Recently, a report from CBC News detailed a growing trend of politically induced anxiety in America. Therapists are seeing an increase in cases specifically related to President Donald Trump, as well as the high volume of negative news coverage, combative social media discussion, and interpersonal conflict centered around Trump and his presidency. They termed the condition “Trump Anxiety Disorder.” Soon, a rash of further coverage followed, and some have connected the newly minted disorder to the preexisting "condition," dubbed “Trump Derangement Syndrome,” that has been referenced in popular media for some time. With the phenomenon now receiving validation from at least some mental health professionals, a number of new cases have been diagnosed in the news and social media.
One example was the story of Chloe Wright, a young woman who reportedly became enraged upon encountering a fellow driver sporting a “Trump” bumper sticker on his car. After allegedly accusing the other driver of being a racist, Wright proceeded to ram her car into the offending vehicle before speeding away from the scene. She was later tracked down by police and arrested for hit and run. Reporter Bill Shields of WBZ CBS Boston concluded his story about Wright by diagnosing her as another case of “Trump Anxiety Disorder.”
Another recent case involved musician Mike Ness of the punk-rock band Social Distortion. According to a report from CBS 13 Sacramento, Ness physically attacked a Trump-supporting fan during a concert. After Ness made negative comments about the President from the stage, the fan had responded with an obscene gesture expressing his disapproval. Enraged, Ness leapt from the stage in the middle of his performance, physically assaulting his fan as others in the crowd restrained the victim from defending against the attack. As a result, the fan received two black eyes, a concussion, and a missing tooth, among other injuries.
Though it is not an official diagnosis, to the extent that therapists and the general public are observing these anxious or dysfunctional behaviors, there does appear to be a curious psychological phenomenon emerging in the Trump era. However, rather than addressing “Trump Anxiety Disorder” as a unique condition, its symptoms are best understood as a set of conditioned behavioral responses, mediated by cognitive-affective and physiological factors. The extent to which these behaviors are exhibited, and the situations in which they manifest, are likely to vary significantly in each case. The goal of this analysis is to provide an overview of the behavioral, cognitive, and physiological factors which may contribute to the symptoms of so-called Trump Anxiety Disorder.
"Donald Trump and his erratic behavior could be leading the United States towards World War III."
- Joe Scarborough, MSNBC
Before examining the behavioral factors involved, it is necessary to clarify the symptoms that are commonly associated with “Trump Anxiety Disorder.” As reported, the condition is defined by anxiety resulting from mention, discussion or thoughts of President Donald Trump. Other symptoms include excessive fear or worry about political events and the potential for catastrophe, loss of sleep, irritability, and increased use of social media. Patients report that these symptoms interfere with normal functioning, including increased social avoidance, physical stress and fatigue. These symptoms are largely consistent with the features of unspecified or general anxiety disorder found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
In related cases, supporters of the president report fear of negative treatment in social settings should their political views become known. However, this form of Trump anxiety has been less reported, at least in the media, and so the primary focus of the present article is to analyze the more commonly cited examples of anti-Trump anxiety. It is that version of Trump Anxiety Disorder that has been conflated with a preexisting term, “Trump Derangement Syndrome,” which has been used for some time, often as a pejorative, to describe irrational or “unhinged” behaviors observed in opponents of President Trump.
Finally, it has been suggested by some therapists, as well as media commentators, that Trump Anxiety Disorder may be associated with the constant and, for some, overwhelming cycle of 24-hour news and social media discussion. This is consistent with a recent report from the American Psychological Association that linked news consumption and social media use with increased reports of anxious and depressive symptoms.
"We're talking about annihilating
millions of people!"
- Joy Behar, The View (ABC)
Anxiety is fundamentally a behavioral response derived from human evolution. Its design is to prepare the body and mind to respond in the event of danger. Through our experiences, as well as some biological functions, we come to associate specific events with threats to our safety, thus evoking anxiety in the presence of potentially dangerous stimuli. In some cases, a conditioned response may become generalized to apply more broadly in situations that are characteristically similar to the original stimulus. For example, the experience of a car accident can become a more general fear of driving, or even anxiety when going outdoors.
Of course, few if any of those experiencing Trump anxiety can claim direct interaction with the President of the United States, but perhaps such conditioning is the result of repeated negative experiences with supporters of the President. In some cases, the learned responses to those events might become generalized to all situations where his specter is felt
This could explain the anxious symptoms observed in cases like that of Ms. Wright and the offending Trump bumper sticker. If she had been the victim of a consistent attacks from Trump supporters, then the sticker which labeled a fellow motorist as part of that same group might signify a similar threat to her safety. Like a Pavlovian dog conditioned to salivate at the sound of a bell, Ms. Wright experienced anxiety at the mere sight of the name “Trump” and reacted accordingly, regardless of any direct threat of harm. It’s possible, but unlikely.
