Read More. What did Freud say about Anxiety? Sigmund Freud took a strong interest in anxiety throughout his professional life. His thinking about the subject changed significantly as his psychoanalytic theories evolved. Please support us An independent charity, we receive no public or government funding.
Share This. Is it Anxiety? Is it Normal to Be Like That? Depressed 19 year old college student Depression helps to contribute to my unemployment! Saving my Son Scary thoughts, dark feelings, help? Swallowing fear Is there something wrong with me? Will this increase my child's chance of developing Autism? Worried about my therapist No Friends Teenager Do environmental factors hold a person back? Social Anxiety Linda writes:. Operant Conditioning and Avoidance Learning. In terms of social relationships, researchers are beginning to focus more attention on the role of peer victimization, social acceptance, and the quality of friendships as important variables in both the development and maintenance of anxiety disorders.
Hudson and Rapee Chapter 14 discuss the impact of social rejection, teasing, and bullying on anxiety and also provide information on including family members in treatment. Researchers from a variety of clinical, theoretical, and international backgrounds have begun to explore the way in which cultural variables influence the development and expression of anxiety disorders. To date, the majority of research in this area has focused on differences in the presentation and prevalence rates of pathological anxiety between Eastern and Western societies.
These data demonstrate that the anxiety disorders appear to be represented relatively consistently across cultures, although their manifestations may be markedly different. For example, obsessional thoughts in individuals with OCD tend to be culturally relevant e. Though research in this area is still in its infancy, investigators hypothesize that the religious beliefs, norms, gender expectations, and illness perceptions of the dominant culture greatly shape the presentation of the anxiety disorders.
Hudson and Rapee Chapter 14 also describe briefly how specific cultural beliefs may shape reported prevalence rates. One of the ways researchers have attempted to differentiate and further understand the anxiety disorders has been to evaluate the presence of specific personality traits among sufferers.
The most consistent finding to date is that neuroticism occurs frequently across anxiety disorders. Other factors, however, have emerged that have become differentially associated with specific anxiety presentations. Rates of avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder are particularly high among patients with social phobia, panic disorder, and OCD, respectively.
The co-occurrence of these disorders presents unique challenges in the domains of assessment and treatment. As reviewed by Brandes and Bienvenu Chapter 45 , comorbid personality and anxiety disorders are associated with a more protracted clinical course, greater impairment and distress, increased suicidal ideation or attempts, and an overall poor response to treatment. A current area of debate involves the significant overlap between the diagnostic criteria for social phobia and avoidant personality disorder. Sharing many key features, some argue that the two disorders essentially capture the same construct at varying levels of intensity and functional impairment, with avoidant personality disorder corresponding to a more severe variant of social phobia.
Further discussion regarding categorical versus dimensional classification approaches can be found in Chapter While the precise nature of the relationship between personality and anxiety is unclear, competing theories have been proposed to explain how they might interact and influence one another.
For example, some researchers argue that personality traits and temperament are inherent factors that place an individual at greater risk for the subsequent development of an anxiety disorder. Others contend that the presence of chronic anxiety precedes and p. Still others propose that the co-occurring disorders share a common underlying cause and are, therefore, etiologically related. Relevant empirical data for these theoretical models and related treatment implications are presented in Chapter In recent years, a number of practice guidelines have been published on the treatment of anxiety disorders.
These include guidelines from the Canadian Psychiatric Association on the treatment of all anxiety disorders Swinson et al. Recommendations from across these guidelines are fairly consistent.
A lifespan view of anxiety disorders
They confirm that anxiety disorders are responsive to intervention, and that effective treatments include pharmacological approaches, psychological approaches particularly cognitive and behavioral treatments , and combinations of these treatments. Part Five of this book provides a detailed review of these strategies for treating anxiety disorders.
In this section, we provide a brief overview of effective treatments. Comprehensive reviews of pharmacological treatments for anxiety disorders may be found in Swinson et al. Effective medications exist for each of the anxiety disorders, with the exception of specific phobias, where the treatment of choice is almost always behavioral in particular, exposure to feared situations and objects , though as-needed p.
Generally, most first-line pharmacological treatments are antidepressants. For example, there is broad support for the use of selective serotonin reuptake inhibitors SSRIs; e.
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Serotonin-norepinephrine reuptake inhibitors SNRIs such as venlafaxine extended-release and more recently, duloxetine are also effective for many of the anxiety disorders. However, older antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors MAOIs , are used less frequently now than they were in the past because they tend to be more difficult to tolerate and are more dangerous in overdose. Benzodiazepines e.
Anxiety disorder - Wikipedia
There is now emerging evidence supporting the use of several anticonvulsants e. Combining atypical antipsychotics e. There is also evidence supporting the use of buspirone for GAD, and beta-adrenergic blockers taken on a p. For treatment refractory cases of OCD, there is preliminary evidence from large case series supporting the use of specific neurosurgical procedures e.
