Mackenzie Brown Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. Aude Henin Child Cognitive Behavioral Therapy Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
A Causal Systems Approach to Anxiety Disorders
A Causal Systems Approach to Anxiety Disorders
Recent research adopting a causal systems approach contributes to our understanding of these cross-syndromal relationships. Although symptoms and the causal relationships between them are central to the causal systems approach to psychopathology, this approach does not focus solely on psychological factors.
Conclusion
Mapping network connectivity between social anxiety symptoms and comorbid depression in people with social anxiety disorder. An integrative network approach to social anxiety disorder: complex dynamic interplay between attentional bias for threat, attentional control, and symptoms.
Neurocircuitry of Anxiety Disorders
Introduction
Some of the structures involved in the fear acquisition process are the amygdala, the dorsal anterior cingulate cortex (dACC), the insular cortex and the hippocampus [3, 16]. In anxiety disorders and mood disorders with anxious features, stressors can cause increased activation of the limbic-hypothalamic-pituitary-adrenal axis (LHPA), the sympathetic nervous system, and other central stress mechanisms [3].
Brain Structures Implicated Across Anxiety Disorders Amygdala
Together, these findings begin to elucidate how the non-pathological functions of the amygdala may predispose some individuals to the development of anxiety disorders. Together, these studies suggest that the perigenal area of the vmPFC can modulate positive affect, while the posterior vmPFC/.
Neural Mechanisms Implicated in Specific Anxiety Disorders Specific Phobia
The PD model of Gorman et al. [129] also points to the role of the hippocampus in the contextualization of fearful situations. The role of the amygdala in the pathophysiology of panic disorder: evidence from neuroimaging studies.
Anxiety Disorders: A Feminist Ecological Approach
Anxiety Disorders: A Feminist Ecological Approach
In addition, many sociodemographic variables interact with and moderate these systems, including gender and ethnicity and other minority identities. Influences from the macrosystem, the exosystem, as well as the influence of minority identities will be discussed here.
Macrosystem
Consistent with these theories, greater endorsement of core aspects of fast-paced capitalism, such as materialism, has been shown to be associated with higher levels of anxiety [9, 10]. In addition to this broad deployment of fear as a driver of consumerism, the view of fear and anxiety disorders within the medical model may represent another aspect of the macrosystem that is important to consider.
Exosystem
In short, a number of factors at the macrosystem level may contribute to increasing the risk of fear in contemporary Western society, due to the rise of modernity and fast-paced capitalism, and the media's use of fear as a means to control consumption. increase within the economic growth model. . In Western cultures, psychological phenomena such as anxiety are often viewed through the lens of the medical model.
Microsystem and Individual Identities
High rates of anxiety in trans and non-binary individuals may be related to lack of social support and stigma and discrimination at the community level [43]. Race or ethnicity may be another visible identity category that may play a role in the etiology, course, and treatment of anxiety disorders.
Two Peas in a Pod? Understanding
Cross- Cultural Similarities and Differences in Anxiety Disorders
Chapter Overview
Cross-Cultural and Cross-Ethnic Differences in Prevalence of Anxiety Disorders
Cross-Cultural Differences in Explanatory Models and Display Rules
These two hypothetical clients might use "thinking a lot" as a general explanation of anxiety; however, there are subtle distinctions in the relationship that. The two commonly used assessment tools to elicit explanatory models are the explanatory model interview catalog (EMIC) (18) and the cultural formulation interview (CFI) in the DSM 5 (12).
Transdiagnostic Constructs Shaping Anxiety Disorders Across Cultures
Anxiety sensitivity (AS), a dispositional vulnerability factor, is defined as the tendency to fear physical, cognitive, and social consequences arising from experiencing anxiety (33). In particular, anxiety sensitivity may result from catastrophic cognitions about anxiety symptoms that vary across cultures.
Case Examples: Conceptualizing Anxiety Across Cultures
The affective vulnerability factor of anxiety sensitivity can be applied to explain the nature of panic-like symptoms accompanying ataque de nervios among Latin American immigrants. Therefore, the putative mechanisms that explain the initial sensations and a subsequent episode of ataque de nervios are multiplex.
Taijin kyofusho
Typically, rumination in SAD involves self-evaluations of one's performance in the situation. The central role of excessive thinking can be easily identified in the etiology and maintenance of GAD, given that excessive worry is an essential diagnostic marker of GAD.
Summary
The reviewed literature highlights the importance of assessing transdiagnostic and transcultural factors that have been associated with variable presentation of anxiety disorders across cultural groups. Available at: http://www.sjsu.edu/people/edward.cohen/courses/c3/s1/snowden_cultural_differences.pdf.
Anxiety Comorbidities: Mood Disorders, Substance Use Disorders, and Chronic
In addition, individuals with anxiety and a comorbid disorder report poorer treatment outcomes than those with a single disorder [11], complicating treatment planning and delivery. This chapter will review anxiety and its comorbidity with mood disorders, substance use disorders, and chronic medical conditions, focusing on chronic pain, and will explore epidemiology, mechanisms, clinical features, and treatments in greater depth.
