Anxiety Disorders Assignment Help

What is anxiety?

The term Anxiety is usually defined as a vague, unexplained, very unpleasant feeling of fear and apprehension. To understand anxiety disorders, it is important to first differentiate between the definition of fear and definition of anxiety.

Fear is defined as an experience when there is a clear and obvious source of danger. Fear involves activation of ‘fight or flight’ response of the sympathetic nervous system. Also, it has its own adaptive value and is the cause behind survival of the species.

E.g. I’m afraid of waves.

The definition of anxiety is related to an experience when the source of danger is vague and not very specific. Anxiety is experienced as an unpleasant inner state where we anticipate something dreadful happening that is not entirely predictable from our actual circumstances. Anxiety is a complex blend of emotions and cognition that is both more oriented to the future and much more diffused that fear.

E.g. I’m anxious about my career.

In mild or moderate degrees Anxiety is adaptive. It is maladaptive when it becomes chronic and severe, as we see in people diagnosed with Anxiety Disorders.

Types of Anxiety Disorders

DSM V classifies all Anxiety Disorders into two major categories as

1. Anxiety Disorders and
2. Obsessive Compulsive and Related Disorders;

Depending upon the manifestation of symptoms of these anxiety disorder these are then further classified into the following types of anxiety disorders.

Source – American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

A. Anxiety Disorders

1. Separation Anxiety
2. Selective Mutism
3. Specific Phobia
4. Social Anxiety Disorder (Social Phobia)
5. Panic Disorder
6. Agoraphobia
7. Generalized Anxiety Disorder
8. Anxiety Disorder due to another medical condition
9. Other specified anxiety disorder
10. Unspecified anxiety disorder

B. Obsessive Compulsive and Related Disorders

1. Obsessive Compulsive Disorder
2. Body Dysmorphic Disorder
3. Hoarding Disorder
4. Trichotillomania (Hair-Pulling Disorder)
5. Excoriation (Skin-Picking Disorder)
6. Obsessive Compulsive and related disorder due to another medical condition
7. Other specified Obsessive Compulsive and related disorder
8. Unspecified Obsessive Compulsive and related disorder

Causes of Anxiety Disorders

A variety of psychosocial factors contribute to development of anxiety and related disorders. Let us discuss the basic cause of anxiety disorder according to different perspectives.

Psychodynamic Perspective : Anxiety disorders are a result of internal conflict. Repressed ‘id’ impulses are displaced and projected onto external objects, leading to experience of anxiety. Also fixation at ‘Anal Stage’ of psychosexual development especially ‘Anal Retention’ may lead to experience of pleasure by controlling, hoarding and obsessive behaviour. It is internalization of harsh and controlling super-ego (i.e. extremely punishing parents) which is too harsh to be managed by ego leading to maladaptive behaviour.

Behavioral Perspective : Anxiety behavior like other behaviours is learnt. Phobias and fears are learned with continuous pairing of neutral stimulus with traumatic or painful events (i.e. classical conditioning). It can also be learned through vicarious conditioning or modelling. Sometimes the secondary gains from anxious and avoidant behaviours leads to reinforcement of maladaptive behavior.

Cognitive Perspective : Anxiety disorder is result of faulty, irrational and dysfunctional thoughts and beliefs. Underestimating internal capacity and overestimating life challenges that lead to development of anxiety with a fear of failure and feeling of apprehension. If these irrational beliefs are not challenged or modified, they lead to manifestation of symptoms of anxiety and related disorders.

Humanistic Perspective : Incongruent self, i.e., when there is huge difference between one’s ‘real self’ and ‘ideal self’ it leads to anxiety. In other words, repeatedly denying true goals, wishes, thoughts and emotions can lead to development of anxiety.

