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Thursday, February 11, 2010

Online degree, online education, part 24. Anxiety Disorders.

Anxiety Disorders in Children and Adolescents in School
Many children and adolescents who either have been diagnosed with an anxiety disorder or have high levels of anxiety experience difficulty in the school setting. Students with anxiety disorders or high levels of anxiety have more difficulty learning new material, receive poorer grades, and do not perform as well on standardized and classroom tests. These students may struggle in core courses such as reading and math. They are also more likely to repeat a grade and drop out of school.
Besides experiencing academic difficulties, children and adolescents with anxiety disorders experience poor peer relationships. Because of cognitive distortions or maladaptive thinking patterns, these children and adolescents view their relationships with others more negatively. These negative perceptions of their relationships with others reduce the likelihood of interactions with peers. These individuals may feel socially isolated and experience depression and feelings of hopelessness.
Symptoms of anxiety can significantly interfere with children or adolescents' social-emotional and academic functioning. In light of these concerns, children and adolescents with an anxiety disorder may be eligible for special education and related services under the Individuals with Disabilities Education Improvement Act of 2004 (IDEA). Specifically, anxiety disorders are categorized under the emotional disturbance (ED) category of disabilities. To meet the criteria for an emotional disturbance, a student must exhibit one or more of the following conditions, and the condition(s) must have occurred over a long period of time and to a marked degree and must adversely affect the individual's educational performance:
1.An inability to learn that cannot be explained by intellectual, sensory, or health factors
2.An inability to build or maintain satisfactory interpersonal relationships with peers and teachers
3.Inappropriate types of behavior or feelings under normal circumstances
4.A general pervasive mood of unhappiness or depression
5.A tendency to develop physical symptoms or fears associated with personal or school problems

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Assessment of individuals With an Anxiety Disorder
To detect an anxiety disorder or high levels of anxiety in individuals of different ages, a multimethod approach to the assessment of anxiety is recommended. A multi-method approach involves the use of different types of measures completed by multiple informants across multiple settings to detect anxiety and comorbid conditions. A variety of assessment techniques, including clinical interviews, rating scales, direct observations, self-report, and psychophysiological measures, are available to assess anxiety in individuals of different ages. Many of these measures are completed by multiple informants (self, parent, spouse, and/or teacher) across multiple settings (home, school, and/or work).
Treatment of Anxiety
Once an assessment or evaluation is completed and high levels of anxiety are detected or an anxiety disorder is diagnosed, assessment results are linked to interventions to ameliorate anxiety and its negative effects. Different treatment strategies are available to address anxiety, including pharmacotherapy, behavioral strategies, and cognitive-behavioral interventions. Additional strategies may also be used to address comorbid issues. Thus, a multimodal approach, consisting of two or more interventions, is often used to alleviate an individual's anxiety and its negative effects.
Pharmacological treatment is one means of alleviating anxiety in individuals. Medications that have been used to treat anxiety include benzodiazepines, selective serotonin reuptake inhibitors, tricyclic antidepressants, and buspirone. Medication is often used in combina-tion with other treatments such as cognitive-behavior therapy because although the medication may reduce anxiety symptoms, it does not help individuals learn to cope effectively with their anxiety.
Behavioral interventions are another means of reducing anxiety in individuals. Relaxation training, systematic desensitization (graduated exposure), and modeling are some of the behavioral strategies used to treat anxiety. These strategies have been shown to be effective. Relaxation training may include deep breathing exercises or progressive muscle relaxation. Progressive muscle relaxation involves individuals learning to relax and tense different muscle groups in order to become more relaxed. Relaxation training may also be found in systematic desensitization. In systematic desensitization, a fear hierarchy is created, consisting typically of 10 to 15 steps evenly spaced. For example, if an individual had a fear of large dogs, the first step in the fear hierarchy may consist of a discussion about dogs. The second step may involve looking at a picture of dogs. The third step of the fear hierarchy may involve driving past a pet shop and so on until the last step, when the individual pets a real-life dog. The purpose of creating a fear hierarchy is to gradually expose the individual, step by step, to the feared stimulus. The graduated exposure can be conducted using imagery or real-life experiences. Relaxation or another incompatible response to anxiety is induced along the way to calm the individual as graduated exposure of the feared stimulus occurs. Modeling is another behavioral strategy used to reduce fears and anxieties. Modeling is based on social learning theory in which an individual observes, either live or on film, a person who interacts successfully with the feared stimulus or situation. The model is typically of the same age and gender as the individual. After watching the model interact successfully with the feared stimulus or situation, the individual is more likely to perform the same behavior, and the fear and anxiety associated with the feared stimulus or situation are reduced.
Cognitive-behavioral strategies, such as self-instruction, self-control training, and rational-emotive therapy, have also been used to alleviate individuals' anxieties. Self-instruction involves the use of positive self-talk to handle anxiety-provoking situations. In self-control training, individuals learn to modify and restructure maladaptive thoughts, resulting in less anxiety in the presence of anxiety-provoking stimuli or situations. Less anxiety experienced then leads to positive changes in behavior because these individuals are more likely to approach the feared stimuli or situations. Replacement of false, irrational beliefs that underlie an anxiety problem with rational beliefs is the focus of rational-emotive therapy.