Anxiety and Mood Disorders
Childhood trauma plays a role in the development of anxiety and mood disorders. Mindfulness-based treatments emphasize experiencing emotions without judgment and have been shown to be effective for anxiety and mood disorders individually.
Anxiety and Substance Use Disorders
Similarly, parenting style has also been associated with greater risk of comorbid anxiety and substance use disorders. Specifically, cold and authoritarian parenting styles were found to be associated with anxiety and substance use disorders [123].
Anxiety and Chronic Pain
Compared to anxiety and mood disorders and anxiety and substance use disorders, significantly less research has been conducted on treatment for comorbid anxiety and chronic pain. Role of self-medication in the development of comorbid anxiety and substance use disorders: a longitudinal investigation.
From OC Spectrum to Anxiety Disorders
We will provide practical, evidence-based recommendations for functional assessment and case design and highlight considerations for the differential diagnosis between OCRD and anxiety disorders. Finally, we will discuss empirically supported interventions and relevant treatment considerations, particularly regarding comorbidity and specific diagnostic versus transdiagnostic interventions.
DSM-5 and Clinical Features: The Obsessive-Compulsive and Related Disorders (OCRDs)
It is more common for women to engage in compulsive purchasing of items, while the excessive acquisition of free items tends to be similar in men and women [36]. However, when hair pulling persists and results in significant physical effects or distress, it is likely to lead to a diagnosis of HPD.
Case Conceptualization: Specificity and Overlap of Cognitive- Behavioral Models
As with anxiety disorders, in the cognitive-behavioral model of OCD, core dysfunctional beliefs contribute to the development and maintenance of OCD symptoms [ 56 , 57 ]. Similarly, a wider range of functional motivations for hair pulling and skin picking have been implicated [ 68 , 69 ].
Considerations for Assessment and Diagnosis
Skin Picking Scale (SPS) The SPS is a brief measure that assesses the severity of SPD with six items that assess (1) the frequency of urges to engage in skin picking, (2) the intensity of these urges, (3) time spent picking, (4) picking-related interference, (5) distress associated with picking behavior, and (6) avoidance [104]. Additionally, intrusive thoughts about catastrophic consequences of physical sensations (eg, "I might be dying," "I'm having a heart attack," "I could lose control") and help not being available or escaping being difficult, if you were to have a panic attack (e.g. in open spaces, public transport) is symptomatic of panic disorder and agoraphobia respectively.
Treatment Implications: Diagnostic-Specific and Transdiagnostic Considerations
Taken together, exposure may serve many important functions in the treatment of anxiety and OCRDs. In HRT, psychoeducation and self-monitoring are essential for the individual to become aware of urges to engage in hair pulling or skin picking in the moment, as well as their personal triggers and associated consequences for the behavior.
Conclusions
Psychometric evaluation of the Yale-Brown obsessive-compulsive scale adapted for body dysmorphic disorder (BDD-YBOCS). Increasing willingness to experience obsessions: acceptance and commitment therapy as a treatment for obsessive-compulsive disorder.
Anxiety Disorders in Children
Introduction and Overview
Symptom Presentation of Common Youth Anxiety Disorders
Young people with social anxiety experience anxiety about how they will be perceived by others in social situations. Young people with separation anxiety experience excessive and developmentally inappropriate anxiety when they are separated from a parent or other attachment figures [11].
Treatment
In addition, the youth learn the final step of the FEAR plan, the R step: Results and Rewards. This approach is a parent-only intervention that targets parental welcoming behaviors related to the adolescent's anxiety.
Special Considerations for Anxiety in Youth
These accommodations are all seen as ways for the parent or family to "give in" to the child's anxiety, and while they work to reduce anxiety temporarily, it reinforces the youth's anxiety and reinforces avoidance in the long run. This parent, on the other hand, is then likely to experience great disruption from the child's anxiety, unable to leave the child to go to the grocery store, spend time with friends, have individual time with another child, etc.
Conclusions and Future Directions
A randomized clinical trial comparing individual cognitive behavioral therapy and child-centered therapy for childhood anxiety disorders. Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: a randomized clinical trial.
Anxiety Disorders in Emerging Adulthood
Emerging Adulthood
Prevention and treatment of mental illness during EA is therefore paramount from a public health perspective. We will first review biological, psychological, and social transitions that occur during EA and discuss ways in which these transitions may contribute to the onset of anxiety disorders.
Biopsychosocial Development in Emerging Adulthood
For example, EAs' perceptions of parental support for their autonomy are associated with greater self-reported autonomy and social functioning during this life stage; and higher levels of autonomy and social functioning in EA are associated with lower symptoms of anxiety and depression [ 33 ]. EAs' ability to navigate this transition appears to be based on strong interpersonal skills including insight, relational reciprocity, and emotion regulation skills [ 36 ].