Publicly reported examples of Trump anxiety do not typically reference this type of direct experience with threats or harm from President Trump or his supporters. Such an explanation would better apply in the less-common cases of Trump supporters who express fear of negative social consequences, such as verbal or physical assault, should their political leanings be exposed. Indeed, those who have experienced hostility of this kind, and then respond with anxious avoidance, provide a better example of classical conditioning. However, this explanation is inadequate to explain the variety of behaviors now associated with Trump Anxiety Disorder.
To understand the full range of responses observed as Trump anxiety, we must consider the role of operant conditioning and social learning in the formation of behavior. Operant conditioning refers to voluntary behaviors, rather than automatic reflex responses, which are typically learned through reinforcement, or reward. So long as a particular behavior is rewarded, that behavior is likely to continue. In cases of Trump Anxiety Disorder, which include a broad variety of behaviors, it can be assumed that at least some of these responses are derived in this way. For example, outwardly expressing disapproval, outrage, or hostility toward President Trump, or those who support him, becomes a part of the behavioral repertoire as the result of positive reinforcement.
Such reinforcement, or reward, can come in a variety of forms. First, consider the verbal community in which the individual with Trump anxiety operates. Mainstream media and social media are frequently cited among the stimuli that evoke these symptoms, and there we can find a heavy and consistent dose of verbal reinforcers. For those who are politically opposed to President Trump, the verbal community is particularly fraught with hyperbolic rhetoric and catastrophic predictions. In this environment, those who express these sentiments, or act to “resist” the President, are rewarded with attention and praise. On the other hand, those who align themselves with Trump, or who do not vociferously reject him, risk criticism or derision.
One need not be the direct recipient of reward or punishment in order to develop a conditioned response. Social learning often occurs vicariously through observation of behavior and its subsequent results. It is clear, then, how an observer might process the expectations in this social environment and begin to model the types of behavior most likely to produce desirable social outcomes. If one’s community is known to reward robust opposition to President Trump, or to encourage hostile action against him and his supporters, then these behaviors become associated favorably within the person’s repertoire. Likewise, a verbal community which punishes even a neutral response to the President offers significant reinforcement for the selection of more aggressive anti-Trump behaviors.
"Let's make sure we show up wherever we have to show up. And if you see anybody from [Trump's] Cabinet in a restaurant, in a department store, at a gasoline station, you get out and you create a crowd. And you push back on them. And you tell them they're not welcome anymore, anywhere..."
- Rep. Maxine Waters (D-CA)
Further explanation for these behavioral responses, and more specifically the anxious and depressive symptoms of Trump Anxiety Disorder, can be found in the cognitive processes that develop as a result of environment and experience. Again, it is necessary to consider the role of the media as a significant source of environmental stimuli. Mainstream news coverage of President Trump presents a decidedly grim view of his policies, actions, and personal character. In one study, it was found that news coverage of the President was more than 80 percent negative on average, with some mainstream outlets delivering as much as 93 percent negative coverage.
Whether driven by bias, as the President claims, or by the desire for ratings and clicks, many of these stories present a catastrophic view of political affairs. As a result, Present Trump has been described in the press as a clear and present danger to the rights of women, minorities, the climate, American democracy, and the very survival of the human race.
Such claims may drive business needs for a news organization, but they also have an effect on the thinking and emotions of those in the audience. Hyperbolic depictions of President Trump, as well as the reactions observed in others, may be internalized as threats to individual values and goals. For example, the LGBT American who sees repeated claims that the President is homophobic may internalize a threat to his own life goals, doubt his ability to attain them, or feel disconnected from others who would—or must—support the President in opposition to the values he holds dear.
Personal goals and values play a key role in behavioral motivation and psychological well-being. Those who feel able to select their own goals, competent to achieve them, and that their goals have social value are most likely to feel motivated, satisfied, and psychologically well. However, when these qualities are diminished, or threatened, motivation and well-being suffer. More specifically, because Trump-related situations offer little chance for the individual American to affect their outcomes, there may be a perceived loss of autonomy to choose certain goals for one’s own life (e.g. marrying one’s partner, living in a clean environment, or avoiding nuclear war).
