?
• What is the impact of social media on the increasing popularity of plastic surgery and other enhancements?

• What are some of the benefits of owning a smartphone and what are some of the drawbacks?
• What has been the impact of online shopping on brick-and-mortar stores?
• What has been the impact of smartphones on marriages and relationships?
• What are the causes and effects of texting while driving?
• What has the rise of “influencers” meant for Hollywood?
• In what ways have photo filters influenced young people’s self-esteem?

Culture and Social Issues Cause & Effect Essay Topics

• What are some of the reasons for substance abuse in young people?
• What are some of the effects of bullying?
• How does economic status affect the quality of health care?
• What are some of the causes of homelessness?
• Explain the effects of ignorance on discrimination.
• What are the impacts of death sentences on social justice?

• How does financial success affect societal privilege?
• What effects does growing up poor have on children?
• In what ways does religion influence society?
• What are the effects of immigration on a host country?
• What are the effects of ageism on job opportunities?
• What is the impact of LGBTQ+ representation in TV and movies?
• What are the effects of school shootings on politics?
• How do school uniforms affect students?
• What are the impacts of high student debt?
• What are the impacts of body shaming on people?
• What were the lasting impacts of the AIDS epidemic on society?

• What would be the impact if abortion were banned in the United States?
• What has been the impact of marriage equality in the United States?
• What are the causes and effects of noise pollution?
• What are the causes and effects of inflation on the economy?
• What are the effects of TV shows on our behavior?

Sports Cause & Effect Essay Topics

• Examine the effects of exercise on mental health.
• What led to baseball being an iconic American sport?
• What drives people to participate in extreme sports?
• In what ways did globalization affect modern sports?
• What were the effects of doping on amateur and professional sports?
• Select a sport and write about the historical factors that led to the popularization of that sport.

• Describe the ways in which youth sports influence a child’s development.
• What were the driving forces behind the first Olympics?
• How can team sports help develop social skills?
• How have e-sports changed the sporting landscape?
• In what ways do race biases influence sports?

• What are the effects of regular workouts on immunity?
• How does participating in sports affect leadership skills?
• In what ways can sports lead to character development?
• What effect does famous athletes’ social commentary have on their fans?

History Cause & Effect Essay Topics

• What are the effects of the war in Syria on the United States?
• What have been the lasting effects of the Civil Rights Movement?
• What were the causes and effects of the attack on Pearl Harbor?
• What led up to the Berlin Wall being torn down and what effects did that have?

• What lasting impact did 9/11 have on modern American society?
• What were the causes of the Salem Witch Trials?
• What was the cultural impact of the Spanish-American War?
• How has globalization led to modern-day slavery?
• What events led to the fall of the Roman Empire?
• What were the impacts of the Great Depression on women’s employment?
• How did cartels come into existence? What effect have they had on the United States and Mexico?
• What were the causes and effects of the Women’s Liberation Movement?
• Give an example of colonialism in history and name the resulting impact to the affected society.

• What led to the rise of ISIS and what has the impact been on international security?
• What factors led to the Titanic’s sinking?
• What were the causes and effects of the Vietnam War?
• Choose an American president. What led him to become president and what were the effects of his presidency?

Mental Health Cause & Effect Essay Topics

• How can stress affect the immune system?
• How does social anxiety affect young people?
• How can high academic expectations lead to depression?
• What are the effects of divorce on young people?
• How does service in the armed forces lead to post-traumatic stress disorder?

• What are the effects of mindfulness on mental health?
• Describe the ways in which the COVID-19 pandemic has impacted mental health.
• How does childhood trauma impact childhood development?
• What impact does witnessing violence have on mental health?
• What is behind increasingly high levels of anxiety in modern American society?

• What are the causes and effects of panic attacks?
• What are the causes and consequences of high stress in the workplace?
• What are some of the causes of insomnia and in what ways does it affect mental health?
• What is the impact of staying home for an extended period of time?

Current Events Cause & Effect Essay Topics

• Choose a local public education campaign. What are the effects of that campaign?
• What are the causes and effects of migration?
• What are the causes and effects of terrorist attacks?

• What are the effects of legalizing genetic engineering research?
• How do low voting rates impact elections and government?
• What is the effect of raising the minimum wage?
• What are the effects of globalization on society?
• How does gerrymandering affect election outcomes?
• What are the causes and effects of police brutality?
• What are the causes and effects of political polarization?

• What are the causes and effects of fake news?
• What are the effects of global war on citizens?
• What is the effect of international aid on poverty or health?
• Why do some countries have nuclear weapons, and what does this mean for other countries?

Education Cause & Effect Essay Topics

• What the effects of teacher quality on student success?
• What are the causes and effects of student loan debt?
• What are the causes and effects of low graduation rates?

