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Wikipedia

Anxiety

Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events.[1][2][3] Anxiety is different from fear in that fear is defined as the emotional response to a real threat, whereas anxiety is the anticipation of a future threat.[4] It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.[5]

A job applicant with a facial expression that in certain cultures is indicative of anxiety

Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.[6] It is often accompanied by muscular tension,[7] restlessness, fatigue, inability to catch one's breath, tightness in the abdominal region, nausea, and problems in concentration. Anxiety is closely related to fear,[3] which is a response to a real or perceived immediate threat (fight or flight response); anxiety involves the expectation of future threat including dread.[7] People facing anxiety may withdraw from situations which have provoked anxiety in the past.[8]

The emotion of anxiety can persist beyond the developmentally appropriate time-periods in response to specific events, and thus turning into one of the multiple anxiety disorders (e.g. generalized anxiety disorder, panic disorder).[9][10] The difference between anxiety disorder (as mental disorder) and anxiety (as normal emotion), is that people with an anxiety disorder experience anxiety most of the days during approximately 6 months, or even during shorter time-periods in children.[7] Anxiety disorders are among the most persistent mental problems and often last decades.[11] Besides, strong percepts of anxiety exist within other mental disorders, e.g. obsessive-compulsive disorder, post-traumatic stress disorder.[12][13]

Anxiety vs. fear

Anxiety is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat.[14] Anxiety is related to the specific behaviors of fight-or-flight responses, defensive behavior or escape.[15] There is a false presumption that often circulates that anxiety only occurs in situations perceived as uncontrollable or unavoidable, but this is not always so.[16] David Barlow defines anxiety as "a future-oriented mood state in which one is not ready or prepared to attempt to cope with upcoming negative events,"[17] and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension.[18] In positive psychology, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient coping skills.[19][3]

Fear and anxiety can be differentiated into four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short-lived, present-focused, geared towards a specific threat, and facilitating escape from threat. On the other hand, anxiety is long-acting, future-focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[20]

Joseph E. LeDoux and Lisa Feldman Barrett have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.[21][22]

Symptoms

Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute anxiety.[23] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. However, most people do not suffer from chronic anxiety.[24]

Anxiety can induce several psychological pains (e.g. depression) or mental disorders, and may lead to self-harm or suicide (for which dedicated hotlines exist).[25][26][27]

The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past.[8] Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping).[8]

The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank"[28] as well as "nightmares/bad dreams, obsessions about sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary."[29] It may include a vague experience and feeling of helplessness.[30]

The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying: "You may ... fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can't get it out of your mind."[31]

The physiological symptoms of anxiety may include:[25][26]

Types

 
Painting entitled Anxiety, 1894, by Edvard Munch

There are various types of anxiety. Existential anxiety can occur when a person faces angst, an existential crisis, or nihilistic feelings. People can also face mathematical anxiety, somatic anxiety, stage fright, or test anxiety. Social anxiety refers to a fear of rejection and negative evaluation (being judged) by other people.[7]

Existential

The philosopher Søren Kierkegaard, in The Concept of Anxiety (1844), described anxiety or dread associated with the "dizziness of freedom" and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In Art and Artist (1932), the psychologist Otto Rank wrote that the psychological trauma of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person's simultaneous fear of – and desire for – separation, individuation, and differentiation.[32]

The theologian Paul Tillich characterized existential anxiety[33] as "the state in which a being is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation), and spiritual (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority" even though such "undoubted certitude is not built on the rock of reality".[33]

According to Viktor Frankl, the author of Man's Search for Meaning, when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a meaning of life to combat the "trauma of nonbeing" as death is near.[34]

Depending on the source of the threat, psychoanalytic theory distinguishes the following types of anxiety:

  • realistic
  • neurotic
  • moral[35]

Test, performance, and competitive

Test

According to Yerkes-Dodson law, an optimal level of arousal is necessary to best complete a task such as an exam, performance, or competitive event. However, when the anxiety or level of arousal exceeds that optimum, the result is a decline in performance.[36]

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students who have test anxiety may experience any of the following: the association of grades with personal worth; fear of embarrassment by a teacher; fear of alienation from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, uncontrollable crying or laughing and drumming on a desk are all common.[37] Because test anxiety hinges on fear of negative evaluation,[38] debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.[39] The DSM-IV classifies test anxiety as a type of social phobia.[40]

Test anxiety remains a challenge for students, regardless of age, and has considerable physiological and psychological impacts. Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.[41] The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions.[42]

Performance and competitive

Performance anxiety and competitive anxiety (competitive trait anxiety, competitive state anxiety) happen when an individual's performance is measured against others. An important distinction between competitive and non-competitive anxiety is that competitive anxiety makes people view their performance as a threat.[43] As a result, they experience a drop in their ordinary ability, whether physical or mental, due to that perceived stress.[44]

Competitive anxiety is caused by a range of internal factors including high expectations, outside pressure,[44] lack of experience, and external factors like the location of a competition.[45] It commonly occurs in those participating in high pressure activities like sports and debates. Some common symptoms of competitive anxiety include muscle tension, fatigue, weakness, sense of panic, apprehensiveness, and panic attacks.[46]

There are 4 major theories of how anxiety affects performance: Drive theory, Inverted U theory, Reversal theory, and The Zone of Optimal Functioning theory.

Drive theory believes that anxiety is positive and performance improves proportionally to the level of anxiety. This theory is not well accepted.[47]

The Inverted U theory is based on the idea that performance peaks at a moderate stress level. It is called Inverted U theory because the graph that plots performance against anxiety looks like an inverted "U".[47]

Reversal theory suggests that performance increases in relation to the individual's interpretation of their arousal levels. If they believed their physical arousal level would help them, their performance would increase, if they didn't, their performance would decrease.[44] For example: Athletes were shown to worry more when focusing on results and perfection rather than the effort and growth involved.[43]

The Zone of Optimal Functioning theory proposes that there is a zone where positive and negative emotions are in a balance which lead to feelings of dissociation and intense concentration, optimizing the individual's performance levels.[48]

Stranger, social, and intergroup anxiety

Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments.[49]

Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. "Stranger anxiety" in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called social anxiety. According to Cutting, social phobics do not fear the crowd but the fact that they may be judged negatively.[50]

Social anxiety varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those with this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including avoidant personality disorder.[51]

To the extent that a person is fearful of social encounters with unfamiliar others, some people may experience anxiety particularly during interactions with outgroup members, or people who share different group memberships (i.e., by race, ethnicity, class, gender, etc.). Depending on the nature of the antecedent relations, cognitions, and situational factors, intergroup contact may be stressful and lead to feelings of anxiety. This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety.[52]

As is the case with the more generalized forms of social anxiety, intergroup anxiety has behavioral, cognitive, and affective effects. For instance, increases in schematic processing and simplified information processing can occur when anxiety is high. Indeed, such is consistent with related work on attentional bias in implicit memory.[53][54][55] Additionally recent research has found that implicit racial evaluations (i.e. automatic prejudiced attitudes) can be amplified during intergroup interaction.[56] Negative experiences have been illustrated in producing not only negative expectations, but also avoidant, or antagonistic, behavior such as hostility.[57] Furthermore, when compared to anxiety levels and cognitive effort (e.g., impression management and self-presentation) in intragroup contexts, levels and depletion of resources may be exacerbated in the intergroup situation.

Trait

Anxiety can be either a short-term "state" or a long-term personality "trait." Trait anxiety reflects a stable tendency across the lifespan of responding with acute, state anxiety in the anticipation of threatening situations (whether they are actually deemed threatening or not).[58] A meta-analysis showed that a high level of neuroticism is a risk factor for development of anxiety symptoms and disorders.[59] Such anxiety may be conscious or unconscious.[60]

Personality can also be a trait leading to anxiety and depression and their persistence.[11] Through experience, many find it difficult to collect themselves due to their own personal nature.[61]

Choice or decision

Anxiety induced by the need to choose between similar options is increasingly being recognized as a problem for individuals and for organizations.[62] In 2004, Capgemini wrote: "Today we're all faced with greater choice, more competition and less time to consider our options or seek out the right advice."[63]

In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making.[64] There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.[64]

Panic disorder

Panic disorder may share symptoms of stress and anxiety, but it is actually very different. Panic disorder is an anxiety disorder that occurs without any triggers. According to the U.S. Department of Health and Human Services, this disorder can be distinguished by unexpected and repeated episodes of intense fear.[65] Someone with panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual's general quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years. Some symptoms include: difficulty breathing, chest pain, dizziness, trembling or shaking, feeling faint, nausea, fear that you are losing control or are about to die. Even though they have these symptoms during an attack, the main symptom is the persistent fear of having future panic attacks.[66]

Anxiety disorders

Anxiety disorders are a group of mental disorders characterized by exaggerated feelings of anxiety and fear responses.[7] Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of anxiety disorders: including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder.[7]

Anxiety disorders are caused by a complex combination of genetic and environmental factors.[67][68] To be diagnosed, symptoms typically need to be present for at least six months, be more than would be expected for the situation, and decrease a person's ability to function in their daily lives.[7][69] Other problems that may result in similar symptoms include hyperthyroidism, heart disease, caffeine, alcohol, or cannabis use, and withdrawal from certain drugs, among others.[70]

Without treatment, anxiety disorders tend to remain.[7][71] Treatment may include lifestyle changes, counselling, and medications. Counselling is typically with a type of cognitive behavioural therapy.[72] Medications, such as antidepressants or beta blockers, may improve symptoms.[71]

About 12% of people are affected by an anxiety disorder in a given year and between 12–30% are affected at some point in their life.[72][73] They occur about twice as often in women than they do in men, and generally begin before the age of 25.[7][72] The most common are specific phobia which affects nearly 12% and social anxiety disorder which affects 10% at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55. Rates appear to be higher in the United States and Europe.[72]

Short- and long-term anxiety

Anxiety can be either a short-term "state" or a long-term "trait." Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fears.[7]

Four ways to be anxious

In his book Anxious: The Modern Mind in the Age of Anxiety[74] Joseph LeDoux examines four experiences of anxiety through a brain-based lens:

  1. In the presence of an existing or imminent external threat, you worry about the event and its implications for your physical and/or psychological well-being. When a threat signal occurs, it signifies either that danger is present or near in space and time or that it might be coming in the future. Nonconscious threats processing by the brain activates defensive survival circuits, resulting in changes in information processing in the brain, controlled in part by increases in arousal and behavioral and physiological responses in the body that then produce signals that feed back to the brain and complement the physiological changes there, intensifying them and extending their duration.
  2. When you notice body sensations, you worry about what they might mean for your physical and/or psychological well-being. The trigger stimulus does not have to be an external stimulus but can be an internal one, as some people are particularly sensitive to body signals.
  3. Thoughts and memories may lead to you to worry about your physical and/or psychological well-being. We do not need to be presence of an external or internal stimulus to be anxious. An episodic memory of a past trauma or of a panic attack in the past is sufficient to activate the defence circuits.
  4. Thoughts and memories may result in existential dread, such as worry about leading a meaningful life or the eventuality of death. Examples are contemplations of whether one's life has been meaningful, the inevitability of death, or the difficulty of making decisions that have a moral value. These do not necessarily activate defensive systems; they are more or less pure forms of cognitive anxiety.

