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Depression and anxiety

Anxiety

Anxiety is a mood, that unpleasant feeling of fear and apprehension accompanied by bodily sensations and occurring with a subjective feeling of uncertainty and threat about the future. Anxiety is a fundamental human emotion that was recognized as long as five thousand years ago. Everyone has experienced it, and will continue to experience it throughout our lives. Anxiety act as a safeguard to keep us from ignoring danger, and has an adaptive role.  However, overwhelming anxiety can disrupt social or occupational functioning or produce significant distress. Anxiety is characterised by fear, concern or dread . This may be related to a specific event or situation that is perceived threatening, or may be more pervasive. Although anxiety is a common difficulty occurring throughout the life-course it typically begins early in life.

Did You Know?

Anxiety disorders affect approximately one in four people at some point in their lives is a state of uneasiness or apprehension that affects everyday life. Anxiety can be manifested in a person’s thoughts, behaviour and somatic manifestation. A preoccupation with unknown dangers or fear of losing control, may take the form of avoiding anxiety provoking situations and limiting an individual’s experiences in life.  The preoccupation may, in turn, lead to emotional stress and turmoil, maladaptive behaviours, and disruptions in interpersonal relationships. Anxiety disorders can affect daily functioning and trigger panic attacks, irrational thoughts, compulsive behaviour and nightmares. The anxiety disorders do not involve a loss of contact with reality: people suffering from them can usually go about most of the day-to-day business of living. Although these people are aware of the illogical and self-defeating nature of their behaviours, they seem incapable of controlling them.

Anxiety disorders affect between 10% and 25% of the population over the course of an individual’s lifetime.

Many anxiety disorders begin in childhood  and may continue into adulthood if left untreated

Women are affected more often than men, up to a ration of 2:1

Anxiety is associated with other psychological disorders such as depression, especially when the onset is after the age of 35 years.

Children of parents with anxiety disorders are 5–7 times more likely to be diagnosed with an anxiety disorder than children of parents without an anxiety disorder

Causes of Anxiety

The mechanisms for the transmission of anxiety are unclear. Family and twin studies (Hettema et al., 2001; Kendler et al., 1992; Lenane et al., 1990;  Torgerson, 1983) suggest some evidence of a genetic inherited influence on anxiety proneness but only moderate (30–40% of the overall variance; Hettema et al., 2001). The environmental factors seem to be significant  in developing anxiety disorders  and it appears important to identify psychosocial factors that put individuals at risk for developing anxiety disorders.

Another factor that seems to play a role in the origins of anxiety is parental rearing behaviour. Research has relatively recently begun to focus on family characteristics that may promote the development of anxiety. Although the family system is complex, research indicates that family relationships differ between anxious and nonanxious families. Several studies have found confirming evidence for the proposed relationship between controlling rearing behaviours and anxiety disorder symptoms, some of them relying on direct observation of parent-child interactions.

Environmental stresses and social circumstances can cause anxiety disorders. Life events and emotional trauma such as loss, bereavement, divorce and abuse play a major role in the development of anxiety-related conditions or can aggravate an existing condition.

Furthermore there are evidence to suggest that neurochemical responses to stressful conditions with abnormal levels of serotonin and norepinephrine (the brain's neurotransmitters) can affect mood and anxiety .

Anxiety categories

There are five major groups of anxiety disorders:   panic disorders,  generalized anxiety disorder, phobias, , obsessive-compulsive disorder, and acute stress /posttraumatic stress disorders. In each of the anxiety disorders, the person can experience panic attacks, intense fear accompanied by symptoms such as a pounding heart, trembling, shortness of breath, or fear of losing control or dying.

Panic disorders- is characterised by severe and frightening episodes of apprehension and feelings of impending doom. Recurrent panic attacks involving a sudden onset of physiological symptoms, such as dizziness, rapid heart rate, and trembling, and sometimes with a fear of being in public places. These episodes are often described as horrible and can last from a few minutes to several hours. The attacks are especially feared because they often occur unpredictably and without warning. Individuals with panic disorder often have other anxiety conditions or mood disturbances.

Did You Know?