• What are the effects of assigning homework?
• What are the causes and effects of school funding disparities?
• What are the causes and effects of the digital divide in education?
• What is the effect of A.I. on education?
• What are the causes and effects of student burnout?
• Should students be required to study a foreign language in school, and what are the effects of learning a foreign language?

• What effect has the COVID pandemic had on education?
• What are the effects of same-sex classrooms or schools?

What are your best cause-and-effect essay topics for students? Come exchange ideas in the We Are Teachers HELPLINE group on Facebook .

Plus, check out our list of interesting persuasive essay topics for kids and teens..

You Might Also Like

80 Intriguing Compare and Contrast Essay Topics for Kids and Teens

Android vs. iPhone? Capitalism vs. communism? Hot dog vs. taco? Continue Reading

Copyright © 2023. All rights reserved. 5335 Gate Parkway, Jacksonville, FL 32256

Home — Essay Samples — Nursing & Health — Anxiety — Research of Social Anxiety Disorder: Symptoms, Causes, Effects and Treatments

Research of Social Anxiety Disorder: Symptoms, Causes, Effects and Treatments

• Categories: Anxiety Anxiety Disorder

About this sample

Words: 1650 |

Published: Sep 1, 2020

Words: 1650 | Pages: 4 | 9 min read

Table of contents

Introduction, the causes of sad, the impacts of sad on people, treatments for sad.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Dr Jacklynne

Verified writer

• Expert in: Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

4 pages / 1995 words

1 pages / 631 words

5 pages / 2463 words

1 pages / 1682 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Anxiety

In the study of psychology, it is important to understand and notice that culture affects the prevalence, diagnosis, and treatment of psychological disorders. Cross-cultural psychology sheds light on which aspects of the human [...]

My current goal for this project is to successfully design and produce a picture book to spread awareness of childhood anxiety and insecurity. By doing this, I aim to educate and comfort those who suffer from these difficulties [...]

The exploration of arousal, stress, and anxiety in sports performance serves as a crucial endeavor in understanding the multifaceted nature of athletic achievement. This paper embarks on a comprehensive analysis, aiming to [...]

Passion for Post-Colonialism and Colonial Injustice/ Frantz Fanon’s passion for Post-Colonialism was sparked by the unjust treatment of French soldiers towards the Martiniquan people where they raped and sexually harassed the [...]

Introduction to the mental health challenges faced by today's adolescents Statistics on the increasing rates of depression and anxiety in teenagers Alarming consequences of mental health issues in [...]

Depression is a disease that afflicts the human psyche in such a way that the afflicted tends to act and react abnormally toward others and themselves. Therefore it comes to no surprise to discover that adolescent depression is [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Cause And Effect Essay Guide

Cause And Effect Essay Examples

Best Cause and Effect Essay Examples To Get Inspiration + Simple Tips

People also read

How To Write A Cause and Effect Essay - Outline & Examples

230+ Cause and Effect Essay Topics to Boost Your Academic Writing

How to Create a Cause and Effect Outline - An Easy Guide

You need to write a cause and effect essay for your assignment. Well, where should you start?

Establishing a relationship between causes and effects is no simple task. You need to ensure logical connections between variables with credible evidence.

However, don't get overwhelmed by the sound of it. You can start by reading some great cause and effect essay examples. 

In this blog, you can read cause and effect essays to get inspiration and learn how to write them. With these resources, you'll be able to start writing an awesome cause and effect paper.

Let’s dive in!

• 1. What is a Cause and Effect Essay?
• 2. Cause and Effect Essay Examples for Students
• 3. Free Cause and Effect Essay Samples
• 4. Cause and Effect Essay Topics
• 5. Tips For Writing a Good Cause and Effect Essay

What is a Cause and Effect Essay?

A cause and effect essay explores why things happen (causes) and what happens as a result (effects). This type of essay aims to uncover the connections between events, actions, or phenomena. It helps readers understand the reasons behind certain outcomes.

In a cause and effect essay, you typically:

• Identify the Cause: Explain the event or action that initiates a chain of events. This is the "cause."
• Discuss the Effect: Describe the consequences or outcomes resulting from the cause.
• Analyze the Relationship: Clarify how the cause leads to the effect, showing the cause-and-effect link.

Cause and effect essays are common in various academic disciplines. For instance, studies in sciences, history, and the social sciences rely on essential cause and effect questions. For instance, "what are the effects of climate change?", or "what are the causes of poverty?"

Now that you know what a cause and effect is, let’s read some examples.

Cause and Effect Essay Examples for Students

Here is an example of a well-written cause and effect essay on social media. Let’s analyze it in parts to learn why it is good and how you can write an effective essay yourself. 

The essay begins with a compelling hook that grabs the reader's attention. It presents a brief overview of the topic clearly and concisely. The introduction covers the issue and ends with a strong thesis statement , stating the essay's main argument – that excessive use of social media can negatively impact mental health.

