Anxiety Disorder

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ANXIETY DISORDERS:

Introduction:-

Everyone experience anxiety from time to time. It is a natural; and common reaction to many of life’s difficulties. For some people, however, anxiety becomes a chronic problem. These people experience high level of anxiety with disturbing regularity. Anxiety disorders are class of disorders marked by feelings of excessive apprehension and anxiety.

Signs and symptoms of Anxiety Disorders:-

As anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person. Despite their different forms, all anxiety disorders share one major symptom: Persistent or severe fear or worry in situations where most people wouldn’t feel threatened.

Emotional symptoms of anxiety:-

In addition to the primary symptoms of irrational and excessive fear and worry, other common symptoms of anxiety include:

  1. Feelings of apprehension or dread.
  2. Trouble concentrating.
  3. Feeling tense and jumpy
  4. Anticipating the worst.
  5. Watching for signs of danger.
  6. Feeling like your mind’s gone blank.

Physical Symptoms of anxiety:-

Anxiety is more than just a feeling. As a result of the body’s fight or flight response, anxiety involves a wide range of physical symptoms, which include:

  1. Pounding heart.
  2. Stomach upset or dizziness.
  3. Frequent urination or diarrhea.
  4. Shortness of breath.
  5. Tremors and twitches.
  6. Muscle tension.
  7. Insomnia

Types of anxiety disorders:-.

There are six major types of anxiety disorders. There disorders are not mutually exclusive, as many people who develop one anxiety syndrome often suffer from another at some point in their lives.

Generalized Anxiety Disorder:-

The “generalized anxiety disorder” is marked by a chronic, high level of anxiety that is not tied to any specific threat. This anxiety is sometimes called “free floating anxiety” because it is not specific. People with this disorder constantly worry about past mistakes and future problems. In particular, they worry about minor matters related to family finances, work, and personal illness. They often read decisions and brood over them endlessly. Their anxiety is commonly accompanied by physical symptoms such as trembling, muscle tension, dizziness faintness, sweating and heart palpitation. This disorder tends to have a gradual onset and is seen more frequently in females than males.

Phobic Disorder:-

A phobic disorder is marked by a persistent and irrational fear of an object or situation that presents no realistic danger. Although, mild phobias are extremely common, people are said to have phobic disorder only when their fears seriously interfere with their everyday behaviour. The physical symptoms of this order are trembling and palpitations. People can develop phobic responses to virtually anything. Nonetheless, certain types of phobia are more common than others. Particularly common are acrophobia (fear of height), claustrophobia (fear of small, enclosed places), brontophobia (fear of storms), hydrophobia (fear of water) and various animals and insect phobias. People confronted with phobic disorder often realized that their fears are irrational yet they still are unable to calm themselves when confronted by a phobic object.

Panic disorder and Agoraphobia:-

A panic disorder is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly. After a number of panic attacks, victims often become apprehensive, wondering when their next panic will occur. Their concern about exhibiting panic in public may escalate to a point where they are afraid to leave home. This creates a condition called “agoraphobia”, which is a common complication of panic disorders.

Agoraphobia is a fear of going out to public places. Because of this fear, some people become prisoners confined to their homes, although many will venture out if accompanied by a trusted companion. Agoraphobia has traditionally been viewed as a phobic disorder. However, more recent research suggests that it is mainly a complication of panic disorder.

Obsessive compulsive disorder:- 

“Obsessive compulsive disorder is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).” Obsessions often center on inflicting harm on others, personal failures, suicide, or sexual acts. People troubled by obsessions may feel that they have lost control of their mind. Compulsions unusually involve stereotyped rituals that temporarily relieve anxiety. Specific types of obsessions tend to be associated with specific type of compulsions. For example, obsession about contamination tends to be paired with cleaning compulsion.

Social Anxiety Disorder:-

If you have a debilitating fear of being seen negatively by others and humiliated by others in public you may have social anxiety disorder. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether performance anxiety is the most common type of social phobia.

Post-traumatic stress disorder (PTSD):-

PTSD is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. Symptoms of PTSD include flashbacks or nightmares about what happened, hyper vigilance, startling easily, withdrawing from others, and avoiding situations that remind of the event.

Causes of Anxiety Disorders: –

Like most psychological disorders, anxiety disorders develop out of complicated interactions among a variety of biological and psychological factors.

Biological Factors:-

In studies that assess the impact of heredity on psychological disorders, investigators look at “concordance rate”.

A concordance rate indicates the percentage of twin pairs or other pairs of relative who exhibit the same disorder. The concordance rate for anxiety disorders in identical twins is higher than that of fraternal twins, who share less genetic overlap. This result suggests that there is genetic pre disposition to anxiety disorders.

Recent evidence suggests that a link may exist between anxiety disorders and neuro-chemical activity in the brain. Neurotransmitters are chemicals that carry signals from one neuron to another. The drugs that reduce excessive anxiety appear to alter neurotransmitter activity at GABA synapses. Abnormalities in neural circuits using serotonin have been implicated in panic and OCD.

