The Causes and Treatments of Anxiety Disorders - Essay Example

The Causes and Treatments of Anxiety Disorders 0 Introduction Anxiety disorders pertain to group of psychological problems, which affect thoughts, feelings, physical sensations, and behavior. The key features of these disorders include excessive fear, avoidance, worry, and anxiety (Gauthier, 1999, p.2). Barker (2004, p.64) asserted that it is also characterized by a high degree of anxiety which is regarded as out of proportion from the stress that the individual is facing. This anxiety is often manifested directly or indirectly. Individuals with anxiety disorders also experience a sense of dread for the future and seem irritable, impatient, and jumpy. These individuals may suffer from depression and insomnia (Carlson, et al., 2004, p.55). The most common anxiety disorders, which are outlined in DSM-IV, include Specific Phobia, Obsessive-Compulsive Disorder, Social Phobia, Post-Traumatic Stress Disorder, and Panic Disorder. Anxiety disorders are one of the most prevalent mental health problems among adults and elderly (Gauthier, 1999, p.2). This paper seeks to determine how the gulf war and September 11 terrorist attack influence the onset and progression of anxiety disorders. In addition, this paper explores the available treatments for these disorders and its effectiveness. Lastly, this paper determines if the treatment available in a particular culture is similar to other cultures. 2.0 Anxiety Disorders 2.1 Causes Anxiety disorders are caused by numerous factors. Psychological, environmental, and biological factors interact with one another to influence the development of anxiety disorders. These factors influence individuals who are inherently predisposed to developing mental problems (Richards, et al., 2007, p.274). According to Richards, et al. (2007, p.274), anxiety disorders are precipitated by stressors or some traumatic life events. This may include death of a loved one, physical illness, losing a job, and the like. These events push individuals who have dispositional tendency to anxiety into a severe anxiety state. There is a tendency for individuals to experience repeated episodes of a certain anxiety disorder in times of stress (Richards, et al., p.274). These environmental factors make individuals predisposed to such disorder later in life. The factors related with the increased probability of developing neurotic mental illness include emotional or sexual abuse, difficulties in peer relationship, and inconsistent parenting (Richards, et al., p.274). Post-traumatic disorder is considered as the only anxiety disorder precipitated by stressful environmental event. The current classification asserts that extremely traumatic events contribute to the onset of anxiety disorders. Psychiatrists diagnosed Post-traumatic Disorder after different degrees of psychological trauma (Richards, et al., 2007, p.274). Events which may precipitate anxiety disorders include the gulf war and 9/11 terrorist attack. 2.1.1 Gulf War The gulf war that occurred during the 1990s marked one of the largest military deployments since Vietnam. The war ended, but it left an indelible and long lasting effect among veterans. Barnet and colleagues (2002 cited in Jamil, et al., 2004) found that U.S. veterans have Post-traumatic Disorder at 1.9% level. Anxiety was also found at 4.0%, while depression was reported at 17.0%. Anxiety Disorders are related with other co-occurring psychiatric disorders. The rate of the prevalence of Panic Disorder, Generalized Anxiety Disorder, and Post Traumatic Disorder was present twice than expected. Black, et al. (2004) further added that anxiety disorders are more frequent among those military personnel who were deployed in the Gulf war compared to those who were not deployed. The study suggests that pre-deployment psychiatric difficulties are associated with the onset and progression of anxiety disorders. These findings are further validated by the study conducted by Fiedler, et al., (2006). Fiedler, et al., (2006) interviewed 784 era veterans and 967 Gulf war veterans to determine their current medical conditions, symptoms, and Axis I psychiatric disorders. The logistic regression models suggest high prevalence of depression and anxiety disorders among Gulf war veterans. In addition, the study found that the Gulf war deployment of military personnel is related to various mental health outcomes even after 10 years of deployment (Fiedler, et al., 2006). A study in Iowa found that 1.9% of the Gulf war veterans manifested symptoms of Post-Traumatic Disorder compared to 0.8% of the controls. Another study showed that military personnel from UK who were deployed to the Gulf War are 2 ½ times likely to exhibit symptoms of Post -Traumatic Disorder compared to the controls (cited in Fulco, et al., 2000). Researchers also found that children who were exposed to the atrocities of the Bosnian war experienced numbing, hyper-arousal symptoms, and a significant degree of re-experiencing which characterized Post-Traumatic disorder. An estimated 8% to 9% military personnel from Hawaii and Pennsylvania who were deployed to the Gulf war showed symptoms of Post-Traumatic Disorder compared to only 1% to 2% of the non-deployed veterans (cited in Husain, et al., 2008). 