General Anxiety Disorder - Coursework Example

General Anxiety Disorder Generalized anxiety disorder (GAD) is a type of anxiety disorder whereby one is extremely worried about things like health, money , family problems and many other things even when there is little or no reason to worry (Abramowitz & Braddock, 2008). Persons suffering from generalized anxiety disorder may always be anxious trying to get through the day and believe that things will go bad for them, often keeping them from being able to perform daily activities. Overview of the Disorder Individuals suffering from GAD have excessive anxiety and worry about a range of topics, events or activities. Worry occurs frequently for at least 6 months, and is clearly excessive i.e. worrying even when there no reason to worry. The worry experienced is hard to control and may shift from one topic to another in both adults and children. The anxiety and worry experienced with at least 3 of the following physical or cognitive symptoms (in children, only one symptom is enough for diagnosis of GAD). (1) Edginess (2) Tiring easily (3) Lack of concentration (4) Irritability [which may be observable or may not be observable in others] (5) increased muscle aches or soreness (6) Difficulty in sleeping. Many people suffering from GAD also experience sweating, nausea or diarrhea. The anxiety, worry or related symptoms make it difficult to carry out day to day activities and responsibilities. These symptoms are not related to any other medical condition and cannot be illuminated by the influence of substances comprising of a prescription medication, alcohol or recreational medicines. These symptoms are not associated with any other mental condition. A qualified professional with a wealth of knowledge about these symptoms and their typical presentations will sometimes rely on clinical judgments to make a diagnosis, after meeting with the patient and asking open-ended questions about their symptoms. In specialized care settings like an anxiety disorder clinic, clinicians use standardized assessment tools to evaluate symptoms. In this case, the clinician completes a semi-structured interview, which has standardized questions with the patient, and the patient’s answers help the clinician make an accurate diagnosis. In adults, well validated commonly used interviews include the Structured Clinical Interviews for DSM Disorders and the Anxiety and Related Disorders Interview Schedule for DSM-5(the ADIS-5). In the child version of ADIS both the child and the parent are asked questions about the child’s symptoms. These interviews do not just ask about anxiety symptoms, but will also evaluate the presence of other, often associated conditions like depression. When the clinician is initially assessing the intensity of the patient’s anxiety, or while the patient is undergoing treatment, he can be asked to complete self-report questionnaires. These typically brief measures can help determine diagnosis (as the Generalized Anxiety Disorder Scale 7 does) or severity of the symptoms. It is not known as to why some people have GAD while others do not, but it has been found by some researchers that several parts of the brain are involved in fear and anxiety (Coutinho, et al., 2010). As for students, such patients are extremely worried about class performance and many other things which in most cases affect their learning and social functioning, hence need for special education services. Such students are emotionally disturbed and there meet the legibility criterion for receiving Special education under IDEA. Statistics on the Prevalence of the Disorder Statistics indicate that generalized anxiety disorder affect about 3.1% of adult Americans of 18 years and above, with the average onset age estimated at 31 years old (Wolitzky-Taylor, et al., 2010). About 6.8 million Americans are affected by GAD, with the population of affected women in their lifetime being twice that of men. 7.7% of GAD cases, which is actually the highest rate occurs in persons aged 45 to 49 years, and the lowest rate of about 3.6% occur in adults aged 60 years and above. The preference for GAD increases with age in women whereas it decreases with age in men. The commonest age range for the symptoms is 45-59, but the diagnosis declines after age 60. GAD becomes chronic if not treated, with most patients still suffering from the disease long after diagnosis. However, statistics indicate that 40% of the patients with GAD can be treated appropriately. Research about the Disorder and Theories about Etiology Just like most mental health conditions, the causes of GAD have not been fully understood by medical researchers (Wood, et al., 2009). However, the causes may include genetics, biochemistry, history and psychological profile of an individual. The disorder is also associated with such risk factors as personality, being female and age. Personality may be a risk factor in that the person with negative temperament or who has the tendency of avoiding dangerous things may be more prone to GAD compared to others. It has been proven through statistics that among the US population affected with GAD; the number of women is twice that of men. Studies indicate that imbalances in neurotransmitters especially deficiency in serotonin, which is important in feelings of well-being may cause GAD. Basically, neurotransmitters are responsible for cell communication in the