Beruflich Dokumente
Kultur Dokumente
Anxiety definition
Anxiety is best defined as an intense feeling of unease, worry, and fear. It is common to
feel anxiety when faced with a challenging situation ( Yolanda Williams )
An emotional state of a human during life is both life – saving and also causes many
problems in the mental life of human beings. The feeling of worry, nervousness, or unease about
something with an uncertain outcome. When an individual faces potentially harmful or worrying
triggers, feelings of anxiety are not only normal but necessary for survival. (Garner, et.al., 2009)
Anxiety serves as the body’s warning system – the brain’s way of telling the body that
something bad could happen. This response relates to but is distinct from fear, which alarms us
when something actually dangerous is happening or is just about to happen. (Donald , et.al.,
2013)
The concepts of state and trait anxiety were first introduced by Cattell (1966; Cattell
&Scheier, 1961, 1963) and have been elaborated by Spielberger (1966, 1972, 1976, 1979). In
general, personality states may be regarded as temporal cross sections in the stream-of-life of a
person (Thorne, 1966), and emotional reactions as expressions of personality states
(Spielberger, 1972). Although personality states are often transitory, they can recur when
evoked by appropriate stimuli; and they may endure over time when the evoking conditions
persist. In contrast to the transitory nature of emotional states, personality traits can be
conceptualized as relatively enduring differences among people in specifiable tendencies to
perceive the world in a certain way and in dispositions to react or behave in a specified manner
with predictable regularity.Personality traits have the characteristics of a class constructs that
Atkinson (1964) calls “motives” and that Campbell (1963) refers to as “acquired behavioral
positions.”
History
The twentieth century has been called the Age of Anxiety, but concerns about fear and
anxiety are as old as humanity itself. Although fear has been of interest since ancient times,
anxiety was not fully recognized as a distinct and pervasive human condition until shortly before
the beginning of the present century. It was Freud who first proposed a critical role for anxiety in
personality theory and in the etiology of psychoneurotic and psychosomatic disorders. Anxiety
was the “fundamental phenomenon and the central problem of neurosis” (Freud, 1836, p.85).
Origin
Angst
Anxiety
The term ‘ anxiety ‘ is derived from the Greek word , ‘ angst ‘ which means fear. ( Watson
et.al., 1988)
Levels of anxiety
1. Mild level of anxiety is healthy, at this level, perceptual field is heighten, pupils dilate to
accommodate much light, hearing and smelling intensified, and sense of touch is highly
sensitive. The individual is highly alert and attentive and learning and cognition is in its best
state. This stage improves academic performance. (Cohen , 2008 )
2. Moderate level of anxiety on the other hand is unhealthy, the perceptional field of a person at
this level is narrowed; individuals experiencing this level of anxiety have selective inattention.
They have decreased focus and automatism can be observed as repetitive purposeless movements
such as shaking of the hands and feet, twirling of hair and, tapping of fingers. Academic
performance at this level depends on the individual's ability to control the anxiety and carry out
the assigned task. (Gadye,2018)
4. Panic level of anxiety is the worst and most severe form of anxiety. Total disruption of
perceptual field is present. It is also characterized by loss of ability to communicate, loss of
rational thought and total loss of conscious thinking. Academic performance at this level is very
poor since the student will be unable to remember exactly what he/she is supposed to do.
(Khemiani et.al.,2012)
Types of anxiety
Major category
State anxiety
State anxiety reflects the psychological and physiological transient reactions directly
related to adverse situations in a specific moment. (Attwell, 2010)
Trait anxiety
Trait anxiety refers to the stable tendency to attend to, experience, and report negative
emotions such as fears, worries, and anxiety across many situations.( Attwell, 2010)
Conscious anxiety
Conscious anxiety is that which we know we fear. Snakes, heights, germs, a first date, a
big presentation, taking a test, or going to the doctor are all common conscious fears. (Attwell,
2010)
Unconscious anxiety
Unconscious anxiety is that which is beyond our conscious awareness. This anxiety most
often declares itself when someone has a panic attack seemingly out of blue. ( Attwell, 2010)
Other anxieties
People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most
days for at least 6 months, about a number of things such as personal health, work, social
interactions, and everyday routine life circumstances. The fear and anxiety can cause significant
problems in areas of their life, such as social interactions, school, and work.
Panic Disorder
People with panic disorder have recurrent unexpected panic attacks. Panic attacks are
sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks
can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.