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Symptoms of Anxiety Disorders

Symptoms of anxiety disorders vary but some of the common symptoms experienced in almost all kinds of anxiety disorders are:

1. Hyper vigilance
2. Shortness of breath
3. Dry mouth
4. Heart Palpitation
5. Excessive Palpitation
6. Tense muscles
7. Disturbed sleep
8. Feeling of uneasiness with inability to stay calm

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Diagnostic Criteria for Anxiety Disorders

Anxiety Disorders are of various types as classified by DSM V. Following are the diagnostic criteria for some common anxiety disorders according to DSM IV –TR Source – American Psychiatric Association. (2000)

{`{as prescribed in Diagnostic and statistical manual of mental disorders (4th ed., text rev.) Washington, DC: Author}`}

Specific Phobia:

1. Marked or persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific object or situation
2. Exposure to phobic stimulus almost invariably provokes an immediate anxiety response or panic attack. (Panic attack is also known as anxiety attack)
3. Person recognizes that the fear is excessive or unreasonable.
4. Phobic situation avoided or endured with intense anxiety or distress.
5. Symptoms interfere significantly with normal functioning or there is marked distress about the phobia.
6. Duration of at least 6 months.

Social Phobia:

1. Marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny of others.
2. Exposure to feared situation almost invariably provokes anxiety or panic.
3. Person recognizes that the fear is excessive or unreasonable.
4. Feared social or performance situation avoided or endured with great distress or anxiety.
5. Symptoms interfere significantly with person’s normal daily routine, occupational or social functioning.

Panic Disorder without Agoraphobia

1. Both (a) and (b)
   1. Recurrent, unexpected panic attacks.
   2. At least one of the attacks followed by 1 month or more of
      
      
      1. Concern about having another one.
      2. ii. Worry about consequences of an attack (“heart attack”)
         
         
2. Absence of agoraphobia.
3. Panic attack not due to physiological effects of a substance or medical condition.
4. Panic attacks not better explained by another mental disorder such as social or specific phobia.

Agoraphobia

1. Anxiety about being in place from which escape might be difficult or in which help may not be available in the event of a panic attack.
2. Situations are avoided or endured with marked distress or anxiety about having a panic attack.
3. Anxiety or avoidance not better accounted for by another anxiety disorder.

Panic Disorder with Agoraphobia

1. Both (a) and (b)
   1. Recurrent, unexpected panic attacks.
   2. At least one of the attacks followed by 1 month or more of
      
      
      1. Concern about having another one.
      2. Worry about consequences of an attack (“heart attack”)
         
         
2. Presence of agoraphobia.
3. Panic attack not due to physiological effects of a substance or medical condition.
4. Panic attacks not better explained by another mental disorder such as social or specific phobia.

Generalized Anxiety Disorder

1. Excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities.
2. Person finds it difficult to control the worry
3. Anxiety and worry associated with 3 or more of following 6 symptoms for more days than not:
   
   
   1. Restlessness or feeling keyed up
   2. Being easily fatigued
   3. Difficulty concentrating
   4. Irritability
   5. Muscle tension
   6. Sleep disturbance
      
      
4. Anxiety and worry not confined to features of another Axis I disorder
5. Symptoms cause clinically significant distress or impairment in functioning.
   
   

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Obsessive – Compulsive Disorder

1. Either obsessions or compulsions :

   Obsessions as defined presence of all these four criteria

   1. Recurrent and persistent impulses, thoughts or images that are experienced at some point as intrusive and cause marked anxiety
   2. Thoughts, impulses or images are not simply excessive worries about real life problems
   3. Person attempts to ignore or suppress them with some other thought or action
   4. Person recognizes they are product of his or her own mind

   Compulsions as defined by the presence of the following two symptoms

   1. Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, etc.) the person feels driven to perform in response to an obsession.
   2. Behaviors or mental acts aimed at reducing distress or preventing some dreaded event or situation
      
      
2. At least at some point person recognizes the obsessions or compulsions are excessive or unreasonable.
3. Obsessions or compulsions cause marked distress, are time-consuming (more than 1 hour a day) or interfere significantly with normal functioning.

