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Anxiety and Anxiety Disorders

Anxiety Disorders: Developing Young

Because anxiety disorders tend to develop at such young ages and can potentially persist throughout the duration of a person’s entire lifespan, it is important to find out just how early an anxiety disorder can begin to emerge in an individual’s life and what types of factors influence this development.  Some research has shown that symptoms can begin to appear in children as young as preschool age, leading researchers Hudson and Dodd (2012) to conduct a longitudinal study with children three to four years of age. The researchers conducted interviews and questionnaires with kids and their mothers about specific variables that could influence the onset of an anxiety disorder and then followed up five years later to determine if those variables may have been contributing factors after all.  The five baseline measures included: a parent report of the child’s behavioral inhibition using the Short Temperament Scale for Children (STSC) approach scale; researcher-observed behavioral inhibition in the child; child anxiety using the Anxiety Disorders Interview Schedule for DSM-IV; maternal anxiety disorders using the same criteria as for child anxiety; maternal overinvolvement and negativity using the Parent Protection Scale and Five Minute Speech Sample; and child-mother attachment, using the preschool version of the Strange-Situation procedure (Hudson & Dodd, 2012).

The researchers found that behavioral inhibition in preschool predicted an anxiety disorder diagnosis five years later, and they also found that the mother’s diagnosis of an anxiety disorder, whether the diagnosis be current or was present at some previous point in her life, also predicted the child’s later diagnosis (Hudson & Dodd, 2012). Furthermore, many of the children showed symptoms of anxiety disorders in the initial phase of the research at ages three and four, which is not an uncommon finding in anxiety disorder research–but when the Hudson and Dodd controlled for this initial anxiety, behavioral inhibition still proved to be a “significant predictor of anxiety” (Hudson & Dodd, 2012).

Identifying signs of anxiety disorders early in life is important for figuring out who may be most vulnerable to these conditions, as well as for helping to avoid any further progression of potentially debilitating anxiety disorders in these children’s lives.  As a teaching assistant in a preschool, I found this journal article particularly interesting and relevant to my own life.  Just as well, even though I knew from prior reading that anxiety disorders can develop young, I always thought of mental health disorders as affecting adults because I myself am an adult, so this journal article makes me keep in mind the fact that some of the children I’m working with may be susceptible to developing mental health disorders themselves.  Mental health is always important to consider for all individuals, and this research by Hudson and Dodd helps to remind us of that.

References:

Hudson, J.L., Dodd, H.F. (2012). Informing Early Intervention: Preschool Predictors of Anxiety Disorders in Middle Childhood. PLoS ONE 7(8): e42359. doi:10.1371/journal.pone.0042359.

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Anxiety and Anxiety Disorders

Agoraphobia: Fear of Open Spaces

The cast of medical mystery TV show House M.D. tackles the difficulty of living with agoraphobia in season five, episode seven of the series as the doctors try to diagnose the physical ailments of a man called Stewart with severe agoraphobia who refuses to leave his home for diagnosis and treatment.  In line with some severe cases of the mental health disorder, Stewart becomes violent and panicked at the beginning of the episode in an encounter with the paramedics who are attempting to take him away from the safe and trusted space of his home and into the foreign place of the hospital.  He breaks free of the gurney restraints and has a physical altercation with the medical personnel before running into his home and locking the door, keeping the strangers out while keeping himself in.  Stewart refuses to leave his home for potentially life-saving medical treatment due to his agoraphobia and the extent to which it affects his life.  This act of self-preservation takes place because Stewart is attempting to keep himself away from public and unknown spaces where his fears could manifest, and his actions make sense because his anxiety was triggered by the transportation of himself toward an ambulance.  His violence can be perceived as the agoraphobic symptom of unusual agitation. 

(Spoiler alert!) At the end of the episode, even though Dr. House’s team acknowledges that their patient’s agoraphobia is not resultant of any of his (now cured) physiological ailments, Stewart is shown miraculously to have “overcome” his agoraphobia, as the viewers watch him gradually convincing himself to part from his house.  Our final image of Stewart is him walking down the block, out into the environment he couldn’t bear to be in at the beginning of the episode due to crippling fear of being out in public spaces.  The episode’s ending seems to push the message that the man was able to conquer his agoraphobia and get rid of it, even though the doctors in the show acknowledge that Stewart’s agoraphobia could not have been caused by what brought him into their care in the first place.  Apparently House and his team are such skilled medical professionals that they succeed in convincing a person to spontaneously get rid of his mental health disorder without administering any real treatment for it. 