During a panic attack, people may experience:
People with panic disorder often worry about when the next attack will happen and
actively try to prevent future attacks by avoiding places, situations, or behaviors they associate
with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause
significant problems in various areas of the person’s life, including the development of
agoraphobia. ( Schmidt et.al., 2002)
Phobia-related disorders
May have an irrational or excessive worry about encountering the feared object or situation
Take active steps to avoid the feared object or situation
Experience immediate intense anxiety upon encountering the feared object or situation
Endure unavoidable objects and situations with intense anxiety
There are several types of phobias and phobia-related disorders:
As the name suggests, people who have a specific phobia have an intense fear of, or feel
intense anxiety about, specific types of objects or situations. Some examples of specific phobias
include the fear of:
Flying
Heights
Specific animals, such as spiders, dogs, or snakes
Receiving injections
Blood(Clarke ,2011 ).
People with social anxiety disorder have a general intense fear of, or anxiety toward,
social or performance situations. They worry that actions or behaviors associated with their
anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry
often causes people with social anxiety to avoid social situations. Social anxiety disorder can
manifest in a range of situations, such as within the workplace or the school environment.(Claeke
, 2011 ).
Agoraphobia
People with agoraphobia have an intense fear of two or more of the following situations:
People with agoraphobia often avoid these situations, in part, because they think being
able to leave might be difficult or impossible in the event they have panic-like reactions or other
embarrassing symptoms. In the most severe form of agoraphobia, an individual can become
housebound. ( Bourne,E.J.,2005)
Separation anxiety is often thought of as something that only children deal with;
however, adults can also be diagnosed with separation anxiety disorder. People who have
separation anxiety disorder have fears about being parted from people to whom they are
attached. They often worry that some sort of harm or something untoward will happen to their
attachment figures while they are separated. This fear leads them to avoid being separated from
their attachment figures and to avoid being alone. People with separation anxiety may have
nightmares about being separated from attachment figures or experience physical symptoms
when separation occurs or is anticipated. ( Barlow,D.H.,2002)
Selective mutism
A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism
occurs when people fail to speak in specific social situations despite having normal language
skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme
shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and
temper tantrums. People diagnosed with selective mutism are often also diagnosed with other
anxiety disorders. ( Attwell , 2010)
Putting the money in denominational order, facing same way in my wallet when
receiving change at the store.
Buying things in multiples of two even the person is not in need of many number of
things.
Checking the lock, kitchen, pipes etc.. are shut or not when going out of house.
Counting everything that falls under the vision like tress, staircase etc… ( Schuster, 2017)
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after
experiencing or witnessing a traumatic event, or learning that a traumatic event has happened to
a loved one. DSM5 defines a traumatic event as exposure to actual or threatened death, serious
injury, or sexual violence. (Herman, J.,1997)
Health Anxiety
Although health anxiety is not a disorder, there are several disorders defined by excessive
anxiety related to somatic or physical symptoms, or having an illness or condition. In adults,
these health worries are excessive, ongoing, and uncontrollable, and often result in frequent visits
to medical professionals and reassurance seeking from loved ones all due to exaggerated fears of
being ill. ( Albom, M., 1997)
Performance anxiety
Any situation where you want to perform at your best and are worried about your ability
to do so can create performance anxiety. It turns out that a person’s mentality is just as important
as their ability. The extreme nervousness experienced before or during participation in an
activity. ( Yali et.al., 1999)
Pregnancy anxiety
A negative emotional state that is tied to worries about “the health and well-being of
one’s baby, the impending childbirth, of hospital and health-care experiences (including one’s
own health and survival in pregnancy), birth and postpartum, and parenting or maternal role”
(Dunkel Schetter, 2011, pp. 534–535).
Sexual anxiety
Researchers found that anxious individuals find it harder to avoid distractions and take
more time to turn their attention from one task to the next than their less anxious peers. This
makes learning, reading, remembering and writing difficult affecting academic performance.
Since, the anxious individuals perform at a comparable level to the non-anxious ones with a
greater cost in terms of effort or perhaps long term stress; it is believed that students with high
anxiety as well as those with low anxiety will have lower academic performance. Therefore,
those with moderate levels of anxiety will perform the best , maintained that if an individual's
experience is negative, then anxiety level will be higher, leading to lower academic performance.
Consequently, if an individual's experience is positive, then the anxiety level will be lower
leading to higher academic performance. From these investigations, it has been observed that
high and lower levels of anxiety is related to poor academic performance while a moderate level
of anxiety is related to optimum academic performance.