Conditioning & learning:-

Many anxiety responses may be acquired through classical conditioning and maintained through operant conditioning. According to Mowrer (1947), an originally neutral stimulus (for example, snow) may be paired with a frightening event (the avalanche) so that it becomes a conditioned stimulus eliciting anxiety. Once a fear is acquired through classical conditioning, the person may start avoiding the anxiety producing stimulus. The avoidance response is negatively reinforced because it is followed by reduction in anxiety. This process involves operant conditioning.

Studies suggest that conditioned fear can be created through observational learning. In particular, parents frequently pass on their anxieties to their children. Thus, if a father hides in a closet every time there is a thunderstorm, his children may acquire their father’s fear of storms.

Cognitive Factors:-

Cognitive theorists believe that certain types of thinking make some people particularly vulnerable to anxiety disorders. According to these theorists, some people are more likely to suffer from anxiety disorders because they tend to.

  1. Misinterpret harmless situations as threatening.
  2. Focus excessive attention on perceived threats.
  3. Selectively recall information that seems threatening.

The cognitive view holds that some people are prone to anxiety disorders because they perceive threat in every corner of their lives.

Stress:-

Finally, studies have supported the long-held suspicion that anxiety disorders are stress related. Farmville and Pallanti (1989) found that patients with panic disorder had experienced a dramatic increase in stress in the month prior to the onset of their disorder.

Treatment of Anxiety Disorders:

In general, anxiety disorders are treated with medication, specific types of psychotherapy or both. Treatment choices depend on the problem and the person’s preference.

Medication:-

Medication will not cure anxiety disorders, but it keeps them under control while the person receives psychotherapy. The principal medications used for anxiety disorder are as follows:-

Antidepressants:-

SSRIs:-

Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRTs. SSRTs alter the level of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, help brain cells communicate with each other.

Anti-Anxiety Drugs:-

High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness.

Clonazepam is used for social phobia and GAD, lorazepam is helpful for panic disorder and alprazolam is useful for both panic disorder and GAD.

Beta-Blockers:-

Beta Blockers, which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicated (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.

Psychotherapy:-

Psychotherapy involves talking with a trained mental health professional such as a psychiatrist, psychologist, social worker or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.

Cognitive Behavioral therapy (CBT):-

CBT is most widely-used therapy for anxiety disorders. As the name suggests, this involves two main components:

Cognitive therapy examines how negative thoughts contribute to anxiety.

Behavior therapy examines how you behave in situations that trigger anxiety. The basic premise of CBT is that our thoughts- not external events affect the way we need.

Thought Challenging in CBT:-

Thought challenging-also known as cognitive restructuring is a process in which you challenge the negative thinking patters that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps.

Identifying your negative thoughts:-

With anxiety disorders, situations are perceived as more dangers than really are. Identifying one own irrational, scary thoughts can be very difficult. One strategy is to tell yourself what you were thinking when you started feeling anxious. Your therapist will help you in this step.

Challenging your negative thoughts:

In the second step, your therapist will teach your how to evaluate your anxiety provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs and tearing out the reality of negative predictions.

Replacing negative thoughts with realistic thoughts:-

Once you have identified the negative thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come out with realistic, calming statements that you can say to yourself when you are facing or anticipating a situations that normally sends your anxiety levels soaring.

Exposure theraphy:-

Exposure theraphy, as the name suggest, exposes you to the situations or objects you fear. The ideal is that through repeated exposoures, you will feal an increasing sense of control over your situation and your anxiety will diminish. The exposure is done in one of the two ways: Your therapist may ask to imagine the scary situations, or you may confront it in real life.

Systematic Desensitization:- 

Rather than facing your fears right away, which can be traumatizing, exposure therapy usually starts with a situation that’s only mildly threatening and works up from three. This step by step approach is called systematic desensitization and involves three parts.

Learning Relaxation skills:

First, your therapist will teach you a relaxation technique, such as progressive muscle relaxation or deep breathing. Once you start confronting, your fears, your will use these relaxation techniques to reduce your physical anxiety response. 

Creating Step by Step list:-

Next, you will create list of 10 to 20 scary situations that progress towards your final goal. For example, if your final goal is to overcome fear of flying, you might start by looking at photos of planes and by taking an actual flight. Each step should be as specific as possible with a clear, measurable objective.

Working through the steps:-

Under the guidance of your therapist, you will then begin to work through the list. The goal is to stay in each scary situation until your fear subsides. That way, you will learn that feelings won’t hurt you and they do go away. Every time the anxiety gets too intense, you will switch to the relaxation technique you learned. Once you are relaxed again, you can turn your attention back to the situation. In this way, you will work through the steps until you are able to complete each one without feeling over disbursed.

 

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