Evaluation of Axiety Disorders
Generalised Anxiety Disorder(GAD)
GAD is characterised by an excessive, irrational worry about everyday events, such as family members going to work or going out. This anxiety will manifest itself in fidgeting, fatigue, insomnia, sweating, difficulty swallowing or breathing, nausea or headaches, among others. To be diagnosed these symptoms must be consistent and ongoing for at least 6 months and must be interfering with the patients daily routine
Treatment and Prognosis
Cognitive-behavioral therapy (CBT) is one type of therapy that is particularly helpful in the treatment of GAD. Cognitive-behavioral therapy examines distortions in our ways of looking at the world and ourselves. Your therapist will help you identify automatic negative thoughts that contribute to your anxiety. For example, if you always imagining the worst possible outcome in any given situation you might challenge this tendency through questions such as, “What is the likelihood that this worst-case scenario will actually come true?” and “What are some positive outcomes that are more likely to happen?”.
Cognitive-behavioral therapy for GAD involves five components:
Education. CBT involves learning about GAD. It also teaches you how to distinguish between helpful and unhelpful worry. An increased understanding of your anxiety encourages a more proactive response to it.
Monitoring. In CBT for GAD, you learn to monitor your anxiety, including what triggers it, the specific things you worry about, and the severity and length of a particular episode. This helps you get perspective, as well as track your progress.
Physical control strategies. Deep breathing and progressive muscle relaxation help decrease the physical over-arousal of the “fight or flight” response that maintains the state of fear and anxiety. CBT for GAD trains you in these techniques.
Cognitive control strategies. Through CBT, you learn to realistically evaluate and alter the thinking patterns that contribute to GAD. As you challenge these negative thoughts, your fears will begin to subside. CBT also teaches you to test the beliefs you have about worry itself, such as “Worry is uncontrollable” or “If I worry, bad things are less likely to happen.”
Behavioral strategies. Instead of avoiding situations you fear, CBT teaches you to tackle them head on. You may start by imagining the thing you’re most afraid of. By focusing on your fears without trying to avoid or escape them, you will begin to feel more in control and less anxious. Time management and problem-solving skills are also effective behavioral techniques for GAD.
The cause is not clear. The condition often develops for no apparent reason. Various factors may play a part. For example:
Your genetic makeup may be important. Some people have a tendency to have an 'anxious personality' which can run in families.
Childhood traumas such as abuse, or death of a parent, may make you more prone to anxiety when you become older.
A major stress in life may 'trigger' the condition. For example, a family crisis. But the symptoms then persist when any 'trigger' has gone. Common minor stresses in life, which you may otherwise have easily coped with, may then keep the symptoms going once the condition has been 'triggered'.
Some people who have other mental health problems such as depression or schizophrenia may also develop GAD.
Often anxiety gets generalized to other situations, and can then become overwhelming or associated with life in general. Typically GAD develops over a period of time and may not be noticed until it is significant enough to cause problems with functioning.
As its name implies, GAD is evidenced by general feelings of anxiety such as mild heart palpitations, dizziness, and excessive worry. The symptoms are difficult to control for the individual and are not related to a specific event (such as in PTSD) and are not as severe as those found with Panic Disorder.
Medication and/or psychotherapy have been found to be helpful, especially therapy aimed at teaching the client how to gain control over the symptoms.
Prognosis is good for the more extreme symptoms, but those associated with underlying fears are more difficult to treat (such as excessive worry). Working through childhood issues can be helpful as these tend to get distorted as they follow us into adulthood (e.g., over-controlling parental styles, sexual abuse, childhood phobias).
Post Traumatic Stress Disorder
The symptoms of PTSD will manifest themselves within 6 months of an extremely traumatic or stressful event. The event can be anything from military service, road traffic accidents or rape, as long as it presents a real threat of physical harm or death.
Symptoms of the episode may include having flashbacks or nightmares of the event. These experiences can be extremely life like and anything related to the event may trigger the flashback.