Agoraphobia, which is typically comorbid with panic disorder, is the fear of open or public places, where people with this anxiety disorder develop severe anxiety or panic symptoms (like an accelerated heart rate and sweaty palms) when they are away from home or in crowded spaces (Miller, 2011).  Possible symptoms include fearing the ensuing panic symptoms, fearing one’s loss of self-control in public, and perceiving that one’s own body does not exist (Miller, 2011).  Because they know how they will feel in such situations, people with agoraphobia actively avoid them, which, in the most severe cases, can result in never leaving home (Miller, 2011).  Developing this mental health disorder can, for example, result from suffering a panic attack in public, thus leading the afflicted person to avoid going out in public so as to prevent a similar incident from taking place (Miller, 2011). 

The viewers are given an accurate and unfortunate interpretation of living with agoraphobia as soon as  House starts in with his ignorant demands of Stewart to leave his home.  True to his arrogant personality, House treats his patient’s phobia as a simple, escapable fear, asking Stewart, “Whatever you’re scared of out there, aren’t you more scared of death?” To people with agoraphobia, being ‘out there’ equates to panic symptoms that can make them feel as though they are dying.  This mental health disorder necessitates treatment like exposure-based cognitive behavioral therapy with relaxation techniques and sometimes medication (Miller, 2011); the severe anxiety and fear entailed in agoraphobia is not easily conquered by sheer force of will.  This line of dialogue from the episode portrays one kind of real stigma against people with this mental health disorder, and it also portrays one misunderstanding about the disorder itself: agoraphobia isn’t about being ‘scared,’ it’s an intense and consuming fear that can be detrimental to a person’s mental and physiological well-being. 

Furthermore, House argues that his patient is “doing it to avoid sunlight and fresh air,” as if to say that Stewart claims to have agoraphobia because he simply does not want to go outside.  Here we see another misinterpretation of the phobia in this line of dialogue as well; agoraphobia is not about wants, it’s about needs.  People with this anxiety disorder feel more than compelled to stay away from public spaces because of their phobia, so they do feel that they need to abide by their severe anxieties and fears — it is a need.  House’s wrongful words about Stewart perpetuate the stigma and misunderstandings of agoraphobia because the show depicts House as a deified doctor who can do everything that everyone else cannot: because of House’s high status in the show, viewers may confuse his arrogant behavior as correct words of wisdom in terms of agoraphobia.  This means to say that people watching the show could be led to believe that, due to House’s high intelligence, it’s true that people with agoraphobia are just “scared” of being in public and that they simply do not wish to go outside — and those viewers who already believe such things might feel justified because House seems to agree.  

The realness and severity of the mental health disorder need to be conveyed accurately and adequately in order to teach people that this is something that can be debilitating and must be taken seriously.  While the show accurately portrayed the intense fear possessed by those with agoraphobia, as well as the stigma and misconceptions of some people without agoraphobia, it failed in the end by alluding to the idea that, prior to his visit with these doctors, this man had not been trying hard enough to trump his fears.  I personally love watching this show, but I felt let down upon re-watching this episode after learning a lot about anxiety disorders like agoraphobia.  Maybe the creators of the show decided that having the man with agoraphobia end up leaving his house at the end would be a great way to finish it off because it evokes an inspiring message for the viewers; I understand that television shows are meant to be entertaining, I just hope that this episode does not make its viewers mistakenly believe that agoraphobia is not a real mental health disorder, or that it doesn’t need to be taken seriously. 

References:

Miller, M. C. (2011). What is agoraphobia?. Harvard Mental Health Letter27(11), 8-8 1p. 

Categories
Anxiety and Anxiety Disorders

The Link Between Anxiety Disorders & Anorexia Nervosa

Anxiety disorders are highly comorbid with anorexia nervosa, meaning that the former will often be diagnosed in people who will also be diagnosed with the latter. “Anorexia nervosa typically involves excessive weight loss or failure to gain expected weight and is characterized by immoderate food restriction and fear of gaining weight, as well as a failure to recognize the seriousness of the low weight” (Meier et al. 2015). Most people who have anorexia nervosa have also been diagnosed with an anxiety disorder, and the diagnosis of the anxiety disorder usually comes before the diagnosis of anorexia nervosa (Meier et al. 2015). Even people with anorexia nervosa who lack an anxiety disorder diagnosis report higher levels of anxiety than people without anorexia nervosa, suggesting that the two mental health disorders are associated with one another (Meier et al. 2015). The most apparent link between anxiety disorders and anorexia nervosa is an intense fear. For people with anorexia nervosa, the fear is of putting on weight, as stated earlier; for people with the anxiety disorder of social phobia, for example, the fear is of being judged poorly by others.

