anxiety

shutterstock_177126911

Introduction

Anxiety is something we can all relate to. For the most part, anxiety represents a healthy and adaptive physiological response to feared stimuli, preparing your body to respond accordingly. Perfect if you a™re being chased by a bear. However, it can be problematic if those feared stimuli are benign, no longer present, or constitute persistent worries about the future.

At it™s most debilitating, anxiety can be classified into a range of psychiatric diagnoses. The most common of these is generalised anxiety disorder (GAD), which has an estimated lifetime prevalence in the UK of between 4-7%. GAD is characterised by a range of physical symptoms such as muscle tension, poor concentration and disturbed sleep, as well as psychological symptoms such as ongoing and uncontrollable worry. Diagnoses such as panic disorder, social anxiety disorder and phobias all feature anxiety as a primary symptom. In total, anxiety-related difficulties have been estimated to affect as many as 18% of a US-based adult population over a 12-month period.

Though previously categorised as anxiety disorders, both obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are increasingly being understood as separate diagnoses, but again with anxiety as a common symptom.

What we know already

People with long-term physical health conditions are more prone to experience anxiety as a result. For example, it is estimated that people with Chronic Obstructive Pulmonary Disease (COPD) are up to 10 times more likely to receive a diagnosis of panic disorder than the general population. This, in turn, has considerable implications on healthcare expenditure.

Psychological treatments such a cognitive-behavioural therapy (CBT) have been widely researched and shown to be effective across a range of anxiety disorders. In the case of specific phobias, these techniques can elicit significant improvement in just one session. However, improvement rates are lower across other anxiety disorders.

In England, the National Institute for Health and Care Excellence (NICE) recommends CBT as the first line treatment of anxiety disorders. Pharmacotherapy, such as Sertraline, can also be beneficial, and is recommended as an adjunct to CBT where the person’™s difficulties are more severe.

Areas of uncertainty

Anxiety has been conceptualised in many ways, which in many ways have shaped the range of treatments available. This proliferation of cognitive, developmental, information-processing, neurochemical and other models of understanding anxiety can create a confusing picture. Similarly, whilst there is a clear hereditary component to anxiety, the precise nature is not yet clear.

Whilst psychological and pharmacological treatments can be effective for many, there is still work to be done in identifying the mechanisms of change and improving outcomes.

What’s in the pipeline?

Historically, research into anxiety disorders focused more heavily on adult populations. However, with the recent emergence of disciplines such as paediatric psychology, there is a greater emphasis on tackling anxiety difficulties at a younger age.

As our understanding of genetics improves, it is likely that we will discover more about the role of heritability in anxiety.

Perhaps, most importantly, given the effectiveness of treatments for anxiety, we should aim to reduce stigma and other barriers to access, to enable earlier intervention and better recovery.

References

Antony, M. M., and Stein, M. B. (2009). Oxford handbook of anxiety and related disorders. Oxford University Press. [Publisher]

Hoge, E. A., Ivkovic, A. and Fricchione, G. L. (2012). Generalized anxiety disorder: diagnosis and treatment. BMJ, 345. [Abstract]

Kesller, R. C., Ciu, W. T., Deler, O. and Walters, E. E. (2005). Prevalence, Severity, and Comorbidity of Twelve-month DSM-IV Disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617-627. [Abstract]

Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. and Galea, A. (2012) Long-term conditions and mental health: the cost of co-morbidities. The King’s Fund, London, UK. [PDF]

Acknowledgement

Written by: Patrick Kennedy-Williams
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our anxiety Blogs

From parent to child: understanding the risk of anxiety in families affected by mood disorders

Close up faces in row, diverse women smile looking at camera, little cute girl, her adult mother, mature grandmother and old great-grandmother portraits. Multi-generational family, heredity, offspring

Aslihan Baser summarises a systematic review and meta-analysis investigating the risk for developing anxiety disorders in children whose parents experience mood disorders.

[read the full story...]

Young people are worried about climate change, but how do they cope?

World Earth Day Concept. Green Energy, ESG, Renewable and Sustainable Resources. Environmental Care. Hands of People  Embracing a Handmade Globe. Protecting Planet Together. Top View

Trish Darcy considers a scoping review of empirical evidence on climate concerns, negative emotions and climate‐related mental illness in young people.

[read the full story...]

Individual, group and guided self-help CBT for panic disorder: most delivery formats equally effective, but more evidence needed

mikayla-mallek-3iT3dnmblGE-unsplash

Hannah Wallace summarises a network meta-analysis comparing four different formats of CBT for panic disorder, which finds “no efficacy differences between CBT delivered as guided self-help, or in the face-to-face individual or group format in the treatment of panic disorder”.

[read the full story...]

From climate anxiety to climate action: developing global mental health recommendations

Wooden,Blocks,With,Words,'take,Action,Now!'.,Business,Concept

Ella Tuominen considers a set of new global recommendations for action on climate change and mental health across sectors including healthcare, research, policy, and third sector organisations.

[read the full story...]

Equity within IAPT: socio-demographic inequalities in accessing treatment

Hands,Of,Elderly,Woman,In,Uganda,,Africa

Lawson Taylor provides an overview of a national cohort study that explored socio-demographic differences in access to NHS Talking Therapies (formerly known as IAPT) services.

[read the full story...]

Are transdiagnostic mental health interventions the future of treatment?

priscilla-du-preez-01EIiXiLPCk-unsplash

Isabeau Tindall summarises a recent meta-analysis by Pim Cuijpers and colleagues investigating the effective of transdiagnostic treatments for depression and anxiety.

[read the full story...]

Guided self-help for anxiety: the importance of choice

Only 7% of the participants accepted being randomised, while 93% chose their treatment, showing a preference for CAT-GSH; however, CAT-GSH and CBT-GSH were found to result in similar anxiety outcomes at the follow-up assessments.

In her latest blog, Francesca Zecchinato summarises findings from a recent pragmatic, partially randomised, patient preference trial on two forms of guided self-help for anxiety.

[read the full story...]

If you’ve got a mental health problem, who you gonna call?

Call,Center,,Online,Customer,Support.,Contact,Us,Customer,Service,For

In her debut blog, Cara McErlain summarises a recent qualitative systematic review exploring patients’ perspectives on barriers and facilitators to accessing mental health support through primary care services in England.

[read the full story...]

Is anxiety a gateway to other mental health problems? Comorbidities with depression and other anxiety disorders

Results from the current study largely replicated findings from the NESDA dataset in demonstrating that those with comorbid anxiety and/or depression have more severe presentations that anxiety or depression alone.

Nina Higson-Sweeney summarises a study using data from the UK-based GLAD and COPING NBR cohorts to investigate factors associated with anxiety disorder comorbidity with anxiety and depression.

[read the full story...]

Using the highs to combat the lows: ketamine-assisted therapy for anxiety and depression

ketamine

In her debut blog, Gabrielle Williams reviews a US study on the safety and effectiveness of ketamine-assisted therapy (a digital intervention combining psychotherapy, journaling and ketamine) for moderate to severe anxiety and depression.

[read the full story...]