body, and they regulate one’s alertness, sleepiness, moods and perceptions (Cash, 2013). When neurotransmitters are at the state of imbalance, they affect one’s mental and physical feelings, which may cause one to always be ready to deal with emergencies, even when they do not exist at all. Presence of stress hormones such as cortisol in the body also lead to anxiety disorders, especially GAD. Studies using magnetic response imaging have led to identification of parts of the brain responsible for anxiety responses. The amygdala part of the brain regulates memory, fear, and emotion, and coordinates these resources to the pulse rate, blood pressure and other responses to stressful events. Evidence indicates that the amygdala of people with anxiety disorders is highly sensitive to unfamiliar situations and its reaction has a high stress response (Muris, 2010). 40% of people with GAD have close relatives with the disorder, with about a half of them having family members with panic disorder and about 30% of them having relatives with simple phobias. When one is exposed to environmental stress for a long time, the body adapts and the body may be unable to stop responding when there is real danger or stress. It is also believed that GAD is a response to stress that is learned naturally, and people generalize their responses to certain experiences to a greater portion of their lives. This is the case especially when a child performs poorly in school; he begins to worry about how other family members will see him. GAD is also common among people with the history of trauma; either they underwent physical, verbal or sexual abuse at their youthful stage. Generalized anxiety may also be a side effect of other diseases like chronic heartburn or heart disease. Women at menopause are likely to suffer from GAD due to hormonal changes (Deecher, et al., 2008). GAD can also result from medications as a side effect, including drugs for treating asthma, high blood pressure and depression. Substance abuse i.e. alcohol, nicotine caffeine can cause the disease or even worsen it if it existed before taking the drug. Treatment and Intervention It is difficult for one to prevent GAD from attacking them, since we cannot avoid anxieties in our daily lives, but an individual can take steps to minimize the impact of symptoms if they experience anxiety. Such steps include getting help early in case if one experiences anxiety, keeping track of their personal life can also help them identify what is causing them stress and what makes them feel better. Avoiding alcohol and drug use can also help one avoid stress, since drugs can cause or worsen anxiety. Those quitting drug uses should consult a psychiatrist since withdrawal can make one anxious, hence seeing the doctor or finding a support group is important. Treatment of GAD can be done using psychologically using psychotherapy, medically or using both. Medically, GAD can be treated using pharmacologic treatment, which has been on the rise in the past decade. When selecting the agent for treatment, such patient characteristics as adverse-effect profile, and the presence of comorbid mood disorders particularly unipolar depression must be considered (Goodwin, 2009). Selective serotonin reuptake inhibitors (SSRIs) are the first line therapies for GAD patients although a well-defined action mechanism for these drugs has not yet been determined. It is however thought to involve the down-regulation of noradrenergic receptors. It is advantageous to use SSRIs because of they can be used for a long time without fear of side effects or abuse. Serotonin norepinephrine reuptake inhibitors (SNRIs) have been proved effective in the treatment of GAD in clinical trials, but the US Food and Drug Administration has approved paroxetine, escitalopram, duloxetine and venlafaxine for this indication. Tricyclic anti-depressants like Tofranil are also recommended, as well as the antidepressants Effexor and Cymbalta, which act on serotonin and norepinephrine. One can also use Buspar, an anti-anxiety drug with fewer side effects compared to benzodiazepines and is not associated with dependency. However buspar may not be recommended for people who have used benzodiazepines in the past because it may be less effective (Bezchlibnyk-Burler, et al. 2013). The use of anti-depressants may however be risky for children, teens and young adults, since they can make them have suicidal thoughts or attempt committing suicide. Apart from pharmacological treatment, patients can also undergo psychological counseling, especially cognitive behavior therapy, commonly known as CBT. CBT addresses the impact of irrational thinking on an individual’s feelings and behavior through patient self-monitoring of worrying, cognitive restructuring, relaxation training and coping skills rehearsal (Abramowitz & Arch, 2014). Patients basically monitor their anxiety symptoms along with situational factors leading and thoughts that may lead to incidents of increased anxiety. This will in turn help them recognize what triggers anxiety and maladaptive thinking patterns and replace unrealistic thinking with realistic problem solving strategies. During CBT, patients also be asked to engage themselves in such exercises as worry exposure, and then asked to think of themselves in more frightening outcomes. They will then instructed on response prevention which in turn enables them avoid