Prevention of Anxiety
Because anxiety is a common mental health concern facing many Americans today, efforts should be directed toward the prevention of anxiety disorders. The emotional, social, and economic costs associated with anxiety disorders are astronomical. Economic costs alone are estimated to be more than $40 billion per year. Yet, few prevention programs exist. Although prevention programs are costly up front, universal (primary), selective (secondary), and indicated (advanced) prevention programs are needed. Future efforts should be directed toward the development and implementation of these programs, as there will never be enough mental health professionals to provide adequate treatment of anxiety and other disorders.

Patricia A. Lowe and Jennifer M. Raad

EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.

Saturday, February 6, 2010

Online Education And Degree. Part 23. Common Features of Anxiety Disorders

Although different types of anxiety disorders exist, according to Michael Telch, Jasper Smits, Matt Brown, and Victoria Beckner, there are some common features across these different disorders. Common features include escape and avoidance behaviors, chronic worry, attentional hypervigilance, faulty threat perception, and sympathetic activation. Individuals with an anxiety disorder try to avoid or escape from stimuli or situations that make them anxious, and they constantly worry about current and future events. These individuals attend excessively to cues that they perceive as threatening. The excessive attention given to these cues is referred to as attentional hypervigilance. Faulty threat perception is another common feature found among individuals with an anxiety disorder. These individuals erroneously perceive situations as threatening. Sympathetic activation is also a core feature found among individuals with an anxiety disorder. Activation of the sympathetic nervous system producing physiological changes in the body occurs in individuals with an anxiety disorder when there is no real or potential threat. Physiological changes experienced by these individuals in the absence of a real or potential threat may include accelerated heart rate, muscle tension, and increased perspiration and respiration.
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Types of Anxiety Disorders
The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR) has identified 15 types of anxiety disorders, including generalized anxiety disorder, separation anxiety disorder, specific phobia, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, panic attack, panic disorder with and without agoraphobia, agoraphobia without a history of panic disorder, anxiety disorder not otherwise specified, anxiety disorder due to a general medical condition, and substance-induced anxiety disorder. Generalized anxiety disorders, phobias, obsessive-compulsive disorders, panic disorders, and posttraumatic stress disorders are the most common types of anxiety disorders.
Although there are several types of anxiety disorders, each involves an excessive degree of worry or fear about certain stimuli, situations, or events, which significantly interferes with an individual's normal state of functioning. Generalized anxiety disorder is characterized by a chronic, excessive, and uncontrollable degree of worry about a variety of events or situations, such as friends, family, school, work, or the future. Symptoms of generalized anxiety disorder include fatigue, irritability, restlessness, muscle tension, and difficulties with concentration and sleep. Another common anxiety disorder, specific phobia, is characterized by an extreme and irrational fear in response to a specific stimulus, such as animals or insects (e.g., dogs), aspects of the natural environment (e.g., storms), blood (e.g., viewing blood or receiving an injection), situations (e.g., being in small spaces), or other stimuli (e.g., loud sounds or costumed characters). This worry must be present for at least 6 months and may lead to symptoms in children such as crying, clinging, tantrumming, dizziness, shortness of breath, and fainting.