Co-morbidity

Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder, bipolar disorder, eating disorders, or certain personality disorders. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety.[75][76]

It is common for those with obsessive–compulsive disorder to experience anxiety. Anxiety is also commonly found in those who experience panic disorders, phobic anxiety disorders, severe stress, dissociative disorders, somatoform disorders, and some neurotic disorders.[77] Anxiety has also been linked to the experience of intrusive thoughts. Studies have revealed that individuals who experience high levels of anxiety (also known as clinical anxiety) are highly vulnerable to the experience of intense intrusive thoughts or psychological disorders that are characterised by intrusive thoughts.[78]

Risk factors

 
A marble bust of the Roman Emperor Decius from the Capitoline Museum. This portrait "conveys an impression of anxiety and weariness, as of a man shouldering heavy [state] responsibilities".[79]

Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety.[80] Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence.[81] Specific measured 'environments' that have been associated with anxiety include child abuse, family history of mental health disorders, and poverty.[82] Anxiety is also associated with drug use, including alcohol, caffeine, and benzodiazepines (which are often prescribed to treat anxiety). Environmental factors and innovative technology, such as artificial intelligence systems, also induce situation-specific and technology-related anxiety. [83]

Neuroanatomy

Neural circuitry involving the amygdala (which regulates emotions like anxiety and fear, stimulating the HPA axis and sympathetic nervous system) and hippocampus (which is implicated in emotional memory along with the amygdala) is thought to underlie anxiety.[84] People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala.[85] Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven.[86][87]

Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward.[88] This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, "a sense of 'responsibility', or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents".[88]

The gut-brain axis

The microbes of the gut can connect with the brain to affect anxiety. There are various pathways along which this communication can take place. One is through the major neurotransmitters.[89] The gut microbes such as Bifidobacterium and Bacillus produce the neurotransmitters GABA and dopamine, respectively.[90] The neurotransmitters signal to the nervous system of the gastrointestinal tract, and those signals will be carried to the brain through the vagus nerve or the spinal system.[89][90][91] This is demonstrated by the fact that altering the microbiome has shown anxiety- and depression-reducing effects in mice, but not in subjects without vagus nerves.[92]

Another key pathway is the HPA axis, as mentioned above.[91] The microbes can control the levels of cytokines in the body, and altering cytokine levels creates direct effects on areas of the brain such as the hypothalamus, the area that triggers HPA axis activity. The HPA axis regulates production of cortisol, a hormone that takes part in the body's stress response.[91] When HPA activity spikes, cortisol levels increase, processing and reducing anxiety in stressful situations. These pathways, as well as the specific effects of individual taxa of microbes, are not yet completely clear, but the communication between the gut microbiome and the brain is undeniable, as is the ability of these pathways to alter anxiety levels.

With this communication comes the potential to treat anxiety. Prebiotics and probiotics have been shown to reduce anxiety. For example, experiments in which mice were given fructo- and galacto-oligosaccharide prebiotics[93] and Lactobacillus probiotics[92] have both demonstrated a capability to reduce anxiety. In humans, results are not as concrete, but promising.[94][95]

Genetics

Genetics and family history (e.g. parental anxiety) may put an individual at increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.[96] Estimates of genetic influence on anxiety, based on studies of twins, range from 25 to 40% depending on the specific type and age-group under study. For example, genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.[97] Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence.[98][99] When investigating how anxiety is passed on from parents to children, it is important to account for sharing of genes as well as environments, for example using the intergenerational children-of-twins design.[100]

Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety. These investigations were based on hypotheses about how certain known genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of these findings are well replicated,[101] with the possible exception of TMEM132D, COMT and MAO-A.[101] The epigenetic signature of BDNF, a gene that codes for a protein called brain derived neurotrophic factor that is found in the brain, has also been associated with anxiety and specific patterns of neural activity.[102] and a receptor gene for BDNF called NTRK2 was associated with anxiety in a large genome-wide investigation.[102] The reason that most candidate gene findings have not replicated is that anxiety is a complex trait that is influenced by many genomic variants, each of which has a small effect on its own. Increasingly, studies of anxiety are using a hypothesis-free approach to look for parts of the genome that are implicated in anxiety using big enough samples to find associations with variants that have small effects. The largest explorations of the common genetic architecture of anxiety have been facilitated by the UK Biobank, the ANGST consortium and the CRC Fear, Anxiety and Anxiety Disorders.[102][103][104]

Epigenetics

Epigenetics of anxiety and stress–related disorders is the field studying the relationship between epigenetic modifications of genes and anxiety and stress-related disorders, including mental health disorders such as generalized anxiety disorder (GAD), post-traumatic stress disorder, obsessive-compulsive disorder (OCD), and more. These change can lead to transgenerational stress inheritance.[105]

Epigenetic modifications play a role in the development and heritability of these disorders and related symptoms. For example, regulation of the hypothalamus-pituitary-adrenal axis by glucocorticoids plays a major role in stress response and is known to be epigenetically regulated.

As of 2015 most work has been done in animal models in laboratories, and little work has been done in humans; the work is not yet applicable to clinical psychiatry.[106] Stress-induced epigenetic changes, particularly to genes that effect the hypothalamic–pituitary–adrenal (HPA) axis, persist into future generations, negatively impacting the capacity of offspring to adapt to stress. Early life experiences, even when generations removed, can cause permanent epigenetic modifications of DNA resulting in changes in gene expression, endocrine function and metabolism.[105] These heritable epigenetic modifications include DNA methylation of the promoter regions of genes that affect sensitivity to stress.

Medical conditions

Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like COPD and asthma, and the difficulty in breathing that often occurs near death.[107][108][109] Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a somatization of anxiety;[110][111] the same is true for some sexual dysfunctions.[112][113] Conditions that affect the face or the skin can cause social anxiety especially among adolescents,[114] and developmental disabilities often lead to social anxiety for children as well.[115] Life-threatening conditions like cancer also cause anxiety.[116]

Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety.[25][117] These disorders include certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[117][118] metabolic disorders (diabetes),[117][119][120] deficiency states (low levels of vitamin D, B2, B12, folic acid),[117] gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[121][122][123] heart diseases, blood diseases (anemia),[117] cerebral vascular accidents (transient ischemic attack, stroke),[117] and brain degenerative diseases (Parkinson's disease, dementia, multiple sclerosis, Huntington's disease), among others.[117][124][125][126]

Substance-induced

Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include alcohol, tobacco, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.[127]

While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated.[128][129] Acute exposure to toxic levels of benzene may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.[130]

Psychological

Poor coping skills (e.g., rigidity/inflexible problem solving, denial, avoidance, impulsivity, extreme self-expectation, negative thoughts, affective instability, and inability to focus on problems) are associated with anxiety. Anxiety is also linked and perpetuated by the person's own pessimistic outcome expectancy and how they cope with feedback negativity.[131][132] Temperament (e.g., neuroticism)[59] and attitudes (e.g. pessimism) have been found to be risk factors for anxiety.[133]

Cognitive distortions such as overgeneralizing, catastrophizing, mind reading, emotional reasoning, binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad "always" happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment. In addition, those who have high anxiety can also create future stressful life events.[134] Together, these findings suggest that anxious thoughts can lead to anticipatory anxiety as well as stressful events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for successful treatment with cognitive therapy.

Psychodynamic theory posits that anxiety is often the result of opposing unconscious wishes or fears that manifest via maladaptive defense mechanisms (such as suppression, repression, anticipation, regression, somatization, passive aggression, dissociation) that develop to adapt to problems with early objects (e.g., caregivers) and empathic failures in childhood. For example, persistent parental discouragement of anger may result in repression/suppression of angry feelings which manifests as gastrointestinal distress (somatization) when provoked by another while the anger remains unconscious and outside the individual's awareness. Such conflicts can be targets for successful treatment with psychodynamic therapy. While psychodynamic therapy tends to explore the underlying roots of anxiety, cognitive behavioral therapy has also been shown to be a successful treatment for anxiety by altering irrational thoughts and unwanted behaviors.

Evolutionary psychology

An evolutionary psychology explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats. This may cause false positive reactions but an individual with anxiety may also avoid real threats. This may explain why anxious people are less likely to die due to accidents.[135] There is ample empirical evidence that anxiety can have adaptive value. Within a school, timid fish are more likely than bold fish to survive a predator.[136]

When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased blood flow in the amygdala.[137][138] In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.

Social

Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), bullying, early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including those with disabilities), and socioeconomics (e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries).[139] A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders.[140] Food-insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food-secure individuals.

Gender socialization

Contextual factors that are thought to contribute to anxiety include gender socialization and learning experiences. In particular, learning mastery (the degree to which people perceive their lives to be under their own control) and instrumentality, which includes such traits as self-confidence, self-efficacy, independence, and competitiveness fully mediate the relation between gender and anxiety. That is, though gender differences in anxiety exist, with higher levels of anxiety in women compared to men, gender socialization and learning mastery explain these gender differences.[141]

Treatment

The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause, the recognition of which is essential in order to decide the correct treatment.[25][117] Anxiety symptoms may mask an organic disease, or appear associated with or as a result of a medical disorder.[25][117][142][26]

Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first line treatment.[143][144][145][146][147] CBT appears to be equally effective when carried out via the internet.[147] While evidence for mental health apps is promising, it is preliminary.[148][149]

Psychopharmacological treatment can be used in parallel to CBT or can be used alone. As a general rule, most anxiety disorders respond well to first-line agents. Such drugs, also used as anti-depressants, are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, that work by blocking the reuptake of specific neurotransmitters and resulting in the increase in availability of these neurotransmitters. Additionally, benzodiazepines are often prescribed to individuals with anxiety disorder. Benzodiazepines produce an anxiolytic response by modulating GABA and increasing its receptor binding. A third common treatment involves a category of drug known as serotonin agonists. This category of drug works by initiating a physiological response at 5-HT1A receptor by increasing the action of serotonin at this receptor.[citation needed] Other treatment options include pregabalin, tricyclic antidepressants, and moclobemide, among others.[150]

Anxiety is considered to be a serious psychiatric illness that has an unknown true pervasiveness due to affected individuals not asking for proper treatment or aid, and due to professionals missing the diagnosis.[3]

Prevention

The above risk factors give natural avenues for prevention. A 2017 review found that psychological or educational interventions have a small yet statistically significant benefit for the prevention of anxiety in varied population types.[151][152][153]

Pathophysiology

Anxiety disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol.[154]

In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder.

The amygdala is central to the processing of fear and anxiety,[155] and its function may be disrupted in anxiety disorders. Anxiety processing in the basolateral amygdala has been implicated with expansion of dendritic arborization of the amygdaloid neurons.[156] SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization.[157]

