anxiety

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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

Medication for generalised anxiety disorder: new network meta-analysis

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A group of UCL Masters Students summarise a recent network meta-analysis of drug treatment for generalised anxiety disorder, which finds that Venlafaxine, Pregabalin, Escitalopram and Duloxetine are all viable alternatives to Benzodiazepines.

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Youth anxiety and depression treatment not as good as we think? What should we tell the children?

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Ola Demkowicz writes her debut elf blog about a study that evaluates reliable improvement rates in depression and anxiety at the end of treatment in adolescents.

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Dental fear and anxiety: Is it related to negative oral health beliefs?

Media coverage of the paper by Davies and Read was emotive and damning in terms of the dangers of antidepressant medication.

This review of the evidence on the relationship of oral health beliefs with dental fear and anxiety included 10 studies and suggests that patients with negative health beliefs are more likely to suffer with dental fear and anxiety.

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Distraction techniques for managing dental anxiety in children and adolescents

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This review assessing whether distraction techniques reduce children’s/adolescent’s anxiety and fear during dental treatment included 20 RCTs providing very low certainty evidence that these techniques have a positive effect.

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Dafni Katsampa considers how mental health problems can affect clinical psychologists, and the impact that stigma has on disclosure and help-seeking.

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Natalie Morgan looks at the association between oestradiol levels, hormonal contraceptive use, and responsiveness to one-session-treatment for spider phobia in women.

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Poor school attendance and anxiety: what’s the link?

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Lucinda Powell summarises a recent systematic review about the association between anxiety and poor attendance at school, which suggests links between anxiety and unexcused absences/truancy, and school refusal.

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Infant-feeding behaviours: Can PSAS scores predict the recipe for success?

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Melisa Selvaratnam summarises a study on postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours.

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What’s the relationship between adolescent depression and adult depression?

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Katie Finning writes her debut elf blog on a recent systematic review which looks at adult mental health outcomes of adolescent depression; including depression, anxiety and suicidality in adults.

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Dropping out of virtual reality exposure therapy for anxiety: comparison with in-vivo exposure therapy

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Aislinn Bergin writes her debut elf blog on a recent meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders.

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