Theories of anxiety
Operant conditioning
B.F. Skinner, one of the prominent psychologist of the last century conducted many
researches demonstrating that behavior was influenced not only by what occurred before it (as
in classical conditioning, but also by what occurred afterward. Skinner believed that human
beings (and animals) learn a behavior through a system of rewards and punishments. These
rewards and punishment occur naturally in the external environment. When psychologists use the
word "environment," they are referring to all the external events that are going on around a
person.
Cognitive theory
In the 1950's, a psychologist named Albert Ellis, and a psychiatrist named Aaron Beck,
which became popular cognitive theory. According to cognitive theory, our dysfunctional
thoughts lead to extreme emotions. These extreme emotions in turn, lead to maladaptive
behaviors. Albert Ellis's cognitive therapy is called Rational Emotive Behavior Therapy (REBT).
He believed peoples' intense suffering from negative emotions was caused by their irrational core
beliefs. Core beliefs refer to the basic beliefs people have about themselves and the world around
them. He realized that people's internal thoughts and perceptions had a large influence on their
emotions. He also believed that a more active and directive approach to modify thoughts would
positively influence behavioral change. According to Beck, the way we interpret environmental
events is a function of our core schema. A core schema is a central assumption about oneself,
others, and the world. These assumptions influence our feelings and behavior.
Psychodynamic theory
In 1890’s Freud didn’t consider anxiety to be related to thoughts or ideas, but he did
observe that it was closely linked to sexuality, defining it as sexual excitation that has been
transformed. Freud’s argument was that when the path to satisfaction is blocked, resulting build-
up of unsatisfied libido takes on a toxic character, finding an outlet in anxiety. His theory of
repression describes how the ideas connected to sexual urges are repelled from consciousness
when they come into conflict with ‘civilized’ social norms. His earlier ‘toxic theory’ of anxiety
as transformed sexual excitation was preserved, but with an important modification: while his
earlier views assumed the cause of anxiety to be external blocks to sexual release, the theory of
repression shifted the emphasis to internal ones or psychological inhibitions. This new
perspective led Freud to a complete reversal of his former position: whereas before he had
posited anxiety as a result of repression, he now understood it as preceding repression and giving
rise to it. (Butler & Mathews , 1983 ).
For Maslow, the goal of any human being is to reach a state of "self-actualization" in
which all their needs are met and a state of contented happiness is achieved. However, these
needs must be met in a particular order. According to Maslow, higher forms of happiness are not
achievable so long as these needs are not met.
May felt that the absence of an innate moral structure in the universe usually led to
people experience anxiety and distress because their expectations of the universe were simply
not being met. His school of existential psychology is intended to deal with exactly this, the
problems that arise from human consciousness working against the problems inherent in
existence.(Butler & Mathews , 1983 ).
Carl Rogers was the first to advocate for the importance of "unconditional positive
regard", a way of viewing one's self in which one is unconditionally positive and accepting,
maintaining the right to be critical without being judgmental or overly harsh. (Butler & Mathews
, 1983 )
Social learning theory combines cognitive learning theory, which posits that learning is
influenced by psychological factors, and behavioral learning theory, which assumes that learning
is based on responses to environmental stimuli. Psychologist Albert Bandura integrated these
two theories in an approach called social learning theory, and identified four requirements for
learning—observation (environmental), retention (cognitive), reproduction (cognitive),
and motivation (both). Bandura did the famous bobodoll experiment and concluded that children
learn aggression, violence, and other social behaviors through observation learning, or watching
the behaviors of others. (Bailey, 2007)
Many animal models of anxiety examine the natural behavioural patterns of mice and rats
to develop ethologically based behavioural tasks (Rodgers et al., 1997). These include
‘approach–avoidance' tasks (Cryan and Holmes, 2005) in which animals are exposed to an
aversive/threatening environment e.g. open, elevated arms of the elevated plus-maze, light arena
(light/dark exploration/emergence tests); and open field tests, with anxiety-like behaviour
(phenotype) in each case, inferred from increased avoidance. Other models include social
interaction tests (review by File and Seth, 2003), punishment-based conflict procedures (e.g.
punished drinking — Vogel et al., 1971), defensive burying tests (Jacobson et al., 2007),
predator stress (Blanchard and Blanchard, 1971), and the examination of ultrasonic vocalizations
induced by stress such as maternal separation (see Sanchez, 2003), while novel techniques
include the use of radiotelemetry to asses a variety of physiological parameters in real time (e.g.
core body temperature, Adriaan Bouwknecht et al., 2007). Such models examine behaviour that
is functionally rather than superficially related to human anxiety (i.e. they show good face
validity) and probe mechanisms derived from theory (possess good construct validity).