But, as most science-related classes will teach us at one point or another, correlation does not equal causation, so an individual may have an anxiety disorder and never develop anorexia nervosa, or another individual will develop an anxiety disorder and soon after develop anorexia nervosa. Either way, that individual with an anxiety disorder would be considered at a significantly higher risk for developing anorexia nervosa later on because of their anxiety disorder, as demonstrated by a Danish population registration study by Meier et al. (2015).

Getting treatment to patients with anxiety disorders then becomes even more pertinent because it would not only help them with that mental health disorder but it would also reduce their risk of developing comorbid disorders like anorexia nervosa. Just as well, conducting research and gathering data on mental health patients who experience this comorbidity—and, just as importantly, those who do not—helps us to understand both the people afflicted with mental health disorders as well as those disorders themselves.

References:

Meier, S.M., et al. (2015). Diagnosed Anxiety Disorders and the Risk of Subsequent Anorexia Nervosa: A Danish Population Register Study. European Eating Disorders Review, 23 (6), 524-530.

Categories
Anxiety and Anxiety Disorders

Modernizing Medicine through Internet-delivered Treatments

Because of the efficacy in terms of both cost and outcome of exposure-based cognitive behavioral therapy (CBT) in treating anxiety disorders, it is imperative to make this type of treatment accessible to all of the patients who can potentially benefit from it (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  One group in particular that can improve from CBT treatment is the child and adolescent population suffering from specific phobia.  According to the DSM-V, the individual with specific phobia has a constant fear of an object, place, or situation, a fear that is disproportional to the threat or danger actually posed by the feared object.  Studies have shown exposure-based CBT to be effective in treating specific phobia in young people, but aside from the lack of awareness about this type of treatment, many children do not receive it because there are not many therapists who have the right training (Vigerland et al. 2013).

One way of providing treatment to a wider range of those who need it is through the Internet using Internet-delivered CBT, or ICBT (Vigerland et al. 2013).  This special kind of cognitive behavioral therapy has done well with adults who have anxiety disorders, and there are also studies that have demonstrated that this method can make for good results with children as well (Vigerland et al. 2013).  In a 2013 study by Vigerland and colleagues, a slightly different approach was taken: here the parents of the child with specific phobia would be the ones primarily helping the child through the treatment.  The parents did have scheduled phone calls with a therapist throughout the treatment process, but moving through the cognitive behavioral therapy was largely reliant on the parents educating themselves with the information provided by the Internet-delivered treatment and following the instructions provided, implementing the treatment with their children (Vigerland et al. 2013).

Exposure-based ICBT for children with specific phobia presents a new and modernized approach to treating this mental health disorder.It takes an evidence-based, effective treatment and adapts it to technological advances, making it more flexible with demanding schedules that leave little spare time for trips to a therapist’s office, thus making treatment a more feasible option for people who have very rigid schedules.  Parents participating in this study were encouraged to follow the time schedule suggested by the researchers, but with this treatment model, each family could work together in treating the child’s specific phobia at their own pace (Vigerland et al. 2013).  Not only is this great for busy, working parents and school-aged children, but this is also a plus for people with mental health disorders who have to rely on public transportation, or getting a ride from a friend, or paying costly taxi fares to get to their therapist appointments. Bringing treatment to the home can save clients a considerable amount of time and money, again making treatment more attainable.  Just as well, speaking to clients over the phone rather than having them come in to the office allows the therapist to treat more clients at a lesser cost for each patient (Vigerland et al. 2013).

This pilot study showed significant reductions in anxiety symptoms reported by both the parents and the children, and almost all of the children responded that they were highly satisfied with the treatment they’d received (Vigerland et al. 2013).  Parents, however, were largely positive about the treatment experience itself, but less so in terms of using the online treatment platform, which did present some difficulties in saving answers and reading therapists’ responses (Vigerland et al. 2013).  Further studies are needed to fine-tune the Internet-based treatment and make it even more effective, but the improvement of Internet-delivered treatments to help those with anxiety disorders is certainly something to look out for in the future.