Like a specific phobia, social phobia is associated with particular circumstances and must involve symptoms present for at least 6 months. An individual with a social phobia experiences extreme worry regarding social situations. The individual may worry over or fear the possibility of ridicule, humiliation, or embarrassment in social situations, such as speaking in class or conversing with peers. Individuals with a social anxiety disorder may attempt to avoid or escape social behaviors, and they often have poor social skills. These individuals may also experience symptoms such as trembling hands or voice, perspiration, muscle tension, and blushing.
Obsessive-compulsive disorder involves obsessions (recurrent or persistent thoughts or worries that intrude on, and interfere with, an individual's normal functioning) and compulsions (repetitive behaviors, rituals, or practices in which the individual engages to provide relief from, or comply with, the obsessive thoughts or worries). Common obsessions and compulsions in children include contamination (hand washing), safety (checking), preoccupations with orderliness and symmetry (ordering, aligning), and counting or touching rituals. Individuals with an obsessive-compulsive disorder may feel embarrassed by their compulsions and may experience difficulties related to concentration, preoccupations, and perfectionist tendencies.
Posttraumatic stress disorder refers to stress or worry experienced by an individual following a traumatic event (such as a serious injury, death, or catastrophic event). The individual reexperiences the event (via flashbacks, nightmares, or images), as well as the accompanying physiological arousal, and may attempt to avoid stimuli associated with the event. Following the event, the individual may feel helpless, fearful, agitated, or disorganized and may experience hypervigilance, irritability, and difficulties with concentration or sleep. These symptoms must be present for at least 1 month following the traumatic event. If symptoms are present for less than 1 month, then an acute stress disorder may be present. Similar to posttraumatic stress disorder, acute stress disorder also results from witnessing or experiencing a traumatic event. Symptoms include reexperiencing the event and the accompanying physiological arousal; however, these symptoms are present for no more than 1 month.
A panic disorder refers to recurrent and unexpected panic attacks that are followed for at least 1 month by concern about, or consequences of, having another attack and/or a change of behavior related to the attack. Panic attacks develop abruptly, often last for approximately 10 minutes, and involve symptoms such as heart palpitations, sweating, chest pain, dizziness, fear of dying, feelings of detaching from one's body, and feelings of losing control. If the attacks become more frequent, the individual may come to fear experiencing a panic attack in public places, and develop agoraphobia (fear of public places) as well. However, agoraphobia may also develop in the absence of, and without resulting from, a panic disorder. In these cases, individuals may avoid public situations, such as being in a crowd or traveling in a train, and may experience symptoms of panic in these situations.
Separation anxiety disorder is an anxiety disorder commonly found in children. Separation anxiety disorder refers to excessive and unrealistic worry in response to separation from home or a caregiver. Children with separation anxiety disorder may experience nightmares with separation themes, headaches, stomachaches, or nausea. These symptoms must be present for at least 4 weeks. Separation anxiety disorders tend to decrease with an increase in age. That is, this type of anxiety disorder is common during the childhood years but declines during the adolescent and adulthood years.
Anxiety disorders may also result from external factors, such as a general medical condition or substance use. Finally, for individuals who experience symptoms of anxiety, but whose symptoms, duration, or impairment do not meet the criteria for a specific disorder, a diagnosis of anxiety disorder not otherwise specified (NOS) may be appropriate.
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EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.

Friday, February 5, 2010

Online degree, part 22. Prevalence of Anxiety and Comorbid Conditions.