See also

References

  1. ^ Davison GC (2008). Abnormal Psychology. Toronto: Veronica Visentin. p. 154. ISBN 978-0-470-84072-6.
  2. ^ Miceli M, Castelfranchi C (2014-11-27). Expectancy and emotion. OUP Oxford. ISBN 978-0-19-150927-8. from the original on 2023-01-17. Retrieved 2022-05-09.
  3. ^ a b c d Chand SP, Marwaha R (2022). "Anxiety". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 29262212. from the original on 2022-06-21. Retrieved 2022-12-15. Anxiety is linked to fear and manifests as a future-oriented mood state that consists of a complex cognitive, affective, physiological, and behavioral response system associated with preparation for the anticipated events or circumstances perceived as threatening.
  4. ^ Crocq MA (September 2015). "A history of anxiety: from Hippocrates to DSM". Dialogues in Clinical Neuroscience. 17 (3): 319–325. doi:10.31887/DCNS.2015.17.3/macrocq. PMC 4610616. PMID 26487812.
  5. ^ Seligman ME, Walker EF, Rosenhan DL. Abnormal psychology (4th ed.). New York: W.W. Norton & Company.[page needed]
  6. ^ Bouras N, Holt G (2007). Psychiatric and Behavioral Disorders in Intellectual and Developmental Disabilities (2nd ed.). Cambridge University Press. ISBN 9781139461306. from the original on 2023-01-17. Retrieved 2018-11-22.[page needed]
  7. ^ a b c d e f g h i j American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. p. 189. ISBN 978-0-89042-555-8.
  8. ^ a b c Barker P (2003). Psychiatric and Mental Health Nursing: The Craft of Caring. London: Edward Arnold. ISBN 978-0-340-81026-2.[page needed]
  9. ^ Robinson OJ, Pike AC, Cornwell B, Grillon C (December 2019). "The translational neural circuitry of anxiety". Journal of Neurology, Neurosurgery, and Psychiatry. BMJ. 90 (12): 1353–1360. doi:10.1136/jnnp-2019-321400. PMID 31256001. S2CID 195758112. Anxiety is an adaptive response that promotes harm avoidance, but at the same time excessive anxiety constitutes the most common psychiatric complaint.
  10. ^ Evans DL, Foa EB, Gur RE, Hendin H, O'Brien CP, Seligman ME, Walsh BT, eds. (2005). Treating and preventing adolescent mental health disorders: what we know and what we don't know. A research agenda for improving the mental health of our youth. New York: Oxford University Press. doi:10.1093/9780195173642.001.0001. ISBN 978-0-19-517364-2. OCLC 56324679. from the original on 2021-12-16. Retrieved 2021-06-02.
  11. ^ a b Hovenkamp-Hermelink JH, Jeronimus BF, Myroniuk S, Riese H, Schoevers RA (May 2021). "Predictors of persistence of anxiety disorders across the lifespan: a systematic review" (PDF). The Lancet. Psychiatry. 8 (5): 428–443. doi:10.1016/S2215-0366(20)30433-8. PMID 33581052. S2CID 231919782.
  12. ^ Marras A, Fineberg N, Pallanti S (August 2016). "Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11". CNS Spectrums. 21 (4): 324–333. doi:10.1017/S1092852916000110. PMID 27401060. S2CID 13129793.
  13. ^ World Health Organization (2023). International Classification of Diseases, eleventh revision – ICD-11. Genova – www.icd.who.int.
  14. ^ Andreas Dorschel, Furcht und Angst. In: Dietmar Goltschnigg (ed.), Angst. Lähmender Stillstand und Motor des Fortschritts. Stauffenburg, Tübingen 2012, pp. 49–54
  15. ^ Heeren A (2020). "On the distinction between fear and anxiety in a (post)pandemic world: a commentary on Schimmenti et al. (2020)". Clinical Neuropsychiatry. 17 (3): 189–191. doi:10.36131/cnfioritieditore20200307. PMC 8629083. PMID 34908991. from the original on 2021-12-16. Retrieved 2020-12-13.
  16. ^ Öhman A (2000). "Fear and anxiety: Evolutionary, cognitive, and clinical perspectives". In Lewis M, Haviland-Jones JM (eds.). Handbook of emotions. New York: The Guilford Press. pp. 573–93. ISBN 978-1-57230-529-8.
  17. ^ Barlow DH (November 2000). "Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory". The American Psychologist. 55 (11): 1247–1263. doi:10.1037/0003-066X.55.11.1247. PMID 11280938.
  18. ^ Iacovou S (2011). "What is the difference between existential anxiety and so called neurotic anxiety? 'The sine qua non of true vitality' an examination of the difference between existential anxiety and neurotic anxiety". Existential Analysis. 22 (2). Gale A288874227.
  19. ^ Csíkszentmihályi M (1997). Finding Flow. ISBN 9780465045136.[page needed]
  20. ^ Sylvers P, Lilienfeld SO, LaPrairie JL (February 2011). "Differences between trait fear and trait anxiety: implications for psychopathology". Clinical Psychology Review. 31 (1): 122–137. doi:10.1016/j.cpr.2010.08.004. PMID 20817337.
  21. ^ Emory M (June 7, 2018). "On Fear, Emotions, and Memory: An Interview with Dr. Joseph LeDoux". Brain World. from the original on April 22, 2021. Retrieved September 11, 2019.
  22. ^ Barrett LF (January 2017). "The theory of constructed emotion: an active inference account of interoception and categorization". Social Cognitive and Affective Neuroscience. 12 (1): 1–23. doi:10.1093/scan/nsw154. PMC 5390700. PMID 27798257.
  23. ^ Rynn MA, Brawman-Mintzer O (October 2004). "Generalized anxiety disorder: acute and chronic treatment". CNS Spectrums. 9 (10): 716–723. doi:10.1017/S1092852900022367. PMID 15448583. S2CID 24207457.
  24. ^ "Generalized Anxiety Disorder". National Institute of Mental Health (NIMH). Retrieved 2023-03-29.
  25. ^ a b c d e World Health Organization (2009). Pharmacological Treatment of Mental Disorders in Primary Health Care (PDF). Geneva. ISBN 978-92-4-154769-7. (PDF) from the original on November 20, 2016.
  26. ^ a b c Testa A, Giannuzzi R, Sollazzo F, Petrongolo L, Bernardini L, Daini S (February 2013). "Psychiatric emergencies (part I): psychiatric disorders causing organic symptoms". European Review for Medical and Pharmacological Sciences. 17 (Suppl 1): 55–64. PMID 23436668. from the original on 2021-02-26. Retrieved 2018-10-26. 
  27. ^ "Depression Hotline | Call Our Free, 24 Hour Depression Helpline". PsychGuides.com. from the original on October 11, 2018. Retrieved October 11, 2018.
  28. ^ Smith M (June 2008). . Helpguide. Archived from the original on 7 March 2009. Retrieved 3 March 2009.
  29. ^ Folk J (13 October 2021) [1987]. Liashko V (ed.). "Anxiety Symptoms, Causes, Treatment". Anxiety Centre. from the original on March 7, 2009. Retrieved 3 March 2009.
  30. ^ Milfayetty S, Fadli RP, Ifdil I, Zola N, Amalianita B, Putri YE, Ardi Z (September 2020). "The Effectiveness of Multidimensional Counseling in the Intervention of Student Anxiety". Addictive Disorders & Their Treatment. 19 (3): 131–5. doi:10.1097/ADT.0000000000000187. S2CID 209255441.
  31. ^ Folk J (27 March 2021) [1987]. Folk M (ed.). "Anxiety symptoms – Fear of dying". Anxiety Centre. from the original on March 5, 2009. Retrieved 3 March 2009.
  32. ^ Rank O (1932). Art and Artist. Norton, W. W. & Company, Inc. ISBN 9780393305746.
  33. ^ a b Tillich P (1952). The Courage To Be. New Haven: Yale University Press. p. 76. ISBN 978-0-300-08471-9.
  34. ^ Abulof U (2015). The Mortality and Morality of Nations. New York: Cambridge University Press. p. 26. ISBN 978-1-107-09707-0.
  35. ^ Hjelle L, Ziegler D (1981). Personality Theories: Basic Assumptions, Research, and Applications. McGraw-Hill. p. 494. ISBN 9780070290631.
  36. ^ Teigen KH (1994). "Yerkes-Dodson: A Law for all Seasons". Theory & Psychology. 4 (4): 525–547. doi:10.1177/0959354394044004. S2CID 145516099.
  37. ^ Colangelo, Raychel; Audet, Karyn (2020-12-31). "Stress in Post-Secondary: Toward an Understanding of Test-Anxiety, Cognitive Performance, and Brief Mindfulness Meditation". Behavioural Sciences Undergraduate Journal. 3 (1): 31–44. doi:10.29173/bsuj500. ISSN 2562-4687.
  38. ^ Liebert RM, Morris LW (June 1967). "Cognitive and emotional components of test anxiety: a distinction and some initial data". Psychological Reports. 20 (3): 975–978. doi:10.2466/pr0.1967.20.3.975. PMID 6042522.
  39. ^ Beidel DC, Turner SM (June 1988). "Comorbidity of test anxiety and other anxiety disorders in children". Journal of Abnormal Child Psychology. 16 (3): 275–287. doi:10.1007/BF00913800. PMID 3403811. S2CID 38476947.
  40. ^ Rapee RM, Heimberg RG (August 1997). "A cognitive-behavioral model of anxiety in social phobia". Behaviour Research and Therapy. 35 (8): 741–756. doi:10.1016/S0005-7967(97)00022-3. PMID 9256517.
  41. ^ Mathur S, Khan W (2011). "Impact of Hypnotherapy on Examination Anxiety and Scholastic Performance among School" (PDF). Delhi Psychiatry Journal. 14 (2): 337–342. CiteSeerX 10.1.1.1027.7497. Archived (PDF) from the original on 2022-10-09.
  42. ^ Ovadia-Blechman Z, Tarrasch R, Velicki M, Chalutz Ben-Gal H (2022). "Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study" (PDF). Frontiers in Psychology. 13: 678098. doi:10.3389/fpsyg.2022.678098. PMC 9167931. PMID 35677145. Archived (PDF) from the original on 2022-10-09.
  43. ^ a b Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG (September 2016). "The Mental Health of Elite Athletes: A Narrative Systematic Review". Sports Medicine. 46 (9): 1333–1353. doi:10.1007/s40279-016-0492-2. PMC 4996886. PMID 26896951.
  44. ^ a b c Ford JL, Ildefonso K, Jones ML, Arvinen-Barrow M (2017-10-27). "Sport-related anxiety: current insights". Open Access Journal of Sports Medicine. 8: 205–212. doi:10.2147/OAJSM.S125845. PMC 5667788. PMID 29138604.
  45. ^ Kang H, Jang S (2018-08-13). "Effects of competition anxiety on self-confidence in soccer players: Modulation effects of home and away games". Journal of Men's Health. 14 (3): 62–68. doi:10.22374/1875-6859.14.3.9. ISSN 1875-6867.
  46. ^ Rowland DL, van Lankveld JJ (2019). "Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground". Frontiers in Psychology. 10: 1615. doi:10.3389/fpsyg.2019.01615. PMC 6646850. PMID 31379665.
  47. ^ a b Jarvis M (2006). Sport psychology : a student's handbook. London: Routledge. ISBN 1-84169-581-5. OCLC 60971762.
  48. ^ Weiner IB, Craighead WE, eds. (2010-01-30). The Corsini Encyclopedia of Psychology (1st ed.). Wiley. doi:10.1002/9780470479216.corpsy0626. ISBN 978-0-470-17024-3.
  49. ^ Hofmann SG, Dibartolo PM (2010). "Introduction: Toward an Understanding of Social Anxiety Disorder". Social Anxiety. pp. xix–xxvi. doi:10.1016/B978-0-12-375096-9.00028-6. ISBN 978-0-12-375096-9.
  50. ^ Thomas B, Hardy S, Cutting P, eds. (1997). Mental Health Nursing: Principles and Practice. London: Mosby. ISBN 978-0-7234-2590-8.[page needed]
  51. ^ Settipani CA, Kendall PC (February 2013). "Social functioning in youth with anxiety disorders: association with anxiety severity and outcomes from cognitive-behavioral therapy". Child Psychiatry and Human Development. 44 (1): 1–18. doi:10.1007/s10578-012-0307-0. PMID 22581270. S2CID 39915581.
  52. ^ Stephan WG, Stephan CW (1985). "Intergroup Anxiety". Journal of Social Issues. 41 (3): 157–175. doi:10.1111/j.1540-4560.1985.tb01134.x.
  53. ^ Richeson JA, Trawalter S (February 2008). "The threat of appearing prejudiced and race-based attentional biases". Psychological Science. 19 (2): 98–102. doi:10.1111/j.1467-9280.2008.02052.x. PMID 18271854. S2CID 11212529.
  54. ^ Mathews A, Mogg K, May J, Eysenck M (August 1989). "Implicit and explicit memory bias in anxiety". Journal of Abnormal Psychology. 98 (3): 236–240. doi:10.1037/0021-843x.98.3.236. PMID 2768658.
  55. ^ Richards A, French CC (1991). "Effects of encoding and anxiety on implicit and explicit memory performance". Personality and Individual Differences. 12 (2): 131–139. doi:10.1016/0191-8869(91)90096-t.
  56. ^ Amodio DM, Hamilton HK (December 2012). "Intergroup anxiety effects on implicit racial evaluation and stereotyping". Emotion. 12 (6): 1273–1280. CiteSeerX 10.1.1.659.5717. doi:10.1037/a0029016. PMID 22775128.