The first body paragraph sets the stage by discussing the first cause - excessive social media use. It provides data and statistics to support the claim, which makes the argument more compelling. The analysis highlights the addictive nature of social media and its impact on users. This clear and evidence-based explanation prepares the reader for the cause-and-effect relationship to be discussed.

The second body paragraph effectively explores the effect of excessive social media use, which is increased anxiety and depression. It provides a clear cause-and-effect relationship, with studies backing the claims. The paragraph is well-structured and uses relatable examples, making the argument more persuasive. 

The third body paragraph effectively introduces the second cause, which is social comparison and FOMO. It explains the concept clearly and provides relatable examples. It points out the relevance of this cause in the context of social media's impact on mental health, preparing the reader for the subsequent effect to be discussed.

The fourth body paragraph effectively explores the second effect of social comparison and FOMO, which is isolation and decreased self-esteem. It provides real-world consequences and uses relatable examples. 

The conclusion effectively summarizes the key points discussed in the essay. It restates the thesis statement and offers practical solutions, demonstrating a well-rounded understanding of the topic. The analysis emphasizes the significance of the conclusion in leaving the reader with a call to action or reflection on the essay's central theme.

This essay follows this clear cause and effect essay structure to convey the message effectively:

Read our cause and effect essay outline blog to learn more about how to structure your cause and effect essay effectively.

Free Cause and Effect Essay Samples

The analysis of the essay above is a good start to understanding how the paragraphs in a cause and effect essay are structured. You can read and analyze more examples below to improve your understanding.

Cause and Effect Essay Elementary School

Cause and Effect Essay For College Students

Short Cause and Effect Essay Sample

Cause and Effect Essay Example for High School

Cause And Effect Essay IELTS

Bullying Cause and Effect Essay Example

Cause and Effect Essay Smoking

Cause and Effect Essay Topics

Wondering which topic to write your essay on? Here is a list of cause and effect essay topic ideas to help you out.

• The Effects of Social Media on Real Social Networks
• The Causes And Effects of Cyberbullying
• The Causes And Effects of Global Warming
• The Causes And Effects of WW2
• The Causes And Effects of Racism
• The Causes And Effects of Homelessness
• The Causes and Effects of Parental Divorce on Children.
• The Causes and Effects of Drug Addiction
• The Impact of Technology on Education
• The Causes and Consequences of Income Inequality

Need more topics? Check out our list of 150+ cause and effect essay topics to get more interesting ideas.

Tips For Writing a Good Cause and Effect Essay

Reading and following the examples above can help you write a good essay. However, you can make your essay even better by following these tips.

• Choose a Clear and Manageable Topic: Select a topic that you can explore thoroughly within the essay's word limit. A narrowly defined topic will make it easier to establish cause-and-effect relationships.
• Research and Gather Evidence: Gather relevant data, statistics, examples, and expert opinions to support your arguments. Strong evidence enhances the credibility of your essay.
• Outline Your Essay: Create a structured outline that outlines the introduction, body paragraphs, and conclusion. This will provide a clear roadmap for your essay and help you present causes and effects clearly and coherently.
• Transitional Phrases: Use transitional words and phrases like "because," "due to," "as a result," "consequently," and "therefore" to connect causes and effects within your sentences and paragraphs.
• Support Each Point: Dedicate a separate paragraph to each cause and effect. Provide in-depth explanations, examples, and evidence for each point.
• Proofread and Edit: After completing the initial draft, carefully proofread your essay for grammar, punctuation, and spelling errors. Additionally, review the content for clarity, coherence, and flow.
• Peer Review: Seek feedback from a peer or someone familiar with the topic to gain an outside perspective. They can help identify any areas that need improvement.
• Stay Focused: Avoid going off-topic or including irrelevant information. Stick to the causes and effects you've outlined in your thesis statement.
• Revise as Needed: Don't hesitate to make revisions and improvements as needed. The process of revising and refining your essay is essential for producing a high-quality final product. 

To Sum Up , 

Cause and effect essays are important for comprehending the intricate relationships that shape our world. With the help of the examples and tips above, you can confidently get started on your essay. 

If you still need further help, you can hire a professional writer to help you out. At MyPerfectWords.com , we’ve got experienced and qualified essay writers who can help you write an excellent essay on any topic and for all academic levels.

So contact our reliable essay writing service today!

Write Essay Within 60 Seconds!

Caleb S. has been providing writing services for over five years and has a Masters degree from Oxford University. He is an expert in his craft and takes great pride in helping students achieve their academic goals. Caleb is a dedicated professional who always puts his clients first.

Paper Due? Why Suffer? That’s our Job!

Keep reading

• Share full article

Advertisement

How an Earthquake Can Throw the Body and Brain Off-Balance

People can experience dizziness, anxiety and even “phantom” aftershocks following a quake.

By Erik Vance

• April 5, 2024

Earthquakes are always unnerving. But for some, the aftershocks can go on beyond the actual tremors: People can experience anxiety, sleep problems and other health issues in the hours and days after a quake.