In addition, and despite the catastrophic media coverage, as President Trump continues to succeed (e.g. positive economic results, appointments to the Supreme Court, evasion of impeachment) the situation gains a sense of stability, or permanence. These situational conditions –external locus of control, personal inefficacy, and situational stability— diminish intrinsic motivations and can foster feelings of helplessness and symptoms of depression.
Therefore, threatening representations of Trump reported in the media have the power to shape how individuals process events and, in turn, can lead to negative impressions that may be internalized as a type of personal failure. In response, a person may experience irrational emotions such as guilt, regret, or shame. To compensate, they may engage in forms of impression management, such as denial (e.g. The President is not legitimate… The Russians are to blame… He is not my president…), justification (e.g. It is acceptable to punch a Trump supporter because the President is a fascist…), or public confession of these emotions.
Impression management may account for some of the rigid and even hostile dialogue observed in situations when an individual is said to be “triggered” by President Trump. In the case of public confession of these emotions, this may also serve as another explanation for the increased social media use associated with Trump Anxiety Disorder.
"I've thought an awful lot about
blowing up the White House... "
Cognition, or how we interpret situations and events, influences and shapes behavioral responses. With repeated exposure and internalization of negative, demotivating, or threatening situations of the type described above, individuals may develop cognitive distortions—or dysfunctional “automatic thoughts”—in relation to President Trump. They may overgeneralize and personalize events, or adopt a rigidly dualistic view framed with “either-or” scenarios.
The oft-repeated notion that all Trump supporters are racists, or “Nazis,” is an example of overgeneralization, where a statement such as, “President Trump has bad policies, so he must be evil,” represents a dysfunctional form of dualistic thinking. Personalized beliefs –or seeing events as reflective of “me” and “my life”—are also common in descriptions of Trump anxiety behavior and may well be reinforced by observed reactions in media and social settings, such as “Trump is a threat to all women,” or “People are going to die as a result of Trump’s policies.”
Individuals who lack the self-regulatory abilities to deal with dysfunctional cognitive associations find themselves limited in their behavioral choices. Here is where Trump-specific forms of anxiety and aggression may emerge. Because a cognitive association—or schema—has been formed, the individual may behave differently in Trump-related situations than he or she would in similar circumstances not involving the President.
This helps to explain the violent behavior of musician Mike Ness. Whether Ness is predisposed to aggression is unknown, though it is reasonable to assume he does not make a regular practice of attacking audience members in the middle of performing a set. In this case, Ness may have been responding differently as the result of a dysfunctional cognitive association between the fan’s behavior and cognitive distortion related to President Trump.
In order to understand the more erratic behaviors associated with Trump Anxiety Disorder – those behaviors that some refer to as “Trump Derangement Syndrome” – it is also necessary to consider the physiological and neurochemical aspects involved. Situations that evoke anxiety trigger the release of neurotransmitters epinephrine (also known as “adrenaline”) and norepinephrine in the brain. These chemicals, which are involved in the “fight or flight” response to danger, produce a range of physiological effects, such as heightened alertness and arousal, a narrowing of vision, and other survival behaviors.
For a person with dysfunctional cognitive schemas leading to frequent anxiety in regard to the President, the 24-hour news cycle and use of social media may work to keep these chemicals at a consistently high level. This can account for the sleeplessness, panic, irritability and fatigue associated with Trump Anxiety Disorder. Additionally, increased use of social media, which is also a symptom of this disorder, is known to stimulate the brain’s reward centers, much like addictive drugs or gambling, and trigger the release of dopamine.
Elevated dopamine levels have been shown to increase impulsivity and risk-taking behavior. For individuals who report the compulsion to check social media as part of Trump Anxiety Disorder, elevated dopamine may well account for the lack of control exhibited in behavioral responses, including the hostility observed in political communications online. Finally, it should be noted that social media use has also been linked with increased symptoms of depression. Though the specific effects of social media on serotonin levels are not fully known, a lack of serotonin is associated with depressive symptoms as well as a decrease in moral judgement.
"This is it. The end of the presidential race, and it feels like the end of the world."
- Trevor Noah, The Daily Show
Given the range of factors that contribute to Trump Anxiety Disorder, a cognitive behavioral approach is best suited for these cases. Cognitive Behavioral Therapy (CBT) is less concerned with a specific diagnosis and instead relies on an individualized plan to address problematic thoughts and behaviors, regardless of the underlying conditions. For this reason, CBT is effective for patients with comorbid diagnoses which may have overlapping or related symptoms, as is the case here.