References:

Vigerland, S., Thulin, U., Ljótsson, B., Svirsky, L., Ost, L., Lindefors, N., & … Serlachius, E. (2013). Internet-delivered CBT for children with specific phobia: a pilot study. Cognitive Behaviour Therapy, 42(4), 303-314.

Wolitzky-Taylor, K., Zimmermann, M., Arch, J. J., De Guzman, & E., Lagomasino, I. (2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9-17.

Categories
Anxiety and Anxiety Disorders

Stigma as a Risk Factor for Anxiety Disorders

In earlier posts we’ve looked at how stigma can prevent people from getting the treatment they need for the mental health disorder they already have, but the findings from a cross sectional study released in August 2015 suggest that stigma might also function as a risk factor for developing a mental health disorder (Ali et al., 2015).  Ali and colleagues set out to see if an increased amount of self-reported stigma felt by people with varying levels of intellectual disability was related to more psychological distress and a lower quality of life; they also wanted to find out whether a higher amount of stigma was related to a lower use of services (2015).  Though the latter hypothesis was rejected by the research, the data did present a strong relationship between self-reported stigma and psychological distress, and the relationship seen here supports findings from previous research about the same relationship (Ali et al., 2015).

In this study, perceived stigma contributed greatly to one’s psychological distress, and psychological distress in general increases the likelihood of an individual developing anxiety, among other mental health disorders (Ali et al., 2015).  More research needs to be done to analyze the association between these factors, but the relationship found in this study suggests that experiencing stigma can put an individual at a higher risk of developing a mental health disorder, especially more vulnerable populations like those with intellectual disabilities (Ali et al., 2015).

I found this study and its outcomes to be important because a lot of the research I’ve seen has observed the effects of stigma on an individual’s life when that stigma concerns his or her mental health disorder, so I wasn’t often thinking about stigma surrounding other factors acting as a substantial contributor to developing a mental health disorder.  Stigma doesn’t affect everyone in the same way, but the findings here did show how crucial it is to eliminate all kinds of stigma in order to lessen the chances that people may develop certain mental health disorders.  Research like the work done here by Ali and colleagues is therefore important not only in prevention and intervention efforts, but it is also important in revealing the true extent of the effects of stigma.  Hopefully studies like this and others can bring about positive change in the behaviors of those who stigmatize others.

References:

Ali, A., King, M., Strydom, A., Hassiotis, A. (2014). Self-reported stigma and symptoms of anxiety and depression in people with intellectual disabilities: Findings from a cross sectional study in England.  Journal of Affective Disorders, 187, 224-231.

Categories
Anxiety and Anxiety Disorders

Stigma: Preventing People from Getting Treatment

Those who have social anxiety disorder worry intensely and immensely about whether or not they are being viewed badly by others (Anderson, Jeon, Blenner, Wiener, & Hope, 2015).  An individual with the disorder struggles with tremendous anxiety over how she is being perceived by the people around her, but this struggle usually goes unseen by others, so receiving treatment for it potentially increases the visibility of her disorder (Anderson, Jeon, Blenner, Wiener, & Hope, 2015).  She—like many others—may feel very uneasy with the notion of other people finding out about her anxiety disorder because she perceives the public stigma surrounding mental illness, especially since the media often associates an individual with a mental illness with violence and dangerousness (Anderson, Jeon, Blenner, Wiener, & Hope, 2015).  She doesn’t want to risk the chance that the people around her might start to reject her because of her disorder and because of how they might view mental illness in general, so she decides not to go for treatment.

For more than 80% of people who have social anxiety disorder, this situation is reality (Anderson, Jeon, Blenner, Wiener, & Hope, 2015).  They don’t get treatment because they don’t want it, and often one reason why they don’t want it is because of the stigma surrounding mental illness.  They see the way people with mental illnesses are portrayed on the evening news, they see news anchors warning their viewers that having a mental illness makes a person violent and undesirable.  Even though this is not at all the truth about people with mental illnesses, who would want to be linked to such terrible ideas?  Many people with social anxiety disorder don’t want to be attached to such an adverse public mindset because they don’t want to be looked upon negatively, leading them to steer clear of treatments that could be of great aid.  But the avoidance of treatment because of the stigma associated with mental illness surpasses those of us who have social anxiety disorder and extends to so many others of us who have different hardships with mental health, too.  This is a problem experienced by people with all kinds of struggles and needs, and it is affecting not only their treatment but their relationships with others, and their self-perceptions and self-esteem.