  57. ^ Plant EA, Devine PG (June 2003). "The antecedents and implications of interracial anxiety". Personality & Social Psychology Bulletin. 29 (6): 790–801. doi:10.1177/0146167203029006011. PMID 15189634. S2CID 8581417.
  58. ^ Schwarzer R, et al. (Psychosocial Working Group) (December 1997). . MacArthur SES & Health Network. Archived from the original on 7 March 2018.
  59. ^ a b Jeronimus BF, Kotov R, Riese H, Ormel J (October 2016). "Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. doi:10.1017/S0033291716001653. PMID 27523506. S2CID 23548727. from the original on 2019-07-24. Retrieved 2019-07-28.
  60. ^ Giddey M, Wright H (1993). Mental Health Nursing: From first principles to professional practice. Stanley Thornes. ISBN 978-0-412-41210-3.[page needed]
  61. ^ . Archived from the original on October 11, 2018. Retrieved October 11, 2018.
  62. ^ Downey J (April 27, 2008). . The Times. London. Archived from the original on February 3, 2014. Retrieved April 25, 2010.
  63. ^ Is choice anxiety costing british 'blue chip' business? December 22, 2015, at the Wayback Machine, Capgemini, August 16, 2004
  64. ^ a b Hartley CA, Phelps EA (July 2012). "Anxiety and decision-making". Biological Psychiatry. 72 (2): 113–118. doi:10.1016/j.biopsych.2011.12.027. PMC 3864559. PMID 22325982.
  65. ^ "What are the five major types of anxiety disorders?". U.S. Department of Health & Human Services. June 8, 2015. from the original on October 25, 2019. Retrieved October 25, 2019.
  66. ^ "Panic Disorder & Panic Attacks". The Cleveland Clinic. from the original on 2019-10-05. Retrieved 2019-10-25.
  67. ^ Hurley K. "Anorexia & Depression: When Eating Disorders Co-Exist with Depression". Psycom.net - Mental Health Treatment Resource Since 1986. from the original on 2020-06-04. Retrieved 2020-06-05.
  68. ^ Gottschalk MG, Domschke K (June 2017). "Genetics of generalized anxiety disorder and related traits". Dialogues in Clinical Neuroscience. 19 (2): 159–168. doi:10.31887/DCNS.2017.19.2/kdomschke. PMC 5573560. PMID 28867940.
  69. ^ "Anxiety". medlineplus.gov. from the original on 2021-10-27. Retrieved 2021-10-27.
  70. ^ Derrick K, Green T, Wand T (December 2019). "Assessing and responding to anxiety and panic in the Emergency Department". Australasian Emergency Care. 22 (4): 216–220. doi:10.1016/j.auec.2019.08.002. PMID 31530499. S2CID 202672894.
  71. ^ a b "Anxiety Disorders". NIMH. March 2016. from the original on July 27, 2016. Retrieved August 14, 2016.
  72. ^ a b c d Craske MG, Stein MB (December 2016). "Anxiety". Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585.
  73. ^ Kessler RC, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, et al. (October 2007). "Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative". World Psychiatry. 6 (3): 168–176. PMC 2174588. PMID 18188442.
  74. ^ LeDoux JE (2015). Anxious: the modern mind in the age of anxiety. London. ISBN 978-1-78074-767-5. OCLC 920462582.
  75. ^ Smoller JW, Andreassen OA, Edenberg HJ, Faraone SV, Glatt SJ, Kendler KS (March 2019). "Correction to: Psychiatric genetics and the structure of psychopathology". Molecular Psychiatry. 24 (3): 471. doi:10.1038/s41380-018-0026-4. PMID 29540840.
  76. ^ Kendler KS (July 2004). "Major Depression and Generalised Anxiety Disorder". FOCUS. 2 (3): 416–425. doi:10.1176/foc.2.3.416.
  77. ^ Stein DJ, Fineberg NA, Bienvenu OJ, Denys D, Lochner C, Nestadt G, et al. (June 2010). "Should OCD be classified as an anxiety disorder in DSM-V?". Depression and Anxiety. 27 (6): 495–506. doi:10.1002/da.20699. PMID 20533366. S2CID 17606388.
  78. ^ Omoregie J, Carson J (1 January 2022). "Reductive mechanisms for unwanted intrusive thoughts: exploring affectivity in clinical and non-clinical samples". Mental Health and Social Inclusion. 27: 51–65. doi:10.1108/MHSI-06-2022-0040. S2CID 251511163.
  79. ^ Scarre C (1995). Chronicle of the Roman Emperors. Thames & Hudson. pp. 168–9. ISBN 978-5-00-050775-9.[page needed]
  80. ^ Reynolds CA (June 16, 2013). "Robert Plomin, John C. DeFries, Valerie S. Knopik, Jenae M. Neiderhiser, Behavioral Genetics (6th Edition)". Behavior Genetics. 43 (4): 360–361. doi:10.1007/s10519-013-9598-6. S2CID 141211176.
  81. ^ Smoller JW, Block SR, Young MM (November 2009). "Genetics of anxiety disorders: the complex road from DSM to DNA". Depression and Anxiety. 26 (11): 965–975. doi:10.1002/da.20623. PMID 19885930. S2CID 35349081.
  82. ^ Craske MG, Stein MB, Eley TC, Milad MR, Holmes A, Rapee RM, Wittchen HU (May 2017). "Anxiety disorders". Nature Reviews. Disease Primers. 3 (1): 17024. doi:10.1038/nrdp.2017.24. PMID 28470168. S2CID 52852105.
  83. ^ Park, Eun Hee; Werder, Karl; Cao, Lan; Ramesh, Balasubramaniam (3 July 2022). "Why do Family Members Reject AI in Health Care? Competing Effects of Emotions". Journal of Management Information Systems. 39 (3): 765–792. doi:10.1080/07421222.2022.2096550.
  84. ^ Rosen JB, Schulkin J (April 1998). "From normal fear to pathological anxiety". Psychological Review. 105 (2): 325–350. doi:10.1037/0033-295X.105.2.325. PMID 9577241.
  85. ^ Nolen-Hoeksema, S. (2013). (Ab)normal Psychology (6th edition). McGraw Hill.[page needed]
  86. ^ Fricchione G (2011). Compassion and Healing in Medicine and Society: On the Nature and Use of Attachment Solutions to Separation Challenges. Johns Hopkins University Press. p. 172. ISBN 978-1-4214-0220-8.
  87. ^ Harris J (1998). How the Brain Talks to Itself: A Clinical Primer of Psychotherapeutic Neuroscience. Haworth. p. 284. ISBN 978-0-7890-0408-6.
  88. ^ a b Bar-Haim Y, Fox NA, Benson B, Guyer AE, Williams A, Nelson EE, et al. (August 2009). "Neural correlates of reward processing in adolescents with a history of inhibited temperament". Psychological Science. 20 (8): 1009–1018. doi:10.1111/j.1467-9280.2009.02401.x. PMC 2785902. PMID 19594857.
  89. ^ a b Kennedy PJ, Cryan JF, Dinan TG, Clarke G (January 2017). "Kynurenine pathway metabolism and the microbiota-gut-brain axis". Neuropharmacology. 112 (Pt B): 399–412. doi:10.1016/j.neuropharm.2016.07.002. PMID 27392632. S2CID 12743048.
  90. ^ a b Dinan TG, Stilling RM, Stanton C, Cryan JF (April 2015). "Collective unconscious: how gut microbes shape human behavior". Journal of Psychiatric Research. 63: 1–9. doi:10.1016/j.jpsychires.2015.02.021. PMID 25772005.
  91. ^ a b c de Weerth C (December 2017). "Do bacteria shape our development? Crosstalk between intestinal microbiota and HPA axis". Neuroscience and Biobehavioral Reviews. 83: 458–471. doi:10.1016/j.neubiorev.2017.09.016. PMID 28918360. S2CID 40601114.
  92. ^ a b Bravo JA, Forsythe P, Chew MV, Escaravage E, Savignac HM, Dinan TG, et al. (September 2011). "Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve". Proceedings of the National Academy of Sciences of the United States of America. 108 (38): 16050–16055. doi:10.1073/pnas.1102999108. PMC 3179073. PMID 21876150.
  93. ^ Burokas A, Arboleya S, Moloney RD, Peterson VL, Murphy K, Clarke G, et al. (October 2017). "Targeting the Microbiota-Gut-Brain Axis: Prebiotics Have Anxiolytic and Antidepressant-like Effects and Reverse the Impact of Chronic Stress in Mice". Biological Psychiatry. 82 (7): 472–487. doi:10.1016/j.biopsych.2016.12.031. PMID 28242013. S2CID 206106596.
  94. ^ Benton D, Williams C, Brown A (March 2007). "Impact of consuming a milk drink containing a probiotic on mood and cognition". European Journal of Clinical Nutrition. 61 (3): 355–361. doi:10.1038/sj.ejcn.1602546. PMID 17151594.
  95. ^ Schmidt K, Cowen PJ, Harmer CJ, Tzortzis G, Errington S, Burnet PW (May 2015). "Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers". Psychopharmacology. 232 (10): 1793–1801. doi:10.1007/s00213-014-3810-0. PMC 4410136. PMID 25449699.
  96. ^ Davies MR, Kalsi G, Armour C, Jones IR, McIntosh AM, Smith DJ, et al. (December 2019). "The Genetic Links to Anxiety and Depression (GLAD) Study: Online recruitment into the largest recontactable study of depression and anxiety". Behaviour Research and Therapy. 123: 103503. doi:10.1016/j.brat.2019.103503. PMC 6891252. PMID 31715324.
  97. ^ Gottschalk MG, Domschke K (June 2017). "Genetics of generalized anxiety disorder and related traits". Dialogues in Clinical Neuroscience. 19 (2): 159–168. doi:10.31887/DCNS.2017.19.2/kdomschke. PMC 5573560. PMID 28867940.
  98. ^ Waszczuk MA, Zavos HM, Gregory AM, Eley TC (August 2014). "The phenotypic and genetic structure of depression and anxiety disorder symptoms in childhood, adolescence, and young adulthood". JAMA Psychiatry. 71 (8): 905–916. doi:10.1001/jamapsychiatry.2014.655. PMID 24920372.
  99. ^ Nivard MG, Dolan CV, Kendler KS, Kan KJ, Willemsen G, van Beijsterveldt CE, et al. (April 2015). "Stability in symptoms of anxiety and depression as a function of genotype and environment: a longitudinal twin study from ages 3 to 63 years". Psychological Medicine. 45 (5): 1039–1049. doi:10.1017/S003329171400213X. PMID 25187475. S2CID 15183002.
  100. ^ Eley TC, McAdams TA, Rijsdijk FV, Lichtenstein P, Narusyte J, Reiss D, et al. (July 2015). "The Intergenerational Transmission of Anxiety: A Children-of-Twins Study". The American Journal of Psychiatry. 172 (7): 630–637. doi:10.1176/appi.ajp.2015.14070818. PMC 8515953. PMID 25906669.
  101. ^ a b Howe AS, Buttenschøn HN, Bani-Fatemi A, Maron E, Otowa T, Erhardt A, et al. (May 2016). "Candidate genes in panic disorder: meta-analyses of 23 common variants in major anxiogenic pathways". Molecular Psychiatry. 21 (5): 665–679. doi:10.1038/mp.2015.138. PMID 26390831. S2CID 3394824.
  102. ^ a b c Purves KL, Coleman JR, Meier SM, Rayner C, Davis KA, Cheesman R, et al. (December 2020). "A major role for common genetic variation in anxiety disorders". Molecular Psychiatry. 25 (12): 3292–3303. doi:10.1038/s41380-019-0559-1. PMC 7237282. PMID 31748690.
  103. ^ Otowa T, Hek K, Lee M, Byrne EM, Mirza SS, Nivard MG, et al. (October 2016). "Meta-analysis of genome-wide association studies of anxiety disorders". Molecular Psychiatry. 21 (10): 1391–1399. doi:10.1016/j.euroneuro.2016.09.604. PMC 4940340. PMID 26754954.
  104. ^ Deckert J, Weber H, Villmann C, Lonsdorf TB, Richter J, Andreatta M, et al. (October 2017). "GLRB allelic variation associated with agoraphobic cognitions, increased startle response and fear network activation: a potential neurogenetic pathway to panic disorder". Molecular Psychiatry. 22 (10): 1431–1439. doi:10.1016/j.euroneuro.2016.09.607. PMID 28167838. S2CID 54353612.
  105. ^ a b Matthews SG, Phillips DI (January 2012). "Transgenerational inheritance of stress pathology". review. Experimental Neurology. 233 (1): 95–101. doi:10.1016/j.expneurol.2011.01.009. PMID 21281632.
  106. ^ Klengel T, Binder EB (June 2015). "Epigenetics of Stress-Related Psychiatric Disorders and Gene × Environment Interactions". review. Neuron. 86 (6): 1343–57. doi:10.1016/j.neuron.2015.05.036. PMID 26087162. 
  107. ^ Baldwin J, Cox J (September 2016). "Treating Dyspnea: Is Oxygen Therapy the Best Option for All Patients?". The Medical Clinics of North America. 100 (5): 1123–1130. doi:10.1016/j.mcna.2016.04.018. PMID 27542431.
  108. ^ Vanfleteren LE, Spruit MA, Wouters EF, Franssen FM (November 2016). "Management of chronic obstructive pulmonary disease beyond the lungs". The Lancet. Respiratory Medicine. 4 (11): 911–924. doi:10.1016/S2213-2600(16)00097-7. PMID 27264777.
  109. ^ Tselebis A, Pachi A, Ilias I, Kosmas E, Bratis D, Moussas G, Tzanakis N (2016). "Strategies to improve anxiety and depression in patients with COPD: a mental health perspective". Neuropsychiatric Disease and Treatment. 12: 297–328. doi:10.2147/NDT.S79354. PMC 4755471. PMID 26929625.
