Review
The default response to uncertainty and the importance of perceived safety in anxiety and stress: An evolution-theoretical perspective

https://doi.org/10.1016/j.janxdis.2016.04.012Get rights and content

Highlights

  • Anxiety, or more general the stress response is a default response to uncertainty.

  • This default response is under tonic inhibition as long as safety is perceived.

  • Chronic anxiety and stress are due generalized unsafety (GU) rather than threat.

  • GU is present in many other conditions, including loneliness, obesity and old age.

  • Intolerance for uncertainty is a natural property, alleviated by perceiving safety.

Abstract

From a combined neurobiological and evolution-theoretical perspective, the stress response is a subcortically subserved response to uncertainty that is not ‘generated’ but ‘default’: the stress response is ‘always there’ but as long as safety is perceived, the stress response is under tonic prefrontal inhibition, reflected by high vagally mediated heart rate variability. Uncertainty of safety leads to disinhibiting the default stress response, even in the absence of threat. Due to the stress response’s survival value, this ‘erring on the side of caution’ is passed to us via our genes. Thus, intolerance of uncertainty is not acquired during the life cycle, but is a given property of all living organisms, only to be alleviated in situations of which the safety is learned. When the latter is deficient, generalized unsafety ensues, which underlies chronic anxiety and stress and their somatic health risks, as well as other highly prevalent conditions carrying such risks, including loneliness, obesity, aerobic unfitness and old age.

Section snippets

How does it start and why respond to neutral (‘uncertain’) situations?

Chronic anxiety, including disorders such as generalized anxiety disorder (GAD), panic disorder (PD) and social anxiety disorder (SAD), but also nonclinical anxiety and ‘just’ habitual worrying are responsible for a considerable part of mental suffering and also form a major risk factor for somatic disease. For example, most types of chronic anxiety are associated with a two to seven-fold risk for cardiovascular disease (Kubzansky and Kawachi, 2000; Roest, Martens, de Jonge, & Denollet, 2010;

Reformulating the question: generalized unsafety theory of stress (GUTS)

We propose that the solution lies in the fact that the way in which the question is formulated is wrong. Available neurobiological evidence and evolutionary logic imply that the stress response, and thus the anxiety response, is a default response of the organism, and that it is the response the organism automatically falls back upon when no other information is available. So, the problem should not be phrased as: “what causes chronic stress responses?” but as “what mechanism allows the default

When life’s uncertainty turns into unsafety: compromised life domains

We will now point out what we mean with each compromised domain and why we hypothesize that the chronic physiological responses associated with them are due to GU.

Summary and conclusion

In this paper we proposed an entirely new theoretical perspective on chronic anxiety and stress, based on evolution-theoretical reasoning and neglected or forgotten neurobiological principles from Hughlings Jackson (1884) and Julius (1995): the generalized unsafety theory of stress (GUTS). The two core ideas of GUTS are that: (1) the stress response is a default response that is normally under tonic inhibition; (2) when no safety is perceived, the default response remains uninhibited. We argued

Acknowledgements

This work was supported byZON-MW (Netherlands Organisation for Health Research and Development); TOP Grant no. 40-00812-98-11029.

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