Prevalence rates of anxiety in community samples are difficult to estimate, especially given the fact that internalizing disorders, such as anxiety, are often difficult to observe and identify. Prevalence estimates for clinical levels of anxiety in children, young and middle-age adults, and older adults range from 5% to 19%, 6% to 8%, and 9% to 11%, respectively. In general, the prevalence of anxiety disorders has been found to increase with age in the child and adolescent population, decline during the young and middle-age adult years, and slightly increase in the older adult years. Gender differences have also been found in the literature. Specifically, females typically report more anxiety symptoms than do males. However, it remains unknown at the present time whether this gender difference is due to females actually experiencing more anxiety symptoms than males or whether females are simply better able to recognize and report their symptoms of anxiety than are males. On the other hand, overall, more females than males are believed to suffer from an anxiety disorder. However, the gender ratios differ based on the type of anxiety disorder diagnosed and the age of the individual. Despite this variability and the need for further research with regard to prevalence rates among different ages and genders, it is clear that anxiety continues to be a major problem for individuals of all ages and one that can potentially lead to significant difficulties within multiple domains of functioning.
Anxiety disorders have high rates of comorbidity with other disorders. The rate of comorbidity between anxiety and depressive disorders may be as high as 55% to 65%. Speculation as to why these rates are so high is that both anxiety and depression share a similar trait known as negative affectivity, or emotional distress. Negative affectivity includes such affective states as worry, self-dissatisfaction, and sadness. High comorbidity rates may also be due to a sequential link between anxiety and depression, with anxiety serving as an early precursor to a depressive disorder. Comorbidity rates are also high between different types of anxiety disorders. It is not uncommon for an individual who has one anxiety disorder to be diagnosed with another anxiety disorder. Other common comorbid conditions include substance use disorders and disruptive behavior disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder.

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From a trait model perspective, anxiety is viewed as a stable personality characteristic. Without treatment, anxiety disorders may persist. Approximately 45% to 65% of individuals diagnosed with an anxiety disorder do not show remission of symptoms. However, approximately 35% to 55% of individuals do show remission, but many who show remission develop other disorders, especially other anxiety disorders. Anxiety disorders interfere with the social and emotional well-being of individuals. If individuals are still in school, academic development may be impaired. For adults, work productivity may decline and unemployment may increase.
Developmental Precursors or Etiological Factors
Different theories exist about the development of an anxiety disorder. The three most popular models used to explain the development of an anxiety disorder are the biological, behavioral, and cognitive models. Biological explanations of anxiety focus on genetics, neurotransmitters, differences in structural regions of the brain, abnormalities in the immune system, and behavioral inhibition. Genetics is believed to play a role in the development of an anxiety disorder. Genetic influences account for approximately 30% to 35% of the variance in anxiety in most cases, suggesting that anxiety is moderately inheritable. The neuro-transmitter gamma aminobutyric acid (GABA) has received some attention as a possible risk factor in the-development of an anxiety disorder. GABA may increase excitatory responses to real or perceived threats, or it may fail to send messages to inhibit these responses. Perturbations in the hypothalamic-pituitary-adrenal axis indicate structural brain differences in individuals with an anxiety disorder. Behavioral inhibition may be another possible etiological factor. Behavioral inhibition characterizes a child's temperament. Children with this type of temperament are shy and exhibit inhibited behaviors in response to novel stimuli. These individuals are also highly physiologically reactive to such stimuli.