  110. ^ Muscatello MR, Bruno A, Mento C, Pandolfo G, Zoccali RA (July 2016). "Personality traits and emotional patterns in irritable bowel syndrome". World Journal of Gastroenterology. 22 (28): 6402–6415. doi:10.3748/wjg.v22.i28.6402. PMC 4968122. PMID 27605876.
  111. ^ Remes-Troche JM (December 2016). "How to Diagnose and Treat Functional Chest Pain". Current Treatment Options in Gastroenterology. 14 (4): 429–443. doi:10.1007/s11938-016-0106-y. PMID 27709331. S2CID 19634934.
  112. ^ Brotto L, Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, et al. (April 2016). "Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction". The Journal of Sexual Medicine. 13 (4): 538–571. doi:10.1016/j.jsxm.2016.01.019. PMID 27045257. from the original on 2020-07-26. Retrieved 2019-12-07.
  113. ^ McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJ (August 2016). "The pathophysiology of acquired premature ejaculation". Translational Andrology and Urology. 5 (4): 434–449. doi:10.21037/tau.2016.07.06. PMC 5001985. PMID 27652216.
  114. ^ Nguyen CM, Beroukhim K, Danesh MJ, Babikian A, Koo J, Leon A (2016). "The psychosocial impact of acne, vitiligo, and psoriasis: a review". Clinical, Cosmetic and Investigational Dermatology. 9: 383–392. doi:10.2147/CCID.S76088. PMC 5076546. PMID 27799808.
  115. ^ Caçola P (2016). "Physical and Mental Health of Children with Developmental Coordination Disorder". Frontiers in Public Health. 4: 224. doi:10.3389/fpubh.2016.00224. PMC 5075567. PMID 27822464.
  116. ^ Mosher CE, Winger JG, Given BA, Helft PR, O'Neil BH (November 2016). "Mental health outcomes during colorectal cancer survivorship: a review of the literature". Psycho-Oncology. 25 (11): 1261–1270. doi:10.1002/pon.3954. PMC 4894828. PMID 26315692.
  117. ^ a b c d e f g h i Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N (February 2013). "Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases". European Review for Medical and Pharmacological Sciences. 17 (Suppl 1): 86–99. PMID 23436670. from the original on 2021-03-04. Retrieved 2018-10-26. 
  118. ^ Samuels MH (October 2008). "Cognitive function in untreated hypothyroidism and hyperthyroidism". Current Opinion in Endocrinology, Diabetes and Obesity. 15 (5): 429–433. doi:10.1097/MED.0b013e32830eb84c. PMID 18769215. S2CID 27235034.
  119. ^ Buchberger B, Huppertz H, Krabbe L, Lux B, Mattivi JT, Siafarikas A (August 2016). "Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis". Psychoneuroendocrinology. 70: 70–84. doi:10.1016/j.psyneuen.2016.04.019. PMID 27179232. S2CID 19858996.
  120. ^ Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (December 2002). "Prevalence of anxiety in adults with diabetes: a systematic review". Journal of Psychosomatic Research. 53 (6): 1053–1060. doi:10.1016/S0022-3999(02)00417-8. PMID 12479986.
  121. ^ Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC (April 2015). "Psychological morbidity of celiac disease: A review of the literature". United European Gastroenterology Journal. 3 (2): 136–145. doi:10.1177/2050640614560786. PMC 4406898. PMID 25922673.
  122. ^ Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F (May 2015). "Systematic review: noncoeliac gluten sensitivity". Alimentary Pharmacology & Therapeutics. 41 (9): 807–820. doi:10.1111/apt.13155. PMID 25753138. S2CID 207050854.
  123. ^ Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H (August 2016). "Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review". Journal of Psychosomatic Research. 87: 70–80. doi:10.1016/j.jpsychores.2016.06.001. PMID 27411754.
  124. ^ Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, et al. (January 2016). "The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis". Journal of Affective Disorders. 190: 264–271. doi:10.1016/j.jad.2015.09.069. PMID 26540080.
  125. ^ Wen MC, Chan LL, Tan LC, Tan EK (June 2016). "Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies". European Journal of Neurology. 23 (6): 1001–1019. doi:10.1111/ene.13002. PMC 5084819. PMID 27141858.
  126. ^ Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, et al. (March 2015). "The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review". Multiple Sclerosis. 21 (3): 305–317. doi:10.1177/1352458514564487. PMC 4429164. PMID 25583845.
  127. ^ National Institute on Drug Abuse (2012-08-03). "Prescription Drug Facts, Effects, Teen Use". NIDA for Teens. from the original on 2022-05-18. Retrieved 2022-05-24.
  128. ^ Brady KT, Haynes LF, Hartwell KJ, Killeen TK (2013). "Substance use disorders and anxiety: a treatment challenge for social workers". Social Work in Public Health. 28 (3–4): 407–423. doi:10.1080/19371918.2013.774675. PMC 3775646. PMID 23731428.
  129. ^ Turner S, Mota N, Bolton J, Sareen J (September 2018). "Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature". Depression and Anxiety. 35 (9): 851–860. doi:10.1002/da.22771. PMC 6175215. PMID 29999576.
  130. ^ "CDC – The Emergency Response Safety and Health Database: Systemic Agent: BENZENE – NIOSH". www.cdc.gov. from the original on January 17, 2016. Retrieved January 27, 2016.
  131. ^ Gu R, Huang YX, Luo YJ (September 2010). "Anxiety and feedback negativity". Psychophysiology. 47 (5): 961–967. doi:10.1111/j.1469-8986.2010.00997.x. PMID 20374540.
  132. ^ Watkins ER (March 2008). "Constructive and unconstructive repetitive thought". Psychological Bulletin. 134 (2): 163–206. doi:10.1037/0033-2909.134.2.163. PMC 2672052. PMID 18298268.
  133. ^ Bienvenu OJ, Ginsburg GS (December 2007). "Prevention of anxiety disorders". International Review of Psychiatry. 19 (6): 647–654. doi:10.1080/09540260701797837. PMID 18092242. S2CID 95140.
  134. ^ Phillips AC, Carroll D, Der G (2015). "Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation". Anxiety, Stress, and Coping. 28 (4): 357–371. doi:10.1080/10615806.2015.1005078. PMC 4772121. PMID 25572915.
  135. ^ Andrews PW, Thomson JA (July 2009). "The bright side of being blue: depression as an adaptation for analyzing complex problems". Psychological Review. 116 (3): 620–654. doi:10.1037/a0016242. PMC 2734449. PMID 19618990.
  136. ^ Gluckman P (2009). Principles of Evolutionary Medicine. Oxford University Press. p. 249. ISBN 978-0199236398.
  137. ^ Zald DH, Pardo JV (April 1997). "Emotion, olfaction, and the human amygdala: amygdala activation during aversive olfactory stimulation". Proceedings of the National Academy of Sciences of the United States of America. 94 (8): 4119–4124. Bibcode:1997PNAS...94.4119Z. doi:10.1073/pnas.94.8.4119. PMC 20578. PMID 9108115.
  138. ^ Zald DH, Hagen MC, Pardo JV (February 2002). "Neural correlates of tasting concentrated quinine and sugar solutions". Journal of Neurophysiology. 87 (2): 1068–1075. doi:10.1152/jn.00358.2001. PMID 11826070. S2CID 6278342.
  139. ^ National Research Council (Us) Institute Of Medicine (Us) Committee On The Prevention Of Mental Disorders Substance Abuse Among Children, Youth, and Young Adults (2009). "Table E-4 Risk Factors for Anxiety". In O'Connell ME, Boat T, Warner KE (eds.). Prevention of Mental Disorders, Substance Abuse, and Problem Behaviors: A Developmental Perspective. National Academies Press. p. 530. doi:10.17226/12480. ISBN 978-0-309-12674-8. PMID 20662125. S2CID 142581788. from the original on 2014-04-18. Retrieved 2014-04-19.
  140. ^ Arenas DJ, Thomas A, Wang J, DeLisser HM (December 2019). "A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity". Journal of General Internal Medicine. 34 (12): 2874–2882. doi:10.1007/s11606-019-05202-4. PMC 6854208. PMID 31385212.
  141. ^ Behnke RR, Sawyer CR (2000). "Anticipatory anxiety patterns for male and female public speakers". Communication Education. 49 (2): 187–195. doi:10.1080/03634520009379205. S2CID 144320186.
  142. ^ Testa A, Giannuzzi R, Sollazzo F, Petrongolo L, Bernardini L, Dain S (February 2013). "Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases". European Review for Medical and Pharmacological Sciences. 17 (Suppl 1): 65–85. PMID 23436669. from the original on 2021-05-05. Retrieved 2018-10-26. 
  143. ^ Stein MB, Sareen J (November 2015). "CLINICAL PRACTICE. Generalized Anxiety Disorder". The New England Journal of Medicine. 373 (21): 2059–2068. doi:10.1056/nejmcp1502514. PMID 26580998.
  144. ^ Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G (March 2014). "Psychological treatment of generalized anxiety disorder: a meta-analysis". Clinical Psychology Review. 34 (2): 130–140. doi:10.1016/j.cpr.2014.01.002. PMID 24487344.
  145. ^ Otte C (2011). "Cognitive behavioral therapy in anxiety disorders: current state of the evidence". Dialogues in Clinical Neuroscience. 13 (4): 413–421. doi:10.31887/DCNS.2011.13.4/cotte. PMC 3263389. PMID 22275847.
  146. ^ Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G (April 2016). "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis". The Cochrane Database of Systematic Reviews. 2016 (4): CD011004. doi:10.1002/14651858.CD011004.pub2. PMC 7104662. PMID 27071857.
  147. ^ a b Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH (March 2016). "Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults". The Cochrane Database of Systematic Reviews. 2016 (3): CD011565. doi:10.1002/14651858.cd011565.pub2. PMC 7077612. PMID 26968204.
  148. ^ Donker T, Petrie K, Proudfoot J, Clarke J, Birch MR, Christensen H (November 2013). "Smartphones for smarter delivery of mental health programs: a systematic review". Journal of Medical Internet Research. 15 (11): e247. doi:10.2196/jmir.2791. PMC 3841358. PMID 24240579.
  149. ^ Singh K, Severn M (2018). e-Therapy Interventions for the Treatment of Anxiety: Clinical Evidence (Report). CADTH Rapid Response Report: Summary with Critical Appraisal. Canadian Agency for Drugs and Technologies in Health. PMID 30329251. Retrieved 2022-12-28.
  150. ^ Bandelow B, Michaelis S, Wedekind D (June 2017). "Treatment of anxiety disorders". Dialogues in Clinical Neuroscience. 19 (2): 93–107. doi:10.31887/DCNS.2017.19.2/bbandelow. PMC 5573566. PMID 28867934.
  151. ^ Moreno-Peral P, Conejo-Cerón S, Rubio-Valera M, Fernández A, Navas-Campaña D, Rodríguez-Morejón A, et al. (October 2017). "Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression". JAMA Psychiatry. 74 (10): 1021–1029. doi:10.1001/jamapsychiatry.2017.2509. PMC 5710546. PMID 28877316.
  152. ^ Pote I (February 19, 2018). "Preventing anxiety with psychological and educational interventions". National Elf Service. from the original on December 16, 2021. Retrieved December 12, 2019.
  153. ^ Schmidt NB, Allan NP, Knapp AA, Capron D (2019). "Targeting anxiety sensitivity as a prevention strategy". The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment. pp. 145–178. doi:10.1016/B978-0-12-813495-5.00008-5. ISBN 978-0-12-813495-5. S2CID 81782119.
  154. ^ Anxiety Disorders at eMedicine
  155. ^ LeDoux J (October 2007). "The amygdala". Current Biology. 17 (20): R868–R874. doi:10.1016/j.cub.2007.08.005. PMID 17956742. S2CID 16348363.
  156. ^ Mitra R, Sapolsky RM (April 2008). "Acute corticosterone treatment is sufficient to induce anxiety and amygdaloid dendritic hypertrophy". Proceedings of the National Academy of Sciences of the United States of America. 105 (14): 5573–5578. Bibcode:2008PNAS..105.5573M. doi:10.1073/pnas.0705615105. PMC 2291109. PMID 18391224.
  157. ^ Mitra R, Ferguson D, Sapolsky RM (September 2009). "SK2 potassium channel overexpression in basolateral amygdala reduces anxiety, stress-induced corticosterone secretion and dendritic arborization". Molecular Psychiatry. 14 (9): 847–55, 827. doi:10.1038/mp.2009.9. PMC 2763614. PMID 19204724.