One such effect is a sense of dizziness after an especially large or frightening earthquake. In Japan, this feeling is called jishin-yoi (which roughly translates to “earthquake drunk,” or “earthquake sickness”). It is also sometimes called post-earthquake dizziness syndrome . Others might report experiencing “phantom” earthquakes that might feel like subtle aftershocks, or like the room has started shaking again, but this is in fact purely psychological.

There is very little research into these phenomena, and most of it has been done in the wake of earthquakes far larger than the one that jolted the Northeast on Friday.

In Tokyo, where aftershocks are more common than in other parts of Japan, one team found that some people still experienced balance issues for as long as four months after a big quake.

“We see it with patients who get off cruises too, or get off a boat. They’ll be lightheaded or have a sensation of movement for days or even months,” said Dr. Landon Duyka, an ear, nose and throat surgeon at Northwestern Medicine.

If you are dizzy or feel like the ground is still moving after an earthquake ends, experts recommend treating it as you would other forms of motion sickness. Try looking at a spot far away and focusing on it, Dr. Duyka said, which “can often help what we call the vestibular system — or your balance system — settle down.”

If your dizzy spell doesn’t go away on its own within a few hours, or if it is particularly intense, you may want to look into over-the-counter antihistamines, like Dramamine, Dr. Duyka said.

Some feelings may be caused more by stress. Experts said that it’s normal to feel anxiety, especially if you’ve never experienced an earthquake before.

You can’t control earthquakes, said Susan Albers, a clinical psychologist at the Cleveland Clinic who has worked with patients who have weather-related fears. “That’s where it really taps into people’s anxiety, and particularly if you’re somebody who already has issues with control.”

Dr. Albers said it’s important to avoid “doom-scrolling” after experiencing a stressful event like an earthquake. If you feel compelled to read about it, she recommended focusing on scientific explanations of earthquakes and how they work, rather than the destruction they cause. This is especially helpful for children, Dr. Albers added.

She also recommended sharing your experience with people around you, talking about where you were and what it felt like. Seek out people who project a sense of ease about the event, Dr. Albers said — or, if you are able, become that person for others.

“Being around people who are calm about the situation can be really helpful,” she said. “Calm is contagious.”

Erik Vance is a staff editor for The Times’s Well desk, where he focuses on coverage of fitness and a healthy lifestyle. More about Erik Vance

Managing Anxiety and Stress

Stay balanced in the face of stress and anxiety with our collection of tools and advice..

How are you, really? This self-guided check-in will help you take stock of your emotional well-being — and learn how to make changes .

These simple and proven strategies will help you manage stress , support your mental health and find meaning in the new year.

First, bring calm and clarity into your life with these 10 tips . Next, identify what you are dealing with: Is it worry, anxiety or stress ?

Persistent depressive disorder is underdiagnosed, and many who suffer from it have never heard of it. Here is what to know .

If you notice drastic shifts in your mood during certain times of the year, you could have seasonal affective disorder. Here are answers to your top questions about the condition .

How much anxiety is too much? Here is how to establish whether you should see a professional about it .

Stress and Its Effects on Health Essay

Introduction, physical effects, psychological effects, behavioral effects.

Stress is the emotional strain or tension experienced by an individual due to a reaction toward various demanding and influential situations. The challenging or compelling situations are termed stressors. Stressors can be internal or external and include life changes such as losing a significant figure, low socioeconomic status, relationship problems, occupational challenges, and familial or environmental factors. An individual’s response to stressors influences the outcome of their life. Health is a state of complete social, emotional, and physical well-being and not merely the absence of disease. Stress is a common risk factor for negative health status secondary to negative adaptation and coping with the stressors. Stressors can create a strain on one’s physical, psychological and behavioral well-being, leading to lasting effects that are detrimental to one’s health.

Stress is associated with various physical health impacts on an individual. In an online cross-sectional survey by Keech et al. (2020) to determine the association between stress and the physical and psychological health of police officers, the findings illustrate that stress negatively impacts physical and psychological well-being. One hundred and thirty-four police officers were involved in the study (Keech et al., 2020). The findings demonstrate that stress resulted in various short and long-term physical effects that included increased heart rates, sweating, high blood pressure, and long-term development of the cardiac condition. In addition, stress resulted in the development of gastrointestinal disorders such as peptic ulcer and irritable bowel syndrome. Keech et al. (2020) note that stress’s associated physical health effects are explained by various mechanisms that include overstimulation of the sympathetic nervous system and the hypothalamic-pituitary-adrenocortical axis.