Epidemiology of Anxiety Disorders in Emerging Adulthood
Furthermore, individuals with anxiety disorders in EA may have difficulty establishing and maintaining high-quality relationships (see [43, 44]). Outcomes Associated with Anxiety Disorders in EA Individuals who experience anxiety disorders before or during EA are at increased risk for negative outcomes.
Risk Factors for Anxiety Disorders in Emerging Adulthood
The use of social media can be beneficial for some EAs if it is used to facilitate face-to-face social interactions (see [64, 65]). However, researchers believe that social media use becomes harmful when it replaces other activities (e.g., face-to-face social interactions, exercise, reading) that predict psychological well-being [63].
Treatment of Anxiety Disorders in Emerging Adulthood
Clinicians treating EAs with anxiety disorders can also use evidence-based strategies to target patient engagement and treatment adherence. For example, family-focused therapy for anxiety disorders (FFT-ADs) is a treatment that uses evidence-based assessment and intervention tools to reduce anxiety maintenance patterns in a family [ 75 ].
Future Research Directions
Association between perceived parental psychological control and internalizing problems in emerging adulthood: The role of identity. Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles.
Anxiety Disorders Among Older Adults
Empirically Supported Treatments and Special Considerations
Prevalence and Key Clinical Features of Anxiety Disorders Among Older Adults
Anxiety Treatments Among Older Adults
Panic anxiety, social anxiety Isocarboxazid10-40 mg/day Selegiline6-12 mg/day Tranylcypromine10-30 mg/day Atypical [32] Bupropion50-300 mg/day Headache, dry mouth, nausea, insomnia, seizures. Oxazepam 30-120 mg/day Alprazolam 0.75-4 mg/day Clonazepam 1-4 mg/day Diazepam 2 mg/day Abbreviations: SSRI-selective serotonin reuptake inhibitor, SNRI-serotonin and norepinephrine reuptake inhibitor, TCA tricyclic oxidase inhibitors, MA- tricyclic antidepressants, MA-tricyclic antidepressants. NSAIDs Nonsteroidal Anti-Inflammatory Drugs NaSSA Noradrenergic and Specific Serotonergic Antidepressant BZ Benzodiazepine 9 Anxiety Disorders Among Older Adults: Empirically Supported Treatments.
![Table 9.1Evidence for the use of antidepressant medications in the treatment of late-life anxiety disorders DrugUsual doseCommon known side effectsKnown interactionCommentClinical indication SSRI [23–26] Escitalopram5–20 mg/dayHyponatremia (fatigue, delir](https://thumb-ap.123doks.com/thumbv2/azdoknet/10578229.0/185.659.93.495.78.898/antidepressant-medications-drugusual-dosecommon-effectsknown-interactioncommentclinical-escitalopram5-dayhyponatremia.webp)
Age-Related Socioemotional Changes and Anxiety
Older adults are more likely than younger adults to use BZs and to use them long-term [21]. Because of these risks, the American Geriatrics Society cautions against prescribing BZs to older adults [26].
Anxiety and Treatment Among Older Adults with Neurocognitive Disorders
If the cognitive material is too challenging, patients may benefit more from behavioral strategies, such as behavioral experiments or activity planning, with an emphasis on maintaining daily structure, pleasant events, and caregiver problem solving [44]. Therapists working with cognitively impaired adults may also consider further adaptations such as treating the patient and caregiver together and exploring memories relevant to the specific patient, as in reminiscence therapy, spiritual care interventions, or music therapy [45 , 46].
Anxiety and Medical Comorbidities
COPD treatments, such as beta-agonists and medications containing theophylline, may themselves worsen the symptoms of anxiety and panic [51]. James' treatment first involved carefully observing and logging the symptoms of atrial fibrillation and panic attacks.
Utilization of Anxiety Treatment Among Older Adults
High prevalence of mood and anxiety disorders among older adults: the National Comorbidity Survey replication. Cognitive-behavioral therapy adjunct to SSRI reduces cortisol levels in older adults with generalized anxiety disorder: a randomized clinical trial.
Anxiety and Bereavement
We will also discuss the known prevalence rates for both anxiety symptoms and anxiety disorders among bereaved individuals, common anxiety reactions following a loss, as well as research into predictors of anxiety in the post-loss period. In addition, we will discuss connections between anxiety symptoms or disorders and complicated grief reactions.
Prevalence of Anxiety Symptoms and Anxiety Disorders Among Bereaved Individuals
Therefore, it is important to understand the experience of anxiety in the bereaved, including risk factors, potential negative long-term consequences, and the best course and methods of intervention. In the next chapter, we will review the literature on the relationship between anxiety and bereavement.
Common Anxiety Reactions Following Loss
In many of these studies, anxiety and related disorders are present not only immediately after the loss, but also up to 6 years [11–13] after the loss. Unlike other anxiety disorders—for which little is known about the loss-specific mechanisms underlying their development among the bereaved—PTSD has a clear loss-related origin, given that the loss itself is the index event that triggers its development.
Predictors of Anxiety and Anxiety Disorders in Bereavement