External links

  •   Media related to Anxiety at Wikimedia Commons

anxiety, misgiving, redirects, here, american, metalcore, band, misgiving, band, other, uses, disambiguation, emotion, which, characterized, unpleasant, state, inner, turmoil, includes, feelings, dread, over, anticipated, events, different, from, fear, that, f. Misgiving redirects here For the American metalcore band see Misgiving band For other uses see Anxiety disambiguation Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events 1 2 3 Anxiety is different from fear in that fear is defined as the emotional response to a real threat whereas anxiety is the anticipation of a future threat 4 It is often accompanied by nervous behavior such as pacing back and forth somatic complaints and rumination 5 A job applicant with a facial expression that in certain cultures is indicative of anxiety Anxiety is a feeling of uneasiness and worry usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing 6 It is often accompanied by muscular tension 7 restlessness fatigue inability to catch one s breath tightness in the abdominal region nausea and problems in concentration Anxiety is closely related to fear 3 which is a response to a real or perceived immediate threat fight or flight response anxiety involves the expectation of future threat including dread 7 People facing anxiety may withdraw from situations which have provoked anxiety in the past 8 The emotion of anxiety can persist beyond the developmentally appropriate time periods in response to specific events and thus turning into one of the multiple anxiety disorders e g generalized anxiety disorder panic disorder 9 10 The difference between anxiety disorder as mental disorder and anxiety as normal emotion is that people with an anxiety disorder experience anxiety most of the days during approximately 6 months or even during shorter time periods in children 7 Anxiety disorders are among the most persistent mental problems and often last decades 11 Besides strong percepts of anxiety exist within other mental disorders e g obsessive compulsive disorder post traumatic stress disorder 12 13 Contents 1 Anxiety vs fear 2 Symptoms 3 Types 3 1 Existential 3 2 Test performance and competitive 3 2 1 Test 3 2 2 Performance and competitive 3 3 Stranger social and intergroup anxiety 3 4 Trait 3 5 Choice or decision 3 6 Panic disorder 4 Anxiety disorders 4 1 Short and long term anxiety 4 2 Four ways to be anxious 5 Co morbidity 6 Risk factors 6 1 Neuroanatomy 6 1 1 The gut brain axis 6 2 Genetics 6 2 1 Epigenetics 6 3 Medical conditions 6 4 Substance induced 6 5 Psychological 6 5 1 Evolutionary psychology 6 6 Social 6 6 1 Gender socialization 7 Treatment 8 Prevention 9 Pathophysiology 10 See also 11 References 12 External linksAnxiety vs fear EditAnxiety is distinguished from fear which is an appropriate cognitive and emotional response to a perceived threat 14 Anxiety is related to the specific behaviors of fight or flight responses defensive behavior or escape 15 There is a false presumption that often circulates that anxiety only occurs in situations perceived as uncontrollable or unavoidable but this is not always so 16 David Barlow defines anxiety as a future oriented mood state in which one is not ready or prepared to attempt to cope with upcoming negative events 17 and that it is a distinction between future and present dangers which divides anxiety and fear Another description of anxiety is agony dread terror or even apprehension 18 In positive psychology anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient coping skills 19 3 Fear and anxiety can be differentiated into four domains 1 duration of emotional experience 2 temporal focus 3 specificity of the threat and 4 motivated direction Fear is short lived present focused geared towards a specific threat and facilitating escape from threat On the other hand anxiety is long acting future focused broadly focused towards a diffuse threat and promoting excessive caution while approaching a potential threat and interferes with constructive coping 20 Joseph E LeDoux and Lisa Feldman Barrett have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety 21 22 Symptoms EditAnxiety can be experienced with long drawn out daily symptoms that reduce quality of life known as chronic or generalized anxiety or it can be experienced in short spurts with sporadic stressful panic attacks known as acute anxiety 23 Symptoms of anxiety can range in number intensity and frequency depending on the person However most people do not suffer from chronic anxiety 24 Anxiety can induce several psychological pains e g depression or mental disorders and may lead to self harm or suicide for which dedicated hotlines exist 25 26 27 The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past 8 Other effects may include changes in sleeping patterns changes in habits increase or decrease in food intake and increased motor tension such as foot tapping 8 The emotional effects of anxiety may include feelings of apprehension or dread trouble concentrating feeling tense or jumpy anticipating the worst irritability restlessness watching and waiting for signs and occurrences of danger and feeling like your mind s gone blank 28 as well as nightmares bad dreams obsessions about sensations deja vu a trapped in your mind feeling and feeling like everything is scary 29 It may include a vague experience and feeling of helplessness 30 The cognitive effects of anxiety may include thoughts about suspected dangers such as fear of dying You may fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm You feel an intense fear when you think of dying or you may think of it more often than normal or can t get it out of your mind 31 The physiological symptoms of anxiety may include 25 26 Neurological as headache paresthesias fasciculations vertigo or presyncope Digestive as abdominal pain nausea diarrhea indigestion dry mouth or bolus Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS Respiratory as shortness of breath or sighing breathing Cardiac as palpitations tachycardia or chest pain Muscular as fatigue tremors or tetany Cutaneous as perspiration or itchy skin Uro genital as frequent urination urinary urgency dyspareunia or impotence chronic pelvic pain syndrome Types Edit Painting entitled Anxiety 1894 by Edvard Munch There are various types of anxiety Existential anxiety can occur when a person faces angst an existential crisis or nihilistic feelings People can also face mathematical anxiety somatic anxiety stage fright or test anxiety Social anxiety refers to a fear of rejection and negative evaluation being judged by other people 7 Existential Edit Further information Angst Existential crisis and Nihilism The philosopher Soren Kierkegaard in The Concept of Anxiety 1844 described anxiety or dread associated with the dizziness of freedom and suggested the possibility for positive resolution of anxiety through the self conscious exercise of responsibility and choosing In Art and Artist 1932 the psychologist Otto Rank wrote that the psychological trauma of birth was the pre eminent human symbol of existential anxiety and encompasses the creative person s simultaneous fear of and desire for separation individuation and differentiation 32 The theologian Paul Tillich characterized existential anxiety 33 as the state in which a being is aware of its possible nonbeing and he listed three categories for the nonbeing and resulting anxiety ontic fate and death moral guilt and condemnation and spiritual emptiness and meaninglessness According to Tillich the last of these three types of existential anxiety i e spiritual anxiety is predominant in modern times while the others were predominant in earlier periods Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences In its pathological form spiritual anxiety may tend to drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority even though such undoubted certitude is not built on the rock of reality 33 According to Viktor Frankl the author of Man s Search for Meaning when a person is faced with extreme mortal dangers the most basic of all human wishes is to find a meaning of life to combat the trauma of nonbeing as death is near 34 Depending on the source of the threat psychoanalytic theory distinguishes the following types of anxiety realistic neurotic moral 35 Test performance and competitive Edit Test Edit Main articles Test anxiety and Mathematical anxiety According to Yerkes Dodson law an optimal level of arousal is necessary to best complete a task such as an exam performance or competitive event However when the anxiety or level of arousal exceeds that optimum the result is a decline in performance 36 Test anxiety is the uneasiness apprehension or nervousness felt by students who have a fear of failing an exam Students who have test anxiety may experience any of the following the association of grades with personal worth fear of embarrassment by a teacher fear of alienation from parents or friends time pressures or feeling a loss of control Sweating dizziness headaches racing heartbeats nausea fidgeting uncontrollable crying or laughing and drumming on a desk are all common 37 Because test anxiety hinges on fear of negative evaluation 38 debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia 39 The DSM IV classifies test anxiety as a type of social phobia 40 Test anxiety remains a challenge for students regardless of age and has considerable physiological and psychological impacts Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety 41 The routine practice of slow Device Guided Breathing DGB is a major component of behavioral treatments for anxiety conditions 42 Performance and competitive Edit Main articles Stage fright Somatic anxiety and Sport psychology Performance anxiety and competitive anxiety competitive trait anxiety competitive state anxiety happen when an individual s performance is measured against others An important distinction between competitive and non competitive anxiety is that competitive anxiety makes people view their performance as a threat 43 As a result they experience a drop in their ordinary ability whether physical or mental due to that perceived stress 44 Competitive anxiety is caused by a range of internal factors including high expectations outside pressure 44 lack of experience and external factors like the location of a competition 45 It commonly occurs in those participating in high pressure activities like sports and debates Some common symptoms of competitive anxiety include muscle tension fatigue weakness sense of panic apprehensiveness and panic attacks 46 There are 4 major theories of how anxiety affects performance Drive theory Inverted U theory Reversal theory and The Zone of Optimal Functioning theory Drive theory believes that anxiety is positive and performance improves proportionally to the level of anxiety This theory is not well accepted 47 The Inverted U theory is based on the idea that performance peaks at a moderate stress level It is called Inverted U theory because the graph that plots performance against anxiety looks like an inverted U 47 Reversal theory suggests that performance increases in relation to the individual s interpretation of their arousal levels If they believed their physical arousal level would help them their performance would increase if they didn t their performance would decrease 44 For example Athletes were shown to worry more when focusing on results and perfection rather than the effort and growth involved 43 The Zone of Optimal Functioning theory proposes that there is a zone where positive and negative emotions are in a balance which lead to feelings of dissociation and intense concentration optimizing the individual s performance levels 48 Stranger social and intergroup anxiety Edit Main articles Stranger anxiety and Social anxiety Humans generally require social acceptance and thus sometimes dread the disapproval of others Apprehension of being judged by others may cause anxiety in social environments 49 Anxiety during social interactions particularly between strangers is common among young people It may persist into adulthood and become social anxiety or social phobia Stranger anxiety in small children is not considered a phobia In adults an excessive fear of other people is not a developmentally common stage it is called social anxiety According to Cutting social phobics do not fear the crowd but the fact that they may be judged negatively 50 Social anxiety varies in degree and severity For some people it is characterized by experiencing discomfort or awkwardness during physical social contact e g embracing shaking hands etc while in other cases it can lead to a fear of interacting with unfamiliar people altogether Those with this condition may restrict their lifestyles to accommodate the anxiety minimizing social interaction whenever possible Social anxiety also forms a core aspect of certain personality disorders including avoidant personality disorder 51 To the extent that a person is fearful of social encounters with unfamiliar others some people may experience anxiety particularly during interactions with outgroup members or people who share different group memberships i e by race ethnicity class gender etc Depending on the nature of the antecedent relations cognitions and situational factors intergroup contact may be stressful and lead to feelings of anxiety This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety 52 As is the case with the more generalized forms of social anxiety intergroup anxiety has behavioral cognitive and affective effects For instance increases in schematic processing and simplified information processing can occur when anxiety is high Indeed such is consistent with related work on attentional bias in implicit memory 53 54 55 Additionally recent research has found that implicit racial evaluations i e automatic prejudiced attitudes can be amplified during intergroup interaction 56 Negative experiences have been illustrated in producing not only negative expectations but also avoidant or antagonistic behavior such as hostility 57 Furthermore when compared to anxiety levels and cognitive effort e g impression management and self presentation in intragroup contexts levels and depletion of resources may be exacerbated in the intergroup situation Trait Edit Anxiety can be either a short term state or a long term personality trait Trait anxiety reflects a stable tendency across the lifespan of responding with acute