Anxiety
ICD-11 definitions
- It is classed under the 06 mental, behavioural or neurodevelopmental disorders and is in a new sub-category called anxiety and fear-related disorder. These are characterised by: excessive fear, anxiety and related behavioural disturbances.
- Symptoms, if they are serve enough can result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
What is anxiety
- Is a word used to describe feelings of unease, worry and fear, and can incorporate both the emotions and physical sensations that we might experience when we are worried or nervous about something. Although usually found to be unpleasant it is related to the fight or flight response, with our normal biological reaction to feeling threatened (mind).
- The fight or flight response is activated when the body is under threat by the release of the hormones adrenaline and cortical, these hormones: make you feel more alert so you can act faster, increases heartbeat and gives u more energy. Once the danger has passed the body releases other hormones to help your muscles relax and may cause you to shake.
- It is different from fear, which is state of immediate apprehension in response to a serious current threat to one’s safety but instead is a state of apprehensions in response to a vague sense of threat or a future event. However they both share the same physiological features and although unpleasant the experiences of fear/ anxiety are adaptive as the body adapts and responds to the environment
- It is a normal behaviour and is valuable defence mechanism, however it becomes an anxiety disorder when it is excessively serve or frequent or appears in inappropriate context and so interferes with normal functioning. Examples are worrying all the time about things that are a regular part of everyday life, or things that aren’t likely to happen.
- The global lifetime prevalence of anxiety disorder is 12.9% and there is global and gender disparity. Over 70% of the individuals with the condition never receive any form of treatment, and up to 90% do not receive adequate treatment.
Conditions included in the category of anxiety and fear-related disorders
- Generalised anxiety disorder, under the ICD-11 it is characterised by general apprehension or excessive/ out of proportion worry. Marked symptoms are persistent for most of the time for at least serval months. The symptoms vary from individual to individuals such as difficulty: concentrating, difficulty breathing, dry mouth, difficulty breathing etc. suffers may also have the day-to-day challenges of reductions in physical, emotional and social functioning.
- Social anxiety disorder, under the ICD-11 it is characterised by excessive fear or anxiety that consistently occurs in one or more social situations. Examples include: social interactions, doing something while feeling observed or preforming in front of others. This condition usually last serval months.
- Panic disorder, under the ICD-11 it is characterised by recurrent unexpected panic attacks not restricted to particular stimuli or situations and concern about recurrence of unexpected panic attacks or their significance. This results in the person avoiding social situation or enduring them with intense fear or anxiety, and it is not the presence of panic attacks alone that warrant the diagnosis of the condition but also if the individual is concerned that they will act in a way that will be negatively evaluated by others with the condition usually lasting for a least serval months.
- Specific phobia, under the ICD-11 it is characterised by fear that results in Signiant distress or impairment and the focus of the apprehension is directly connected to encountering or anticipating the feared stimulus (spiders). The relevant social situations are consistently avoided or endured with intense fear or anxiety, the individual is concerned that they will act in a way that will be negatively evaluated by other. This condition last for at least several months.
- Acrophobia (with panic attacks)
- Mixed depressive and anxiety disorder
- Separation anxiety disorder
- Selective mutism
Symptoms
- Physiological:
o Palpitations, pounding heart, or accelerated heart rate
o Sweating/ perspiring
o Trembling or shaking
o Dry mouth (not due to medication or dehydration)
o Difficulty breathing
o Feeling of choking
o Chest pain or discomfort
o Nausea or abdominal distress
o Non-specific physiological arousal
- Cognitive:
o Feeling dizzy, unsteady, faint or light-headed
o Feelings that objects are unreal or that oneself is distant or ‘not really here’.
o Fear of losing control, going crazy or passing out
o Fear of dying
o Hot flushes or cold chills
o Numbness or tingling sensations
- Behavioural:
o Exaggerated response to minor surprises or being startled
o Difficulty concentrating or mind going black because of worrying or anxiety
o Persistent irritably
o Sleep disturbances
Explanations for anxiety
- Cognitive explanation, this believes that that anxiety is caused by dysfunctional ways of thinking. General anxiety disorder is primarily caused by maladaptive thoughts and assumptions which then lead to inappropriate behaviour. Cognitive thinking is biased towards threating information, and these with GAD attend to threating cues in the environment more than non-threatening cues when faced with both equally.
o Treatment is through CBT, and talking therapy and helps the clients understand the role worrying plays. Its main aims is to alter thoughts on worrying and this leads to a change in associated feelings/ emotions and behaviour. It is particularly effective at treating general anxiety disorder helping to retain reactions to stress and worry.
o CBT process
1. Identify own thoughts (self-observation), examples can include ‘ I’m not good at this’. The aim is to step back from automatic thoughts that lead to a behaviour and onto an emotional response.