Overstimulation of the sympathetic nervous system results in increased sympathetic actions on the peripheral body organs leading to increased sweat production, heart rate, respiration rate, and urinary and bowel elimination. The study notes that chronic stress without positive adaptation measures results in the progressive development of hypertension, peptic ulcers, and irritable bowel syndrome as long-term effects (Keech et al., 2020). Within the gastrointestinal tract, chronic stress activity on the sympathetic nervous system results in increased parietal cell action. Overactivity of the parietal cells results in excessive gastric acid production, gradually eroding the mucosa, and ulceration occurs.

The effects of stress on the cardiovascular system are explained in a review by Kivimäki & Steptoe (2017) to determine the impact of stress on the development and progression of cardiovascular diseases. In the review, stress is identified to cause cardiovascular conditions secondary to the effects of sustained sympathetic action on heart contractility and peripheral vascular resistance (Kivimäki & Steptoe, 2017). The sympathetic nervous system contributes to normal heart and blood vessel contractility. However, when the system is overstimulated, a surge in contractility above the normal limits ensues, leading to the progressive development of heart conditions.

Psychological well-being incorporates a positive mental health status evidenced by an individual’s satisfaction with life, happiness, rational thinking and decision-making, and positive mood patterns. Stress has been associated with alterations in an individual’s psychological wellness. An explanation for alteration in an individual’s psychological well-being secondary to stress is negative adaptation. Keech et al. (2020) note that an individual’s response to a stressor determines whether stress results in positive or negative effects. In the online cross-sectional survey by Keech et al. (2020), the findings illustrate that pressure resulted in the development of anxiety, depression, and bipolar disorders as long-term effects among the participants. Exposure to stressful situations resulted in progressively developing anxiety among the individual secondary to persistent worry over the issue. The anxiety results in other physical manifestations, including increased heart rate, palpitations, sweating, and altered mobility. Depression and bipolar conditions were also associated with chronic stress secondary to the impacts of stress on neurotransmitter function and nerves.

Similar findings are noted in a cross-sectional study by Zhang et al. (2020) to compare the prevalence and severity of stress-associated mental health symptoms, including anxiety, depression, and insomnia among healthcare workers during the COVID pandemic. Five hundred and twenty-four healthcare workers were involved in the study. The study findings illustrate that 31.3% of the participants developed depression secondary to the stressful working environment, 41.2% reported anxiety, and 39.3% reported sleep disturbances (Zhang et al., 2020). The scientific explanation for the relationship between stress and depression was attributed to the effects of stressful periods on neurotransmitter homeostasis. Chronic stress results in the altered regulation of neurotransmitters in the central nervous system. Alterations in serotonin, norepinephrine, and dopamine resulted in the progressive development of depression and anxiety. Sleep disturbances reported by the participants are attributed to alterations in cortisol hormone homeostasis secondary to overstimulation of the hypothalamic-pituitary-adrenocortical axis.

Stressful situations can also lead to alterations in the behavioral patterns of an individual. The most common behavioral effects secondary to stress include the development of eating disorders, altered sleeping patterns, impaired concentration, and drug abuse especially alcohol. Alterations in sleep and eating patterns are linked to stress’s effects on the hypothalamic-pituitary-adrenocortical axis (HPA). Exposure to stressful events leads to increased activation of the HPA axis with a net effect of increased catecholamine production (adrenaline and noradrenaline) (Moustafa et al., 2018). Increased adrenaline and noradrenaline production results in dysregulation in the eating and sleeping patterns. Sustained high levels of cortisol results in difficulty falling asleep and increased metabolic processes. The biological clock regulates the typical sleeping pattern that relies on producing the sleep hormone melatonin. Melatonin production by the pineal gland is regulated indirectly by the concentration of serum cortisol levels and directly by light perception. Imbalances in the serum concentration cycle secondary to stress results in imbalanced melatonin production and concentration with a net effect of sleeping difficulties.

The emotional strain caused by stress increases the risk of alcohol and other illicit drug use and dependence. Moustafa et al. (2018) conducted an integrative literature review to determine the relationship between childhood trauma, early-life stress, alcohol and drug use, addiction, and abuse. The review findings illustrate that stress increases the risk of alcohol and drug use, addiction, and abuse among the victims. An explanation for the increased risk is the individuals’ lack of identification and implementation of effective coping strategies (Moustafa et al., 2018). Lack of effective coping strategies results in maladaptive measures such as illicit drug use and alcohol consumption. Extensive use of the maladaptive measures results in progressive addiction and drug abuse among individuals with an increased predisposition to other health effects. Alcohol consumption and other illicit drug use over time increase the risk of developing cardiac, respiratory, and liver conditions.

Stress is the emotional strain or tension experienced by an individual due to a reaction toward various demanding and influential situations. Individual response to stressors influences their health. Maladaptive response to stress results in various physical, psychological, and behavioral negative effects. Negative effects of stress on physical health include increased heart rates, sweating, high blood pressure, and long-term development of the cardiac condition. Psychological effects include the development of anxiety, depression, and bipolar disorders. The behavioral effects of stress on an individual include the development of eating disorders, altered sleeping patterns, impaired concentration, and abuse of alcohol and other drugs. Based on the research findings, it is essential for healthcare providers to identify strategic measures and health initiatives to educate and sensitize the community members on effective stress management approaches in all settings to aid in combating the health effects.