state anxiety in the anticipation of threatening situations whether they are actually deemed threatening or not 58 A meta analysis showed that a high level of neuroticism is a risk factor for development of anxiety symptoms and disorders 59 Such anxiety may be conscious or unconscious 60 Personality can also be a trait leading to anxiety and depression and their persistence 11 Through experience many find it difficult to collect themselves due to their own personal nature 61 Choice or decision Edit Anxiety induced by the need to choose between similar options is increasingly being recognized as a problem for individuals and for organizations 62 In 2004 Capgemini wrote Today we re all faced with greater choice more competition and less time to consider our options or seek out the right advice 63 In a decision context unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision making 64 There are primarily two forms of this anxiety type The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities 64 Panic disorder Edit Main article Panic disorder Panic disorder may share symptoms of stress and anxiety but it is actually very different Panic disorder is an anxiety disorder that occurs without any triggers According to the U S Department of Health and Human Services this disorder can be distinguished by unexpected and repeated episodes of intense fear 65 Someone with panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual s general quality of life It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years Some symptoms include difficulty breathing chest pain dizziness trembling or shaking feeling faint nausea fear that you are losing control or are about to die Even though they have these symptoms during an attack the main symptom is the persistent fear of having future panic attacks 66 Anxiety disorders EditMain article Anxiety disorder Anxiety disorders are a group of mental disorders characterized by exaggerated feelings of anxiety and fear responses 7 Anxiety is a worry about future events and fear is a reaction to current events These feelings may cause physical symptoms such as a fast heart rate and shakiness There are a number of anxiety disorders including generalized anxiety disorder specific phobia social anxiety disorder separation anxiety disorder agoraphobia panic disorder and selective mutism The disorder differs by what results in the symptoms People often have more than one anxiety disorder 7 Anxiety disorders are caused by a complex combination of genetic and environmental factors 67 68 To be diagnosed symptoms typically need to be present for at least six months be more than would be expected for the situation and decrease a person s ability to function in their daily lives 7 69 Other problems that may result in similar symptoms include hyperthyroidism heart disease caffeine alcohol or cannabis use and withdrawal from certain drugs among others 70 Without treatment anxiety disorders tend to remain 7 71 Treatment may include lifestyle changes counselling and medications Counselling is typically with a type of cognitive behavioural therapy 72 Medications such as antidepressants or beta blockers may improve symptoms 71 About 12 of people are affected by an anxiety disorder in a given year and between 12 30 are affected at some point in their life 72 73 They occur about twice as often in women than they do in men and generally begin before the age of 25 7 72 The most common are specific phobia which affects nearly 12 and social anxiety disorder which affects 10 at some point in their life They affect those between the ages of 15 and 35 the most and become less common after the age of 55 Rates appear to be higher in the United States and Europe 72 Short and long term anxiety Edit Anxiety can be either a short term state or a long term trait Whereas trait anxiety represents worrying about future events anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fears 7 Four ways to be anxious Edit In his book Anxious The Modern Mind in the Age of Anxiety 74 Joseph LeDoux examines four experiences of anxiety through a brain based lens In the presence of an existing or imminent external threat you worry about the event and its implications for your physical and or psychological well being When a threat signal occurs it signifies either that danger is present or near in space and time or that it might be coming in the future Nonconscious threats processing by the brain activates defensive survival circuits resulting in changes in information processing in the brain controlled in part by increases in arousal and behavioral and physiological responses in the body that then produce signals that feed back to the brain and complement the physiological changes there intensifying them and extending their duration When you notice body sensations you worry about what they might mean for your physical and or psychological well being The trigger stimulus does not have to be an external stimulus but can be an internal one as some people are particularly sensitive to body signals Thoughts and memories may lead to you to worry about your physical and or psychological well being We do not need to be presence of an external or internal stimulus to be anxious An episodic memory of a past trauma or of a panic attack in the past is sufficient to activate the defence circuits Thoughts and memories may result in existential dread such as worry about leading a meaningful life or the eventuality of death Examples are contemplations of whether one s life has been meaningful the inevitability of death or the difficulty of making decisions that have a moral value These do not necessarily activate defensive systems they are more or less pure forms of cognitive anxiety Co morbidity EditAnxiety disorders often occur with other mental health disorders particularly major depressive disorder bipolar disorder eating disorders or certain personality disorders It also commonly occurs with personality traits such as neuroticism This observed co occurrence is partly due to genetic and environmental influences shared between these traits and anxiety 75 76 It is common for those with obsessive compulsive disorder to experience anxiety Anxiety is also commonly found in those who experience panic disorders phobic anxiety disorders severe stress dissociative disorders somatoform disorders and some neurotic disorders 77 Anxiety has also been linked to the experience of intrusive thoughts Studies have revealed that individuals who experience high levels of anxiety also known as clinical anxiety are highly vulnerable to the experience of intense intrusive thoughts or psychological disorders that are characterised by intrusive thoughts 78 Risk factors Edit A marble bust of the Roman Emperor Decius from the Capitoline Museum This portrait conveys an impression of anxiety and weariness as of a man shouldering heavy state responsibilities 79 Anxiety disorders are partly genetic with twin studies suggesting 30 40 genetic influence on individual differences in anxiety 80 Environmental factors are also important Twin studies show that individual specific environments have a large influence on anxiety whereas shared environmental influences environments that affect twins in the same way operate during childhood but decline through adolescence 81 Specific measured environments that have been associated with anxiety include child abuse family history of mental health disorders and poverty 82 Anxiety is also associated with drug use including alcohol caffeine and benzodiazepines which are often prescribed to treat anxiety Environmental factors and innovative technology such as artificial intelligence systems also induce situation specific and technology related anxiety 83 Neuroanatomy Edit Neural circuitry involving the amygdala which regulates emotions like anxiety and fear stimulating the HPA axis and sympathetic nervous system and hippocampus which is implicated in emotional memory along with the amygdala is thought to underlie anxiety 84 People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala 85 Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system which includes the amygdala and nucleus accumbens giving increased future anxiety but this does not appear to have been proven 86 87 Research upon adolescents who as infants had been highly apprehensive vigilant and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward 88 This suggests a link between circuits responsible for fear and also reward in anxious people As researchers note a sense of responsibility or self agency in a context of uncertainty probabilistic outcomes drives the neural system underlying appetitive motivation i e nucleus accumbens more strongly in temperamentally inhibited than noninhibited adolescents 88 The gut brain axis Edit The microbes of the gut can connect with the brain to affect anxiety There are various pathways along which this communication can take place One is through the major neurotransmitters 89 The gut microbes such as Bifidobacterium and Bacillus produce the neurotransmitters GABA and dopamine respectively 90 The neurotransmitters signal to the nervous system of the gastrointestinal tract and those signals will be carried to the brain through the vagus nerve or the spinal system 89 90 91 This is demonstrated by the fact that altering the microbiome has shown anxiety and depression reducing effects in mice but not in subjects without vagus nerves 92 Another key pathway is the HPA axis as mentioned above 91 The microbes can control the levels of cytokines in the body and altering cytokine levels creates direct effects on areas of the brain such as the hypothalamus the area that triggers HPA axis activity The HPA axis regulates production of cortisol a hormone that takes part in the body s stress response 91 When HPA activity spikes cortisol levels increase processing and reducing anxiety in stressful situations These pathways as well as the specific effects of individual taxa of microbes are not yet completely clear but the communication between the gut microbiome and the brain is undeniable as is the ability of these pathways to alter anxiety levels With this communication comes the potential to treat anxiety Prebiotics and probiotics have been shown to reduce anxiety For example experiments in which mice were given fructo and galacto oligosaccharide prebiotics 93 and Lactobacillus probiotics 92 have both demonstrated a capability to reduce anxiety In humans results are not as concrete but promising 94 95 Genetics Edit Genetics and family history e g parental anxiety may put an individual at increased risk of an anxiety disorder but generally external stimuli will trigger its onset or exacerbation 96 Estimates of genetic influence on anxiety based on studies of twins range from 25 to 40 depending on the specific type and age group under study For example genetic differences account for about 43 of variance in panic disorder and 28 in generalized anxiety disorder 97 Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence 98 99 When investigating how anxiety is passed on from parents to children it is important to account for sharing of genes as well as environments for example using the intergenerational children of twins design 100 Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety These investigations were based on hypotheses about how certain known genes influence neurotransmitters such as serotonin and norepinephrine and hormones such as cortisol that are implicated in anxiety None of these findings are well replicated 101 with the possible exception of TMEM132D COMT and MAO A 101 The epigenetic signature of BDNF a gene that codes for a protein called brain derived neurotrophic factor that is found in the brain has also been associated with anxiety and specific patterns of neural activity 102 and a receptor gene for BDNF called NTRK2 was associated with anxiety in a large genome wide investigation 102 The reason that most candidate gene findings have not replicated is that anxiety is a complex trait that is influenced by many genomic variants each of which has a small effect on its own Increasingly studies of anxiety are using a hypothesis free approach to look for parts of the genome that are implicated in anxiety using big enough samples to find associations with variants that have small effects The largest explorations of the common genetic architecture of anxiety have been facilitated by the UK Biobank the ANGST consortium and the CRC Fear Anxiety and Anxiety Disorders 102 103 104 Epigenetics Edit This section is an excerpt from Epigenetics of anxiety and stress related disorders edit Epigenetics of anxiety and stress related disorders is the field studying the relationship between epigenetic modifications of genes and anxiety and stress related disorders including mental health disorders such as generalized anxiety disorder GAD post traumatic stress disorder obsessive compulsive disorder OCD and more These change can lead to transgenerational stress inheritance 105 Epigenetic modifications play a role in the development and heritability of these disorders and related symptoms For example regulation of the hypothalamus pituitary adrenal axis by glucocorticoids plays a major role in stress response and is known to be epigenetically regulated As of 2015 most work has been done in animal models in laboratories and little work has been done in humans the work is not yet applicable to clinical psychiatry 106 Stress induced epigenetic changes particularly to genes that effect the hypothalamic pituitary adrenal HPA axis persist into future generations negatively impacting the capacity of offspring to adapt to stress Early life experiences even when generations removed can cause permanent epigenetic modifications of DNA resulting in changes in gene expression endocrine function and metabolism 105 These heritable epigenetic modifications include DNA methylation of the promoter regions of genes that affect sensitivity to stress Medical conditions Edit Many medical conditions can cause anxiety This includes conditions that affect the ability to breathe like COPD and asthma and the difficulty in breathing that often occurs near death 107 108 109 Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a somatization of anxiety 110 111 the same is true for some sexual dysfunctions 112 113 Conditions that affect the face or the skin can cause social anxiety especially among adolescents 114 and developmental disabilities often lead to social