A new process model is putting a sharper focus on one of the most persistent mysteries in mental health: why stressful life events so often continue to accumulate after internalizing disorders such as depression and anxiety have already taken hold. In a Perspective published in Nature Reviews Psychology, researchers propose that people affected by internalizing psychopathology may not only experience more stress from their environments but may also become caught in patterns of emotion, behaviour and thinking that unintentionally generate additional stressful events. The model offers a unified explanation for how psychological vulnerability can become embedded in everyday interactions, gradually amplifying distress and contributing to chronic illness.
The concept at the center of the framework is known as stress generation. Unlike stressors that occur independently of a person’s actions, stress-generating events are at least partly shaped by an individual’s behaviour, relationships or decisions. Examples might include escalating an argument, withdrawing from social contact, failing to meet an obligation because of low motivation, or repeatedly seeking reassurance in ways that strain relationships. The researchers emphasize that this process is not deliberate and should not be interpreted as blaming people for their suffering. Instead, stress generation describes a dynamic interaction between symptoms and the social environment, in which psychological difficulties can alter behaviour and those behavioural changes can produce new sources of stress.
The proposed model begins with changes in affective functioning, the systems involved in emotional experience and regulation. Internalizing disorders are commonly associated with heightened negative affect, reduced positive affect, emotional reactivity and difficulty returning to an emotional baseline after distress. A person may become more sensitive to rejection, more easily overwhelmed by ordinary setbacks or less able to experience reward from social and daily activities. These affective alterations can influence how situations are interpreted and how quickly a person responds to them. A minor disagreement, for example, may feel unusually threatening, while a neutral message from a friend may be experienced as evidence of disapproval. Over time, such emotional shifts can shape patterns of action that affect relationships, work and other areas of life.
The next stage involves everyday behaviour. When people are experiencing persistent sadness, fear, irritability or emotional exhaustion, they may avoid demanding situations, reduce communication, postpone responsibilities or respond more intensely during interpersonal conflict. These behaviours can provide short-term relief. Avoiding a difficult conversation may temporarily reduce anxiety, and withdrawing from social contact may protect someone from immediate embarrassment or perceived rejection. However, the same strategies can create longer-term consequences, including missed deadlines, financial complications, social isolation or resentment from family members and colleagues. In this way, behaviour that is understandable in the moment can unintentionally increase the probability of future stress.
The model gives particular importance to cognitive vulnerability, which can determine whether an emotional or behavioural reaction remains contained or develops into a larger chain of events. Cognitive vulnerability includes persistent patterns such as negative interpretations, rumination, hopeless expectations and beliefs that stressful outcomes are inevitable. Rumination can keep attention fixed on a conflict long after it has ended, while threat-focused thinking can encourage defensive or avoidant responses. When these cognitive processes interact with strong negative emotion, a person may repeatedly revisit the same event, interpret ambiguous actions in the most damaging way and respond as though a feared outcome has already occurred. That response may then provoke real interpersonal difficulties, providing apparent confirmation of the original belief.
This sequence can create a feedback loop between the individual and the surrounding social environment. An emotionally distressed person may withdraw, communicate less clearly or react defensively. Other people may respond with frustration, criticism or reduced support. The individual can then perceive those reactions as further evidence of rejection or hostility, increasing emotional distress and making additional problematic behaviour more likely. The process is not necessarily confined to one relationship or one type of stressor. Repeated cycles may spread across friendships, family interactions, romantic relationships, academic settings and workplaces. As stress accumulates, the resulting burden may worsen symptoms, creating the conditions for another round of stress generation.
The researchers describe this process as transdiagnostic, meaning that it may operate across multiple internalizing conditions rather than belonging to a single diagnosis. Depression, generalized anxiety, social anxiety and related forms of psychopathology often differ in their specific symptoms, but they can share underlying features such as negative affect, avoidance, interpersonal sensitivity and repetitive negative thinking. These common factors may help explain why stress generation is linked to impairment across diagnostic categories. Instead of treating each disorder as an isolated cause of stress, the framework maps how shared emotional, behavioural and cognitive mechanisms can produce similar patterns of escalating difficulty in different people.
A major implication of the model is that stress generation should not be viewed as a single event with a single cause. It is better understood as a process unfolding over time. Affective disruption may increase the likelihood of a particular behaviour, the behaviour may alter the social environment, and the resulting consequences may activate cognitive vulnerabilities that intensify emotional symptoms. The timing and sequence of these steps are important. A brief episode of avoidance may have little effect in one context but lead to substantial stress when it occurs repeatedly, affects an important responsibility or is interpreted by others as indifference. This process-based perspective may help researchers identify which links in the chain are most influential for different individuals.
The framework also points to several possible intervention targets. Treatment could focus directly on emotional regulation, helping people reduce reactivity and recover more effectively after distress. Behavioural approaches could address avoidance, withdrawal, disrupted routines and communication patterns that increase the likelihood of conflict or missed obligations. Cognitive interventions could target rumination, catastrophic interpretations and rigid expectations about rejection or failure. Because the model describes a reciprocal relationship between individuals and their environments, interventions might also include interpersonal strategies designed to repair damaged relationships, increase constructive communication and strengthen access to social support. Interrupting even one part of the cycle could potentially prevent later stressors from developing.
The Perspective does not present stress generation as an unavoidable consequence of internalizing psychopathology, nor does it suggest that individuals are responsible for every stressful event they experience. Rather, it offers a mechanistic account of how symptoms and circumstances can influence one another, sometimes producing self-reinforcing patterns that prolong illness and increase impairment. By bringing affective, behavioural and cognitive processes into a single framework, the model may help explain why some people recover after a stressful episode while others enter a cycle of accumulating difficulties. It also shifts attention toward prevention: identifying early changes in emotion, behaviour or thinking could make it possible to intervene before ordinary problems escalate into major life stress. For a field increasingly focused on personalized and transdiagnostic treatment, understanding how stress is generated may become a crucial step toward breaking the feedback loops that keep internalizing disorders alive.
Subject of Research: Stress generation processes in internalizing disorders
Article Title: A process model of stress generation in internalizing disorders
Article References: Starr, L.R., Dozois, D.J.A., Rnic, K. et al. A process model of stress generation in internalizing disorders. Nature Reviews Psychology (2026). https://doi.org/10.1038/s44159-026-00607-5
Image Credits: AI Generated
DOI: 10.1038/s44159-026-00607-5
Keywords: stress generation, internalizing disorders, depression, anxiety, affective functioning, cognitive vulnerability, behavioural processes, rumination, interpersonal stress, mental health interventions