Avoidance or numbing is also a sign. You could either avoid the topic, getting absorbed in a hobby for example or your job, or emotionally numbing youself from the world.
Hypervigilance can also be a symptom of PTSD, always being on gaurd and looking out for danger. The person can find it hard to sleep or become irritable
This is a preview of the whole essay
Treatment or Prognosis
There are both physical and psychological treatments for PTSD. Some of them are outlined below:
Trauma-focused cognitive-behavioral therapy.
Cognitive-behavioral therapy for PTSD involves gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event, particularly thoughts that are irrational and replacing them with more balanced picture.
EMDR (Eye Movement Desensitization and Reprocessing)
EMDR mixes aspects of cognitive-behavioral therapy with eye movements and other forms of rhythmic or left-right stimulation, such as handtapping or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments, retaining their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.
Drugs can sometimes be prescribed to sufferers of PTSD although this treats secondary symptoms, such as anxiety or depression and not the root causes of PTSD. Medications that are usually used to help PTSD sufferers include serotonergic (SSRIs) like Prozac, Zoloft, Paxil, and medicines that help decrease the physical symptoms associated with illness, like Catapres, Tenex and . Individuals with PTSD are much less likely to experience a relapse of their illness if antidepressant treatment is continued for at least a year. These medicines have been found to help PTSD sufferers modify information that is taken in from the environment and to decrease fear. Research also shows that this group of medicines tends to decrease anxiety, depression, and panic. SSRIs may also help reduce aggression and suicidal thoughts that can be associated with this disorder.
By definition, PTSD always follows a traumatic event which causes intense fear and/or helplessness in an individual. Typically the symptoms develop shortly after the event, but may take years. The duration for symptoms is at least one month for this diagnosis.
Symptoms include re-experiencing the trauma through nightmares, obsessive thoughts, and flashbacks (feeling as if you are actually in the traumatic situation again). There is an avoidance component as well, where the individual avoids situations, people, and/or objects which remind him or her about the traumatic event (e.g., a person experiencing PTSD after a serious car accident might avoid driving or being a passenger in a car). Finally, there is increased anxiety in general, possibly with a heightened startle response (e.g., very jumpy, startle easy by noises).
Psychological treatment is considered the most effective means to recovery from PTSD, although some medications (such as antianxiety meds) can help alleviate some symptoms during the treatment process.
Prognosis ranges from moderate to very good. Those with the best prognosis include situations where the traumatic event was acute or occurred only one time (e.g., car accident) rather than chronic, or on-going trauma (e.g., ongoing sexual abuse, war).
Social phobia, involves intense fear of certain social situations — especially situations that are unfamiliar or in which you’ll be watched by others. These social situations may be so frightening that you get anxious just thinking about them or go to great lengths to avoid them.
Underlying social anxiety disorder is the fear of being scrutinized, judged, or embarrassed in public. You may be afraid that people will think badly of you or that you won’t measure up in comparison to others. And even though you probably realize that your fears of being judged are at least somewhat irrational, you still can’t help feeling anxious.
Here is a list of the psychological and physical symptoms of Social Phobia:
Psychological symptoms of social phobia
- Intense worry for days, weeks, or even months before an upcoming social situation.
- Extreme fear of being watched or judged by others, especially people you don’t know.
- Excessive self-consciousness and anxiety in everyday social situations.
- Fear that you’ll act in ways that that will embarrass or humiliate yourself.
- Fear that others will notice that you’re nervous.
- Avoidance of social situations to a degree that limits your activities or disrupts your life.
Physical symptoms of social phobia
Medication for social phobia
Medication is sometimes used to relieve the symptoms of anxiety, but it’s not a cure for social phobia. If medication is ceased, your symptoms will probably return full force. Medication is considered most helpful when used in addition to therapy that address’ the root cause of the social phobia.
Three types of medication are used in the treatment of social phobia:
- Beta blockers – Beta blockers are used for relieving performance anxiety. They work by blocking the flow of adrenaline that occurs when you’re anxious. While beta blockers don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.