Finally, there is preliminary evidence supporting the use of several herbal products and other alternative treatments for particular anxiety disorders see Chapter Although there are a few preliminary studies supporting the use of client-centered psychotherapy, brief psychodynamic psychotherapy, and interpersonal psychotherapy for particular anxiety disorders e. Furthermore, some studies have found cognitive behavioral therapy CBT to be more effective for treating anxiety disorders than other approaches, such as supportive psychotherapy e. Cognitive behavioral therapy is not a single approach to treatment, but rather one that involves a wide variety of strategies that often differ across patients and across disorders.
Although investigators have begun to study transdiagnostic approaches to treating anxiety disorders see Chapter 33 , most studies have tended to focus on the treatment of a single anxiety disorder. Evidence-based cognitive and behavioral strategies for anxiety disorders include psychoeducation e. Variations on these approaches have also been studied. For example, applied tension is an effective treatment for blood and injection phobias. Finally, eye movement desensitization and reprocessing EMDR; a treatment that combines imaginal exposure with bilateral eye movements, as well as other strategies has been studied for a number of anxiety disorders, though most of this work has been in the area of PTSD.
Table 1 lists well-supported psychological treatment strategies for each of the main anxiety disorders, as well as strategies for which support is preliminary, mixed, or tentative. Although a few studies have found combined treatments to be superior to either medication or CBT alone, most studies across the anxiety disorders have found combined treatments to be equivalent to monotherapies immediately following treatment Black, ; Chapter 32 , this volume.
However, there is evidence that over the long term once treatment has been discontinued , CBT alone leads to superior outcomes for the treatment of panic disorder, relative to those following medication alone or the combination of medication and CBT Barlow et al. The long-term effects of treatment on other anxiety disorders remain to be studied. Also, most studies on combined treatment have studied the effects of beginning CBT and pharmacotherapy concurrently. Additional research on the sequential introduction of CBT and pharmacotherapy is needed.
Anxiety disorders include a diverse group of conditions that share a number of common features, such as a predominance of anxiety and fear, avoidance of feared situations and experiences, and reliance on safety behaviors designed to reduce perceived threat. There is strong evidence supporting the role of biological, psychological, and environmental factors in the cause and maintenance of anxiety disorders. Although anxiety disorders are often chronic conditions, most individuals experience a reduction in symptoms following treatment with medications, cognitive behavioral therapy, or a combination of these approaches.
The remainder of this handbook provides detailed reviews on the phenomenology, etiology, assessment, and treatment of each of the main anxiety disorders, as well as for several related conditions. Well-Established Strategies a. Although preliminary studies suggest it is effective for reducing social anxiety e. Although preliminary studies suggest it is effective for reducing phobic fear e.
A small number of studies have compared virtual exposure to live exposure, finding few differences e. However, dismantling studies are needed to determine whether they add any specific benefits beyond the other strategies included in standard treatments. However, dismantling studies are needed to determine whether it adds any specific benefit beyond in vivo exposure and ritual prevention.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders 4th ed. Washington, DC: Author. Find this resource:. Practice guideline for the treatment of patients with panic disorder. American Journal of Psychiatry , Suppl. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder.
Arlington, VA: Author. Available online at www. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Anderson, P. Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depression and Anxiety, 22 , — Barlow, D.
Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Journal of the American Medical Association, , — Barr, C. Rearing condition and rh5-HTTLPR interact to influence limbic-hypothalamic-pituitary-adrenal axis response to stress in infant macaques. Biological Psychiatry, 55 , — Beck, A. Cognitive therapy and the emotional disorders.
Contemporary Views of Behavioral Learning Theory
New York: International Universities Press. Bienvenu, O. Low extraversion and high neuroticism as indices of genetic and environmental risk for social phobia, agoraphobia, and animal phobia. American Journal of Psychiatry, , — Black, D. E cacy of combined pharmacotherapy and psychotherapy versus monotherapy in the treatment of anxiety disorders. CNS Spectrums, 11 , 29— Bond, A.
Treatment of generalised anxiety disorder with a short course of psychological therapy, combined with buspirone or placebo. Journal of Affective Disorders, 72 , — Campbell, L. Generalized anxiety disorder. Barlow Eds. New York: Guilford. Campbell-Sills, L. Guideline watch: Practice guideline for the treatment of patients with panic disorder. Journal of Traumatic Stress. Caspi, A. Gene-environment interactions in psychiatry: Joining forces with neuroscience. Nature Reviews: Neuroscience, 7 , — Charney, D. Psychobiological mechanisms of resilience and vulnerability: Implications for successful adaptation to extreme stress.
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Clark, D. A cognitive approach to panic. Behaviour Research and Therapy, 24 , — Cognitive therapy versus exposure plus applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74 , — Cohen, J. Connor, K.
Depression and Anxiety, 18 , 76— Craske, M. Fear and learning: From basic processes to clinical implications. Davidson, J. Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Archives of General Psychiatry, 61 , — Davidson, P. Journal of Consulting and Clinical Psychology, 69 , — Emmelkamp, P.
Virtual reality treatment in acrophobia: A comparison with exposure in vivo. Cyberpsychology and Behavior, 4 , — Etkin, A. Functional neuroimaging of anxiety: A meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Foa, E. Journal of Clinical Psychiatry, 60 Suppl. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Furmark, T.