Additionally, cognitive behavioral theory, though rooted in traditional behaviorism, takes the view that behaviors are caused not by events alone but rather a person’s reactions to events. Therefore, these treatments target the cognitive processing that occurs between stimulus and response in order to disrupt the sequence of behavior in problematic situations. For the patient exhibiting Trump-related anxiety, a cognitive behavioral therapist would seek to identify and understand the associations and dysfunctional schemas at work, and then work with the patient to develop skills for managing them more positively.
First, a patient may be encouraged to talk about the emotions felt in situations involving President Trump with the goal of validating and accepting these feelings. Often, this process of acceptance can lead to significant comfort. For example, the individual may not have been able to express their Trump-related fears to another person without judgement or debate, leading to additional feelings of guilt or shame for having them, or to further avoidance which may ultimately serve to reinforce the anxious symptoms.
Specific behaviors that manifest in response to President Trump, as well as the scenarios that evoke these behaviors, must then be identified and mapped out. One patient may report that all references to Trump, whether in the media or in person, trigger anxiety and result in a general sense of fear and dread. Another might experience symptoms only in personal settings where a Trump supporter is present, but these situations lead them to aggressive behaviors. Once individual behavioral sequences are known, a targeted plan can be created to modify them.
The primary goal of a cognitive-behavioral approach is to reorganize thought processes in order to change behavior. To achieve this, the therapist might teach the patient to use mindfulness techniques in order to recognize contributing thoughts and emotions as they occur, as well as strategies for coping with and counteracting their effects. For example, an encounter with a Trump supporter can be reframed as an opportunity to learn something new, rather than to fend off a threat. In therapy, the patient might be encouraged to imagine such a scenario and rehearse scripts to use in similar situations. This builds a new repertoire of skills that can be called upon with less effort, increasing the chance of disrupting dysfunctional sequences.
Depending on the individual case, a script might include positive ways of engaging in dialogue with a Trump supporter, or methods of redirecting discussion away from triggering topics -- like immigration or race -- and toward an area of common ground -- like tax reform and job creation. These skills allow the person suffering from Trump anxiety to positively interact with a triggering situation, rather than avoid or confront. This can serve to reinforce a sense of self-efficacy and positive expectancy in political situations, and thus motivate similar behaviors in the future.
Repeated exposure to triggering stimuli is also an effective method of weakening a conditioned response. The patient who feels overwhelmed by the volume and negativity of Trump-related news and social media can diminish fear responses by consuming this content while practicing coping skills learned in therapy. In some cases, this exposure might be done in the presence of a therapist who would guide the patient through increasingly difficult scenarios.
This process may begin with the patient watching portions of CNN news covering the President from a critical perspective that aligns with the patient’s negative feelings or beliefs. Once this is mastered, the exposure may increase to viewing Fox News programs that express pro-Trump positions. Finally, the patient may be encouraged to engage in social media interaction or in-person discussion with a Trump supporter. As these stimuli fail to produce negative reactions, the conditioned response may be eliminated entirely.
As with any method of treatment, a cognitive-behavioral approach to Trump Anxiety Disorder has some limitations. Cognition and motivation are mediated by myriad factors – not all of which are conscious to the patient-- and thus it is difficult to account for the full range of individual stimuli involved. Further complicating matters, some patients may not accurately report their perceptions of behavioral situations, or they may be reacting to extrinsic pressures. Performance expectations that exist in a social environment, such as family, work or school, can be powerful motivators of behavior. Consider the college student residing on a campus where it is seen as unacceptable to behave in any way other than decidedly anti-Trump.
On the other hand, a person’s behavioral response could just as well be motivated by a fear of being judged according to a stereotype associated with his or her political persuasion. For example, in an encounter between a Trump supporter and a progressive, the progressive may fear being judged as a “crazy liberal” while the Trump supporter may fear being seen as an “ignorant racist.” Their resulting anxiety over avoiding those stereotypes can actually produce behaviors that confirm them.
A cognitive-behavioral approach to addressing Trump Anxiety Disorder provides the opportunity to reframe irrational thought processes and disrupt problematic behavior, regardless of their root causes. However, as with any behavioral therapy, it is limited by the ability to isolate and control stimuli and reinforcers. In a culture awash with polarized media, politicized social environments, and increasingly hyperbolic rhetoric, this may be exceedingly difficult. Regardless of the intervention used, it will be most effective to address Trump Anxiety Disorder as a range of overlapping behavioral, social, cognitive-affective, and physiological processes, rather than an unique psychological condition.
Adapted from the academic paper, Trump Anxiety Disorder as the Behaviorist Views It, written by Anthony J. Rotolo (August 2008).