Anxiety

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Anxiety is a physiological state characterized by cognitive, somatic, emotional, and behavioral components (Seligman, Walker & Rosenhan, 2001). These components combine to create the feelings that we typically recognize as fear, apprehension, or worry. Anxiety is often accompanied by physical sensations such as heart palpitations, nausea, chest pain, shortness of breath, stomach aches, or headache. The cognitive component entails expectation of a diffuse and certain danger. Somatically the body prepares the organism to deal with threat (known as an emergency reaction): blood pressure and heart rate are increased, sweating is increased, bloodflow to the major muscle groups is increased, and immune and digestive system functions are inhibited. Externally, somatic signs of anxiety may include pale skin, sweating, trembling, and pupillary dilation. Emotionally, anxiety causes a sense of dread or panic and physically causes nausea, diarrhea, and chills. Behaviorally, both voluntary and involuntary behaviors may arise directed at escaping or avoiding the source of anxiety and often maladaptive, being most extreme in anxiety disorders. However, anxiety is not always pathological or maladaptive: it is a common emotion along with fear, anger, sadness, and happiness, and it has a very important function in relation to survival.

Neural circuitry involving the amygdala and hippocampus is thought to underlie anxiety (Rosen & Schulkin, 1998). When confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased bloodflow in the amygdala. In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.

Generalized Anxiety Disorder

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Generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things, which is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically catastrophize, anticipate disaster, and are overly concerned about everyday matters such as health issues, money, family problems, or work difficulties. They often exhibit a variety of physical symptoms, including fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. These symptoms must be consistent and on-going, persisting at least 6 months, for a formal diagnosis of GAD to be introduced. Approximately 6.8 million American adults experience GAD, affecting about twice as many women as men.

Current Research

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For current research articles click - here

Symptoms

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Although anxiety attacks are not experienced by every anxiety sufferer, they are a common symptom. Anxiety attacks usually come without warning, and although the fear is generally irrational, the perceived danger is very real. A person experiencing an anxiety attack will often feel as if they are about to die or pass out.

Emotional symptoms of anxiety include a fear (such as that one has a mental illness, disease or will die), they may feel the need to avoid certain stressful sitatuons or social sitatuons due to fear of embarrassment. There may be considerable confusion and irritability when the anxiety is taking place. Physical symptoms include hot flushes, chest pain, sudden tiredness, headaches, shortness of breath, problems digesting and nausea.

Theories

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Two Factor Theory of Anxiety

Sigmund Freud recognized anxiety as a "signal of danger" and a cause of "defensive behavior". He believed we acquire anxious feelings through classical conditioning and traumatic experiences.

We maintain anxiety through operant conditioning; when we see or encounter something associated with a previous traumatic experience, anxious feelings resurface. We feel temporarily relieved when we avoid/remove ourselves from situations which make us anxious/fearful, known as 'negative-reinforcement', but this only increases anxious feelings the next time we are in the same position, and we will want to escape the situation again and therefore will not make any progress against the anxiety, only intensifying the emotions or 'fear.' Phobias can be developed this way, as well as cured using the opposite 'positive-reinforcement' whereby instead of removal from the anxiety causing situation (which acts as a 'reward' [negative-reinforcement]) something positive can be added to the situation instead to act as a reward, like actually facing your fear and coming away from it safely. This is known as positive reinforcement of a negative situation.

Types of Anxiety

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Existential Anxiety

Theologians like Paul Tillich and psychologists like Sigmund Freud have characterized anxiety as the reaction to what Tillich called, "The trauma of nonbeing." That is, the human comes to realize that there is a point at which he or she might cease to be (die), and their encounter with reality becomes characterized by anxiety. Religion, according to both Tillich and Freud, then becomes a carefully crafted coping mechanism in response to this anxiety since they redefine death as the end of only the corporal part of human personal existence, assuming an immortal soul. What then becomes of this soul and through what criteria is the cardinal difference of various religious faiths.

Philosophical ruminations are a part of this condition, and this is part of obsessive-compulsive disorder. They are typically about sex and religion or death. However, truly rational philosophical thinking is usually driven by a desire for a rational understanding of Ultimate Reality, rather than a desire to avoid death.

According to Viktor Frankl, author of Man's Search for Meaning, when faced with extreme mortal dangers the very basic of all human wishes is to find a meaning of life to combat this "trauma of nonbeing" as death is near and to succumb to it (even by suicide) seems like a way out.

The "father" of existentialism, Soren Kierkegaard, regarded all humans to be born into despair by default (in The Sickness Unto Death). Such despair was created by having a false conception of the self. He regarded the mortal self which can exist relatively, and therefore be born or die, as the false self. The true self was the relationship of self to God (the Absolute, or Ultimate Reality), rather than to any relative object.

Test Anxiety

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students suffering from test anxiety may experience any of the following: the association of grades with personal worth, embarrassment by a teacher, taking a class that is beyond their ability, fear of alienation from parents or friends, time pressures, or feeling a loss of control. Emotional, cognitive, behavioral, and physical components can all be present in test anxiety. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, and drumming on a desk are all common. An optimal level of arousal is necessary to best complete a task such as an exam; however, when the anxiety or level of arousal exceeds that optimum, it results in a decline in performance. Because test anxiety hinges on fear of negative evaluation, debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia. In 2006, approximately 49% of high school students were reportedly experiencing this condition.

While the term test anxiety refers specifically to students, many adults share the same experience with regard to their career or profession. The fear of failing a task and being negatively evaluated for it can have a similarly negative effect on the adult.

Stranger Anxiety

Anxiety when meeting or interacting with unknown people is a common stage of development in young people.

