Abstract
The stress generation model suggests that people with internalizing disorders are at increased risk of engaging in behaviours that lead to stressful events. Although stress generation has been shown to contribute directly to chronicity and impairment across mental health conditions, a unifying framework charting how internalizing disorders translate into self-generated stress is needed to understand how stress-generating processes unfold mechanistically. In this Perspective, we present a process model of stress generation that details how affective, behavioural and cognitive factors in people with or at risk of internalizing psychopathology translate into stressful life events. Specifically, we outline a process that develops from alterations in affective functioning to problematic daily behaviours that can — particularly among individuals with high cognitive vulnerability — escalate into self-generated stressful life events. We describe how transdiagnostic factors associated with internalizing psychopathology might trigger escalating feedback loops between the individual and their interpersonal environment. Our model introduces multiple points of intervention that can make targeting stress generation a feasible goal for reducing the impairment and chronicity associated with internalizing disorders.
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Subjects
- Human behaviour
- Psychiatric disorders
- Psychology
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Authors and Affiliations
Department of Psychology, University of Rochester, Rochester, NY, USA
Lisa R. Starr
Department of Psychology, University of Western Ontario, London, Ontario, Canada
David J. A. Dozois
Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
Katerina Rnic & Joelle LeMoult
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
Angela C. Santee
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L.R.S. conceived the Perspective, led the conceptualization, and coordinated the writing of the manuscript. All authors co-developed the conceptual framework, wrote sections of the manuscript and provided critical feedback and revisions. All authors approved the final version of the manuscript
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Starr, L.R., Dozois, D.J.A., Rnic, K. et al. A process model of stress generation in internalizing disorders.
Nat Rev Psychol (2026). https://doi.org/10.1038/s44159-026-00607-5
Accepted:04 August 2026
Published:21 August 2026
Version of record:21 August 2026
DOI
:https://doi.org/10.1038/s44159-026-00607-5