Keech, J. J., Cole, K. L., Hagger, M. S., & Hamilton, K. (2020). The association between stress mindset and physical and psychological well being: Testing a stress beliefs model in police officers . Psychology & Health , 35 (11), 1306-1325. Web.

Kivimäki, M., & Steptoe, A. (2017). Effects of stress on the development and progression of cardiovascular disease . Nature Reviews Cardiology , 15 (4), 215–229. Web.

Moustafa, A. A., Parkes, D., Fitzgerald, L., Underhill, D., Garami, J., Levy-Gigi, E., Stramecki, F., Valikhani, A., Frydecka, D., & Misiak, B. (2018). The relationship between childhood trauma, early-life stress, and alcohol and drug use, abuse, and addiction: An integrative review . Current Psychology , 40 (2), 579–584. Web.

Zhang, X., Zhao, K., Zhang, G., Feng, R., Chen, J., Xu, D., Liu, X., Ngoubene-Italy, A. J., Huang, H., Liu, Y., Chen, L., & Wang, W. (2020). Occupational Stress and Mental Health: A comparison between frontline medical staff and non-frontline medical staff during the 2019 novel Coronavirus Disease outbreak . Frontiers in Psychiatry , 11 . Web.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2023, December 19). Stress and Its Effects on Health. https://ivypanda.com/essays/stress-and-its-effects-on-health/

"Stress and Its Effects on Health." IvyPanda , 19 Dec. 2023, ivypanda.com/essays/stress-and-its-effects-on-health/.

IvyPanda . (2023) 'Stress and Its Effects on Health'. 19 December.

IvyPanda . 2023. "Stress and Its Effects on Health." December 19, 2023. https://ivypanda.com/essays/stress-and-its-effects-on-health/.

1. IvyPanda . "Stress and Its Effects on Health." December 19, 2023. https://ivypanda.com/essays/stress-and-its-effects-on-health/.

Bibliography

IvyPanda . "Stress and Its Effects on Health." December 19, 2023. https://ivypanda.com/essays/stress-and-its-effects-on-health/.

• History and Concept of the Psychoneuroimmunology
• Insomnia: Cause and Effect
• Genes, Neurotransmitters, and Emotions
• Post-Traumatic Stress Disorder and Its Theories
• Effect of Stress Hormones on Brain Cells
• Pathophysiology of Stress, Processed Foods, and Risky Alcohol Consumption
• Coronary Heart Disease Caused by Stress
• Mood and Stress Psychology: Causes, Effects and Treatments
• Adrenocorticotropic Hormone Regulation
• Jessie as the Most Sympathetic Character of “Night, Mother” by Marsha Norman
• Intergenerational Trauma and Traumatic Memory
• The Lifespan Theory Applied to a Grieving Case
• Psychological Conditions in Addition to Highly Superior Autobiographical Memory
• Self-Control: Individual Development Plan
• Arachnophobia: Systematic Desensitization Project

Cause & Effect of Columbine Shooting

This essay about the Columbine High School shooting analyzes the complex causes and significant effects of this tragic event. It explores how the combination of individual issues like social isolation and broader societal factors such as easy access to firearms and insufficient mental health resources contributed to the incident. The aftermath led to national debates and substantial changes in policies concerning school safety, mental health support, and gun control laws. Schools implemented measures like zero-tolerance policies and emergency response planning, while mental health awareness and gun control discussions gained prominence. The essay also touches on how Columbine has influenced American culture and continues to serve as a reference point for discussions about violence in schools and the responsibilities of communities. The piece underscores the importance of addressing both immediate and underlying factors to prevent future tragedies.

How it works

On April 20, 1999, the Columbine High School in Littleton, Colorado, became the site of one of the most infamous school shootings in American history. This tragic event not only altered the lives of those directly involved but also had far-reaching effects on society’s approach to school safety, mental health, and gun control laws. The causes of the Columbine shooting are multifaceted, involving complex interactions between individual psychology, societal influences, and systemic failures, while the aftermath has provoked significant changes in public policy and cultural attitudes.

The shooters, Eric Harris and Dylan Klebold, were two seniors at Columbine High School who had planned the attack for over a year. Their motivations have been the subject of extensive analysis and debate, with factors such as social isolation, bullying, and a fascination with violence being cited as possible influences. However, it is the intersection of these personal issues with broader societal and systemic failings that paints a fuller picture of the tragedy’s causes. The easy accessibility of firearms, the lack of mental health resources for young people, and the media’s role in sensationalizing violence all contributed to creating an environment where such a tragedy could occur.