So-called "stranger anxiety" in younger people is not a phobia in the classic sense; rather it is a developmentally appropriate fear by young children of those who do not share a 'loved-one', caretaker or parenting role. In adults, an excessive fear of other people is not a developmentally common stage.

Anxiety in Palliative Care

Some research has strongly suggested that treating anxiety in cancer patients improves their quality of life. The treatment generally consists of counseling, relaxation techniques or pharmacologically with benzodiazepines.

Natural Treatments

Kava root is an effective natural treatment for short-term relief of mild anxiety. Due to recent findings regarding side effects of prolonged used of Kava-Kava, some individuals have turned to other natural herbs such as valerian (herb) root, Chamomile, orange peel and peppermint, for example.

Diagnosis

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According to the Diagnostic and Statistical Manual IV-Text Revision (DSM-IV-TR), the following criteria must be met for a person to be diagnosed with Generalised Anxiety Disorder.

1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
2. The person finds it difficult to control the worry.
3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
   1. restlessness or feeling keyed up or on edge
   2. being easily fatigued
   3. irritability
   4. muscle tension (difficulty falling or staying asleep, or restless unsatisfying sleep)
   5. difficulty concentrating or the mind going blank
4. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder.
5. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
6. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

GAD-7 Screening Test

A new test has recently been introduced called the GAD-7 Screening Test which has a high rate of accuracy in screening for Generalised Anxiety Disorder. It is a self-administered test that screens for Generalised Anxiety Disorder. These figures suggest that the 5% prevalence for GAD may be too low and that up to 20% of people may have GAD.

Prevalence

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The World Health Organization's Global Burden of Disease project did not include generalised anxiety disorders. In lieu of global statistics, here are some prevalence rates from around the world:

• Australia: 3 percent of adults
• Canada: Between 3-5 percent of adults
• Italy: 2.9 percent
• Taiwan: 0.4 percent
• United States: Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, in a given year

Potential Causes of GAD

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Some research suggests that GAD may run in families, and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders. Some people with GAD report onset in early adulthood, usually in response to a life stressor. Once GAD develops, it is chronic.

Treatment

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SSRIs

Pharmaceutical treatments for GAD, include selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that influence brain chemistry to block the reabsorption of serotonin in the brain. SSRIs are mainly indicated for clinical depression, but are also effective in treating anxiety disorders. Common side effects include nausea, sexual dysfunction, headache, diarrhea, among others. Common SSRIs perscribed for GAD include:

• fluoxetine (Prozac)
• paroxetine (Paxil)
• escitalopram (Lexapro)

Other Drugs

• imipramine (Tofranil)
• venlafaxine (Effexor)

Benzodiazepines

Benzodiazepines (or "benzos") are fast-acting sedatives that are also used to treat GAD and other anxiety disorders. These are often given in the short-term due to their nature to become habit-forming. Side effects include drowsiness, reduced motor coordination and problems with equilibrioception. Common benzodiazepines used to treat GAD include:

• alprazolam (Xanax)
• chlordiazepoxide (Librium)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)

Cognitive Behavioral Therapy

A psychological method of treatment for GAD is cognitive behavioral therapy (CBT), which involves a therapist working with the patient to understand how thoughts and feelings influence behavior. The goal of the therapy is to change negative thought patterns that lead to the patient's anxiety, replacing them with positive, more realistic ones. Elements of the therapy include exposure strategies to allow the patient to gradually confront their anxieties and feel more comfortable in anxiety-provoking situations, as well as to practice the skills they have learned. CBT can be used alone or in conjunction with medication.

GAD and Comorbid Depression

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In the National Comorbidity Survey (2005), 58% of patients diagnosed with major depression were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with panic disorder, 9.9%. Patients with a diagnosed anxiety disorder also had high rates of comorbid depression, including 22.4% of patients with social phobia, 9.4% with agoraphobia, and 2.3% with panic disorder. For many, the symptoms of both depression and anxiety are not severe enough (i.e. are subsyndromal) to justify a primary diagnosis of either major depressive disorder (MDD) or an anxiety disorder.

Patients can also be categorized as having mixed anxiety-depressive disorder, and they are at significantly increased risk of developing full-blown depression or anxiety. Appropriate treatment is necessary to alleviate symptoms and prevent the emergence of more serious disease.

Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone. In addition, social function and quality of life are more greatly impaired.

In addition to coexisting with depression, research shows that GAD often coexists with substance abuse or other conditions associated with stress, such as irritable bowel syndrome. Patients with physical symptoms such as insomnia or headaches should also tell their doctors about their feelings of worry and tension. This will help the patient's health care provider to recognize whether the person is suffering from GAD.

Controversy

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The loose diagnostic criteria advanced by the DSM-IV makes it very easy for practitioners diagnose a patient with GAD. Assessment of the incidence and prevalence of GAD is difficult, because a large proportion of people with GAD have a comorbid diagnosis, either physical or mental. The diagnosis of GAD can be challenging because the difference between normal anxiety and GAD is not always distinct. Furthermore, the diagnostic criteria — restlessness, fatigue, difficulty concentrating, irritability, muscle tension or sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) — are common factors of human life, otherwise known as normal anxiety. Without the evidence of the patient showing increased motor tension, autonomic hyperactivity (shortness of breath, rapid heart rate, dry mouth, cold hands, and dizziness) but not panic attacks; and increased vigilance and scanning (feeling keyed up, increased startling, impaired concentration), anxiety is not necessarily indicative of an anxiety disorder.


(adapted from Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Generalized_anxiety_disorder and http://en.wikipedia.org/wiki/Anxiety)