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ANXIETY DISORDERS – A PSYCHOLOGICAL APPROACH TO HELP YOU UNDERSTAND YOURSELF BETTER [part 2]

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Anxiety

Rather than being directed toward the person’s present circumstances, anxiety is associated with the anticipation of future problems. Anxiety can be adaptive at low levels, because it serves as a signal that the person must prepare for an upcoming event.

An anxious mood is often associated with pessimistic thoughts and feelings. The person’s attention turns inward, focusing on negative emotions and self-evaluation rather than on the organization or rehearsal of adaptive responses that might be useful in coping with negative events.

Excessive worry

Worrying is a cognitive activity that is associated with anxiety.

►Worry can be defined as a relatively uncontrollable sequence of negative, emotional thoughts that are concerned with possible future threats or danger.

Worriers are preoccupied with “self-talk” rather than unpleasant visual images.

Anxiety disorder Description and symptoms
Generalized anxiety disorder (GAD) Excessive anxiety and worry that occur on most days for a period of 6 months about events and activities such as work or school. Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbance.
Specific phobia (sometimes called Simple phobia) Persistent, excessive and unrealistic fear triggered by a presence of a particular situation or object.
Social phobia Persistent and marked fear and 1 or more social or performance situations.
Agoraphobia The fear of experiencing the symptoms of fear and the fear of being in places from which escape might be difficult (it is also possible to experience agoraphobia without panic).
Panic attack A discrete period of intense fear or discomfort that appears abruptly and unexpectedly and peaks within 10 minutes. Symptoms include pounding heart, shaking, trembling, and shortness of breath, sweating, abdominal distress, lightheadedness and fear of losing control.

Panic attacks can occur with or without agoraphobia.

Obsessive-compulsive disorder (OCD) May be defined by either obsessive or compulsive symptoms. Obsessions are recurrent and persistent thoughts or images that cause distress and are experienced as intrusive and inappropriate and compulsions are repetitive behaviors that the person feels driven to perform.
Posttraumatic stress disorder (PTSD) The persistent experiencing of a traumatic event (example: in images or dreams) and the avoidance of stimuli associated with the trauma. Symptoms include sleep disturbances, difficulty concentrating, angry outbursts or an exaggerated startle response.
Acute stress disorder Resembles PTSD, but symptoms persist for at least 2 days but less than 4 weeks.

It is normal to be anxious?

Almost everyone can recall at least 1 episode of anxious arousal and fear – an experience of worry tension, a racing heart, sweaty palms or an upset stomach. Indeed, anxiety and fear can serve an adaptive function. Anxious arousal tells as to take special action, to fight what is threatening us or to flee. The fact that most of us experience some degree of anxiety suggests that is a part of normal functioning.

It is entirely anxiety-free normal or even desirable?

If we are anxiety-free are we better off?

The answer is no.

Very low level of anxiety, like high levels, can be detrimental to performance: with few exceptions, we perform best when we experience mild level of anxiety. Example: when you have anxiety for your examination you will be pushed to study otherwise you will not prepare for examination.

The interaction of person and situation anxiety

Does anxiety come entirely from within the person?

Is it the result of a chemical imbalance or of maladaptive thinking?

Or is it caused by environmental conditions?

Theories about anxiety disorders

Each of the following theoretical perspectives – biological, cognitive, behavioral or psychodynamic – has generated extensive literature on anxiety and the development of anxiety disorders. In addition to the interactional (diathesis-stress) perspective just described, we consider how these 4 major perspectives explain anxiety and anxiety disorders.

 Biological theories

Anxiety and the anxiety disorders are often linked to the body’s physical systems of arousal. In times of heightened distress, our bodies react. When we turn a corner in our neighborhood and see the smoke of a burning home, when we receive a phone call from a hospital late in the evening or when we see but can’t stop a toddler who is wandering in a busy parking lot, our bodies do indeed react.

The autonomic nervous system carries messages between the brain and major organs of the body – the heart, stomach and adrenal glands. In turn, the adrenal glands release a hormone, adrenaline, which activates this system. When signals of distress are legitimate, adrenaline galvanizes the individual to action. In the absence of crisis, however excessive adrenaline can cause anxious distress.

Medications for anxiety disorders

Because anxiety symptoms often co-occur with depression, it should not be surprising that some of the antidepressants also reduce anxiety.

Panic disorders, in particular, respond relatively well to antidepressants. According to one published report, 60-90% of such patients display significant improvements when treated with antidepressants.

Cognitive causes

The basic idea underlying cognitive approaches is that anxiety results when we try to understand the events and experiences that we are a part of it in distorted irrational ways.

Ellis pointed out that people with unhealthy emotional lives are also victims of cognitive irrationality – they view the world based on self-defeating assumptions.

Anxiety disorders have multiple causes and multiple expressions. As we discussed, several forces interact in the development of disorders of anxiety, and not all expressions of these disorders are the same. Indeed, several different types of anxiety disorder appear in contemporary classification schemes.

Generalized anxiety disorder (GAD)

Generalized anxiety disorder is unfocused, prolonged anxiety and worry. Anxiety is about minor every day events. Genetics and psychological factors are responsible for GAD.

Before GAD can be diagnosed, several criteria must be met. According to DSM-IV-TR. The excessive and unrealistic anxiety and worry must be present for a minimum of 6 months; impulses must be experienced as difficult to control; and they must be associated with at least 3 of the following symptoms:

  • Restlessness, feeling on the edge
  • Easily fatigued
  • Difficulty in concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep or restless and unsatisfying sleep)

Although 98.6% of GAD patients meet the criterion of 3 out of 6 symptoms, a large percentage of patients with other anxiety disorders also fulfill this criterion. Raising the criterion to 4 or more symptoms increases diagnostic accuracy.

Treating GAD

Borkovec and his colleagues (1983) have provided some interesting information about the ability of clients to learn how to manage their worrying.

In one study clients reported that worry consumed approximately 50% of each day and caused them major problems. During an intervention, the clients participated in a program that included:

  1. Establishing a specified half-hour period (same place, same time) for daily worrying.
  2. Identifying negative thoughts and tasks – relevant thoughts.
  3. Postponing worrying until the allotted time.
  4. At the time assigned for worrying, engaging in intense worrying and problem solving.

After 4 weeks, the treated subjects showed a reduction in the percentage of time they spent worrying.

Apparently, providing a time and place for worrying (stimulus control) reduces its detrimental effects.

READ PART 1


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