Anxiety Disorders and Therapy Treatments
Abnormal Psychology and Therapy Treatments
The difference between normal and abnormal psychological behavior exists when the latter manifest symptoms that cause significant distress and/or impairment in one’s everyday psychological functioning, thereby warranting a clinical diagnosis to determine the most effective methods of treatment. Every person experiences some degree of anxiety as an adaptive motivator to focus one’s primary concern toward stressful events that could cause more distress if avoided, for example; but intensely persistent anxiety can impair cognitive functioning, memory processing, and may lead to the production of maladaptive behaviors as a result of these impairments (Kowalski & Westen, 2009).
Anxiety Disorders are the most frequent mental disorders to occur in the general population, and includes experiences of frequent, intense, and even continuous feelings of anxiety when compared to the general public (Kowalski & Westen, 2009). To better understand anxiety and other disorders, we will discuss how each psychological school of thought explains causality and the preferred treatment methods for panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and substance abuse disorder; following this discussion, we will conclude by explaining the similarities and differences found amongst the treatment methods for each school of psychological thought.
Panic Attack disorder (PAD) is characterized by feelings of doom, attacks of intense fear and a sense of wanting to run from the situation (Kowalski & Westen, 2009). The feelings are not justified by the situation and produces physiological symptoms such as dizziness, shortness of breath, heart palpitations, and chest pains (Kowalski & Westen, 2009). During an attack one may feel like they are going crazy or are going to die (Kowalski & Westen, 2009). The symptoms of a panic attack usually come on suddenly, peak within 10 minutes and then subside. There are some attacks that last longer and may even happen in several successions making it hard to know where one ends and the other begins (Ankrom, 2009). PAD is classified into three categories: (1) Spontaneous is when attacks happen out of the blue without any warning and no triggers or situations are associated with it, (2) bound to situation where it is cued by an actual or anticipated exposure to a feared situation, and (3) predisposed to a situation where a person fears it but may not always have an attack when experiencing the situation (Ankrom, 2009).
Generalized Anxiety Disorder (GAD)
Whereas panic disorder is characterized by intense anxiety attacks, generalized anxiety disorder (GAD) is “characterized by persistent anxiety at a moderate but disturbing level and excessive and unrealistic worry about life circumstances” (Kowalski & Westen, 2009, p. 540), including such symptoms as muscle tension, fatigue, restlessness, difficulty sleeping, irritability, edginess, and gastrointestinal discomfort or diarrhea (ADAA, 2010).StanfordUniversityMedicalCenter (2010) reveals that 18 percent of Americans have an anxiety disorder. The development of this disorder is at its highest risk between childhood and middle age, with genetic diathesis and stressful life events during childhood playing a beneficial role in its manifestation (ADAA, 2010). For example, constant exposure to verbal, physical, sexual, and drug abuse as a child is a strong predictor of developing generalized anxiety disorder, as well as substance abuse disorder; any parents who expose their children to this type of family environment are not psychologically healthy and they maintain excessive neurotic traits that can be inherited, such as high levels of anxiety. More specifically, clients with GAD show no physiological activity in the pregenual anterior cingulate of the prefrontal cortex which inhibits the amygdala to regulate negative emotion (StanfordUniversityMedicalCenter [SUMC], 2010).
People with GAD can function normally in occupational and social situations, but simple life events can be difficult once their anxiety becomes severe (ADAA, 2010). Treatments for this disorder include cognitive-behavioral therapy, relaxation techniques, and biofeedback to control muscle tension, as well as some common anti-anxiety medications like diazepam, alprazolam, and lorazepam (Substance Abuse and Mental Health Services Administration [SAMHSA], 2010).
Obsessive–compulsive disorder (OCD) is exhibited by obsessive, recurrent behaviors and compulsions causing severe distress and interference with a person’s life. People with this disorder experience irresistible acts that must be performed even though they know they are acting irrationally (Kowalski & Westen, 2009). “Symptoms of OCD usually appear gradually and can be long-lasting if not treated. Stress from unemployment, relationship difficulties, problems at school, illness or childbirth can be strong triggers for symptoms of OCD” (Kelly, 2010, p. od). Some common compulsive acts include counting, hand washing, and touching certain objects. Many people with OCD have obsessive thoughts regarding contamination, violence, or doubt. Typically, they experience intense anxiety or even panic if they are unable to perform their rituals, and the disorder typically starts between childhood and early adulthood (Kowalski & Westen, 2009).