The immediate aftermath of the shooting was marked by grief and shock, but it quickly spurred a national conversation about school safety and gun control. In response, schools across the United States implemented new policies such as zero-tolerance approaches to bullying and violence, the introduction of school resource officers, and the development of emergency response plans. These measures reflect a shift towards a more proactive stance on preventing violence in schools, although their effectiveness remains a subject of debate.

Moreover, the Columbine shooting had a profound effect on the national discourse surrounding mental health, particularly in relation to young people. It highlighted the need for better mental health services and support systems within schools and communities, leading to increased advocacy for mental health awareness and the destigmatization of seeking help. The tragedy also contributed to the intensification of the gun control debate in the United States, with calls for stricter background checks, safe storage laws, and measures to prevent the sale of firearms to individuals at risk of committing acts of violence.

The legacy of Columbine extends beyond policy changes and has deeply influenced American culture. It has inspired a myriad of books, films, and discussions that seek to understand the complexities of school shootings and their impact on society. The tragedy has become a pivotal reference point in conversations about youth alienation, violence in media, and the responsibilities of educational institutions and communities in fostering safe environments.

In conclusion, the Columbine shooting remains a stark reminder of the devastating consequences of societal and systemic failures to address the root causes of violence among youth. It underscores the importance of comprehensive strategies that include gun control, mental health support, and the cultivation of inclusive, supportive communities as essential components in preventing future tragedies. The ongoing discussion and policy reforms initiated in the wake of Columbine reflect its lasting impact on American society, serving as a call to action to address the complex interplay of factors that can lead to such catastrophic events.

Cite this page

Cause & Effect of Columbine Shooting. (2024, Apr 14). Retrieved from https://papersowl.com/examples/cause-effect-of-columbine-shooting/

"Cause & Effect of Columbine Shooting." PapersOwl.com , 14 Apr 2024, https://papersowl.com/examples/cause-effect-of-columbine-shooting/

PapersOwl.com. (2024). Cause & Effect of Columbine Shooting . [Online]. Available at: https://papersowl.com/examples/cause-effect-of-columbine-shooting/ [Accessed: 17 Apr. 2024]

"Cause & Effect of Columbine Shooting." PapersOwl.com, Apr 14, 2024. Accessed April 17, 2024. https://papersowl.com/examples/cause-effect-of-columbine-shooting/

"Cause & Effect of Columbine Shooting," PapersOwl.com , 14-Apr-2024. [Online]. Available: https://papersowl.com/examples/cause-effect-of-columbine-shooting/. [Accessed: 17-Apr-2024]

PapersOwl.com. (2024). Cause & Effect of Columbine Shooting . [Online]. Available at: https://papersowl.com/examples/cause-effect-of-columbine-shooting/ [Accessed: 17-Apr-2024]

Don't let plagiarism ruin your grade

Hire a writer to get a unique paper crafted to your needs.

Our writers will help you fix any mistakes and get an A+!

Please check your inbox.

You can order an original essay written according to your instructions.

Trusted by over 1 million students worldwide

1. Tell Us Your Requirements

2. Pick your perfect writer

3. Get Your Paper and Pay

Hi! I'm Amy, your personal assistant!

Don't know where to start? Give me your paper requirements and I connect you to an academic expert.

short deadlines

100% Plagiarism-Free

Certified writers

Iran launches retaliatory attack on Israel that risks sparking regional war

Iran launched a retaliatory attack against Israel on Saturday that risks sparking a regional conflict involving U.S. military forces. The operation, which Israeli officials said included more than 300 missiles and drones, marked the first time that Iran has launched a direct military attack on the Jewish state. 

Of some 30 cruise missiles launched toward Israel, 25 were intercepted by Israeli fighter jets and none managed to enter the country, Rear Adm. Daniel Hagari, an Israel Defense Forces spokesperson, said early Sunday. A "few" of the nearly 120 ballistic missiles fired toward Israel fell inside the country, he said, causing slight damage to infrastructure on the Nevatim Air Force Base but leaving it fully operational.

The assault severely injured a 10-year-old girl, but otherwise caused no casualties, Hagari said. About 31 people were treated for anxiety or injuries they sustained while heading to a protected area when sirens sounded, Israel’s first responder service said.

Follow live coverage on the aftermath of Iran's attack

Defense Secretary Lloyd Austin said in a statement late Saturday that the U.S. military shot down “dozens” of missiles and drones en route to Israel from Iran, Iraq, Syria and Yemen, calling Iran's assault "unprecedented."

“We condemn these reckless and unprecedented attacks by Iran and its proxies, and we call on Iran to immediately halt any further attacks, including from its proxy forces, and to deescalate tensions,” Austin said in the statement. “We do not seek conflict with Iran, but we will not hesitate to act to protect our forces and support the defense of Israel.”

Iran’s U.N. Mission issued a statement on X saying that Iran’s military action was in response to Israel’s attack on an Iranian diplomatic facility in Syria, an apparent reference to the April 1 bombing of an Iranian consular building in Damascus that killed two generals and five officers in the Iranian Revolutionary Guard Corps.