A 2015 study by Kristin N. Anderson and colleagues examined the kinds of traits associated with social anxiety disorder, major depressive disorder, and the general idea of mental illness, as well as the social distance preferred by the participants from people with these disorders.  A particularly interesting finding was that the participants wanted greater social distance from people who were embarrassed by their own illness (Anderson, Jeon, Blenner, Wiener, & Hope, 2015).  I found this intriguing because people are embarrassed by their illness when they are sent the message that their illness is something to be embarrassed about, i.e. when they see stigma surrounding their illness.  What we get then is a reciprocal relationship which is facilitated by the public stigma around mental illness: people see that their illness is frowned upon, leading them to feel embarrassed, causing people to avoid them because they are embarrassed.  Though it is not entirely made clear as to why these participants wanted to stay away from people who were embarrassed about their mental illness, it is clear that people are embarrassed by their illness because their society tells them they should be embarrassed.  But then, when they are embarrassed, they are rejected even more by that same society.

Stigma surrounding mental illness is making those who do have mental illnesses feel isolated and undeserving of treatment, reflecting an internalization of that public stigma.  We need to educate people on mental illness so that they know better than to learn from the media that mental illness is bad.  Just as well, Anderson and colleagues’ study showed that people who had past involvement with mental health treatment had less of a desire to maintain social distance from people with mental illnesses, demonstrating that people who have more experience or knowledge about mental illnesses are more open to engaging with others who have them (Anderson, Jeon, Blenner, Wiener, & Hope, 2015).  There shouldn’t be a stigma surrounding mental illness: the traits associated with that stigma are misleading, and they can be detrimental to those who do have mental illnesses, so working to break down that stigma should be a number one priority.

References:

Anderson, K.N., Jeon, A.B., Blenner, J.A., Wiener, R.L., & Hope, D.A. (2015). How People Evaluate Others with Social Anxiety Disorder: A Comparison to Depression and General Mental Illness Stigma. American Journal of Orthopsychiatry, 85, 131-138.

Categories
Addiction Anxiety and Anxiety Disorders

Rated PG: Interactions Between Anxiety, Alcohol Dependence, and Parental Support

Though the development of an alcohol use disorder (AUD) is commonly associated with externalizing personality traits and disorders, like impulsivity and ADHD respectively, studies suggest that internalizing personality traits and disorders can also contribute to the onset of an AUD (Gorka et al., 2014).  People with an anxiety disorder, for example, may turn to alcohol in order to feel better, thus establishing a coping strategy for their mental illness based on avoiding their anxiety disorder (Gorka et al., 2014).  Research concerning the internalizing pathway to developing an AUD has been conflicting: some studies have suggested that having an anxiety disorder puts an individual at a higher risk for AUD onset, while others have found that having an anxiety disorder reduces an individual’s risk (Gorka et al., 2014).  Because of these disagreeable findings, we can conclude that there are other factors at work that have an influence over the relationship between anxiety disorders and the onset of an alcohol use disorder.

Stephanie M. Gorka and colleagues decided to look into the influence parental support had on the relationship between anxiety disorders and alcohol use disorders.  They defined parental support as being composed on demonstrations by the parent of “companionship, intimacy, affection, and instrumental aid” (Gorka et al., 2014).  Prior to looking at the interactions between anxiety disorders, parental support, and alcohol dependence, the researchers looked at the relationship between the first two elements only: less parental support for individuals with anxiety disorders could put those individuals at a higher risk for developing an AUD because of lower self-esteem and increased vulnerability (Gorka et al., 2014).  Conversely, those who had anxiety disorders in addition to higher parental support were thought to be at less of a risk for AUD onset because they had a better relationship with their parent and thus spent less time with peers who could potentially expose them to alcohol.

Keeping this in mind the researchers did their study in four waves through self-reports and found that, as hypothesized, those who had low maternal support coupled with anxiety disorders were more likely to develop an AUD than those without anxiety disorders, by 65% (Gorka et al., 2014).  Those who had anxiety disorders coupled instead with high maternal support were 35% less likely to have the onset of an AUD (Gorka et al., 2014).  Interestingly enough, the effect of higher maternal support on AUD onset was not as strong as the effect of lower maternal support on AUD onset; this means to say that having increased maternal support in one’s life had less of an impact on an individual’s development of an alcohol use disorder than did low maternal support.