  • The lifetime prevalence rate for panic disorder is approximately 3.5% and two times more common in women.
  • Women are more likely than men to suffer a recurrence of panic symptoms after the remission of the disorder.
  • One third to one-half of individuals diagnosed with a panic disorder also have agoraphobia.
  • The age of onset is primarily at the late adolescence and mid-30s

Generalised anxiety disorder ( GAD) – individuals with generalized anxiety disorder tend to have milder anxiety-evoking thought dealing with themes such as misfortune, financial concerns, academic and social performance, and rejection. The generalised anxiety disorder  is characterised  by a  “chronic pathological worry .  These concerns are accompanied by physiological responses such as heart palpitations, muscle tension, restlessness, trembling, sleep difficulties, poor concentration, and persistent apprehension and nervousness.

Did You Know?

  • The lifetime prevalence rate for generalised anxiety disorder is approximately 5% of the adult population with women twice as likely to receive this diagnosis as men.
  • Over two thirds of cases of GAD have co-occuring disorders such as depression, substance abuse, or phobia.
  • The disorder is chronic, and it produces social and functional impairment. However fewer than half of the individuals suffering from it seek treatment.

Treatment of Panic Disorders and Generalized Anxiety Disorder

Treatment of panic disorder and GAD can generally take one of two approaches: biochemical (via medication) and psychotherapeutic. The latter are usually cognitive behavioural therapy.

Phobias

The world phobia comes from the Greek word that means “fear . A phobia is a strong, persistent, and unwarranted fear of some specific object or situation. An individual with a phobia attempts to avoid the object or situation inappropriately (as it does not present any real danger). There are three main groups of phobic disorders:

  1. Specific (isolated) phobias: are unwarranted fears caused by the presence or anticipation of a specific object or situation. These phobias can be blood, injuries, injections, situations (planes, elevators, enclosed spaces), animals, heights, water. Lifetime prevalence is about 7% for men and 16% for women.
     
  2. Agoraphobia- The term originates from the Greek for fear of the market place, but it now has a wider meaning than just fear of open or public space. It also involves fear of being far from home, family and friends. Many people with agoraphobia are unable to leave the house or do so only with great distress. This is an intense fear of being in public places where escape or help may not be readily available. Many people report having panic attacks before developing agoraphobia and is far more prevalence in females.
     
  3. Social phobias- is an intense, excessive fear of being scrutinized by others and also a fear that the person may act in a humiliating or embarrassing way. The most common fears in social phobia involve public speaking and meeting new people. The age of onset is mid-teens and life prevalence between 3-13%.

Did You Know?

Although specific (isolated)phobias are the most common in the general population, agoraphobia is the cause of 60% of the phobic clients seen by professionals.

Phobias are more common in women with the age of onset between 20-40.

Causes of Phobias

How do such strong and “irrational “ fears develop? Research suggested evidence from an interaction of biological, cognitive and environmental factors.

Treatment of Phobias

Specific and social phobias have been successfully treated by Cognitive Behavioural Therapy.

Obsessive compulsive disorders

Obsessive compulsive disorders  is the experience of obsessions (intrusive uncontrollable thoughts, impulses, or images that produce anxiety) or compulsions (the need to perform acts or behaviours or to dwell on thoughts to reduce anxiety). Although obsessions and compulsions can occur separately, they frequently occur together.

Obsessions: An obsession is an intrusive and repetitive anxiety-arousing through or image. The person may realize that the thought is irrational, but he/she cannot keep it from arising over and over again.

Compulsion is the need to perform acts or to dwell on mental acts repetitively. Distress or anxiety occurs if the behaviour is not performed of if it is not done “correctly .  The three most common compulsions among a sample of adolescents involved excessive or ritualized washing, repeating ritual (such as going in and out of a door and getting up and down from a chair), and checking behaviour (door and appliances)

Did you know?

  • Prevalence of obsessive compulsive-disorder have included 1-3%  of the general population.
  • Equally common in males and females
  • Two-thirds of individuals have an age of onset before 25 years with a mean age of about 22 years

Causes of Obsessive compulsive disorders (OCD)

The causes of OCD is some way from being understood. There is a increase genetic predisposition in first degree relatives and a greater link between monozygoticas compared to dizygotic twins. There is also a genetic association between Tourette’s syndrome, chonic motor tic disorder and OCD. Personality disorder is said to predispose to the development of OCD (anankastic personality type). Some other psychoanalytic theories suggest that OCD may represent a defence against anxiety associated with sexual and aggressive impulses.

