Chapter 9: Anxiety

Mental Health Social Work Practice in Canada

The Nature of Anxiety ​

Anxiety is a universal human experience, and the boundaries between normal variation and pathological fear are fuzzy

Anxiety is characterized by:​

1. Diffuse, unpleasant, and vague experience of apprehension​

2. Physical symptoms​

Causes of Anxiety​

• Intrapsychic​: Unresolved issues ​

• Biological​: Adrenal cortex​

• Social and Environmental​: Learned responses​

• Global​: Shared threats

Symptoms of Anxiety​: Physical

• racing heart or palpitations​

• shallow breathing​

• trembling, shaking​

• sweating​

• dizziness​

• muscle tension​

• nausea and gastric distress​

Symptoms of Anxiety​: Cognitive

• fearful thoughts​

• fearful predictions​

• fearful beliefs​

• preoccupation with the potential threat​

Symptoms of Anxiety​: Behavioural

• avoidance of situations and stimuli that will trigger the anxiety ​

• over-preparation ​

• rituals​

• repeated checking ​

• hypervigilance ​

Types of Anxiety Disturbances​

• Panic disorder​

• Specific phobia​

• Agoraphobia​

• Social anxiety disorder​

• Generalized anxiety disorder​

• Obsessive-compulsive disorder​

Characteristics of Panic Disorder​

• Palpitations, sweating, trembling or shaking​

• Shortness of breath or choking feeling​

• Chest pain or discomfort​

• Nausea or abdominal distress​

• Dizziness, light-headedness, feeling faint​

• Derealisation (feelings of unreality) or depersonalization (feeling detached from self)​

• Fear of losing control; fear of dying​

• Paraesthesias​

• Chills or hot flashes​

characteristics of Specific Phobias​: Childhood fears that naturally subside

• Fear of separation/unfamiliar adults​

• Fear of animals/darkness/monsters​

• Fear of school​

Characteristics of Specific Phobias​: Common fears in adulthood​

• Loud noises, heights, small spaces​

Characteristics of Specific Phobias​: Phobias

• Intense fears that result in elaborate compensatory behaviours to avoid exposure​

Characteristics of Agoraphobia​

• Greek agora or “marketplace” and platzschwindel to describe dizziness experienced​

• Heightened startle reflex, increased heart rate, and emotional arousal in response to feared situations​

• Develop anticipatory anxiety managed through avoidance​

• Fears become generalized and activities become limited​

Characteristics of Social Anxiety Disorder​

• Incapacitating anxiety in certain social situations​

• Attempt to reduce symptoms by suddenly leaving the social situation or simply refusing to attend​

• Compensatory approaches serve to reinforce beliefs of social incompetence and consequently avoidance symptoms increase​

• Social media and screen time associated with depression, anxiety and other forms of psychological distress​

Characteristics of Generalized Anxiety Disorder​

• Persistent anxiety and worry that is out of proportion with actual events or circumstances​

• Pervasive worry is accompanied by a variety of somatic symptoms that cause significant impairment in social or occupational functioning and marked distress​

• Significantly reduced quality of life due to physical and emotional difficulties and social functioning ​

Characteristics of Obsessive-Compulsive Disorder​ Two factors: ​

1. Cognitive obsessions that increase the person’s level of anxiety​

2. Compulsive behaviours aimed at reducing the anxiety​

Compulsive behaviours aimed at reducing the anxiety​

Repeated ritualistic behaviours ​​

Cognitive obsessions that increase the person’s level of anxiety​

Intrusive and persistent thoughts ​

Mindfulness Based Stress Reduction​ Incorporates:​

• Relaxation techniques such as yoga or deep breathing​

• Education regarding sources of stress and common coping techniques​

• Cognitive awareness and restructuring​

Systematic Desensitization and Exposure Therapy​

• Exposure to anxiety provoking stimuli​

• Flooding = exposure to highly distressing stimuli​

• Exposure can be imaginal or in vivo​

• Systematic desensitization = gradually increasing distressing stimuli combined with progressive relaxation​

• Manage anxiety through relaxation techniques​

• Avoidance not permitted​

• Develop habituation response​

Family Cognitive-Behavioural Therapy​

• Anxiety problems often occur in more than one family member (e.g., children and parents)​

• Parents may inadvertently model anxiety behaviour (e.g., fears and avoidance)​

• Education of family members​

• Modify maladaptive family beliefs​

• Modify maladaptive family behaviours​

• Support mastery​