This study shows us that mental health and a person’s environment are highly intertwined and that interactions between these two elements are more complicated than they may appear on the surface—especially since a person’s environment can influence their mental health, and their mental health state can then make them susceptible to (or protect them from) other kinds of mental health issues.  Though many anxiety disorders can be comorbid with other conditions, it is important to continue to research the way anxiety disorders may or may not contribute to the development of other non-anxiety health problems, whether they be mental or physical.  We would not only understand the onset of other conditions more thoroughly, but it would expand our knowledge surrounding mental health as well.

References:

Gorka SM, et al. (2014). Anxiety disorders and risk for alcohol use disorders: The moderating effect of parental support.  Drug and Alcohol Dependence, 140, 191-197.

Categories
Anxiety and Anxiety Disorders Depression

Unknown Treatment: The Lack of Awareness about CBT

According to the DSM-V (2013), anxiety disorders refer to any disorders in which the diagnosed person experiences “excessive fear and anxiety and related behavioral disturbances,” and the varying disorders differ from one another depending upon what causes this fear or anxiety in the individual (p. 189).  A great number of studies have shown that the most effective method of treatment for these disorders is exposure-based treatment, either on its own or as part of cognitive behavioral therapy (CBT), through which the sufferer is slowly brought into contact with what he or she is afraid of (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Not only have we seen the effects of exposure-based therapy in efficacy studies and clinical studies, but when comparing it to SSRI medication and psychotherapy as treatments for anxiety disorders, exposure-based CBT has proven to be the most superior form of treatment (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).

“Only up to 11% of adults with anxiety disorders receive the kind of treatment they should be getting”

More surprising though is the finding that most adults in the United States haven’t even heard of this type of treatment, and furthermore only up to 11% of adults with anxiety disorders receive the kind of treatment they should be getting.  These adults don’t know about exposure-based CBT, and as a result end up spending more on costly pharmacological treatments instead, even though a psychosocial treatment like exposure-based CBT would prove to be the most cost-effective route to take (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Just as well, in all studies thus far that have taught adults about various anxiety disorder treatments, there has consistently been a majority whom have expressed preference toward exposure-based psychosocial approaches rather than pharmacological approaches, further reinforcing the need to spread information about the effectiveness, in terms of both cost and outcome, of exposure-based cognitive behavioral therapy (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  What we see here then is that most adults in the United States who are receiving treatments for anxiety disorders are undergoing treatments which have proved less effective than others because these people haven’t learned about anything that would work better for them in regards to money and outcome.

Wolitzky-Taylor and colleagues looked at the electronic medical records at the Los Angeles Adult Outpatient Psychiatry Clinic over the span of six months in order to see just how much exposure-based CBT was used as treatment for people with anxiety disorders who have low incomes and go to a large community mental health center (2015).  This facility was chosen because it reflected other clinics like it due to its urban location and its patient diversity, though it may have more professionals trained in CBT than the average community clinic since about 75% of the staff has had basic CBT training and supervision before. But even in a clinic with an unusually high number of clinicians trained in cognitive behavioral therapy, less than 4% of all 582 patients diagnosed with anxiety disorders in that six-month period received one session or more of exposure-based treatments (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Despite being present in a setting where CBT training was found to be more prevalent than in most other community clinics, it was still only a minority of patients who were receiving this type of treatment—we can understand from this that the average clinic is thus providing even less cognitive behavioral therapy to other patients nationally.

For the approximate 4% of the total patients in the Los Angeles County AOPC receiving treatment for anxiety disorders, those who did get exposure-based CBT were not receiving a dose that would be enough to help treat their disorders, meaning that they were not attending as many sessions as recommended based on past studies conducted (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Since patients aren’t going to the recommended amount of sessions, which would be between ten and sixteen of them, the clinicians need to work out a plan for each patient that would best utilize the amount of time that he or she does have in order to get optimal results.