Acute stress an d Post-Traumatic stress disorder (PTSD)

Acute and posttraumatic stress disorders are anxiety disorders that develop in responses to an extreme psychological or physical trauma. The reaction to the event must involve intense fear, evoke helplessness, or horror. Although stress disorders have many similarities to other anxiety disorders, they have some unique symptoms, such as detachment from others, restricted range of affect, nightmares, and loss of interest in activities.

Acute stress reaction is a transient disorder which develops in an individual with no other apparent mental disorder in response to exceptional physical and or mental stress; it usually stops within hours or days.

Post-Traumatic stress disorder (PTSD) is a reaction of normal individuals to an extreme trauma (e.g.,  natural, man- made disasters, combat, serious accident, witnessing the violent death of others, being the victim of torture, abuse, terrorism, rape or other crimes). The experience is overwhelming and overloading of normal emotional processing.

Did you know?

  • Anxiety and depression are commonly associated.
  • PTSD-8% elevated rates are found among refugees
  • PTSD-More common in females, and in survivors of rape, military combat, accidents, traumas
  • PTSD-The onset follows the trauma with a latency period of few weeks to months.
  • Acute stress disorder lifetime prevalence 14-33% from specific traumas.

Cause of Acute stress an d Post-Traumatic stress disorder

The development of acute or posttraumatic stress disorders appears to depend on the nature of the traumatic event, on a response that shows intense fear and horror, and on vulnerability factors involving past history, personality and family support.

Treatment for Cause of Acute stress and Post-Traumatic stress disorder

Cause of Acute stress an d Post-Traumatic stress disorder have been successfully treated by Cognitive Behavioural Therapy.

Anxiety, Depression and Emotional dysfunctioning in Cognitive Behavioural Therapy

The Basic premise of cognitive theories of emotional disorder is that dysfunction arises from an individual's interpretation of events. These 'irrational beliefs' consists of unconditional shoulds, musts, commands and demands and are the source of disturbed emotional and behavioural consequences.

Ellis (1962) noted 11 beliefs which he considered as the sources of emotional dysfunction. For example: ' A person must be perfectly competent, adequate and achieving to be considered worthwhile; it is essential that a person be loved or approved of by virtually everyone in the community'. Dysfunctional processing of this kind is manifest at a surface level as a stream of negative automatic thought in people's consciousness. Distortions in processing and negative automatic thoughs reflect the operation of understanding beliefs and assumptions stored in memory.

These beliefs and assumptions are a stable representation of a person's'objective reality' of a world view and the self, stored in memory structures that cognitive psychologists called schemas. Toxic childhood experiences are the primary origin of Early Maladaptive Schemas. The schemas that develop earliest and are the strongest typically originated in the nuclear family. Other influences, such as peers, school, groups in the community, and the surroundings culture, is important as the child matures and may lead to the development of schemas.

As Young, Klosko and Weishaar cogently express, four Early Maladaptive Shemas types of early life experiences could emotionaly shape our beliefs and assumptions.The first is toxic frustration of needs( e.g. emotional deprivation or abandonment), for example the child's environment is missing something important such as stability, understanding and love. The second type or early life experience is traumatization or victimization. These is the case where a child suffered from harm or victimized and develops schemas such as Mistrust/Abuse, Defectiveness/Shame, or Vulnerability to Harm. In the third type, the child experiences too much of a good thing: The parent provide the child with too much of something that, in moderation, is healthy for a child. The result is a schema of dependency/incompetence. The child's core emotional needs for autonomy or realistic limits are not met. Thus parents may be overly involved in the life of a child, may overprotect a child, or may give a child an excessive degree of freedom and autonomy without limits. The fourth type of life experience that generates schemas is selective internalization or identification with significant others. The child selectively identifies with and internalizes the parent's thoughts, feelings, experiences and behaviours.

 

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