2.1.2 9/11 Schlenger and colleagues (2002 cited in Simpson, et al., 2010, p.11) assess the aftermath of the 9/11 terrorist attack. These researchers found that the number of individuals who have Post-Traumatic Disorder are higher in New York compared to rest of the U.S. An estimated 43% of Americans who lost a brother, spouse, or any loved-one meet the criteria of Post-Traumatic Disorder two to three years after the 9/11 terrorist attack. In addition, Neria and colleagues (2002 cited in Simpson, et al., 2010, p. 11) found that approximately 20% of individuals who personally witnessed the terrorist attack meet the criteria of Post-traumatic disorder one year after it happened. Individuals who know someone who died in the attack have twice the likelihood of developing Post-traumatic disorder. In addition, Hoven and colleagues (2005 cited in Simpson, et al., 2010, p. 11) found that 18% of public-school children in New York manifest post-traumatic disorder six months after the attack. Individuals who were directly exposed to 9/11 attack have a higher likelihood of developing Post-Traumatic Disorder. 2.2 How Environmental Factors Contribute to the Onset and Progression of Anxiety Disorder The Gulf War and 9/11 terrorist attack overwhelm the resources of individuals to cope with such traumatic incidents. This consequently triggers the onset of anxiety disorders (Reyes, et al., 2008). Majority of the survivors experience avoidance, negative self-image, increased arousal, and anger as responses to a traumatic incident. Post-traumatic disorder is triggered by the hypersensitivity of the response system of the brain. The onset and development of Post-Traumatic disorder is determined by the individual’s genetic predisposition and the severity and nature of the traumatic incident. Clark and Beck (2011) asserted that all individuals have a "breaking point" in developing Post-Traumatic disorder. An individual who possesses high genetic predisposition for Post-Traumatic disorder is likely to develop such disorder in encountering less traumatic incident. Meanwhile, a highly intense trauma may be necessary to impel an individual with minimal genetic predisposition for Post-Traumatic disorder over his/her breaking point. Several therapists note that the persistence or disappearance of post-traumatic symptoms over few weeks relies on the individuals response (Clark & Beck, 2011). 3.0 Treatment Anthony (2011) reiterated that psychological approaches serve as suitable treatments for anxiety disorders. Researchers stress that the treatment of anxiety disorders also includes repeated exposure to the feared objects, thoughts, sensations, and situations. Therapists have recently taken advantage of the VR technology to minimize individual’s distress through virtual exposure of the feared objects and situations. Exposure-based strategies are employed for specific phobias; however, they are integrated with other strategies for other anxiety disorders (cited in Anthony, 2011). Some researchers noted that multisession treatments, which include “Eye Movement Desensitization and Processing (EMDR)” and exposure treatment are beneficial among individuals who have Post-traumatic disorder. Exposure therapy employs cognitive, behavioral technique, which is similar to debriefing. A therapist asked the client to recall or relive the traumatic experience in a graphic detail. Meanwhile, EMDR utilized bilateral eye movement and focused attention to reprocess the traumatic memories. However, the effectiveness of EMDR is still shrouded in a heated controversy (Padgett, 2002). Cognitive therapy is a psychological treatment which can last from 8 to 16 sessions. Cognitive model supports the premise that individual’s interpretation of the events and not the events per se caused the negative emotions which include anger, sadness, and anxiety (Wright & Thase, 1997, p.9). An “anxiety program” becomes activated once individuals perceive that a sensation or situation is dangerous (Wright & Thase, 1997, p.9). This “anxiety program” originally functions to protect individuals from a dangerous, primitive environment. However, the perceived danger is more imagined instead of real in anxiety disorders (Wright & Thase, 1997, p.9). Thus, individuals respond inappropriately to perceive threats or dangers. The “anxiety program” leads to series of vicious circles, which exacerbate the anxiety disorder (Wright & Thase, 1997, p.9). The cognitive therapy involves four processes, which include “eliciting automatic thoughts, testing automatic thoughts, identifying the maladaptive underlying assumptions, and testing the validity of maladaptive assumptions.” The automatic thoughts which are commonly referred as cognitive distortions are cognitions which interfere with the external events and the individual’s emotional reaction to such particular event (Sadock, et al., 2007, p.959). Thus, individuals who experience the gulf war or 9/11 attack may hold the belief that