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  1. Home
  2. Books
  3. Anxiety Disorders
  • Cited by 41
Publisher:
Cambridge University Press
Online publication date:
November 2010
Print publication year:
2010
Online ISBN:
9780511777578
DOI:
https://doi.org/10.1017/CBO9780511777578
Subjects:
Psychiatry and Clinical Psychology, Medicine, Psychiatry
Information

Book description

Anxiety disorders are amongst the most common of all mental health problems. Research in this field has exploded over recent years, yielding a wealth of new information in domains ranging from neurobiology to cultural anthropology to evidence-based treatment of specific disorders. This book offers a variety of perspectives on new developments and important controversies relevant to the theory, research, and clinical treatment of this class of disorders. Clinicians will find reviews of state-of-the-art treatments for panic disorder, social anxiety disorder, phobias, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder, as well as controversies over diagnostic and treatment issues. Researchers will find in-depth consideration of important selected topics, including genetics, neuroimaging, animal models, contemporary psychoanalytic theory, and the impact of stressors. This book illustrates the enormous advances that have occurred in anxiety research and describes the evolving multi-disciplinary efforts that will shape the future of the field.

Reviews

‘It is uncommon to read a good book on anxiety disorders. This one, however, is unusually fine. Anxiety Disorders: Theory, Research and Clinical Perspectives is highly descriptive and clinically useful. It is well researched and a pleasure to read … It is written in a compelling style, which is a benefit to the student, clinician, or educated layman. The references are excellent and the index is helpful. This is a good book for any clinician interested in anxiety. It covers theory, diagnoses, treatment, and future directions … I highly recommend it.’

James Allen Wilcox Source: Annals of Clinical Psychiatry

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Contents

Page 2 of 2

Contents
  • 20 - Attachment, separation, and anxiety disorders
    pp 227-238
  • View abstract

    Summary

    Health anxiety and medically unexplained symptoms are challenging both for patients and for clinicians. This chapter discusses a conceptual framework for health anxiety, focusing on diagnostic considerations, epidemiology, etiology, measures of health anxiety, clinical considerations, practical management, treatments, and future research directions. Determining the prevalence of health anxiety is challenging in large part due to variability in classification. When considering predisposing factors for health anxiety, family studies can be informative. While the genetics of health anxiety are not yet understood, by examining related disorders people can gain a sense of familial risk factors. The somatic amplification seen in health anxiety, as well as somatization and pain disorders, may also occur through a process of immune-mediated sensitization. The two treatment modalities for hypochondriasis with the most empirical support, cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are discussed in the chapter.
  • 21 - Non-human primate models in understanding anxiety
    pp 239-248
  • View abstract

    Summary

    This chapter addresses the complex inter relationships between anxiety disorders (ADs) and personality disorders (PDs), including diagnostic controversies, patterns of comorbidity, and prognostic implications for treatment. The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) created five axes for diagnostic classification, including Axis I for illnesses such as ADs and Axis II for PDs. The presence of an Axis I state disorder may confound diagnosis of Axis II trait. The biopsychosocial model suggests that illness arises from the interplay of genetic, trait, and environmental influences. PDs are less prevalent than ADs. Limited information exists on the comorbidity between ADs and PDs in the general population. Available data suggest that PD comorbidity among ADs is common, except in the case of specific phobia. Current evidence yields more questions than answers, due in part to the complexity of assessing PDs and the labor and expense of large-scale, longitudinal studies.
  • Section 4 - Treatment of anxiety: current status and controversial issues
    pp 249-361
  • View abstract

    Summary

    This chapter describes the clinical relevance of idioms of distress for the generation and treatment of anxiety disorders, focusing mainly on those related to panic disorder and post-traumatic stress disorder (PTSD) in Southeast Asian and Latino populations. It reviews idioms of distress that are cultural illness syndromes. Certain idioms of distress may indicate impairment in psychosocial functioning, including work and social functioning, as well as general well-being, as assessed by quality-of-life and disability measures. The chapter also presents a model of how anxiety disorders and idioms of distress mutually reinforce each other, forming interacting escalating loops that link expectation, attention, catastrophic cognitions, and activation of the autonomic nervous system. Awareness of the relationship between cultural syndromes and anxiety disorders can enhance clinicians' ability to engage patients about a variety of therapeutic approaches and to tailor evidence-based treatments to patients' cultural understandings and experiences.
  • 23 - Treatment of social anxiety disorder
    pp 260-270
  • View abstract

    Summary

    This chapter discusses the evidence for the role of genetic factors in the etiology of anxiety disorders, and summarizes the genetic study designs used in research on anxiety disorders. Molecular genetic study designs used to investigate the genetics of anxiety disorders include linkage analysis and candidate gene association studies. Twin studies support a heritability estimate between 30% and 40%. More recently, regulators of G-protein signaling have been investigated regarding anxiety-related phenotypes including panic disorder. Family studies suggest that risk of social anxiety disorder (SAD) to first-degree relatives of SAD probands ranges from 16% to 26%. Investigations of panic disorder, specific phobias, SAD, and obsessive-compulsive disorder (OCD) have produced some evidence of linkage to specific regions. Two exciting yet mostly unexplored areas in anxiety disorder research are gene-environment interaction and epigenetic studies. Epigenetic research examines the dynamic heritable changes in the function of a gene.
  • 25 - Panic disorder and agoraphobia
    pp 284-296
  • View abstract