These new techniques, which include the possibility of creating transgenic and knockout
animals to investigate the effects of any known gene, are expected to speed up the molecular
dissection of anxiety and ultimately lead to the design of more efficient anxiolytic drugs.
(Laborit ,1993 )
The consequences of anxiety during test or examination may limit the educational or
vocational development and promotion through the educational system. It is normal for a student
to feel anxious before a test or examination, but it becomes problematic when the level of
anxiety is excess. The negative effects of anxiety can be explained by two models namely; the
Interference and the Learning Deficit Models.
According to the interference model, anxious( J. A. Afolayan et al, 2013 ) students are
distracted due to task irrelevant cognitions and negative thoughts during examinations, while the
learning deficit model proposes that it is student’s ineffective study habits during preparation for
an examination that causes them to be anxious .(Bower , Gilligan , Monterio ,1981 ).
Causes of anxiety
Personality factors
Research suggests that people with certain personality traits are more likely to have
anxiety. For example, children who are perfectionists, easily flustered, timid, inhibited, lack self-
esteem or want to control everything, sometimes develop anxiety during childhood, adolescence
or as adults.
Anxiety conditions may develop because of one or more stressful life events. Common triggers
include:
Chronic physical illness can also contribute to anxiety conditions or impact on the treatment
of either the anxiety or the physical illness itself. Common chronic conditions associated with
anxiety conditions include:
diabetes
asthma
Some physical conditions can mimic anxiety conditions, like an overactive thyroid. It can be
useful to see a doctor and be assessed to determine whether there may be a medical cause for
your feelings of anxiety.
While some people may experience an anxiety condition on its own, others may
experience multiple anxiety conditions, or other mental health conditions. Depression and
anxiety conditions often occur together. It's important to check for and get assistance for all these
conditions at the same time.
Substance use
Some people who experience anxiety may use alcohol or other drugs to help them
manage their condition. In some cases, this may lead to people developing a substance use
problem along with their anxiety condition. Alcohol and substance use can aggravate anxiety
conditions particularly as the effects of the substance wear off. It's important to check for and get
assistance for any substance use conditions at the same time.
Reference
American Psychiatry Association 1994. DSM IV Diagnostic and Statistical - Manual, 4th
Edition. American Psychiatric Association: Washington, D.C.
Bailey, J.E., 2007. A validation of the 7.5% CO2 model of GAD using paroxetine and lorazepam
in healthy volunteers. J. Psychopharmacol. 21 (1), 42–49.
Grillon, C., 1998b. Effects of experimental context and explicit threat cues on acoustic startle in
Vietnam veterans with posttraumatic stress disorder. Biol. Psychiatry 44 (10), 1027–1036.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures
of positive and negative affect: The PANAS scales. Journal of Personality and Social
Psychology, 54(6), 1063–1070.
Yali, A. M., & Lobel, M. (1999). Coping and distress in pregnancy: An investigation of
medically high risk women. Journal of Psychosomatic Obstetrics & Gynecology, 20(1), 39–52.
Albom, M. (1997). Tuesday with Morrie: An old man, young man, and life’s greatest lesson,
New York: Doubleday.
Bourne, E.J. (2005).Anxiety and phobia workbook. Oakland, CA: New Harbinger Publications.
Bronson, P. (2002). What should I do with my life? The true story of people who answered the
ultimate question. New York: Random House.
Freud, A. (1946). The ego and the mechanism of defence. New York: International Universities
Press, Inc.
Schmidt, M.D., Leonard J., & Warner, B.(2002). Panic: Origins, insight, and treatment.
Berkeley, CA: North Atlantic Books.
Clark, D. (2011) Implementing NICE guidelines for the psychological treatment of depression
and anxiety disorders: The IAPT experience, International Review of Psychiatry 23, 375–84.
Bower, G. H., Gilligan, S. G., & Monteiro, K. P. Selectivity of learning caused by affective
states. Journal of Experimental Psychology: General, 1981, 110, 451–473.
J. A. Afolayan et al Adv. Appl. Sci. Res., 2013, 4(5):25-33 , 28 Pelagia Research Library)
Argote, L., McEvily, B., & Reagans, R. (2003). Managing knowledge in organizations: An
integrative framework and review of emerging trends [Electronic version]. Management Science,
49(4), 571-582