imagining of more frightening situations and instead look for alternative outcomes to the most feared stimuli. Patients are asked to take note of behaviors and thoughts that trigger anxiety and encouraged to do away with them. Comparing both the pharmacological and psychotherapeutic methods of treatment, it is advisable to use both of them, since they tend to balance in terms of strengths. A combination of both is likely to yield better results compared to the situation whereby only one of them is applied. For instance, combining cognitive behavior therapy with diazepam was particularly found to be more effective than diazepam alone. However, in the process of deciding whether to use psychotherapy, medication or both, the following factors need to be considered: cost, time, severity of the condition, patient’s preference, side effects of the medication, latency, availability of psychotherapy, qualification of the therapist and comorbidities. However, it should be noted that there is a tendency of those using drugs to over depend on them, the reason why use of drugs should be discouraged to some extent. But according to psychiatrists, one can start with drugs and later on combine it with psychotherapy sessions for better results. Relevance to School Psychological Practice In the school set up, students with GAD may be helped through counseling in the following ways: first, they should be subjected to individual psychotherapy. This is because students may for instance take failure in class as their own fault, and as a result consider themselves stupid. Individual psychotherapy can help these young people reduce the symptoms of GAD, become aware of their feelings of failure and self-blame and deal with them accordingly. Cognitive behavior therapy should be encouraged in schools so that these teens can be taught on how to reduce anxiety. Teens are taught to abandon patterns of thinking that trigger anxiety and replace them with positive thinking patterns. They will be allowed to practice this positive thinking outside the therapeutic sessions and later share their experiences with their therapist. Schools should encourage parents to practice parent guidance sessions, as they will assist parents in identifying and managing their child’s anxieties and also address complex feelings that may arise from raising a child with a mental condition. In addition, schools should set aside some time for group psychotherapy. Here, children will be given an opportunity to share with other children who face adversity, allowing the child to practice symptom-combating skills in a setting that is carefully structured. Schools can also help these young people overcome the social, behavioral and academic demands of the school. For instance, a child who is always concerned about his academic performance should be reassured that he can do better in co-curricular activities. Schools should establish check-ins on arrival to ensure that there is a smooth transition into school as well as accommodating those who arrive late as a result of difficulties due to transitions. Allowing extra time for movement from one location to the next is also important in order to accommodate those with transition difficulties. It is also important for teachers to reward student’s efforts, since this would boost their confidence and therefore help avoid GAD cases due to low personality. Calming activities may also be useful especially in distracting children from physical symptoms, peer interactions should also be encouraged, and as a teacher, one should provide assistance with these interactions. For those avoiding school, teachers should try and find out why they are doing so and deal with the problem accordingly, may be allowing the student attend for a shorter school day. References Abramowitz, J. S., & Arch, J. J. (2014). Strategies for improving long-term outcomes in cognitive behavioral therapy for obsessive-compulsive disorder: insights from learning theory. Cognitive and Behavioral Practice, 21(1), 20-31. Abramowitz, J. S., & Braddock, A. (2008). Psychological treatment of health anxiety and hypochondriasis: A biopsychosocial approach. Boston, MA: Hogrefe Publishing. Bezchlibnyk-Burler, K. Z., Jeffries, J. J., Procyshyn, R. M., & Virani, A. S. (2013). Clinical handbook of psychotropic drugs. Boston, MA: Hogrefe Publishing. Cash, A. (2013). Psychology for dummies. New Jersey: John Wiley & Sons. Coutinho, F. C., Dias, G. P., Nascimento Bevilaqua, M. C., Gardino, P. F., Range, B. P., & Nardi, A. E. (2010). Current concept of anxiety: implications from Darwin to the DSM-V for the diagnosis of generalized anxiety disorder. Expert Rev Neurother. 10(8):1307-20. Deecher, D., Andree, T. H., Sloan, D., & Schechter, L. E. (2008). From menarche to menopause: exploring the underlying biology of depression in women experiencing hormonal changes. Psych neuroendocrinology, 33(1), 3-17. Goodwin, G. O. (2009). Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for Psychopharmacology. Journal of Psycho pharmacology, 23(4), 346-388. Muris, P. (2010). Normal and abnormal fear and anxiety in children and adolescents. Amsterdam, Netherlands: Elsevier. Wolitzky-Taylor, K. B., Castriota, N., Lenze, E. J., Stanley, M. A., & Craske, M. G. (2010). Anxiety disorders in older adults: a comprehensive review. Depression and anxiety, 27(2), 190-211. Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224-234. Read More