bombing, terrorist attack, or any undesirable incident will occur again. The therapist helps the client in validating these automatic thoughts. The goal of the therapy is to eliminate exaggerated or inaccurate thoughts of the client (Sadock, et al., 2007, p.959). The therapist then helps the client determine his/her maladaptive thoughts and test its validity. The therapy ends when the client has eliminated inaccurate automatic thoughts and maladaptive assumptions. This approach is proven effective by various studies (Sadock, et al., 2007, p.959). According to Ciscle and Koster (2010 cited in Anthony 2011), individuals who have high level of anxiety tend to attend or concentrate to threat-related information. Individuals are commonly unaware that they concentrate or attend to information that is associated with their fear or anxiety. Some researchers asserted that this bias contributes to their worry and anxiety and the elimination of this bias consequently leads to decrease in anxiety. Several studies showed that this attentional bias can be reduced through cognitive, behavioral therapy (cited in Anthony 2011). Kabat-Zin (1994 cited in Anthony 2011) stressed that “mindfulness and acceptance-based treatments” can address anxiety disorders among individuals. Mindfulness is defined as paying attention nonjudgmentally to the present moment. Meditation is considered as one of most commonly utilized and effective method in facilitating mindfulness. Therapists who employ these techniques encourage clients to embrace unwanted feelings and thoughts instead of an attempt to avoid or control them (cited in Anthony, 2011). Antidepressants are commonly used as pharmacological treatment for anxiety disorders of adults. Fluoxetine, Psertraline, Paroxetine, and several other medications are regarded as effective compared to placebo for several anxiety disorders. A certain individual may respond well to pharmacotherapy or psychological treatment, or a combination of these two (Anthony 2011). 4.0 Applicability of the treatment to Other Culture Treatments applied in a particular culture may not be effective to other cultures. However, treatments proven to be effective in a certain culture are commonly utilized in other cultures. McKay (2009) asserted that it is essential to identify the local psychological mechanisms which precipitate a certain anxiety disorder in order to accurately address such mechanisms in the treatment. Cross-cultural researchers showed that anxiety disorders are present universally in human societies. However, the phenomenology of these disorders significantly varies across different cultures (Friedman, 1997). Individuals who are embedded in a different socio-cultural environment require a different treatment. Spiegler (2009) found that exposure therapies are effective among European-American and Latino-American compared to other groups. Spiegler (2009) further added that socio-cultural context may affect the processes and outcomes of the therapy. 5.0 Conclusion Anxiety disorders refer to a group of psychological problems, which affect the feelings, physical sensations, thoughts, and behaviors of individuals. These disorders may emerge due to biological, psychological, and environmental factors. Various researches showed that the gulf war and 9/11 terrorist attack increase the prevalence of anxiety disorders. Individuals began to raise the universal question on the influence of nature or nurture in developing such disorders. Researchers stress that individuals inherently predisposed to mental problems may develop anxiety disorder upon encountering traumatic incidents such as the gulf war and the 9/11 attacks. Thus, a combination of biological and environmental factors contributes to its onset and development. Several researchers stressed that these anxiety disorders can be addressed through pharmacological approaches or psychological treatments, or both. Psychological treatments proposed by researchers include cognitive therapy, cognitive-behavioral therapy, exposure therapy, and “mindfulness and acceptance-based treatments. However, it should be noted that these therapies or treatments may fail to be effective to other cultures. References Anthony, M., 2011. Recent advances in the treatment of anxiety disorders. Canadian Psychology, 52 (1), pp.1+. Barker, P., 2004. Basic child Psychiatry. USA: Wiley-Blackwell. Black, D.W. et al., 2004. Gulf war veterans with anxiety: prevalence, comorbidity, and risk factors. Epidemiology, 15 (2), pp.135-42. Carlson, K.J. Eisenstat, S.A. & Ziporyn, T.D., 2004. The new Harvard guide to women’s health. USA: Harvard University Press. Clark, D. & Beck, A.T., 2011. Cognitive therapy of anxiety disorders: science and practice. USA: Guilford Press. Fiedler, N. et al, 2006. Military deployment to the gulf war as a risk factor for psychiatric illness among US troops. Psychiatry, 188, pp.453-9. Friedman, S., 1997. Cultural issues in the treatment of anxiety. USA: Guilford. Fulco, C. Liverman, C.T. & Sox, H.C., 2000. Gulf war and health, Volume 2. USA: National Academic Press. 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