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

Bullying in childhood: cause or consequence of mental health problems? #AntiBullyingWeek

Victims who reported being bullied on numerous occasions had higher rates of psychosis

Stefan Brugger publishes his debut elf blog on a recent study, which looks at the role of vulnerability and resilience in relation to mental health and bullying in childhood.

Today marks the start of #AntiBullyingWeek, so look out for lots of activity around this theme on social media.

[read the full story...]

Brief behavioural therapy for children and adolescents with anxiety and depression

michal-parzuchowski-224092

Mona Jones publishes her debut elf blog on a recent RCT of brief behavioural therapy for paediatric anxiety and depression in primary care.

[read the full story...]

Are digital tools the answer to improving employee wellbeing and effectiveness? #WorldMentalHealthDay

climate-kic-350836

It’s #WorldMentalHealthDay today and the theme this year is promoting awareness of mental health in the workplace.

We’re getting in on the act with Chris O’Sullivan looking in detail at a recent systematic review of web-based psychological interventions delivered in the workplace, to improve employee wellbeing and effectiveness.

[read the full story...]

Preventing anxiety disorders in young people at risk

jiri-wagner-227868

Belinda Platt reports on a recent systematic review and meta-analysis looking at the prevention of anxiety disorders in at-risk children and adolescents.

[read the full story...]

cCBT for people with learning disabilities: Pesky gNATs #MHNR2017

Pesky Gnats

Leen Vereenooghe presents the results of an RCT of computerised cognitive behavioural therapy for people with learning disabilities, featuring the computer game “Pesky gNATs: The Feel Good Island”.

[read the full story...]

Brief, intensive and concentrated CBT for anxiety disorders in children

child-2122019_1280

Simon Brett summarises a recent systematic review of brief, intensive and concentrated cognitive behavioural therapy for anxiety disorders in children, which finds some promising results for this more focused approach to care.

[read the full story...]

Ecological momentary interventions: smartphones have changed everything and here’s how digital mental health might begin to catch up

rawpixel-com-303966

Mark Brown is feeling positive about the digital future on mental health after reviewing a new paper about ecological momentary interventions for depression and anxiety.

[read the full story...]

Investigating the link between loneliness and sleep quality in young people

6837914844_2ec2ee4ddc_o

Ahmed Al-Shihabi and Farhana Mann report on a recent twin study that explores the links between loneliness and sleep quality in young adults.

[read the full story...]

Turn on, tune in, drop out! Music therapy no better than usual care for young people

children-1005468_1280

Lisa Burscheidt is rather disappointed by a randomised controlled trial of music therapy for children and adolescents with behavioural and emotional problems.

[read the full story...]