The researchers found that, in regards to the total 582 patients receiving treatment for anxiety disorders, almost 90% of the patients were offered pharmacological treatment for their anxiety disorder, and that almost 90% of those accepted this treatment.  Just as well, almost 70% of the patients were offered a non-CBT type of psychotherapy, and almost all of these patients accepted that treatment.  These treatments are less effective than exposure-based cognitive behavioral therapy, in terms of both cost and outcome, and patients with anxiety disorder are neither being presented with the option of receiving CBT nor bringing up the option themselves.  Information about this type of treatment for anxiety disorders needs to be better distributed amongst adults with anxiety disorders so that they can get the right kind of treatment and get on the best track toward improved health.

References:

Wolitzky-Taylor, K., Zimmermann, M., Arch, J. J., De Guzman, & E., Lagomasino, I. (2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9-17.

Categories
Anxiety and Anxiety Disorders

An Overview of Anxiety Disorders

By Kristen O’Neill

Anxiety is a natural response that our bodies use when confronted with stressful situations. Everyone has experienced nervousness or apprehension before a big event at some point in their life, but for people with an anxiety disorder, that worry and uneasiness can hit them sporadically and start to negatively impact the way they live. Even though anxiety disorders are the most common mental illnesses in the United States, only “about one-third of those suffering receive treatment” (“Facts and Statistics”).

Though there are many anxiety disorders, this post will cover just some of them; Generalized Anxiety Disorder, Panic Disorder, Social Phobia, Selective Mutism, and Separation Anxiety.

Generalized Anxiety Disorder is characterized by “exaggerated worry and tension…even when there is no apparent reason for concern” (“Generalized Anxiety”). This chronic concern and anxiety over everyday life can also cause physical symptoms like having trouble sleeping, muscle tension, and irritability (“Symptoms”). People with this disorder worry about “money, health, family, [and] work” and worse still, they have struggle to stop worrying enough to move on in their daily life (“Generalized Anxiety”).

Someone suffering from Panic Disorder has random, intense panic attacks that occur out-of-the-blue, leaving them with symptoms like sweating, chest pain, nausea, feelings that they’re choking, derealization  (feeling separated from reality or the world around them (“Depersonalization”)), and fear of sudden death (“Panic Attack”). In between attacks, people with panic disorder fear when the next attack may happen. This disorder, unfortunately, often leads people to distance themselves from family or friends because they don’t know how to explain the sudden attacks, or aren’t aware they can seek treatment (“Panic Disorder”).

Social Phobia, also known as Social Anxiety Disorder, causes people to fear being judged or ridiculed by others. It is not simply shyness, but a deeper anxiety that might cause them to avoid engaging in relationships which in turn leads them to feel powerless, alone or ashamed. They can be hit with feeling of terror over embarrassing themselves or doing something wrong, which can be so extreme as to disrupt their daily life (“Social Anxiety”). Previous standards mandated that to be diagnosed the patient must recognize their fear is excessive or unreasonable, but now it has been recognized that these individuals often overestimate the danger in ‘phobic’ situations (“Highlights of Changes”).

Selective Mutism is a disorder in which the individual finds that they are unable to speak in certain situations even if they can speak and do speak in different circumstances. It largely affects children but is classified as an anxiety disorder because most children with selective mutism are anxious (“Highlights of Changes”). Selective mutism can interfere with school and work, and symptoms can even include social isolation and withdrawal (“Selective Mutism”).

And, finally, there is Separation Anxiety, which for a lot of people may bring to mind infants and toddlers clinging to their parents or even pets who don’t react well to their owner’s leaving. Recently authorities in the field have recognized that not only can people have this disorder develop after the 18-year old deadline that was previously in place, but that “a substantial number of adults report onset of separation anxiety after age 18” (“Highlights of Changes”). Generally it involves people, both children and adults, who experience anxiousness when separated from a safe haven, such as their home, or the person they are attached to (“Separation Anxiety”). They may suffer from a fear that they will be attacked, or that they are just generally not safe when separated from their object of attachment (“Separation Anxiety”).

Works Cited

“Highlights of Changes from DSM-IV-TR to DSM-5.” American Psychiatric Publishing, 2013. Web. 7 Mar. 2015. < http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf>

“DSM-5: Changes to the Diagnostic and Statistical Manual of Mental Disorders.” Anxiety and Depression Association of America. Web. 7 Mar. 2015. <http://www.adaa.org/understanding-anxiety/DSM-5-changes>

“Panic Attack DSM-V Revisions.” Anxiety Treatment Clinic. Web. 7 Mar. 2015. <http://anxietytreatmentclinic.com/blog/panic-attack-dsm-v-revisions/>

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