Substance Abuse Disorder
People with anxiety disorders are at an increased risk to abuse alcohol or become dependent on it as a way to cope with the disorders (U.S. National Library of Medicine, 2010). Kowalski and Westen (2009) define substance abuse disorder as “disorders involving continued use of a substance (such as alcohol or cocaine) that negatively affects psychological and social functioning” (p. 527). In table 1, the U.S. National Library of Medicine (2010) provides a list of the symptomatic behaviors of alcoholism:
|Table 1: Symptoms and Behaviors of Alcoholism|
- Continuing to drink, even when health, work, and family are being harmed
- Drinking alone
- Episodes of violence when drinking
- Hostility when confronted about drinking
- Unable to stop or reduce alcohol intake
- Making excuses to drink
- Missing work or school, or a decrease in performance
- No longer taking part in activities because of alcohol
- Need for daily or regular alcohol use to function
- Neglecting to eat
- Not caring for physical appearance
- Secretive behavior to hide alcohol use
- Shaking in the morning
(U.S. National Library of Medicine, 2010, Alcoholism and alcohol abuse)
The U.S. National Library of Medicine (2010) reveals that approximately 17.6 million American adults have alcohol related and dependency problems, including such symptoms as a strong need to drink (craving), not being able to stop drinking once started (loss of control), the physical withdrawal symptoms of nausea, sweating, or shakiness when without alcohol (physical dependence), and the need to drink more alcohol in order to get drunk (tolerance). Children of parents with alcoholism are four times as likely to experience alcohol related problems compared to children of non-alcoholics, possibly manifested in the children’s different physiological responses to alcohol (Kowalski & Westen, 2009); children of alcoholics may be more inclined to enjoy the taste of alcohol, for example.
Eclectic Treatment for Disorders
When professionals treat clients with disorders, many use a combination of approaches, or an eclectic approach. Psychoanalysis, cognitive-behavioral, humanistic, family and marital, and group therapy, along with biological medication depending on the type and severity of the disorder are the most common approaches.
Psychotherapies focus on the idea that exploring one’s unconscious mind through insight and the client-therapist relationship is the way to effective change (Kowalski & Westen, 2009). However, these types of therapies are too extensive and expensive because they require more sessions to allow the client to reveal conflicts on their own time through free association (Kowalski & Westen, 2009). A Cognitive–behavioral therapist begins with an analysis of the patient’s behavior and then modifies the therapy to his or her problematic behaviors, thoughts, and emotions (Kowalski & Westen, 2009). Whereas psychodynamic therapies sit back and let the patient reveal aspects of psychological functioning, cognitive-behavioral therapies “effectiveness … lies in its ability to target highly specific psychological processes” (Kowalski & Westen, 2009, p. 560), using behavioral concepts, such as systematic desensitization, exposure and operant techniques, skills training, and participatory modeling to alter maladaptive behaviors through environmental reinforcement.
Whereas humanistic therapies focus on the client using empathy and unconditional positive regard to restore genuineness and attunement to help the clients see their self as they really are in the here-and-now, group therapy, including family and marital therapy, focus on problematic patterns within social interactions that contribute to maladaptive psychological functioning. Medications such as serotonin reuptake inhibitors (SSRIs), benzodiazepines, and antidepressant drugs can ease symptoms in anxiety disorders but are not right for everyone. When one has experienced mild symptoms for a short time, one is better able to respond to medication as part of the treatment. As with any medicine, there are side effects and patients should discuss all their options with their doctor to determine the best treatment plan for them (Kelly, 2010).
While various schools of thought exist for treatment of psychological disorders, there is still controversy over which treatment works best. “The current controversy over empirically supported therapies, efficacy versus effectiveness, and the Consumer Reports study reflects in some respects a tension that has long existed between clinicians and researchers” (Kowalski & Westen, 2009, p.584).
There is important evidence, however, showing that cognitive-behavioral therapy is highly effective in the treatment of anxiety disorders while long-term treatments may be more effective for multi-symptom disorders (Kowalski & Westen, 2009).
ADAA. (2010). Anxiety Disorders Association of America. Retrieved from http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Ankrom, S. (2009). Panic Disorder. Retrieved from http://panicdisorder.about.com/od/treatments/a/ssri.htm
Kelly, Owen, PhD, 2010. Obsessive-Compulsive Disorder. Retrieved from http://ocd.about.com/od/treatment/f/medication_response.htm
Kowalski, R., & Westen, D. (2009). Psychology (5th ed.).Hoboken,NJ: Wiley.
StanfordUniversityMedicalCenter[SUMC] (2010). People with anxiety disorder less able to regulate response to negative emotions, study shows. ScienceDaily. Retrieved September 11, 2010, from http://www.sciencedaily.com/releases/2010/02/100210124805.htm
U.S.National Library of Medicine. (2010). MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm