Most Effective Anxiety and Panic Attacks Cures

Panic Away Handbook

The author of the Panic Away program, Barry began his research studying books on psychology, but he was not so happy with what he found there. The method described promise to teach people to get rid of the panic attacks and anxiety permanently, but they just teach methods for managing it. The two main goals of Panic Away are to stop panic attacks and to eliminate general anxiety and the 21 7 Technique is the core of the Panic Away program. Barry McDonagh describes the 21 7 technique as first aid for anxiety and it is made up of two components: 1. The 21 Second Countdown Technique which is designed to stop panic attacks, and 2. The Seven Minute Exercise which is designed to reduce general feelings of anxiety. Overall, the Panic Away a guide is worth to read. It is not a potion, pill or any magic formula. This program addresses actual science and speaks to folks in all situations. The information that is contained in this a guide provides sufferers the confidence that they can tackle the problems. These include panic attacks and anxiety that comes during driving, air travel or during interviews. Various users also stand behind this technique, assuring those with panic attacks that this ebook is a system that really works. Continue reading...

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Prevalence Of Anxiety Disorders

The American Psychiatric Association first recognized anxiety disorders in 1980 as a separate group of psychiatric disorders. The concept of neurosis (neurasthenic neurosis, anxiety neurosis, phobic neurosis, and obsessive-compulsive neurosis) in previous classifications was abandoned because it was considered too vague. Anxiety disorders now include PD, PTSD, social phobia, specific phobia, OCD, and GAD. Anxiety disorders are by far the most common of psychiatric disorders (25 ), followed by affective disorders (17 ). In the past decade, large epidemiological studies have provided information about the prevalence of anxiety disorders in the general population. A landmark epidemiological study in the United States in 1994 found lifetime prevalence rates for all anxiety disorders combined to be 19.2 for men and 30.5 for women. Phobic disorders are the most common diagnosis in broad-based assessments of psychiatric disorders in the community (affecting about 13 of individuals at any...

Cognitivebehavioral Therapy For Anxiety Disorders

Cognitive-behavioral therapy is the most empirically supported psychosocial treatment for anxiety disorders. The cognitive-behavioral understanding of anxiety disorders is largely based on learning theory. Mowrer's two-factor theory suggests that anxiety disorders are created initially via classical conditioning, and then maintained via operant conditioning. According to this theory, anxiety develops when a neutral stimulus becomes paired with an aversive response. For example, someone who was bitten by a spider begins to pair the concept of spider with anxious feelings through classical conditioning. The person then realizes that he or she feels better by avoiding spiders, and the drop in anxiety that follows that avoidance acts as a negative reinforcer, Cognitive factors can also play a large role in the development and maintenance of anxiety disorders, because in addition to learned associations, anxiety can also result from people's perceptions of a given situation. For example,...

Alterations in Neurochemical Stress Response Systems in Patients with Anxiety Disorders

Anxiety disorder patients have long-term alterations in neurochemical systems that are involved in mediating the stress response and are sensitive to chronic stress. The findings in PTSD and PD (most extensively studied of the anxiety disorders) are summarized in Table II. There is extensive evidence indicating that NE plays a role in human anxiety and is dysregulated in anxiety disorders. PTSD and PD seem to have similar alterations in noradrenergic function. However, the causes of the two syndromes may differ, with PD associated more with genetic factors and PTSD with the effects of severe psychological trauma.

Serotonin and aggression panic attack and related disorders

The possible overlap between anxiety, depression, panic attack, aggression and obsessive-compulsive disorders, and the involvement of serotonin in the symptoms of these disorders, has recently led to the investigation of various selective serotonin reuptake inhibitors (SSRIs) and selective 5-HT receptor agonists antagonists in the treatment of these conditions. In experimental studies, there is evidence that drugs such as eltoprazine, which binds with high affinity to 5-HT1A, 5-HT1B and 5-HT2c sites, are active antiaggressive agents, whereas selective 5-HT1A agonists and 5-HT2 and 5-HT3 antagonists are inactive. There is also preliminary evidence to suggest that SSRIs such as fluoxetine reduce impulsive behaviour which may contribute to their therapeutic action in the treatment of obsessive-compulsive disorders and possibly in reducing suicidal attempts. Zohar and Insel have suggested that the symptoms of obsessive-compulsive disorder are due to supersensitive 5-HT1-type receptors and...

Beta Blockers and Anxiety Fear

One class of drugs is an exception to the uncertainty about central versus peripheral effects. The beta-adrenergic blocking agents are specifically presumed to work peripherally in the body outside the central nervous system. These drugs act by interfering with the action of adrenalin at the peripheral neural sites, where adrenalin produces the characteristic visceral arousal symptoms. If Schachter is correct, then these antiadrenergic drugs that act peripherally should effectively reduce anxiety, anger, and perhaps other emotions. Once again, the evidence seems to be contradictory. In laboratory studies of the effects of beta-blockers, the effects seem to be difficult to demonstrate (Reisenzein, 1994). However, extensive reviews demonstrate successful practical uses of beta-blockers for some kinds of anxiety disorders (Noyes, 1985) and also for reducing performance anxiety (Dimsdale, Newton, & Joist, 1989). Despite the mixed results with experimental populations, little question...

Anxiolytics and the Treatment of Anxiety Disorders

Until the late 1960s, the symptoms of anxiety and insomnia were mainly treated with barbiturates. The barbiturates are known to cause dependence, and severe withdrawal effects were sometimes reported following the abrupt termination of their administration. Furthermore, their efficacy in the treatment of anxiety disorders was limited. The discovery of the benzodiazepine anxiolytic chlordiazepoxide some 30 years ago, and the subsequent development of numerous analogues with an essentially similar pharmacological profile, rapidly led to the replacement of the barbiturates with a group of drugs that have been widely used for the treatment of anxiety disorders, insomnia, muscle spasm and epilepsy and as a preoperative medication. The benzodiazepines have also been shown to have fewer side effects than the barbiturates, to be relatively safe in overdose and to be less liable to produce dependence than the barbiturates. They have now become the most widely used of all psychotropic drugs...

Anxiety and distress Table 173

Of the eight etiologic studies identified, four studies showed a lack of clear effect. Two papers, both published from the Israeli civil servant cohort, reported strong or moderate association between anxiety and the incidence of angina.39,40 The remaining two studies gave evidence for an association between phobic anxiety and fatal CHD, but did not show a clear effect on non-fatal CHD or of free-floating anxiety.41,42 Furthermore, the studies with longer follow up were less likely to find a positive association than the studies with less extended follow up. This is exemplified by the Northwick Park Heart Study where the association between anxiety and fatal CHD found after 10 years of follow up,41 disappeared when the follow up was extended by another decade.43 Hence, anxiety may be a result of preclinical CHD rather than a cause of fatal CHD. Of the 18 prognostic studies, half found a lack of clear association and one reported results significantly contrary to the hypothesis. Four...

Animal Research in Fear and Anxiety

Animal tests of fear and anxiety are used both to screen new compounds for potential anxiolytic action and to study their neural substrates. Until the mid-1970s, animal tests consisted of delivering shocks as a punishment, most often for an operant lever-press response. These tests were developed as screening tests for the pharmaceutical industry. Matching particular tests of fear and anxiety to particular anxiety disorders is an extremely difficult task. The social interaction test (placing rats in an unfamiliar or brightly lit environment), the elevated plus-maze (placing the animal on an elevated open arm), predator exposure stress, forced swim, and social defeat or subordination stress are models of fear and anxiety. In the wide range of approaches used to study fear and anxiety in animal studies, two sets of tests probe their responses. The first set uses models of conditioned fear the second uses models of unconditioned fear. Both models presuppose that aversive stimuli, such as...

Psychological studies of anxiety and attention

Most psychological studies of anxiety and attention have employed between-subjects designs comparing chronically-anxious and non-anxious individuals. The majority of these studies have focused on individuals suffering from a clinically-diagnosed anxiety disorder, although others have sampled anxiety across a more normal range by comparing individuals who are above and below the median in terms of the personality dimension of 'trait anxiety'. These are reasonable research strategies in that both clinical and trait measures of anxiety are assumed to reflect chronic activation in the brain's defensive circuitry. It should be kept in mind, however, that many of these studies do not directly manipulate the individuals level of state anxiety, and when they do, the manipulations tend to promote relatively mild states of anxiety. Many of the earliest studies provided evidence that anxiety produces a focused state of attention characterized by impaired processing of peripheral or secondary...

Exacerbating and alleviating anxiety

A frequent criticism of the publicity surrounding hereditary cancer risk is that it simply promotes anxiety while doing nothing practical to counter it. Setting aside the fact that publicity is generated largely by the popular media, over which cancer geneticists have no control, several studies of patients who have made use of cancer family clinical services provide a measure of reassurance. They have, in the main, confirmed that perceptions of risk before clinic attendance are often unrealistic, that there is some improvement in accuracy after attendance and that levels of anxiety tend to decline, at least in the short term, regardless of changes in risk perception. Hence there is some justification for the claim that cancer family clinics are responding to a pre-existing and hitherto unmet need and that they fulfil a useful function, even before they have been shown to influence cancer morbidity or mortality (Evans et al., 1994 Lloyd et al., 1996 Cull et al., 1999).

Sources of Information on Test Anxiety

Test takers who want help in coping with test anxiety will find a wealth of materials available in bookstores and on the Internet. Examples include the following Taking the anxiety out of taking tests A step-by-step guide, by S.Johnson. New York Barnes & Noble Books, 2000. No more test anxiety Effective steps for taking tests and achieving better grades, by E. Newman (available with audio CD). Los Angeles Learning Skills Publications, 1996. The Test Anxiety Scale (Saranson, 1980), which provides a quick way to gauge the extent to which one may be prone to experience test anxiety and is available free of charge from Learning Skills Publications (at http www.learning skills.com test.html) and several other Internet sites. Many Web sites sponsored by university counseling centers are accessible by searching for test anxiety on the Internet these sites provide tips on study habits and other information on coping with test anxiety. test anxiety, the following works are recommended Sapp,...

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by psychic and somatic tension. Although the DSM has focused increasingly on the cognitive aspects of GAD, this disorder often presents with somatic symptoms, and indeed it is the most common anxiety disorder in primary care settings 6 . Although GAD has at times been considered a residual disorder, there is growing evidence that it is in fact an independent disorder, characterized by specific symptomatology, high prevalence and significant disability 7 . GAD is associated with a good deal of psychiatric comorbidity, but no more so than is major depression 8 . The condition has a later onset than most other anxiety disorders, but it tends to precede other comorbid disorders, especially major depression 9 . Other important comorbidities in GAD include somatization disorder, other anxiety disorders, and substance use disorders. The disability that is associated with comorbid GAD and depression is significantly higher than the...

Panic Disorder And Agoraphobia

Panic disorder is characterized by unexpected panic attacks. These may be followed by panic attacks in response to particular stimuli, and by agoraphobia. Panic disorder with or without agoraphobia is a prevalent and disabling disorder. Panic-depression is a particularly common comorbidity, and contributes to the potentially negative impact of panic disorder 28 . Alcohol and substance abuse and dependence are also frequent comorbidities in panic and other anxiety disorders. A biological perspective suggests that there are multiple risk factors for the onset of panic disorder 29 , including both biological risk factors (e.g. family history) and environmental ones (e.g. separation). Genetic variants may well be important in the pathogenesis of panic, but at present are not clinically useful as risk markers. Long-term studies of anxiety disorders are relatively few, but these provide additional information about resilience and vulnerability factors 30 . Anxiety sensitivity is a trait...

Social Anxiety Disorder

Social anxiety disorder (SAD) is characterized by fear of embarrassing oneself in social or performance situations. Subjects with generalized SAD fear several different social situations. SAD is a particularly prevalent and disabling anxiety disorder 59,60 . Thus, subjects with SAD are more likely to be single, are less likely to complete high school or tertiary studies, and are more likely to be unemployed and receive a lower income 6 . It seems reasonable to argue that early intervention for SAD, even in childhood and adolescence, may prevent the negative impact of this disorder. Long-term studies are, however, needed in this area. SAD has a relatively early onset, and can persist for many years. Comorbid disorders often begin later on 61 . These include major depression, other anxiety disorders and substance use disorders. Simple screening questions 62 or scales, such as the Liebowitz Social Anxiety Scale (LSAS) and the Mini-Social Phobia Inventory (SPIN), are useful for screening...

Screening For Anxiety Disorders

In the above discussion of each of the major anxiety disorders, there are overlapping themes. These are highly prevalent, disabling and costly conditions. Despite the availability of effective pharmacotherapy and psychotherapy, they remain underdiagnosed and undertreated 74-77 . Cross-sectional studies of rates of appropriate diagnosis are partly flawed insofar as prevalence of psychiatric disorders is higher in follow-up patients nevertheless, underdiagnosis is a real problem 78,79 . Thus, there is clearly need for more widespread screening to maximize the chance of early detection and management. Screening would seem to be particularly relevant in primary care settings 80 , although there are also important opportunities for screening in other contexts, including direct screening of the public 81 . A range of screening instruments for anxiety disorders is available for use in primary care 82 . A number have also been studied in more specialized populations, settings and cultures...

Prevention Of Anxiety Disorders

As our understanding of the pathogenesis of anxiety disorders becomes increasingly sophisticated, it may also be possible to develop effective interventions to help prevent their onset 73,103 . In addition, screening strategies discussed above may yield a group of individuals who do not yet have an anxiety disorder, but who are nevertheless at risk should they not receive help. Thus, there is increasing interest in the prevention of childhood anxiety disorders by child-focused methods, parent-focused methods and environmental restructuring methods. Such strategies can be universal, selective or indicated 104 . We discuss each of them in turn. Universal prevention strategies are provided to entire populations. Lowry-Webster et al. 105 assigned 594 children aged 10-13 to CBT conducted by classroom teachers or to assessment only. Barrett and Turner 106 assigned 489 children aged 10-12 years to a psychologist-led programme, a teacher-led programme or to usual care. In both studies,...

Relationship between plasma anxiolytic concentrations and the therapeutic response

While the individual drugs in the benzodiazepine group differ in potency, all benzodiazepines in common use have anxiolytic, sedative-hypnotic, anticonvulsant and muscle-relaxant activity in ascending order of dose. The main clinical difference between the individual drugs lies in the time of onset of their therapeutic effect, and the intensity and duration of their clinical activity. The extent of accumulation of an anxiolytic will depend on the elimination half-life in relation to the dosing interval. Thus drugs with long half-lives will have cumulative sedative effects, and may impair cognition, following repeated administration. However, despite increasing blood and presumably brain concentrations of the drug, central depression does not increase in parallel because of the development of tolerance to the non-specific depressant actions of the drug. Long half-life anxiolytics are slowly eliminated whereas short half-life drugs tend to be eliminated rapidly. This means that the dose...

Application Of The Model Of The Neural Circuitry Of Anxiety And Fear To Anxiety Disorders

The primary goal of research in the clinical neuroscience of anxiety disorders is to apply findings related to the effects of stress on the brain in animals to patients with anxiety disorders. Different methods contributed to the working model of the neural circuitry of anxiety and anxiety disorders that is presented here. The neural circuits mediating symptoms of anxiety disorders can be studied by measuring neurotransmitters and hormone levels in blood, urine, and saliva by assessing behavioral and biochemical responses to pharmacological challenge to specific neurochemical systems by measuring key brain structures with structural neuroimaging by provoking Among the most characteristic features of anxiety disorders such as PTSD and PD is that anxiogenic memories (e.g., of the traumatic experience or first panic attack) can remain indelible for years or decades and can be easily reawakened by all sorts of stimuli and stressors. The strength of traumatic memories relates, in part, to...

Neural Circuits In Anxiety And Fear

The major afferent arm of neural circuitry includes exteroceptive sensory systems of the brain, consisting of serially organized relay channels that convey directly or through multisynaptic pathways information relevant to the experience of fear. The sensory information contained in a fear- or anxiety-inducing stimulus is transmitted from peripheral receptor cells in the eyes, ears, nose, skin, the body's own visceral information (e.g., blood glucose, arterial pressure, and CO2 levels), or any combination of these. Except for olfactory information, which goes directly to amygdala and enthorhinal cortex, these sensory inputs are relayed through the dorsal thalamus to amygdala and cortical brain areas, such as primary visual (occipital), auditory (temporal), or tactile (postcentral gyrus) cortical areas. Input from peripheral visceral organs As this primary sensory input comes into the brain stem and midbrain, it is matched against previously stored patterns of activation and if...

Key Brain Structures Mediating Fear And Anxiety Behaviors

The brain structures that constitute a neural circuit of fear and anxiety should have the following features 1. There is sufficient afferent sensory input to permit assessment of the fear- or anxiety-provoking nature of the external threat or internal stress. 3. Efferent projections from the brain structures should be able to mediate an individual's neuroendocrine, autonomic, and motor response to threat as well account for the pathological reactions that result in anxiety-related signs and symptoms. To underscore its survival importance, many brain areas with redundant circuits are involved to subserve this important constellation of behaviors. Critical brain structures capable of incorporating an individual's prior experience or memory into the appraisal of stimuli are amygdala, LC, hippocampus, thalamus, hypothalamus, periaqueductal grey (PAG), and pre-frontal cortex. Alterations in neurochemical and neurotransmitter systems that mediate the stress response also play a role in...

History of Neuroanatomical Modeling of Fear and Anxiety

There has been a long history of hypotheses related to the neurobiology of human anxiety. The central role of a subcortical network of brain structures in emotion in general was hypothesized by Papez in 1937. In 1949, MacLean coined the term limbic system, integrating Papez's original circuit (hypothalamus, anterior thalamus, cingulate gyrus, and hippocampus) and other anatomically and functionally related areas (amygdala, septum, and orbitofrontal cortex). Over the years, various regions have been added or removed from this emotion processing circuit. Papez hypothesized that several telencephalic and diencephalic structures which form a border (limbic border) around the diencephalon constituted a circuit, which controlled the emotions. He suggested that blockage of information flow at any point along this circuit would cause disorders of affect (i.e., mood). Removal of the cerebral cortex of the cat, leaving only subcortical regions including amygdala, thalamus, hippocampus, and...

Observation of Early Signs of Anxiety

In order for applied relaxation to work optimally patients must use the relaxation technique as early as possible in the response to an anxiety reaction or a panic attack. Reacting quickly to the first signs of anxiety greatly increases the patients' ability to employ AR effectively. In order to increase the patient's awareness of the initial signs of anxiety, homework assignments involve observing and recording these reactions. In the panic diary the patient records the situation, the symptoms of the panic attack, and the severity of the attack (0-100), as well as the very first signs that were experienced. Therapist and patient examine the panic diary and focus on identifying the earliest signs of the onset of the panic attacks. An attempt is made to determine what the patient felt, thought about, or did just before the first symptom occurred. Sometimes it can be advantageous to let patients imagine their most recent panic attack. This procedure often assists patients in remembering...

Special Section on Drugs Anxiolytic of choice

A common anxiolytic that is used is lorazepam (Ativan), a benzodiazepine with rapid onset and moderate duration 0.5-2 mg IV is the recommended dose, but start with 0.5 mg at first and then give additional 0.5 mg doses every 5-10 min until the total dose is reached. Midazolam (versed), which is commonly used for procedures such as colonoscopy, is not ideal because it is too short acting and requires frequent dosing.

Working Model For The Neural Circuitry Of Anxiety Disorders

Neural Circuits Anxiety Disorders

Anxiety disorders are characterized by dysfunction of an interrelated neurochemical and neuroanatomical system. PTSD and PD share many biological and phenomenological similarities that allow them to be considered related. Phobic disorders and GAD are still in early stages of investigation. Although phenomen-ologically they are similar to PTSD and PD, it is premature to include them in a model for human anxiety disorders. PTSD is related more to the deleterious effects of environmental stress, whereas PD is not as clearly related to stress and may be related more to genetic variability in anxiety. In stress-related anxiety disorders (i.e., PTSD), PTSD symptoms as well as cognitive dysfunction associated with PTSD may be linked to hippocampal dysfunction. A model can be created which incorporates informatiom from animal and clinical research relevant to these disorders, keeping in mind that working models are subject to modification with new information, and that generalizations...

Social Avoidance And Anxiety

Beliefs about being defective and the importance of appearance to the self will drive varying degrees of social anxiety and avoidance. Thus, depending on the nature of their beliefs, patients will tend to avoid a range of public or social situations or intimate relationships because of the fear of negative evaluation of the imagined defects. Many patients endure social situations only if they use camouflage (for example, excessive makeup) and various safety behaviors. These are often idiosyncratic and depend on the perceived defect and cultural norms. Behaviors such as avoidance of eye contact or using long hair or excessive makeup for camouflage are obvious but others are subtler and are more difficult to detect unless the patient is asked or observed as to how they behave in social situations. For example, a BDD patient preoccupied by his nose avoided showing his profile in social situations and only stood face on to an individual. A patient preoccupied by blemishes under her eye...

Misattribution and Fear Anxiety

Schachter's misattribution studies were followed by a multitude of other misattribution studies, in which subjects were induced to attribute their natural arousal to various pills and procedures, such as white noise, strange rooms, and the lights or ventilation of a room (for reviews, see Ross & Olson, 1981 Reisenzein, 1983). The feelings that were successfully reduced by these procedures include anxiety, anger, cognitive dissonance, and the discomfort of social comparison (Tesser, Pilkington, & Mcintosh, 1989). Olson, both by himself (1988) and in conjunction with Ross (Olson & Ross, 1988), tested predictions of this model by inducing participants to misattribute the arousal of speech anxiety. Speech anxiety is a particularly good test of the analysis because three previous studies (Cotton, Baron, & Borkovec, 1980 Singerman, Borkovec, & Baron, 1976 Slivken & Buss, 1984) had failed to find misattribution effects, in studies that failed to meet Ross and Olson's...

Conditioning of Anxiety Relief

In his monograph Psychotherapy by Reciprocal Inhibition published in 1958, which stimulated the widespread introduction of behavioral modification procedures to psychiatry and psychology, Wolpe suggested that anxiety-relief responses might be directly conditioned to convenient stimuli and subsequently used to counter anxiety. He based the suggestion on the observation that if a stimulus was repeatedly presented to an eating animal just before withdrawing its food, that stimulus acquired the property of inhibiting feeding even when the animal was in the middle of a meal. Wolpe argued that by analogy it might be expected that a stimulus that consistently coincided with the termination of a noxious stimulus might acquire anxiety-inhibiting effects. He pointed out the possibility was supported by experiments showing that approach responses were conditioned to a stimulus repeatedly presented at the moment of termination of an electric shock, in contrast to the avoidance that is conditioned...

Serotonin and anxiolytic activity

Although the benzodiazepine anxiolytics primarily interact with the GABA receptor complex, there is ample experimental evidence to show that secondary changes occur in the turnover, release and firing of 5-HT neurons as a consequence of the activation of the GABA-benzodiazepine receptor. Similar changes are observed in the raphe nuclei where a high density of 5-HT1A receptors occurs. Such findings suggest that 5-HT may play a key role in anxiety disorders. Undoubtedly one of the most important advances implicating serotonin in anxiety has been the development of the azaspirodecanone derivatives buspirone, gepirone and ipsapirone as novel anxiolytics. All three agents produce a common metabolite, namely 1-(2-pyrimidinyl) piperazine or 1-PP, which may contribute to the anxiolytic activity of the parent compounds. It soon became apparent that these anxiolytic agents do not act via the benzodiazepine or GABA receptors but show a relatively high affinity for the 5-HT1A sites the 1-PP...

Mood Anxiety and Somatoform Disorders

The cooccurrence of migraine and psychiatric disorders has been studied extensively in several population-based and longitudinal surveys. Migraine is associated with both affective and anxiety disorders. Breslau and colleagues reported on the association of International Headache Society (IHS)-defined migraine with higher lifetime rates of affective disorder, anxiety disorder, illicit drug use disorder, and nicotine dependence. Migraine with aura was associated with an increased lifetime prevalence of both suicidal ideation and suicide attempts, controlling for sex, major depression, and other concurring psychiatric disorders. The relative risk for the first onset of major depression in migraineurs after the onset of migraine versus no prior migraine was 4.1 (95 CI, 2.2-7.4), whereas the relative risk for the first onset of migraine in persons with prior major depression versus no history of major depression was 3.3 (95 CI, 1.6-6.6). These data indicate that the lifetime association...

Anxiety

The Expression of Fear and Anxiety II. Prevalence of Anxiety Disorders III. Etiology of Anxiety and Anxiety Disorders IV. Functional Neuroanatomical Models of Fear and Anxiety V. Key Brain Structures Mediating Fear and Anxiety Behaviors VI. Neural Circuits in Anxiety and Fear VIII. Application of the Model of the Neural Circuitry of Anxiety and Fear to Anxiety Disorders IX. A Working Model for the Neural Circuitry of Anxiety Disorders

Hyperventilation

Hyperventilation induces rapid, transient reductions in ICP because substantial decreases in CO2 cause vasoconstriction and decreased cerebral blood flow. Autoregulatory capability is required for this response. This measure is effective in many forms of edema, although there is a theoretical risk of causing injury due to hypoxia associated with excessively diminished cerebral blood flow. A target CO2 of 2530 mm Hg is recommended when hyperventilation is employed.

Anxiety Disorders

The biofeedback techniques primarily used in the treatment of anxiety disorders are frontal EMG, finger temperature, SCA, and heart rate feedback. These modalities are used to train a deep state of relaxation. The clinician can then use the deep state of relaxation as an incompatible response to the anxiety state. Although specific biofeedback such as heart rate might be used for a cardiac phobic, the most widely used technique is to train on the most active modality, based on the individual's ability and the clinician's experience.

Buspirone

Buspirone is a prototype anxiolytic drug from the azapirone family introduced in 1984. The agent is not chemically or pharmacologically related to the other sedative-hypnotics, although its efficacy profile is comparable with that of the benzodiazepines. Clinical indications for buspirone are not fully delineated however, it appears most useful in the treatment of conditions such as chronic anxiety, especially in the elderly, and mixed anxiety-depression states. It does not affect GABA or benzodiazepine receptors and therefore produces less sedation, euphoria, psychomotor impairment, and ethanol potentiation. It does affect CNS serotonergic, dopaminergic, and noradrenergic neurotransmission, but the mechanisms are not fully understood. Buspirone appears to have several merits when compared with the other sedative-hypnotics. It exhibits a virtual absence of potential for addiction, a wide margin of therapeutic safety, and no documented delayed toxicity or withdrawal reactions with...

Panic Disorder

A number of different techniques have been employed to bring under control somatic responses that are related to panic. The most frequently used technique is respiratory training. David H. Barlow and his associates have termed this approach panic control training. Eleven sessions of a combination of cognitive restructuring with breathing retraining und interoceptive exposure constitute a highly effective treatment in panic disorder. This treatment worked equally well with and without imipramine, a tricyclic antidepressant, and appeared more durable than imipramine alone six months after treatment cessation. Psychological treatments of panic disorder have previously been shown to be more effective than alprazolam, a benzodiazepine. In 1988, Gudrun Sartory and Deli Olajide compared breathing retraining with Valsalva, a vagal innervation technique, and found a slight advantage of the latter. Both groups received progressive relaxation and the instruction that panic could be brought under...

Azopirones buspirone

As with most medications in the therapy of dyspnoea, there are limited data to inform the use of buspirone in clinical practice. Buspirone is a non-sedating anxiolytic with a gradual onset of action after it is commenced. There are two double-blind, RCTs that explore the effect of buspirone in people with COPD. The first of these explored in a placebo-controlled study the use of 10-20mg of buspirone three times daily on dyspnoea measured on Borg scale and physiological parameters of exercise. The cohort of 11 males had moderate to severe COPD and anxiety. Neither dyspnoea scores nor anxiety scores (measured on the State Trait Anxiety Inventory) dropped by the end of the six-week study. There was no improvement in exercise workload including 12-minute walking distance.41 A study that was reported the same year explored the use of 20mg of buspirone per day in 16 people for 2 weeks. All had moderate to severe COPD with FEV1 of 1.15 + -0.42 and FEV1 FVC of 50.7 + -15.0 per cent. At the...

Phase 1 Anxiety

The first level of behavior seen in a potentially violent patient is anxiety. This may not only occur with the patient. Family and visitors waiting long periods in the emergency department waiting room may also exhibit anxiety and should be dealt with before visiting the patient so as not to intensify the patient's behavior. In general, the signs of increasing anxiety are indicated by body language. Movements that seem to have no purpose other than to expend energy may be the first clue. These may include pacing, wringing of hands, clenching of fists, unwillingness to stay in the treatment area, or a disheveled appearance. Speech may be pressured and loud. Questions such as Why am I here or How long is this going to take may be asked. It is not necessarily what is said, but the manner of speech that gives a clue to the presence of anxiety. One of the most common reasons that a patient's condition may evolve beyond anxiety is that the staff ignores these signals, rather than...

Kinds of Stress Response

There are four kinds of stress response. Some reduce an animal's state of being others enhance it. Understress occurs in simple environments that lack certain features (social companions, play items) (stimulus underload). Sometimes animals give behavioral signs of understress (lethargy exaggerated, repetitive activity apparently devoid of purpose (stereotypy) some other disturbed behavior). Eustress (good stress) situations of extraordinary responses, but which the animal finds tolerable or even enjoyable. Overstress environmental situations that provoke minor stress responses. Distress (bad stress) circumstances that provoke major stress responses. Judging from signs of negative emotions (anxiety, fear, frustration, pain), distress causes an animal to suffer, but to what extent is not yet known.

TABLE 53 Hospital Disaster Areas

PSYCHIATRY In the event of a disaster involving mass casualties and extensive property damage, it is common for patients to present with episodes of anxiety, depression, and psychosis. Hysterical persons, whether patients, visitors, or staff, can be extremely disruptive to hospital disaster operations. A separate, isolated area must be predesignated to receive individuals in need of psychological intervention.

Empirical Support Of Cbt For Addictive Behaviors

Replacement behaviors, and changing the relationships between cognitive distortions and physiological arousal and gambling. The investigators used relaxation training, imaginal and in vivo exposure, and cognitive restructuring as primary modalities. Following treatment the client showed a significant decrease in frequency and intensity of gambling impulses. With the exception of placing a single bet, the client did not gamble for 10 months. Additionally, the client reported a decrease in anxiety based on the Beck Anxiety Inventory.

Aims and scope of the volume

There has been considerable anxiety, ethical debate, and regulatory and legislative intervention on both national and international scales in response to the advent of culturable hES cells, and to the far-reaching ideas for their application in future cell-based therapies. Although undoubtedly appropriate and necessary, much of this debate has far outrun both the present and potential scientific and medical realities. Moreover, some of it is based on misconception and misinterpretation. I have elsewhere discussed scientific and medical possibilities, which might lead towards more rational and considered approaches to regulating the derivation and use of hES cells (5).

Ethics And Personal Responsibility

Fearing that formal review agencies will hold us accountable after the fact stresses and distresses some of us. Some agencies, such as local, state, and national professional ethics committees, focus specifically on the ethical aspects of our work. Others, such as state licensing boards and the civil courts, enforce professional standards of care that may reflect ethical responsibilities. The prospect of review agencies second-guessing us with the benefit of hindsight can make difficult judgments a nightmare for some therapists. They may suffer a debilitating performance anxiety, dread going to work, and discover that the focus of their work has changed from helping people to avoiding a malpractice suit.

Mechanical Ventilation

Require hyperventilation, then the respiratory rate should be started at 2 the normal rate for age (20 breaths min for infants, 15 breaths min for young children, and 10 breaths min for older children and adolescents). Children should be adequately sedated and paralyzed during mechanical ventilation until definitive care is started in a pediatric intensive care unit.

Theoretical Basis

AMT was developed in 1971 as a solution to the in-appropriateness of desensitization for dealing with what is now called generalized anxiety disorder (GAD). Desensitization is effective for phobias but requires the identification of the stimuli precipitating the anxiety response. In GAD, clients experience a more chronic, generalized state of anxiety, and the external cues eliciting anxiety cannot be identified so precisely. Desensiti-zation was, therefore, not applicable, and alternative interventions were needed. AMT is based on Richard Suinn's suggestion that clients can be taught to identify the internal signs, both cognitive and physical, that signal the presence of anxiety and to react to those signs by engaging in responses that remove them. This formulation was based on learning theory that conceptualized anxiety as a drive state and postulated that behaviors could be learned to eliminate the drive. Anxiety was viewed as having both response and stimulus properties. It was a...

Docherty et als Model

Stage 1, which Docherty et al. called overextension, is characterized by experiences of passivity, overstimulation, irritability, persistent anxiety and first signs of cognitive impairment (distractability). This stage tends to show a lengthy, insidious course. Predominant at stage 2, called restricted consciousness, are such symptoms as apathy, social withdrawal, hopelessness and somatization, but also deterioration of personal appearance and - here the authors follow Sullivan - obsessional and phobic symptoms. The third stage, disinhibition, brings forth symptoms that give the impression of patients losing their inhibitory abilities hypomania, elevation of mood and occasional ideas of reference. This stage, still part of the prepsychotic prodromal period, is followed by a fourth called psychotic disorganization, characterized by disorganization of cognition and perception, hallucinations, ideas of reference, disorders of self and sometimes by catatonic symptoms. In the stages that...

Preparation for Anaesthesia

As more day surgery is performed and more patients are admitted to hospital close to the scheduled time of surgery, premedication has become less common. The main indication for premedication remains anxiety, for which a benzodiazepine is usually prescribed, sometimes with metoclopramide to promote absorption. Premedication serves several purposes anxiolysis smoother induction of anaesthesia reduced requirement for intravenous induction agents and possibly reduced likelihood of awareness. Intramuscular opioids are now rarely prescribed as premedication. The prevention of aspiration pneumonitis in patients with reflux requires premedication with an H2 antagonist, the evening before and morning of surgery, and sodium citrate administration immediately prior to induction of anaesthesia. Topical local anaesthetic cream over two potential sites for venous cannulation is usually prescribed for children. Anti-cholinergic agents may be prescribed to dry secretions or to prevent bradycardia,...

Summary Of Management Guidelines

The age-related differences are difficult to remember and cause major problems in pediatric resuscitation. One should not have to memorize numbers such as drug doses, tube sizes, or cardiac compression ratios. The proper organization of equipment, the posting of pediatric CPR data and equipment sheets, and the use of a length-based system (TableJ 0.-.5) can eliminate the need to commit many variables to memory and can reduce the possibility of errors. This eliminates much of the general anxiety connected with pediatric resuscitation and leaves clinicians free to apply the principles of resuscitation to the children as presented.

Description Of Treatment

Applied behavior analysis is a specific area of research and intervention within behavior modification. Several characteristics of behavior modification include an emphasis on overt behavior, a focus on current determinants of behavior, and reliance on the psychology of learning as the basis for conceptualizing clinical problems (e.g., anxiety, depression) and their treat

Interventions With Family Caregivers

For example, a person who asks to see her deceased mother might be feeling lonely or in need of reassurance. Providing comfort or talking with her about her mother will be more effective than telling her that her mother is dead, which will only increase her anxiety. The patient's cognitive errors are part of the disease and cannot usually be corrected, but the feelings that are associated with their beliefs can be addressed.

Overlap of Personality Emotion and Psychopathology

The same is true for depression and anxiety. Personality and emotion may be discriminated in terms of their causality and their time frame, with emotions being regarded as situationally dependent reactive states and personality characteristics as enduring traits. Plutchik (1980, pp. 173-198) defined personality in terms of the characteristic emotions displayed and experienced in interpersonal interactions. In this view, the emotions we tend to feel and or express most often when interacting with other human beings are our personality a timid or shy person feels and expresses fear most often in her or his interactions with others, while a friendly person feels and expresses friendliness or trust. Working in the opposite direction (from personality to emotion), Cffend Moskowitz (1998) demonstrated the validity of personality descriptors as predictors of affect. As well, Yik and Russell (2001) indicated the presence of relationships between momentary affects described...

Structure and function of nerve cells

Causally related to schizophrenia, depression and anxiety. It should be apparent to anyone interested in the neurosciences that the brain is more than a sophisticated computer that follows a complicated programme, and any dogmatic approach to unravelling the complexities of this dynamic, plastic collection of organs which we call brain is doomed to failure.

Differences in Specialized Instruments

In comparison with the MMPI, the NEO PI-R and Cattell's 16 PF, there are tests which do not attempt to provide a broad overview of personality, but rather address one particular aspect of it. Feingold (1994) performed a meta-analysis of previously examined studies that had employed inventories and specialized tests measuring Self-Esteem, Internal Locus of Control (belief in one's own agency), Anxiety, and Assertiveness. He reported that overall males scored higher in Self-Esteem, Assertiveness, and Internal Locus of Control, while scoring lower in Anxiety than females (Feingold, 1994, p. 438). Again, the reported differences, though statistically significant, were small. Feingold's findings are generalizable because they were based on a variety of measurement instruments including Rotter's Locus of Control test, the State-Trait Anxiety Inventory, and the Taylor Manifest Anxiety Scale, and on behavior as well as personality inventories. The meta-analysis of sex differences in...

An Overview of Sex Differences in Personality

Differences between men and women are evident on scales designed to measure sex role identification. Differences for these scales occur in the obvious direction (males are more Masculine, females more Feminine) in part because of the way in which the scales were created. Sex differences are also present in scales measuring aspects of personality not directly related to sex roles. Men, in comparison with women, obtain scores which indicate that they are more Assertive, less Anxious, have higher Self-Esteem and a greater sense of agency (Internal Locus of Control). On the basis of a meta-analysis of the norms for commonly used personality inventories including the MMPI, Cattell's 16 PF, and the NEO PI-R, Feingold (1994) reached several broad conclusions as to sex differences in personality. Scales from all tests were realigned with the facets of the NEO Personality Inventory. Feingold (1994) concluded that, by and large, females scored higher than males on scales addressing Anxiety (a...

Sex Differences in Emotion Emotion Inventories

Affect Adjective Check List (MAACL-R) (Zuckerman & Lubin, 1985) and the Profile of Mood States (POMS) (McNair, Lorr, & Droppleman, 1992). Sex differences are evident for both these instruments. The manual for the MAACL-R (Zuckerman & Lubin, 1985, p. 6) reports higher mean scores for women on scales representing Anxiety, Depression, and Positive Affect, and higher mean scores for men on the scale representing Sensation Seeking. In the POMS sex differences for a college sample show females scoring higher on the factors of Tension Anxiety, Depression Dejection, and Confusion (McNair et al., 1992, p. 21). A study of outpatients showed similar patterns of sex differences, with male outpatients additionally scoring higher on Vigor (McNair et al., 1992, p. 18). The state-trait distinction between personality and emotionality is parallelled in two Spielberger instruments, the State-Trait Anger Expression Inventory (STAXI-2) (Spielberger, 1999) and the State-Trait Anxiety Inventory...

Innovations And Future Directions

It is important to conduct research designed to identify the differential cognitive and behavioral deficits associated with irritable moods and anger attacks. Research on cognitive- behavioral therapeutic efficacy has outpaced efforts in this realm. The benefits of identifying cognitive and behavioral processes unique to different anxiety disorders have resulted in significant advances in their treatment of these disorders. Similar advances could be experienced in the realm of anger disorders. Finally, advances in cognitive neuroscience are contributing to the development of a better understanding of the role of biological factors in a variety of behavioral disorders, including anger problems. These advances neither mandate the use of pharmacological interventions nor preclude the use of cognitive-behavioral therapy. However, they do indicate that some people with anger problems may benefit from pharmacological interventions. Cognitive-behavioral therapists have developed treatment...

Sex Differences in Psychopathology

Women are also more likely to be diagnosed with several types of Anxiety Disorder, for example, Panic Attacks (DSM-IV, p. 399), Phobias (pp. 408, 414), and Generalized Anxiety Disorder (p. 534), though Obsessive-Compulsive disorder is equally evident in both sexes (p. 421). Again, this is an extension of the finding that women scored higher on Anxiety-related personality scales and emotions. Males were more likely than females to be diagnosed as having Conduct Disorder (p. 88) and Oppositional Defiant Disorder (p. 92). Both these diagnoses involve behavior related to anger and aggression, although both also belong to the category of problems usually first diagnosed before adulthood. An adult diagnosis of Intermittent Explosive Disorder (one which reflects the existence of bursts of aggressive impulses) is also more frequent in males than in females (p. 616). one sex at the emotional level (e.g., Anger in men or Anxiety in women), is more likely to be a personality characteristic...

Recommended Readings

Anger-control problems are an often-overlooked disorder and they have received limited attention in the treatment literature. An examination of the American Psychiatric Association DSM-IV reveals nine diagnostic categories for Anxiety Disorders and ten diagnostic categories of Depressive Disorders, but only three diagnostic categories for anger-related problems, namely, Intermittent Explosive Disorders, and two Adjustment Disorders with Conduct-Disorder features. The dearth of research on anger is further highlighted by DiGiuseppe and Tafrate (2001) who noted that for every article on anger over the past 15 years, there are ten articles in the area of depression and seven articles in the area of anxiety. The absence of research activity on anger is somewhat surprising given that anger-related behaviors are one of the most common psychiatric symptoms that cut across some 19 different psychiatric conditions. Anger, hostility, and accompanying violence are often comorbid with other...

Psychiatric Disorders

A number of psychiatric disorders have been linked with abnormalities in the function of the anterior cingulate cortex. Activity is elevated in this region in obsessive-compulsive disorder, tic disorder, and depression, and normalization of activity in this region occurs with behavioral and pharmacological treatment of these disorders in some cases. With severe forms of these disorders, such as with obsessive-compulsive disorder, cingulotomies have been shown to be effective in relieving the symptoms.

Genetics And Evolution

As described, the anterior cingulate cortex has been implicated in a number of psychiatric disorders. Interestingly, all of these disorders show familial patterns of inheritance, increased risk among first degree relatives of affected patients, and increased concordance in identical vs fraternal twins. The heritability (see Glossary) has been estimated for schizophrenia (0.6), attention deficit hyperactivity disorder (0.79), obsessive-compulsive disorder (0.68), and major depression disorder (0.6). Estimates of heritability have been extended to specific cognitive functions in normal populations as well. Tasks that activate the anterior cingulate cortex, such as spatial working memory, divided attention, and attentional set shifting, have been examined in identical and fraternal twin populations and have high heritabilities. These findings suggest that genetic factors play a role in behaviors associated with anterior cingulate abnormalities and normal anterior cingulate function....

Introduction to Rapid Relaxation

The purposes of rapid relaxation (RR) are to teach the patient to relax in natural but not anxiety-arousing situations, and to further reduce the time it takes to become relaxed. The goal for this is 20-30 seconds. In order to reach these goals the patient should use rapid relaxation 15-20 times a day in natural situations. At this stage it is very important that the therapist spends some time to thoroughly go over the goals with the patient and to write down suitable situations that function as signals for RR training. The therapist asks the patient to describe what an ordinary day looks like to them and what they do between getting out of bed in the morning through going to bed at night. Among those activities that the patient does one can choose signal situations in such a way that it make up at least 15 practice occasions per day.

Instruction of Rapid Relaxation

If, after doing all the above, the patient still feels that they haven't achieved a deep enough degree of relaxation, one can take one more deep breath as described above. In some cases the entire sequence can be repeated for a third time. After this the patient should be content with the degree of relaxation achieved. Otherwise there is a risk that the patient will trigger symptoms of hyperventilation, which of course counteracts the purpose of RR.

Introduction to Application Training

The only rationale you give the patient at this stage is that it is now time to start practicing in reality what they have learned in theory. Before starting this phase it is very important to give the patient an instruction that sets their expectations at the right level. You remind the patient that applied relaxation is a skill and as with any other skill it takes practice to refine it. This means that the patient should not expect that AR functions at 100 the first time it is applied, such as with a panic attack. Instead, one must be satisfied with the anxiety not increasing as much as it had before, but that it levels out at a mild to moderate level. It is very important that the patient does not get demoralized but that they continue to apply AR every time they are in an anxiety situation. Relatively soon one will notice an effect from AR, and eventually the anxiety reactions will dissipate altogether. Before the patient goes out into real life situations and starts applying the...

Contributions from Neuroimaging Studies

Functional brain imaging studies have examined brain metabolism and blood flow at rest and during stress symptom provocation in patients with anxiety disorders. Patterns of regional blood flow that are evoked reflect the engagement of neural structures in fear and anxiety responses. PET has been used to measure the closely related processes of brain metabolism (using radiolabeled glucose or 18F 2-fluoro-2-deoxyglucose) and blood flow (with radiolabeled water or 15O H2O), whereas SPECT was used to measure brain blood flow (with 99mTc HMPAO). An increase in the function of neurons in a specific area is reflected by an increase in metabolism and a shunting of blood flow toward the area that can be measured with these imaging techniques. Pharmacologic and cognitive provocation of PTSD symptom has been used in order to identify neural correlates of PTSD symptomatology and of traumatic remembrance in PTSD. Administration of yohimbine (which increases NE release) resulted in increased PTSD...

Future Directions

Cognitive-behavioral treatments for anxiety disorders have been empirically supported as effective in reducing anxiety symptoms. While these treatments have generally been targeted to specific disorders, a more recent trend has been to focus on commonalities among anxiety disorders, so that treatments can address these commonalities across diagnoses rather than using a different treatment package for each disorder. Clinical researchers have also been making strides in expanding the CBT packages that are available to additional populations, such as tailoring them to children, or to people with multiple diagnoses (such as those with both anxiety and substance abuse problems), and in disseminating these treatments to a broader range of clinicians. See also Anxiety anger management training (AMT), Anxiety Children, Anxiety in Children FRIENDS program, Exposure therapy, Generalized anxiety disorder, Social anxiety disorder 1, Social anxiety disorder 2

Consciousness and Thinking

However, it was plain to Charles Darwin,* and to his valued colleague George Romanes, that if anatomical and physiological traits were evolutionary continuous* (see CONTINUITY) between nonhuman animals and humans, so too were mental ones. This was true not only of intelligence, but also of emotion and feeling, the most morally relevant aspect of thinking, since, as the philosopher Jeremy Bentham claimed, the ability to experience pain,* fear,* anxiety, hunger, thirst, pleasure, and so on is surely what makes a being worthy of moral concern, since what we do to it matters to it. Darwin made his position on animal feeling clear in his book The Expression of the Emotions in Man and Animals, and Romanes gathered and critically evaluated stories (anecdotes) about animal thought in his books Animal Intelligence and Mental Evolution in Animals. The strongest reason for the return of talk about animal mind has been moral (see MORAL STANDING OF ANIMALS). Since the 1960s, society has grown...

Congenital heart disease

The patient group includes children and young people. Exercise and physical activity levels are dependent on the differing types of congenital heart disease. There may be barriers to exercise in this group, such as current symptoms, lack of interest in exercise and health fears (Swan and Hillis, 2000). A review by Brugemann, et al. (2004) found that patients with congenital heart disease should be included in multidisciplinary CR. In addition, physical training was found to be safe. A pre-training exercise test is required to determine specific and appropriate physical workload. Furthermore, education, psycho-social support and coping strategies to help reduce anxiety are essential parts of CR for this patient group. Paediatric specialists have advocated exercise-training programmes for children with congenital heart disease. A review of literature by Imms (2004) suggests that CR programmes for children should also promote occupational performance activity and integrate exercise into...

Cognitive Behavior Therapy

The major factors distinguishing CBT for children from other psychosocial interventions for youth are their focus on maladaptive learning histories and erroneous or overly rigid thought patterns as the cause for the development and maintenance of psychological symptoms and disorders. As such, CBT for children is focused on the here and now rather than oriented toward uncovering historical antecedents of mal-adaptive behavior or thought patterns. Treatment goals are clearly determined and parents and youth seeking treatment are asked to consider the types of changes they are hoping to see as a result of treatment. Progress is monitored throughout treatment using objective indicators of change, such as monitoring forms and rating devices. CBT for children also emphasizes a skills building approach, and thus is often action-oriented, directive, and frequently educative in nature. For this reason, CBT typically includes a homework component in which the skills learned in treatment are...

Control of the Work of Breathing

Control of breathing is required when tachypnea accompanies shock. Respiratory muscles are significant consumers of precious D o2 during shock and contribute to lactic acid production. Mechanical ventilation and sedation and decrease the work of breathing in shock and have been shown to improve survival. In the absence of a full shock picture, arterial blood-gas analysis can assist in the decision to perform intubation and mechanical ventilation. Sa o2 should be restored to greater than 93 percent and ventilation controlled to maintain a Pa co2 of 35 to 40 mmHg. Attempts to normalize pH above 7.3 by hyperventilation are not beneficial. Mechanical ventilation not only provides oxygenation and corrects hypercapnia, but assists, controls, and synchronizes ventilation, which ultimately decreases the work of breathing.

Control of Oxygen Consumption

The control of Vo2 is important in restoring the balance of oxygen supply and demand to tissues. A hyperadrenergic state results from the compensatory response to shock, physiologic stress, pain, and anxiety. Shivering frequently results when a patient is unclothed for examination and then left inadequately covered in a cold resuscitation room. The combination of these variables increases systemic oxygen consumption. Pain further suppresses myocardial function, thus impairing D o2 and Vo2.15 Providing analgesia, muscle relaxation, warm covering, anxiolytics, and even paralytic agents, when appropriate, decreases this inappropriate V o2. It is also important to provide appropriate anesthesia analgesia for invasive procedures, since this is many times inappropriately forgotten in the haste of expedient intervention.

Contemporary Views Of Cbt With Children

In addition to a child's social network, the family is considered to be a favorable environment for effecting change in the child's dysfunctional cognition. Therefore, CBT-based family anxiety management (FAM) training programs have also been developed to incorporate family-directed problemsolving strategies. In addition to helping parents recognize and effectively manage their own emotional distress, and identify behaviors that may advance or sustain their child's anxiety, parents are taught to utilize their own strengths as care-providers by assisting their children to practice newly developed coping skills, facilitate new experiences for children to test dysfunctional beliefs, and provide positive reinforcement. While parents typically participate in FAM training as a supplement to their child's ICBT or GCBT involvement, FAM can also be conducted without child participation (parents only) or with the family unit as a whole (parents and children participating as a collaborative...

Contemporary Contributors

FRIENDS has a reputation as the only clinically validated early intervention program for anxiety and depression in Australia, and has been distributed nationally under the Mental Health Strategy (satisfying federal guidelines for evidence-based research). Its strong evidence base has encouraged international demand, with the program now being used, validated, and translated in different languages around the world. While culturally sensitive supplements to FRIENDS have also been developed (Barrett, Sonderegger, & Sonderegger, 2001b), recent studies (e.g., Barrett, Moore, & Sonderegger, 2000 Barrett, Sonderegger, & Sonderegger, 2001a Barrett, Sonderegger, & Xenos, in press) have shown FRIENDS in its current format to also be effective in reducing anxiety and stress among culturally diverse migrants and refugee youth. For more information on FRIENDS, see www.friendsinfo.net.

Empirical Basis For Cbt With Children

Although high parental control, parental anxiety, and parental reinforcement of avoidant coping strategies have been associated with children's anxiety symptoms (Shortt, Barrett, Dadds, & Fox, 2001), parents can also be a valuable resource in bringing about positive change in their children. Howard and Kendall (1996) were the first to evaluate the effectiveness of ICBT plus parent involvement using a multiple baseline design. Six clinically anxious children (aged 9-13) and their families participated in treatment that was initiated following baseline assessment periods of 2, 4, or 6 weeks (during which time diagnostic criteria was maintained). Four of six clients experienced treatment gains from pre- to posttreatment as indicated by self-, parent, and teacher reports, and diagnostic ratings by clinicians who were blind to participants' treatment status. The remaining two clients also showed treatment gains on most measures, and for five of the six participants, improvements were...

Initial Baseline Assessment

Transcranial Doppler measurements enable the noninvasive evaluation of blood flow velocities of some cerebral arteries. Investigations have suggested that the monitoring cerebral blood flow is vital in critically ill patients. In particular, the risks of cerebral vasoconstriction induced by hyperventilation, and the sepsis-induced nonhomogenous cerebral blood flow seen in some patients with sepsis, may place certain patients at risk for cerebral ischemia.

Clinical Features

The hallmark of shock is hypoperfusion, often, but not always, accompanied by hypotension. The systolic blood pressure is typically less than 90 mmHg, although it may be within a normal range, especially if the patient has preexisting hypertension. Another blood pressure parameter that may be more sensitive is a 30 mmHg decrease in mean blood pressure or a pulse pressure (systolic-diastolic) of less than 20 mmHg. Although a compensatory sinus tachycardia is common and does not require specific treatment, excessively high or low heart rates do require immediate therapy. Compensatory sympathetic stimulation leads to cool and clammy skin. Oliguria reflects development of poor renal perfusion. Diminishing cerebral perfusion and hypoxemia lead to anxiety and confusion.

Susceptibility to Mood Enhancement by Diet

There is another link between macronutrient intake, stress, and mood. Chronic dysfunction of the stress-sensitive hormone cortisol and its controlling hypothalamic pituitary adrenal (HPA) axis is associated with depression and anxiety and with abdominal obesity. Moreover, protein-rich meals that prevent a meal-induced fall in arousal also stimulate the release of cortisol in unstressed people, and the degree of this effect is positively correlated with the probability of poor psychological well-being. Chronically, a carbohydrate-rich diet is associated with better overall mood state and lower average plasma cortisol than a high-protein diet. Acutely, a carbohydrate preload, but not protein or fat load, enhances cortisol release during stress. This may be related to findings from both human and animal research that suggest that eating carbohydrate-rich and perhaps high-fat foods can help restore normal HPA axis function and gluco-corticoid stress responses. Raised levels of cortisol in...

Empirical Studies

This prediction is supported by studies by McCabe and her colleagues that employed imagery training to enhance sexual arousal among inorgasmic. Imagery training was used in both of these studies to desenzitize inorgasmic women to the anxiety and fears that they held regarding sexual arousal and orgasmic responding. This process of desentitization was designed to enhance both physiological arousal and subjective levels of arousal. It was, therefore, a form of arousal training that was designed to operate at both the physiological and subjective level. The data from both studies demonstrated some level of effectiveness using these techniques.

Nonpharmacologic Modalities Cognitive Behavioral and Physical Therapies for Analgesia and Anxiolysis

Traditionally, nonpharmacologic techniques of pain management in the ED are limited to application of heat or cold, and immobilization and elevation of injured extremities. Other techniques may prove to have a role in the ED and post-ED setting. Among these are cognitive-behavioral techniques, which are effective in reducing pain and anxiety, may control mild pain when used alone, and also enhance patient satisfaction. These techniques include reassurance, explanation, relaxation, music, psychoprophylaxis, biofeedback, guided imagery, hypnosis, and distraction. They are a useful adjunct to pharmacologic management of moderate to severe pain.1 Successful application of these therapies requires a cognitively intact patient and skilled personnel, but many of the techniques require only a few minutes to teach the patient.

Is Addiction a Real Disease

This same area has connections to the emotional areas of the brain (i.e., limbic system). Thus, drug use and addiction can be seen as a disease of brain reward with significant physical and psychological consequences. To truly understand the concept of addiction, one must look at issues of both positive and negative reinforcement. The pleasure effects of the drugs obviously result in positive reinforcement. However, continued drug use ultimately leads to changes in neurotransmitter levels and a host of negative states and emotions (e.g., depression, anxiety, fatigue, etc.). In these cases, continued use of the drug leads to a decrease in these unpleasant effects and results in what is called negative reinforcement (e.g., removal of unpleasant feelings) and the subsequent return to a normal (in this case, drugged brain) state. Research has led to a new understanding of addiction that is not based solely on withdrawal effects.

Thoughts on Brenda and Michael

It is suggested by Blanchard (1946) that in a certain proportion of cases, perhaps 20 per cent, reading disability is a symptom of an underlying neurotic anxiety. She does not dispute that there may be many cases where there is emotional disturbance resulting from the failure at reading, but her special concern is with those cases where the neurotic anxiety is itself a causal factor. In such cases it would seem that improvement at reading is difficult or impossible without an adequate working through of the unconscious fantasies which underlie the neurosis.

Measurement of dyspnea

Non-pharmacological treatments may offer relief for the extreme distress but not for the actual intensity of dyspnea. Therefore, if possible the 'anxiety' or 'distress' associated with dyspnea should be measured. The changes in intensity and distress associated with dyspnea can be measured over time to evaluate treatment modalities and fluctuations that will predict changes in the patient's activities and care needs.

Differences in Personality

Females express more fear, are more susceptible to anxiety, are more lacking in task confidence, seek more help and reassurance, maintain greater proximity to friends, score higher on social desirability, and at the younger ages at which compliance has been studied, are more compliant with adults (Block, 1976, p. 307). There is much evidence showing that women have stronger guilt feelings, and are more intropunitive than men (Wright, 1971). It has been stated that women experience higher rates of childhood abuse, especially sexual abuse, which is a predictor of later depression, and may have depressions related to hormonal changes and to sex-role conditioning that encourages patterns of negative thinking and passivity (McGrath, Keita, Strickland, & Russo, 1990). In the United States, it has been estimated that between 2.3 and 3.2 of men, and between 4.5 and 9.3 of women, meet the diagnostic criteria for major depressive disorder at any given moment (Depression Guideline Panel,...

Programming of Change

Specific goals are established for each session. Perhaps only one or two behaviors will be focused on in a session, or the initial repertoire might be such that all needed verbal and nonverbal behaviors can be practiced. Assessment of the client's behavior in relation to given situations will reveal available behaviors and training should build on available repertoires. Hierarchies ranked in terms of the degree of anxiety or anger that different social situations create can be used to gradually establish effective assertive skills and lessen anxiety Rehearsal starts with situations creating small degrees of anger or anxiety. Higher-level scenes are introduced as anxiety or anger decreases. Thus, introduction of scenes is programmed in accord with the unique skill and comfort levels of each client. Improvements are noted and praised. Praise for improvement should be in relation to a client's current performance levels.

Hardware and Software

The internal video circuit had to be adapted for Internet video streaming. An encoder transformed the analogue signal of the internal video circuit into a digital video stream. The encoding was done on-line in real time with a delay (buffer) of five seconds, and the frame rate was ten frames per second. A 56K modem on an average bandwidth network was able to adequately handle the data flow. A higher-quality modem did not provide a better image of the newborn, because the load of encoded data was relatively low changes in light intensity were few, the newborn hardly moved, and movement around the crib was limited. Sound was not encoded because of privacy considerations rather than technical limitations the microphone of a newborn in one crib could transmit speech from physicians or nurses providing care to another nearby newborn. Furthermore, it is was feared that parents might misinterpret sounds on the ward, such as the audio control signals from respiratory equipment, thus raising...

Cognitive Restructuring Changing What Clients Say to Themselves

Thoughts relevant to assertive behavior include helpful attributions (casual accounts or behavior), realistic expectations (I may not succeed no one succeeds all the time), helpful rules (when in doubt think the best), self-reinforcement for efforts to improve and positive consequences, problem-solving skills, and accurate perception and translation of social cues (e.g., noting and accurately interpreting a smile as friendly). In addition, cognitive skills (e.g., distraction) are involved in the regulation of affect (e.g., anger or anxiety). Unrealistic beliefs (such as I must always succeed) and other kinds of thoughts such as negative self-statements that get in the way of assertive behavior should be identified and replaced by helpful self-statements and beliefs. This process is initiated during assessment and continues during intervention. Discussion of beliefs about what is proper assertive behavior and who has what rights

The Ethics and Goals of Advertising

Youth, power, beauty, sex, and affluence), associating the product with images of attractive people in beautiful surroundings. The consumer is left to feel tremendous anxiety about the possible consequences of making the wrong choice of detergent, antiperspirant, or health plan.

Measurement of the affective responses to dyspnea

Both normal subjects50 and patients with COPD who are exercising54 or completing daily self-reports43 can distinguish the intensity of their shortness of breath from the anxiety and or distress it causes them. After treatment, patients have stated that the intensity of shortness of breath with exercise may be at the same level, but because they feel more in control of the symptom, they are less anxious about the symptom, and therefore, the same intensity of shortness of breath is less distressing for them. In addition, there is also evidence that patients with chronic illness may not change their rating of the level of the intensity of shortness of breath over time despite worsening of lung function60 or advancing disease.61 However, their anxiety or distress with the dyspnea may decrease after treatments such as pulmonary rehabilitation or exercise training.62 Therefore, it is important that the anxiety or distress associated with dyspnea be measured in addition to the intensity. At...

Conclusion and Limitations

Parents were enthusiastic about the possibility of using Telebaby as a complement to their regular hospital visits. The login activity of parents showed that using standard Internet technology to distribute multimedia images allowed parents to visit their newborn more often than they could have without the technology and markedly reduced the anxiety associated with the mother-child separation. The preliminary results of a questionnaire administered to parents (n 27) indicated that Telebaby gives the parents a feeling of control in regard to knowing the state of their newborn. Parents of newborns are preoccupied lack of a working system lowers their feeling of control over the state of their newborn and raises anxiety.

Phase II cardiac rehabilitation

This is the initial post-discharge stage, and can tend to be rather low key, although it is a time when patients may feel isolated and somewhat insecure, and when high levels of anxiety may be present. Thus, it is important that patients and their families significant others have access to appropriate health care professionals. Depending on the service available, contact with the cardiac rehabilitation team may be by phone or home visit, with primary care also involved. This is the stage where modification of risk factors will start and goals set in phase I CR should start to be realised. For patients issued with the heart manual post-MI, this can be used immediately (Lewin, et al., 1992), and for other patients an individualised walking programme may be started at this stage. The use of pedometers can help patients and CR staff monitor home walking programmes.

Phase III cardiac rehabilitation

The structure of phase III is usually at least two supervised exercise sessions per week, lasting over a period of between 6 and 12 weeks. One session of education per week may be offered. Physical training is often the key component of phase III CR, but psycho-social counselling and education regarding risk factors and lifestyle are important. Strategies to enable a reduction in depression, anxiety and uncertainty, accepting the heart disease and learning to cope with it are discussed as appropriate. As with earlier phases of CR, the involvement of family and significant others continues to be important. Risk stratification prior to patients commencing phase III exercise classes is essential and will be examined in Chapter 2.

The Paediatric Patient

There is no universally good premedicant for children, trimeprazine makes many children irritable and uncontrollable in an unpredictable way and the injectable premedicants are probably better avoided because of the distress caused by the injection. Day case admission can result in insufficient time for anxiolytic pre medication to have effect (and the use of sedatives in day surgery may be undesirable). All children should have topical local anaesthetic cream or gel applied to the proposed venepuncture site at least 1 hour before anaesthesia. Drug doses in children should always be calculated on a weight-related basis, a calculation which will give an approximation of the required dose. If dilution of a drug is proposed then each syringe should be labelled with the drug name and concentration. Ambiguity must be avoided at all costs.

Physical Examination

The physical examination is not helpful in distinguishing patients with acute coronary syndromes from those with noncardiac chest pain syndromes unless an alternate diagnosis is clear. Patients with acute coronary syndromes may appear deceptively well without any clinical signs of distress or may be uncomfortable, pale, cyanotic, and in respiratory distress. Vital signs may reveal bradycardia, tachycardia, or irregular pulses. Bradycardic rhythms are more common with inferior wall myocardial ischemia. In the setting of an anterior wall infarction, bradycardic rhythms or heart block is an extremely poor prognostic sign. Blood pressure can be normal, elevated (due to baseline hypertension, sympathetic stimulation, and anxiety) or decreased (due to pump failure or inadequate preload). Extremes of blood pressure are associated with a worse prognosis.

TABLE 478 Frequency of Occurrence of Arrhythmias during Acute Myocardial Infarction

Sinus tachycardia is quite prominent in patients with anterior wall AMI. Because of increased myocardial oxygen utilization, persistent sinus tachycardia is associated with a poor prognosis. The etiology of the sinus tachycardia should be determined. It may include anxiety, pain, left ventricular failure, fever, pericarditis, hypovolemia, atrial infarction, pulmonary emboli, or use of medications that accelerate heart rate. Similarly, paroxysmal supraventricular tachycardia, atrial fibrillation, and atrial flutter are associated with an increased mortality. Atrial premature contractions are common. They occur in up to 50 percent of AMI patients, and are not associated with an increased mortality related to the acute event.

Past medical and drug history

The possibility of a psychiatric history should be considered. Some clusters of symptoms at presentation are more likely to be linked with psychiatric diagnoses. People presenting with multiple symptoms, and concerns over many foods and other environmental problems, have been shown to be more at risk of symptoms of depression or anxiety.10 Parents may make claims of multiple food allergies in their children. Such claims have been known to be sufficiently extreme to be diagnosed as Munchausen's by Proxy.11

Management of Head Injury

The crux of immediate management in head injury is to avoid secondary injury. The primary injury has already occurred and any damage done will be largely irreversible. Oedema develops around the injury site and secondary injury must be avoided by reducing ICP (especially avoiding dramatic rises in ICP) and preventing hypoxic damage. The main decision to be made is whether the patient requires tracheal intubation, for control of ICP, surgery to other parts of the body, investigation such as CT scanning or for transport to other facilities. In general, a GCS less than 8 indicates the need for major intervention and intensive care management. In addition to the GCS, the pattern of respiration, pulse and blood pressure should be taken into consideration. Spontaneous hyperventilation indicates significantly raised ICP, as does arterial hypertension accompanied by bradycardia. Control of ICP is of the utmost importance. Uncontrollable confusion and irritability may indicate significant...

Psychodynamic Approaches

Initial attempts to account for variations in patterns of marital interaction across cultures focused in particular on marital aloofness. The goal was to explain why husbands and wives in some societies tended to avoid one another and to devalue the importance of their relationship. The most influential explanations of marital aloofness, in turn, relied on a prior commitment to psychodynamic theory, which assumes that human motivation is influenced by unconscious mechanisms meant to minimize anxiety. With regard to marital interaction, the assumption was that aloof marriages prevail in societies where men are anxious about sex and or women. To deal with their anxiety, men simply avoid their wives. As is characteristic of psycho-dynamic theory, the source of male anxiety was traced to childhood.

Assessment And Differential Diagnosis

BDD is regularly associated with comorbid or secondary disorders, including major depression (approximately 60-80 ), social phobia (lifetime rate of 38 ), substance use disorder (lifetime rate of 36 ), and obsessive-compulsive disorder (lifetime rate of 30 ) (Phillips & Diaz, 1997). Individuals with BDD may hold their preoccupations with a delusional intensity, which would warrant the added diagnosis of delusional disorder, somatic type (APA, 2000). However, recent theory suggests that adding the delusional diagnosis has little value and contradicts current etiopathol-ogy and treatment response indications (Castle & Phillips, 2002).

The Therapeutic Environment Animals as an Aspect of Milieu Therapy

For example, Aaron Katcher, Arline Segal, and Alan Beck reported, in their study on anxiety and discomfort before and during dental surgery, that subjects viewing the aquarium appeared more comfortable and less anxious than those subjects in a control group not viewing an aquarium. Watching a school of fish can be quite relaxing for some. With proper lighting and an attractively designed tank, clients can feel more at ease when they enter an office or while in therapy.

Clinical Case Formulation

Increasingly, clinical case formulation is being viewed by behavior therapists as a crucial contribution to successful treatment outcome. Recent volumes on clinical case formulation highlight the prominent role case formulation plays in treatment planning. However, appreciation for the importance of clinical case formulation in the behavioral paradigm is a relatively recent phenomenon. Behavioral models of clinical case formulation have focused on the identification of antecedent conditions and behavioral effects that maintain the target problem. Clinical case formulations have spanned a wide array of disorders and behaviors including transient tic disorder, delusional speech in schizophrenia, trichotillomania, obsessive-compulsive disorder, developmental disabilities, chronic cough, and borderline personality disorder.

Exposure Hierarchy and Response Prevention

A hierarchy of graded imaginal and in vivo exposures is collaboratively constructed in the early stages of treatment. For clients with BDD concerns, exposure therapy is helpful in decreasing self-consciousness and body-related anxiety and minimizing the avoidance of feared body image situations (Rosen et al., 1995). Hierarchy items can be adjusted by modifying situations with respect to familiarity of people, physical proximity to others, and type of social interaction (Rosen et al., 1995).

Psychological factors

Effort to protect the heart) and further preoccupation with symptoms. Reduced activity leads to physical deconditioning, often producing more fatigue, more time to dwell on any symptoms or bodily sensations, and therefore generates further anxiety. Other patients become trapped in a downward spiral of increasing disability, and a very small number will succumb to a restricted and fearful lifestyle that has been labelled in many different ways over the years for example cardiac neurosis, neurocirculatory asthenia or effort syndrome. These patients are currently described as demonstrating undue illness behaviour. They demonstrate high levels of anxiety, physical deconditioning, a dependent attitude towards medical care, and often an almost obsessional preoccupation with the details of their medical history.

Evidence For Cognitive Behavior Therapy

Preliminary evidence for the efficacy of cognitive behavior therapy (CBT) in BDD comes from two randomized controlled trials (RCT) (Rosen, Reiter, & Orosan, 1995 Veale, Gournay et al., 1996). There are also several case series of behavioral and cognitive therapy (Geremia & Neziroglu, 2001 Gomez Perez, Marks, & Gutierrez Fisac, 1994 Marks & Mishan, 1988 Neziroglu & Yaryura Tobias, 1993 Wilhelm, Otto, Lohr, & Deckersbach, 1999). In the first RCT, Rosen et al. (1995) randomly allocated 54 patients diagnosed as having BDD to either group CBT or a waiting list. After treatment, 82 (22 out of 27 subjects) of the CBT group were clinically improved and no longer met the criteria for BDD compared to 7 (2 out of 27 subjects) in the waiting list group. The subjects were, however, different from those described at other centers for example, they were all female, 38 were preoccupied by their weight and shape alone, and they tended to be much less socially avoidant and handicapped...

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