- Antidepressants – Antidepressants can be helpful when social phobia is severe and debilitating.
- Benzodiazepines – Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so they are usually prescribed only when other medications for social phobia have not worked.
Therapy for social phobia
Of all the treatments available, CBT has been shown to work the best for treating social phobia. Cognitive-behavioral therapy is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better.
Cognitive-behavioral therapy for social phobia typically involves:
- Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.
- Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.
- Facing the social situations you fear in a gradual, systematic way, rather than avoiding them.
Other cognitive-behavioral techniques for social anxiety disorder include role-playing and social skills training, often as part of a therapy group.
Group therapy for social anxiety disorder uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you’re afraid of, you will become more and more comfortable and confident in your social abilities, and your anxiety will lessen.
There are three main underlying causes of social phobia that have been identified in most cases:
- Heredity causes - In many cases individuals and children whose parents have social phobia tend to have social phobia too due to their similar genetic code, but this does not mean that disorder has to persist for life, it can be overcome with proper treatment especially at an early age.
- Environmental Causes - When we are child we are very vulnerable to the environment in which we live, we acquire our values, behaviors and beliefs that in some cases are wrong. If a child lives in a family where they avoid social activities, where they don’t let the child give his opinion or the parents are too protective then it can cause social phobia in the child.
- Neurological causes - There are also many cases in which a chemical imbalance in the brain causes social phobia, this is due to the imbalanced distribution of serotonin in the brain cells. When this happens a normal social situation can be seen as frightening by the individual.
Often a traumatic event is the precursor for a phobia, which may or may not be at the conscious level.
Symptoms include either extreme anxiety and fear associated with the object or situation or avoidance. To be diagnosed, the symptoms must be disruptive to everyday functioning (such as quitting a great job merely because you have to use an elevator).
Treatment is often behavioral in nature, with the therapist guiding the client through exercises more closely resembling the feared object or situation. Exploring underlying issues can also be beneficial.
Prognosis is very good if treated effectively.
Obsessive Compulsive Disorder
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational – but even so, you feel unable to resist them and break free.
OCD causes the brain to get stuck on a particular thought or urge. For example, you could check the stove twenty times to make sure it’s really turned off.
Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas and you know that they don’t make any sense. Unfortunately, these obsessive thoughts are usually disturbing and distracting.
Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive behaviors often end up causing anxiety themselves as they become more demanding and time-consuming.
Most people with obsessive-compulsive disorder fall into one of the following categories:
- Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
- Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
- Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.
- Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
- Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.
Common obsessive thoughts in OCD include:
- Fear of being contaminated by germs or dirt or contaminating others
- Fear of causing harm to yourself or others
- Intrusive sexually explicit or violent thoughts and images
- Excessive focus on religious or moral ideas
- Fear of losing or not having things you might need
- Order and symmetry: the idea that everything must line up “just right.”
- Superstitions; excessive attention to something considered lucky or unlucky
Common compulsive behaviors in OCD include:
- Excessive double-checking of things, such as locks, appliances, and switches.
- Repeatedly checking in on loved ones to make sure they’re safe.
- Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
- Spending a lot of time washing or cleaning.
- Ordering, evening out, or arranging things “just so.”
- Praying excessively or engaging in rituals triggered by religious fear.
- Accumulating “junk” such as old newspapers, magazines, and empty food containers, or other things you don’t have a use for.
There are many effective treatments for OCD, ranging from therapy to self-help and medication. However, the treatment for OCD with the most research supporting its effectiveness is cognitive-behavioral therapy.
Cognitive-behavioral therapy for obsessive-compulsive disorder involves two components:
- Exposure and response prevention
- Cognitive therapy
Exposure and response prevention for OCD
Exposure and response prevention involves repeated exposure to the source of your obsession. Then you are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety.
For example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public restroom and then be prevented from washing up. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you learn that you don’t need the ritual to get rid of your anxiety – that you have some control over your obsessive thoughts and compulsive behaviors.