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Anxiety Disorder Therapeutic Treatment & Prevention

There are various types of therapeutic treatments for anxiety disorder treatment and even for prevention of anxiety disorders. Some of the commonly used therapeutic treatment techniques are:

Behavioral Therapy – Behavioral therapy work towards modifying or changing the maladaptive behavior. It directly deals with the symptoms. It is very helpful especially for Specific and Social Phobia. Techniques used by behavioral therapists are –

1. Exposure Therapy – Basic principle of this therapy is motivating the client to maintain contact with the actual noxious stimuli or with their imagined presence until client becomes used to them. There are 3 types of therapy based on exposure principle.

1. Systematic Desensitization – A series of fear arousing stimuli, carefully graded from mild to strongly fearful are used. When a client is comfortable with one level of fear producing stimuli, the next, slightly stronger stimuli is introduced.
2. Implosive Therapy – It is based on imaginary recreation of a complex high intensity, fear arousing situation.
3. In Vivo Experience – It is forced, prolonged and intense exposure to the fear arousing stimulus until client becomes comfortable with its presence.

2. Modeling and Social Skills Training – Modeling helps in acquisition of new skills and response capabilities. Modeling and guidance help the client attain a sense of mastery or self – efficacy. Similarly social skills training also helps client acquire skills and self - confidence to deal with situations which are anxiety provoking.

Cognitive Therapy – Cognitive therapy is aimed towards modifying or changing the irrational and false beliefs of the client. Some of the popular techniques used by cognitive therapists are –

1. Cognitive Restructuring – Developed out of the ‘rational emotive therapy’ of Albert Ellis, cognitive restructuring calls the attention of the client to the unrealistic thoughts that serve as cues for his or her maladaptive behavior. Therapist helps the client review their irrational beliefs and expectations and develop more rational ways of looking at their lives.

2. Thought Stopping – It works on the assumption that a sudden distracting stimulus, such as an unpleasant noise, will serve to terminate obsession thoughts. The client is asked to get the thought firmly in mind then the therapist loudly says “stop”. This sequence obsession thought followed by “Stop” – is repeated several times with the client, rather than therapist, yelling ‘Stop’.

3. Cognitive Rehearsal – In this approach client is asked to mentally rehearse adaptive approaches to problematic situations. It is particularly useful for problems that cannot be conveniently stimulated in a clinical setting.

4. Thought Distraction – Client is asked to distract his/her attention away from the thoughts which are anxiety provoking. By engaging in some other physical or mental activity, client is asked to break the flow of anxiety provoking thoughts. Psychodynamic Therapy – This approach deals with analyzing the internal conflicts of the individual. This approach is focused on analyzing the root cause of the problem rather than superficially dealing with the symptoms. The therapy involves interpretation of dreams, free association, slip of tongue, etc. This approach deals with the underlying cause of the problem at a deeper level but it is very time consuming.

Drug Therapy – Commonly prescribed drugs for anxiety disorders are –

1. Benzodiazepines – These include Librium, Valium, etc.
2. Anti-depressants – Tricyclic drugs like Imipramine, Clomipramine, etc.

There are certain side- effects of these drugs like drowsiness, lethargy, motor impairment, sleep disturbances and reduced ability to concentrate. Drugs must be prescribed with care, considering the medical condition of the client.

Other Techniques –

1. Relaxation Techniques – Relaxation techniques like Jacobson Muscle Relaxation Technique helps clients attain increased calmness and decrease their feeling of apprehension and anxiety.

2. Bio-feedback – By indicating the increased level of physiological arousal, this method helps individual be more self- aware. It teaches them how to control brain activity and in turn how to manage stress and anxiety.

3. Meditation – It is aimed at client to retain the attention either by mindfulness or concentration. It leads to experience of a calmness and peace which helps reduce anxiety and fear.

For effective therapeutic treatment of panic disorders and anxiety disorders it is advisable to be creative while using the therapeutic techniques for treatment of anxiety disorders. Therapist can use combinations of therapeutic treatments and can also modify them according to the need of the client for effective results.

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