Power point

Anxiety: What is it and how to treat it?

Kipsey Broussard

Liberty University

Abstract

Anxiety can be scary and debilitating. There are several forms of anxiety that are defined in the DSM-5 and the ICD 10. Anxiety affects twice as many women as men. Anxiety disorders account for a large quantity of the mental illnesses today. “This makes it the most prevalent mental health condition.” (Craske & Stein, 2016) Anxiety is so widely spread that one in fourteen people around the world have been diagnosed with some form of anxiety disorder. Anxiety is defined as “chronic and persistent worry.” (Stein & Sareen, 2015) This paper will discuss the signs and symptoms if different types of anxiety and will also look at different types of treatment. Physicians and psychologists have come a long way in understanding and treating anxiety disorders today.

Introduction

Fear and anxiety go hand-in-hand. According to Miltenberger, “a fear is composed of both operant and respondent behavior. A person is afraid of a certain stimulus. The bodily respondent behavior is fear.” (p. 490, 2016) There are eight different forms of anxiety defined in the DSM-5 and ICD-10 manuals. In each of the different types of anxiety the first symptom listed is “marked fear.” This coincides with Miltenberger’s definition of fear listed above. There are many tools and methods used in the aide of diagnosis. Although there is medical testing to diagnose anxiety disorders, disorders in adults are usually done in a clinical setting with structured interviews. As of 2016 the pathophysiology of anxiety and anxiety disorders were poorly understood. Not only is anxiety diagnosed alone but it is also an important symptom when it comes to diagnosing other mental health issues and substance use disorders.

Research, Diagnosis, and Treatment

Through much research, clinicians and doctors alike have been able to separate and diagnose several different types of anxiety. The different types of anxiety that are outlined are: separation anxiety disorder, specific phobia, social anxiety disorder, panic disorders, agoraphobia, generalized anxiety disorder, anxiety disorders associated with a mental condition, substance induced anxiety, and illness anxiety (hypochondriasis) (Cranske & Stein, 2016). Because different forms of anxiety can mimic one another the diagnosing physician will need to investigate the patients associated beliefs or cognitions to properly diagnose which form of anxiety the patient is suffering from. Through research it is known that adults 55 years or older have a 20% less chance of developing an anxiety disorder than the population between 35-54 years of age. There are many risk factors for anxiety. Many children who suffer from child abuse, sexual abuse and have a parent who suffers from a mental disorder are more likely to develop an anxiety disorder over the course of their life.

One form of treatment has risen the ladder in the last decade. This is treatment through online e-mental health. A great deal of patients have a hard time opening when they are in a face-to-face setting. Through online help the patient can be comfortable in their own setting. Klein, Meyer, Austin & Kyrios did a research study testing the effectiveness of five fully automated self-help cognitive behaviors (2011). This research study was conducted for a 12-week period. The study was done based on each of the 225 patients choosing one of the five e-therapies treatments. The findings showed reduced anxiety disorder in people who were clinically diagnosed, increased confidence in the patient management of self-care, a decrease in the total number on clinical diagnosis and improved quality of life overall (Klein et al, 2011). Another study was done on the efficacy of treatment for anxiety disorder. The research was on the 3 main forms of anxiety disorder. The three disorders are panic disorder, generalized anxiety disorder, and social phobia. There are ten different medications that are being used in the treatment of anxiety disorder. These medications are Selective Serotonin reuptake inhibitors (SSRI), serotonin-noradrenaline reuptake inhibitors (SNRI), pregabalin, tricyclic antidepressants, benzodiazepines, moclobemide, phenelzine, buspirone, and hydrozyzine (Bandelow, Reitt, Rover, Michaelis, Gorlich & Wedeking, 2011). Patients were chosen using the Scottish Intercollegiate Guidelines Network (SIGN). 234 patients were studied pre-treatment and post-treatment. The study showed that anti-anxiety drugs worked better and quicker than psychological therapies. Ultimately the research has concluded that the choice between medication or psychotherapy should be left up to the patient. A study has shown that the use of benzodiazepine, such as zanex or valium, used with a SSRI works very well but patients like the benzos because they are a rapid treatment. Thus, the patients do not want the SSRI anymore (Rov-Byrne, 2015).

Self-Treatment for Anxiety

I intend on using herbal medications to treat my anxiety over pharmaceuticals such as benzodiazepines, due to the fact that they are highly addicting, and I have already fought that battle early in my life. I have suffered from anxiety since I was 16. Although there are many promising herbs there is only one that has shown effective in treating anxiety. This herb is piper methysticum better known as Kava. On the down side Kava has been shown to be associated with hepatotoxicity. Although there can be negative consequences I believe it to be better than the side effects of pharmaceuticals and therefore this is the self-treatment that I am going to use. Along with Kava passionflower was also shown to help with Anxiety (Dave, Vishnupriya & Gayathri, 2016). I will be using token economy in my self-treatment. Token economy is defined as giving a token when desirable behavior is shown. The tokens can then be traded in for back-up reinforcers. (Miltenberger, 2016). Since I have agoraphobia and generalized anxiety disorder I do not like to go anywhere crowded or even into a restaurant by myself to eat. Therefore, an example for my treatment would be walking into a crowded store or starting a conversation with a stranger at a get-together. If I successfully do this several times I could trade in my tokens for a treat such as Starbucks or a pedicure. I will try my self-treatment method over the course of the next couple of weeks using herbal alternative medications and token economy. I have suffered with anxiety for most of my life and look forward to testing these two treatments.

Conclusion

With anxiety being one of the highest diagnosed mental health disorders there is no wonder so many medications are available for treatment. Studies have been done on both pharmaceuticals and herbal alternative medicine. Both forms have been shown to do remarkable things in patients. Which one ultimately rest on the patient’s shoulders. Some patients may even try both forms before making a decision. Anxiety has circled the globe for thousands of years with so many forms having the same or similar symptoms. It was not until 1984 that the DSM-IV was rewritten so that doctors, clinics & psychologists could diagnose patients into the right category. Leaps and bounds have been made in understanding and treating anxiety in the world today. ‘Because fear is one of the main symptoms of anxiety, the fear needs to be addressed first and foremost. By doing that the physician can better understand why the patient is suffering from this disorder. I know where my fears lie and what brought me to them. That was the first step in my course of treatment. You can not address a behavior if you do not know what first started it. Anxiety needs to be broken down so that each piece can be looked at. With the help of the DSM-IV, physicians, herbs, and medications the world does not have to feel chronic and persistent worry.

References

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders.Dialogues in Clinical Neuroscience, 19(2), 93.

Craske, M. G., & Stein, M. B. (2016). Anxiety. The Lancet, 388(10063), 3048-3059. doi:http://dx.doi.org.ezproxy.liberty.edu/10.1016/S0140-6736(16)30381-6

Dave, P. H., Vishnupriya, V., & Gayathri, R. (2016). Herbal remedies for anxiety and depression-A review. Research Journal of Pharmacy and Technology, 9(8), 1253. doi:10.5958/0974-360X.2016.00237.7

Klein, B., Meyer, D., Austin, D. W., & Kyrios, M. (2011). Anxiety online: A virtual clinic: Preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms. Journal of Medical Internet Research, 13(4), e89. doi:10.2196/jmir.1918

Miltenberger, R.G. (2016) Behavior Modifications. Boston, MA: Cengage Learning

Roy-Byrne, P. (2015). Treatment-refractory anxiety; definition, risk factors, and treatment challenges. Dialogues in Clinical Neuroscience, 17(2), 191.