Studies show that exposure and response prevention can actually “retrain” the brain, permanently reducing the occurrence of obsessive-compulsive disorder symptoms. This type of OCD therapy can even extinguish compulsive behaviors entirely.
Cognitive therapy for OCD
The cognitive therapy component for OCD focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.
In addition to cognitive-behavioral therapy, the following treatments are also used for obsessive-compulsive disorder (OCD):
Medication – Antidepressants are sometimes used in conjunction with therapy for the treatment of OCD. However, medication alone is rarely effective in relieving the symptoms of OCD.
Family Therapy – Because OCD often causes problems in family life and social adjustment, family therapy is often advised. Family therapy promotes understanding of the disorder and can help reduce family conflicts. It can also motivate family members and teach them how to help their loved one.
Group Therapy – Group therapy is another helpful obsessive-compulsive disorder treatment. Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.
Biological theories of OCD have focused on a circuit in the brain which regulates primitive aspects of our behavior such as aggression, sexuality, and bodily excretions. This circuit relays information from a part of the brain called the orbitofrontal cortex to another area called the thalamus and includes other regions such as the caudate nucleus of the basal ganglia. When this circuit is activated, these impulses are brought to your attention and cause you to perform a particular behavior that appropriately addresses the impulse.
For example, after using the restroom, you may begin to wash your hands to remove any harmful germs you may have encountered. Once you have performed the appropriate behavior -- in this case, washing your hands -- the impulse from this brain circuit diminishes and you stop washing your hands and go about your day.
It has been suggested that if you have OCD, your brain has difficulty turning off or ignoring impulses from this circuit. This, in turn, causes repetitive behaviors called and uncontrollable thoughts called . For instance, your brain may have trouble turning off thoughts of contamination after leaving the restroom, leading you to wash your hands again and again.
In support of this theory, the associated with OCD often have themes which are related to sexuality, aggression, and contamination -– the very thoughts and impulses this circuit controls. In addition, neuroimaging studies in which scientists and doctors to peer into the living brain have confirmed abnormal activity in this brain circuit among people with OCD. Specifically, people with OCD show abnormal activity in different parts of this circuit including the orbital frontal cortex, cingulate cortex and caudate nucleus of the basal ganglia.
Finally, as many people with OCD respond to treatment with medications including SSRIs which boost the neurochemical serotonin, it has been suggested that dysregulation of this brain circuit may be related to a problem with the serotonin system.
Almost everyone experiences bizarre or unexpected thoughts throughout the day. According to theories of OCD, if you are vulnerable to OCD you are unable to ignore these thoughts. In addition, you may feel that you should be able to control these thoughts and that these thoughts are dangerous.
For example, you might believe that having these thoughts means you are going crazy or that you might actually carry out the imagined or feared behavior (such as stabbing your partner).
Because these thoughts are labeled as dangerous, you remain vigilant and watchful of them, just as you might constantly look out the window if you heard there was a burglar in the neighborhood. Constantly noticing these thoughts further reinforces or “proves” the dangerousness of these thoughts. This sets up a vicious cycle where you become trapped monitoring these dangerous thoughts. Being trapped in this cycle can make it difficult -– if not impossible -– to focus on anything else besides the distressing thoughts and an obsession is born.
Compulsions such as hand-washing may be a learned process. For example, in response to feeling contamination, you might wash your hands. This reduces your anxiety which feels good and in turn reinforces the hand-washing behavior. Because of this reinforcement, every time you experiences the obsession (such as contamination), you carry out the compulsion (such as washing their hands) to reduce your anxiety.
Psychodynamic theories of OCD stress that obsessions and compulsions are signs of unconscious conflict that you might be trying to suppress, resolve or cope with. These conflicts arise when an unconscious wish (usually related to a sexual or aggressive urge) is at odds with socially acceptable behavior.
It has been suggested that when these conflicts are extremely repulsive or distressing, you can only deal with them indirectly by transferring the conflict to something more manageable such as .
Although it has been suggested that making the person aware of these conflicts can reduce symptoms of OCD, there is little scientific evidence that this actually works.