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Behavioral explanations for the development of an anxiety disorder focus on learned behaviors. According to behaviorists, anxiety is a learned behavior that is acquired and maintained through a combination of classical and operant conditioning, operant conditioning alone, or modeling. From a classical and operant conditioning perspective, anxiety problems result when a neutral stimulus, such as a large dog, is paired repeatedly with an aversive stimulus (i.e., an unconditioned stimulus), such as a loud noise, to produce an unconditioned response, such as a startled reaction. Through repeated pairings with the unconditioned stimulus, the neutral stimulus becomes a conditioned stimulus, and this conditioned stimulus will produce a conditioned response. In other words, the presence of a large dog will result in a startled response without the loud noise being present on a regular basis. The conditioned stimulus (i.e., a large dog) will then be avoided, and by avoiding the conditioned stimulus, an individual's anxiety is reduced. The avoidance behavior demonstrated by the individual in response to the large dog is an example of operant conditioning. In operant conditioning, the stimulus, task, or situation feared is maintained by a negative reinforcement con-tingency. The feared stimulus, task, or situation is avoided, and the avoidant behavior is maintained because it reduces the individual's anxiety. In modeling, the individual observes the behavior of significant others in response to aversive stimuli, tasks, or situations. When significant others exhibit avoidance behavior and anxiety in response to aversive stimuli, the individual learns to model these behaviors. Exposure to similar aversive stimuli, tasks, or situations will produce similar behaviors.
The cognitive approach to anxiety disorders assumes that distorted cognitions are responsible for symptom manifestation. According to cognitive psychologists, individuals who have an anxiety disorder or experience high levels of anxiety exhibit threat-related attentional and interpretative biases. These individuals attend to threat-related stimuli, and they interpret ambiguous or neutral stimuli as threatening.

EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.

Wednesday, February 3, 2010

Online Education, College Degree, Part 21. ANXIETY.

Anxiety is a common mental health concern facing many Americans today. In 1997 Thomas Huberty defined anxiety as a unique emotional state characterized by feelings of distress and tension about real or anticipated threats that may manifest in cognitive, behavioral, or physiological patterns. Anxiety can have devastating effects on individuals, as it can interfere with their learning and social and emotional development. In this entry, general information about anxiety is presented. Common features found among the anxiety disorders, types of anxiety disorders, and etiologi-cal factors underlying anxiety disorders are discussed. Prevention and intervention strategies are covered.
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Components of Anxiety
Anxiety is a complex emotional state and may involve and influence multiple domains of an individual's functioning. Specifically, an individual may experience cognitive, behavioral, and physiological effects. Common cognitive symptoms of anxiety include excessive worries, concentration difficulties, and memory and attention problems. Anxiety may also be manifested through such behavioral symptoms as motor restlessness, difficulty sitting still, and attempts to escape or avoid anxiety-provoking stimuli or situations. Finally, anxiety also includes physiological symptoms, such as muscle tension, increased perspiration, rapid heartbeat, headaches, and stomachaches.
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Anxiety as a Unique Emotion
Anxiety is a unique emotion as it can be viewed in both a positive or negative light. A slight amount of anxiety can be helpful and facilitate an individual's performance, whereas too much anxiety can be debilitating and hinder one's performance. In small amounts, anxiety can serve as a motivator and lead to optimal performance in school, work, sports, or other areas in an individual's life. For example, a student can become slightly anxious before a major exam. The slight anxiety felt can motivate the student to study for the exam and do better because of the time spent preparing for the exam. In contrast, high levels of anxiety may interfere with the student's ability to concentrate, process information, or retrieve information from long-term memory. Under these circumstances, the student is less likely to perform his or her best on the exam.
Anxiety can also alert an individual to a potential danger. The fight-or-flight response, also referred to as the acute stress response, involves the activation of the sympathetic nervous system in an emergency situation. The individual will respond to a threatening or dangerous situation by fighting or fleeing. Thus, many believe that anxiety serves as a survival mechanism and protects the individual from harm.
Besides its positive and negative aspects, anxiety can be viewed as a normal indicator of development. During the normal course of development, individuals experience fears and anxieties, but the specific fears and anxieties experienced vary as a function of age. Moreover, there is some evidence to suggest that the number of specific fears and anxieties decrease with age, whereas others suggest that the number of specific fears and anxieties remain the same across the life span. Sources of anxiety for infants include loud noises, strangers, and novel stimuli, and for toddlers, separation from major attachment figures and imaginary creatures. Children fear large animals, darkness, and natural events, and adolescents fear social alienation. Sources of anxiety for adults include natural events, injury, and financial issues. Most individuals experience these age-specific anxieties and fears, which are mild and transient in nature.
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EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.