The statement said that Iran considered the matter “concluded” after the missile and drone strikes. But it warned that if Israel makes “another mistake,” Iran would deliver “a considerably more severe“ response. 

President Joe Biden said he spoke with Israeli Prime Minister Benjamin Netanyahu overnight and reaffirmed the United States’ commitment to the security of Israel. He also praised the country’s ability to fend off attacks as a sign to others who threaten the security of Israel.

“Tomorrow, I will convene my fellow G7 leaders to coordinate a united diplomatic response to Iran’s brazen attack,” Biden said. “My team will engage with their counterparts across the region. And we will stay in close touch with Israel’s leaders.”

U.S. forces in Iraq and Syria, as well as American warships in the region, were part of the effort to counter the Iranian attack, U.S. officials said. They include the USS Carney, a destroyer that has been involved in knocking out missiles and drones in the Red Sea fired by Iranian-backed Houthi forces from Yemen.

Through decades of tensions with Israel, Iran has previously avoided a direct conflict with the Jewish state, instead opting to damage its adversary through armed proxies in Lebanon, Syria, Gaza and elsewhere.

In back-channel communications with the U.S. over the past two weeks, Iran indicated it would retaliate against Israel but wanted to avoid an escalation that would lead to all-out war, U.S. officials said.

The question now is whether Iran’s attack will be interpreted in the way Tehran has planned, or trigger an unintended reaction from Israel that could escalate into an uncontrollable cycle of violence, analysts said.

Growing tensions

Tensions in the region have been at boiling point since Hamas’ deadly Oct. 7 terror attack and mass hostage taking and Israel’s subsequent full-scale assault on the Gaza Strip, which has resulted in the deaths of more than 33,000 and pushed the population to the brink of starvation.

The blast at the Iranian consular building in Damascus killed two of Iran’s top commanders, including Brig. Gen. Mohammad Reza Zahedi, a senior member of the Quds Force, the Islamic Revolutionary Guard Corps ’ elite foreign espionage group.

His death marked the killing of the most senior Iranian official since Gen. Qassem Soleimani was targeted by an American airstrike in 2020.

Zahedi was a key figure in coordinating the so-called Axis of Resistance — the anti-Israel, anti-Western network of Iran-backed groups that operate with militants from across the Arab world . Tehran currently backs Hamas , Hezbollah and the Houthis — all of which in recent months have either attacked Israel directly or conducted attacks citing resistance to Israel.

How will Netanyahu respond?

There is concern among top U.S. officials that Israel could quickly respond to Iran’s attacks without thinking through the potential fallout, according to a senior administration official and a senior defense official. 

Those concerns stem in part from the Biden administration’s views of the approach Netanyahu and other Israeli officials have taken to Israel's war against Hamas, as well as the attack in Damascus. 

U.S. officials have privately expressed frustration with Israel’s decision to strike the Iranian consulate in Syria, saying Israeli leaders did not think through the timing and implications of the attack, including how it might affect negotiations over the release of hostages held by Hamas. 

“I don’t think they had a strategy,” the senior administration official said. “The Israelis don’t always make the best strategic decisions.” 

Senior leaders at the Pentagon also have privately expressed frustration at the timing of the Damascus strike, according to the senior defense official, because it had the potential to be “catastrophically escalatory.”

In the days leading up to Iran’s retaliatory attack on Israel, U.S. intelligence showed that Iran’s leaders felt the need to respond to Israel’s strike in Damascus due to concern of domestic blowback if the strike went unanswered, according to the senior administration official.

Biden has privately expressed concern that Netanyahu is trying to drag the U.S. more deeply into a broader conflict, according to three people familiar with his comments.  

While the White House believes the Israelis are not looking for a wider war or a direct war with Iran, particularly given the resources they have fighting the war in Gaza, U.S. officials can’t be certain, the senior administration official said.

The official described Israel’s approach to military operations as “frenetic.” 

“There’s this urgency to act,” the official said, “and that’s what happened in Damascus.” The official said it’s the same frustration U.S. officials have with the way Israel is operating in Gaza. 

The defense official echoed that sentiment, saying the Israelis have shown they are much better at operations than they are at planning. “They have surprised us with their really short-sided planning for the past few months so in that way Damascus isn’t as surprising,” the defense official said.

Now, the U.S. is contending with a potential war between rival nation states, the senior administration official said. That would be a dramatic and dangerous expansion of the long-simmering conflict between Iran and Israel that could further destabilize the Middle East.

Courtney Kube is a correspondent covering national security and the military for the NBC News Investigative Unit.

Carol E. Lee is the Washington managing editor.

Dan De Luce is a reporter for the NBC News Investigative Unit. 

Aurora Almendral is a London-based editor with NBC News Digital.