    Summary

    This chapter reviews the methods for validating animal models of psychiatric disorders and discusses specific models of anxiety in mice. It demonstrates the importance of understanding the validity of a particular animal model, which assists in determining its clinical relevance in the context of careful interpretation. Currently, two main types of genetically modified mice are used in laboratory: knockout mice or knock-in mice and transgenic mice. The chapter reviews how state-of-the-art transgenic technology can be used to make animal models that allow us to consider the contribution of particular genes to anxiety-like behaviors. Several lines of evidence from human studies have implicated the 5-HT1A receptor in affective disorders. The studies of the 5-HT1A receptor provide an illustrative example of the strengths and weaknesses inherent in using the genetic technologies to investigate the pathophysiology of anxiety.
  • 26 - Treatment of late-life generalized anxiety disorder
    pp 297-305
  • View abstract

    Summary

    The most widely studied behavioral model of fear is classical fear conditioning as it may be assessed across many different species, including humans. Conflicting signals can be divided in two basic categories: emotional and non-emotional. Cortical control of anxiety appears to be especially important in the presence of emotional stimuli. Human brain imaging studies have found insular abnormalities in anxiety patients. Patients with panic disorders display decreased gamma-aminobutyric acid (GABA A)/benzodiazepine sites in the insular cortex, while phobic patients show an increase in insular activity during the presentation of fearful faces. Serotonin plays an important role in the regulation of emotions, including anxiety, fear, and depression. The complex and important role that the serotonergic system plays in emotional regulation is also unambiguous. Serotonergic modulation occurs via interaction with a wealth of receptors with complementary and sometimes opposite effects acting at different levels in the circuitry underlying anxiety.
  • 27 - Childhood anxiety disorders: best treatment options and practice
    pp 306-322
  • View abstract

    Summary

    Anxiety disorders clearly have learned and non-learned components, suggesting that both types of animal models are of potential relevance. Defensive fear and anxiety behaviors have been extensively studied in rodents, using behavioral paradigms that test such behaviors in response to both learned and innately threatening stimuli. This chapter reviews these studies of learned fear and innate anxiety, detailing the latest advances in the understanding of neurobiological mechanisms and their implications for treatment. It also considers data from human studies to examine the relevance of these animal models of normative defensive behaviors to the pathological anxious behaviors seen in patients with anxiety disorders. Generalized anxiety disorder (GAD) offers perhaps the most compelling case for the relevance of innate anxiety, in that patients worry about numerous aspects of their lives without any logical rationale or previous experience.
  • 28 - Brain stimulation in the treatment of anxiety disorders
    pp 323-335
  • View abstract

    Summary

    This chapter explores that clinical anxiety involves changes in brain systems that are involved in the generation and regulation of normal emotion. It focuses on a core circuit for negative affective reactivity identified in animal and human studies of fear conditioning. The executive working memory system is a set of cortical networks that comprise a system for goal-directed, flexible control over attention and memory. The affective appraisal system is a set of paralimbic cortical and subcortical regions involved in emotion generation and regulation, self-related cognition, long-term memory retrieval, and context based modulation of conditioned fear. The number of functional neuroimaging studies of negative emotion in clinical anxiety disorders has grown at a rapid pace, now reaching a point at which a quantitative meta-analytic review is feasible. Compared to depression, relatively few neuroimaging coupled intervention studies have been reported for each anxiety disorder.
  • 29 - Complementary and alternative medicine approaches to the treatment of anxiety
    pp 336-347
  • View abstract

    Summary

    Cognitive-behavioral treatments (CBT) for the anxiety disorders are steeped in a tradition of learning theory and empiricism, stemming back to the beginning of the twentieth century and standing the test of time in rigorous clinical trials and experimental research. This chapter reviews the overarching model and standard components of cognitive and behavioral practice, and highlights a number of critical issues and academic debates that now face the discipline. Recent cognitive-behavioral conceptualizations build upon anxious apprehension and focus on the experience of emotion dysregulation. Treatment from the CBT perspective is multifaceted and geared towards addressing each of the three components of anxiety (cognitive, affective/somatic, and behavioral) through specific, empirically derived techniques. These techniques include psychoeducation, self-monitoring, relaxation, cognitive restructuring, and exposures. Providing CBT to individuals suffering from anxiety is a complex and continually evolving process.
  • 30 - The treatment of anxiety disorders in primary care
    pp 348-355
  • View abstract

    Summary

    There has been a tendency in the more recent revisions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA) and in studies of post-traumatic stress disorder (PTSD) to expand somewhat haphazardly the DSM-III formulation of Criterion A traumatic events. This chapter explains how the field might develop a more rigorous Criterion A definition. The definition of traumatic stressors was broadened in DSM-IV. The strongest claim to primacy would be for stressors that are necessary and sufficient to elicit the syndrome of PTSD symptoms and signs. Stressful events occur along a continuum of situations in which people live their lives. What to include in and exclude from the definition of Criterion A stressors in the next formulation of PTSD should depend on a great deal of systematic research with all types of situations and related negative events.
  • 31 - Conclusion: gaps in knowledge and future directions
    pp 356-361
  • View abstract

    Summary

    This chapter describes the research pertaining to the association between attachment relationships and vulnerability to anxiety disorders. It focuses on recent research that suggests possible pathways from attachment to anxiety disorders in the areas of emotional regulation, anxiety sensitivity, and cognitive style. Recently, attachment researchers have begun to conceptualize the working model in a way more consistent with what is known about brain functions and with the fact that the quality of relationships often varies over time. Researchers have studied the relationship between adult attachment style and psychological functioning. Much research has identified a correlation between insecure attachment and anxiety sensitivity. Childhood separation anxiety disorder (C-SepAD) is the most common childhood anxiety disorder. Researchers have studied attachment style among people with post-traumatic stress disorder (PTSD). More research is needed, however, to elucidate specific relationships between attachment and other DSM-IV anxiety disorders.

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