2. Challenge thoughts, the therapist will teach the patient to evaluate their anxiety-provoking thoughts by questioning the evidence for them and testing the reality. Am I really that bad, or I’m good at lots of other stuff.
3. Replace the cognitively biased thoughts with a more objective evaluation of the situation, using pre-prepared statements. I’m goanna practice to get better.
o CBT behavioural techniques:
§ Behavioural activation, this is when the client identifies their own unhelpful beliefs and proves them wrong, this results in their beliefs beginning to change. An example would be someone who is socially anxious set homework to meet a friend for a walk on the weekend in the park.
§ Relaxation training, is used for anxiety disorder and phobias and is useful to reduce physiological effects of stress. These physiological effects can include physical tension which is exhausting, disturbs sleep, reduces immune function and leads to gastrointestinal problems. This can be mitigated by Jacobsen’s deep muscle relaxation techniques, such as alternatively tensing and relaxing muscle groups: learn to relax muscle without prior tensing, monitor physical tension, help identify triggers and clues when relaxation techniques are most useful and in vivo relaxation which uses techniques in real life situations small to start with.
- Behavioural explanation, this explains anxiety as a result of learned behaviour. Anxiety and phobias are learned through association ;and this learning can occur without intention or awareness that something has been learned, So Any change in behaviour suggest the person has learned. It can be split into two different ways of learning:
o Classical conditioning, this is the idea that we learn through association. A new stimulus becomes conditioned with an unconditional stimulus to produce the unconditioned response of fear, this leads to you associating the new stimulus with the fear. An example is little albert, or pavlovas dogs.
o Operant conditioning, which was proposed by skinner and is learning through reinforcement and is a method of learning that uses rewards and punishments to modify behaviour. Maladaptive coping strategies reinforce (reward) the behaviour and sustain the experience of anxiety, when the maladaptive coping strategies are stopped or replaced the maladaptive behaviour become extinct.
o There are a number of different Treatment:
§ Exposure therapy and systematic desensitisation, this involves exposing the patient to the anxiety source or its context without the intention to cause any danger. It is a gradual exposure to the anxiety source within a controlled and safe environment, this is then thought to help overcome anxiety or distress and to gain control of the overwhelming situation. This follows the basis that what was learned can be potentially unlearned and encourages clients to face up to the events and situation which caused them fear. It is also based on the principle of habituation , which is the idea that a person’s behavioural and sensory response is reduced overtime following repeated exposure to the stimuli.
§ Progressive muscle relaxation, these teach you how to relax your muscles through a two-step process:
1. Systematically tense particular muscle groups in your body such as your neck and shoulders.
2. Release the tension and notice how your muscles feel when you relax them.
§ ACT
§ Dialectical behavioural therapy
§ Response prevention therapy
§ Virtual reality
§ Applied relaxation
- Biological explanation, this how physiological and anatomical changes can cause anxiety:
o Evidence suggest there is a genetic link and that people might inherit a genetic trendy to be more anxious than others. Evidence came from M-M, F-F and M-F twin studies with a lifetime history of General anxiety disorder, telephone interviews, heritability blood relatives. Suggest an innate low threshold for anxiety.
o Neuroscience indicates that anxiety disorders arise from a disfunction in the modulation of the brain circuits that regulate the emotional response to potentially threating stimuli. Many brain regions including the Amygdala plays a crucial role in the regulation of negative emotion-situated in the median temporal lobes, this evident by the fact that patients with anxiety disorder activate the amygdala in response to a given stimulus more than non-anxious controls. The inhibitory neurotransmitter GABA in central to the regulation of anxiety.
o Treatment, can be given by two different medications:
§ Benzodiazepine is frequently used in the treatment of general anxiety disorder and is seductive used as a short-term treatment during severe periods of anxiety. It eases symptoms within 30 – 90 minutes of taking the medication, it works by enhancing responses to the inhibitory neurotransmitter GABA. The overall success rate is 35% with a further 40% showing moderate improvement but are still symptomatic, however the side effects mean that they are not always the drug of choice. There can also be ethical issues if there is a reliance on the drug.
§ Selective serotonin reuptake inhibitors , these primarily affect the level of serotine which is a neurotransmitter in the brain involved in regulating: mood, emotions and anxiety. It is helps alleviate the symptoms by regulating serotine levels and can have a calming effect. Examples include: fluoxetine, sertraline, paroxetine, citalopram, escitalopram.