anxiety for children as well 115 Life threatening conditions like cancer also cause anxiety 116 Furthermore certain organic diseases may present with anxiety or symptoms that mimic anxiety 25 117 These disorders include certain endocrine diseases hypo and hyperthyroidism hyperprolactinemia 117 118 metabolic disorders diabetes 117 119 120 deficiency states low levels of vitamin D B2 B12 folic acid 117 gastrointestinal diseases celiac disease non celiac gluten sensitivity inflammatory bowel disease 121 122 123 heart diseases blood diseases anemia 117 cerebral vascular accidents transient ischemic attack stroke 117 and brain degenerative diseases Parkinson s disease dementia multiple sclerosis Huntington s disease among others 117 124 125 126 Substance induced Edit Several drugs can cause or worsen anxiety whether in intoxication withdrawal or as side effect These include alcohol tobacco sedatives including prescription benzodiazepines opioids including prescription pain killers and illicit drugs like heroin stimulants such as caffeine cocaine and amphetamines hallucinogens and inhalants 127 While many often report self medicating anxiety with these substances improvements in anxiety from drugs are usually short lived with worsening of anxiety in the long term sometimes with acute anxiety as soon as the drug effects wear off and tend to be exaggerated 128 129 Acute exposure to toxic levels of benzene may cause euphoria anxiety and irritability lasting up to 2 weeks after the exposure 130 Psychological Edit Poor coping skills e g rigidity inflexible problem solving denial avoidance impulsivity extreme self expectation negative thoughts affective instability and inability to focus on problems are associated with anxiety Anxiety is also linked and perpetuated by the person s own pessimistic outcome expectancy and how they cope with feedback negativity 131 132 Temperament e g neuroticism 59 and attitudes e g pessimism have been found to be risk factors for anxiety 133 Cognitive distortions such as overgeneralizing catastrophizing mind reading emotional reasoning binocular trick and mental filter can result in anxiety For example an overgeneralized belief that something bad always happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment In addition those who have high anxiety can also create future stressful life events 134 Together these findings suggest that anxious thoughts can lead to anticipatory anxiety as well as stressful events which in turn cause more anxiety Such unhealthy thoughts can be targets for successful treatment with cognitive therapy Psychodynamic theory posits that anxiety is often the result of opposing unconscious wishes or fears that manifest via maladaptive defense mechanisms such as suppression repression anticipation regression somatization passive aggression dissociation that develop to adapt to problems with early objects e g caregivers and empathic failures in childhood For example persistent parental discouragement of anger may result in repression suppression of angry feelings which manifests as gastrointestinal distress somatization when provoked by another while the anger remains unconscious and outside the individual s awareness Such conflicts can be targets for successful treatment with psychodynamic therapy While psychodynamic therapy tends to explore the underlying roots of anxiety cognitive behavioral therapy has also been shown to be a successful treatment for anxiety by altering irrational thoughts and unwanted behaviors Evolutionary psychology Edit An evolutionary psychology explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats This may cause false positive reactions but an individual with anxiety may also avoid real threats This may explain why anxious people are less likely to die due to accidents 135 There is ample empirical evidence that anxiety can have adaptive value Within a school timid fish are more likely than bold fish to survive a predator 136 When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes PET scans show increased blood flow in the amygdala 137 138 In these studies the participants also reported moderate anxiety This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors Social Edit Social risk factors for anxiety include a history of trauma e g physical sexual or emotional abuse or assault bullying early life experiences and parenting factors e g rejection lack of warmth high hostility harsh discipline high parental negative affect anxious childrearing modelling of dysfunctional and drug abusing behaviour discouragement of emotions poor socialization poor attachment and child abuse and neglect cultural factors e g stoic families cultures persecuted minorities including those with disabilities and socioeconomics e g uneducated unemployed impoverished although developed countries have higher rates of anxiety disorders than developing countries 139 A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression anxiety and sleep disorders 140 Food insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food secure individuals Gender socialization Edit Contextual factors that are thought to contribute to anxiety include gender socialization and learning experiences In particular learning mastery the degree to which people perceive their lives to be under their own control and instrumentality which includes such traits as self confidence self efficacy independence and competitiveness fully mediate the relation between gender and anxiety That is though gender differences in anxiety exist with higher levels of anxiety in women compared to men gender socialization and learning mastery explain these gender differences 141 Treatment EditSee also Fear Management The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause the recognition of which is essential in order to decide the correct treatment 25 117 Anxiety symptoms may mask an organic disease or appear associated with or as a result of a medical disorder 25 117 142 26 Cognitive behavioral therapy CBT is effective for anxiety disorders and is a first line treatment 143 144 145 146 147 CBT appears to be equally effective when carried out via the internet 147 While evidence for mental health apps is promising it is preliminary 148 149 Psychopharmacological treatment can be used in parallel to CBT or can be used alone As a general rule most anxiety disorders respond well to first line agents Such drugs also used as anti depressants are the selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors that work by blocking the reuptake of specific neurotransmitters and resulting in the increase in availability of these neurotransmitters Additionally benzodiazepines are often prescribed to individuals with anxiety disorder Benzodiazepines produce an anxiolytic response by modulating GABA and increasing its receptor binding A third common treatment involves a category of drug known as serotonin agonists This category of drug works by initiating a physiological response at 5 HT1A receptor by increasing the action of serotonin at this receptor citation needed Other treatment options include pregabalin tricyclic antidepressants and moclobemide among others 150 Anxiety is considered to be a serious psychiatric illness that has an unknown true pervasiveness due to affected individuals not asking for proper treatment or aid and due to professionals missing the diagnosis 3 Prevention EditThe above risk factors give natural avenues for prevention A 2017 review found that psychological or educational interventions have a small yet statistically significant benefit for the prevention of anxiety in varied population types 151 152 153 Pathophysiology EditAnxiety disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance decreased GABA ergic tone allelic polymorphism of the catechol O methyltransferase COMT gene increased adenosine receptor function increased cortisol 154 In the central nervous system CNS the major mediators of the symptoms of anxiety disorders appear to be norepinephrine serotonin dopamine and gamma aminobutyric acid GABA Other neurotransmitters and peptides such as corticotropin releasing factor may be involved Peripherally the autonomic nervous system especially the sympathetic nervous system mediates many of the symptoms Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder The amygdala is central to the processing of fear and anxiety 155 and its function may be disrupted in anxiety disorders Anxiety processing in the basolateral amygdala has been implicated with expansion of dendritic arborization of the amygdaloid neurons 156 SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization 157 See also EditList of people with an anxiety disorder Angst Intense feeling of apprehension anxiety or inner turmoil Fear Basic emotion induced by a perceived threat Tripartite Model of Anxiety and Depression Uncanny Psychological experience of something as strangely familiarReferences Edit Davison GC 2008 Abnormal Psychology Toronto Veronica Visentin p 154 ISBN 978 0 470 84072 6 Miceli M Castelfranchi C 2014 11 27 Expectancy and emotion OUP Oxford ISBN 978 0 19 150927 8 Archived from the original on 2023 01 17 Retrieved 2022 05 09 a b c d Chand SP Marwaha R 2022 Anxiety StatPearls Treasure Island FL StatPearls Publishing PMID 29262212 Archived from the original on 2022 06 21 Retrieved 2022 12 15 Anxiety is linked to fear and manifests as a future oriented mood state that consists of a complex cognitive affective physiological and behavioral response system associated with preparation for the anticipated events or circumstances perceived as threatening Crocq MA September 2015 A history of anxiety from Hippocrates to DSM Dialogues in Clinical Neuroscience 17 3 319 325 doi 10 31887 DCNS 2015 17 3 macrocq PMC 4610616 PMID 26487812 Seligman ME Walker EF Rosenhan DL Abnormal psychology 4th ed New York W W Norton amp Company page needed Bouras N Holt G 2007 Psychiatric and Behavioral Disorders in Intellectual and Developmental Disabilities 2nd ed Cambridge University Press ISBN 9781139461306 Archived from the original on 2023 01 17 Retrieved 2018 11 22 page needed a b c d e f g h i j American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders Fifth ed Arlington VA American Psychiatric Publishing p 189 ISBN 978 0 89042 555 8 a b c Barker P 2003 Psychiatric and Mental Health Nursing The Craft of Caring London Edward Arnold ISBN 978 0 340 81026 2 page needed Robinson OJ Pike AC Cornwell B Grillon C December 2019 The translational neural circuitry of anxiety Journal of Neurology Neurosurgery and Psychiatry BMJ 90 12 1353 1360 doi 10 1136 jnnp 2019 321400 PMID 31256001 S2CID 195758112 Anxiety is an adaptive response that promotes harm avoidance but at the same time excessive anxiety constitutes the most common psychiatric complaint Evans DL Foa EB Gur RE Hendin H O Brien CP Seligman ME Walsh BT eds 2005 Treating and preventing adolescent mental health disorders what we know and what we don t know A research agenda for improving the mental health of our youth New York Oxford University Press doi 10 1093 9780195173642 001 0001 ISBN 978 0 19 517364 2 OCLC 56324679 Archived from the original on 2021 12 16 Retrieved 2021 06 02 a b Hovenkamp Hermelink JH Jeronimus BF Myroniuk S Riese H Schoevers RA May 2021 Predictors of persistence of anxiety disorders across the lifespan a systematic review PDF The Lancet Psychiatry 8 5 428 443 doi 10 1016 S2215 0366 20 30433 8 PMID 33581052 S2CID 231919782 Marras A Fineberg N Pallanti S August 2016 Obsessive compulsive and related disorders comparing DSM 5 and ICD 11 CNS Spectrums 21 4 324 333 doi 10 1017 S1092852916000110 PMID 27401060 S2CID 13129793 World Health Organization 2023 International Classification of Diseases eleventh revision ICD 11 Genova www icd who int Andreas Dorschel Furcht und Angst In Dietmar Goltschnigg ed Angst Lahmender Stillstand und Motor des Fortschritts Stauffenburg Tubingen 2012 pp 49 54 Heeren A 2020 On the distinction between fear and anxiety in a post pandemic world a commentary on Schimmenti et al 2020 Clinical Neuropsychiatry 17 3 189 191 doi 10 36131 cnfioritieditore20200307 PMC 8629083 PMID 34908991 Archived from the original on 2021 12 16 Retrieved 2020 12 13 Ohman A 2000 Fear and anxiety Evolutionary cognitive and clinical perspectives In Lewis M Haviland Jones JM eds Handbook of emotions New York The Guilford Press pp 573 93 ISBN 978 1 57230 529 8 Barlow DH November 2000 Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory The American Psychologist 55 11 1247 1263 doi 10 1037 0003 066X 55 11 1247 PMID 11280938 Iacovou S 2011 What is the difference between existential anxiety and so called neurotic anxiety The sine qua non of true vitality an examination of the difference between existential anxiety and neurotic anxiety Existential Analysis 22 2 Gale A288874227 Csikszentmihalyi M 1997 Finding Flow ISBN 9780465045136 page needed Sylvers P Lilienfeld SO LaPrairie JL February 2011 Differences between trait fear and trait anxiety implications for psychopathology Clinical Psychology Review 31 1 122 137 doi 10 1016 j cpr 2010 08 004 PMID 20817337 Emory M June 7 2018 On Fear Emotions and Memory An Interview with Dr Joseph LeDoux Brain World Archived from the original on April 22 2021 Retrieved September 11 2019 Barrett LF January 2017 The theory of constructed emotion an active inference account of interoception and categorization Social Cognitive and Affective Neuroscience 12 1 1 23 doi 10 1093 scan nsw154 PMC 5390700 PMID 27798257 Rynn MA Brawman Mintzer O October 2004 Generalized anxiety disorder acute and chronic treatment CNS Spectrums 9 10 716 723 doi 10 1017 S1092852900022367 PMID 15448583 S2CID 24207457 Generalized Anxiety Disorder National Institute of Mental Health NIMH Retrieved 2023 03 29 a b c d e World Health Organization 2009 Pharmacological Treatment of Mental Disorders in Primary Health Care PDF Geneva ISBN 978 92 4 154769 7 Archived PDF from the original on November 20 2016 a b c Testa A Giannuzzi R Sollazzo F Petrongolo L Bernardini L Daini S February 2013 Psychiatric emergencies part I psychiatric disorders causing organic symptoms European Review for Medical and Pharmacological Sciences 17 Suppl 1 55 64 PMID 23436668 Archived from the original on 2021 02 26 Retrieved 2018 10 26 Depression Hotline Call Our Free 24 Hour Depression Helpline PsychGuides com Archived from the original on October 11 2018 Retrieved October 11 2018 Smith M June 2008 Anxiety attacks and disorders Guide to the signs symptoms and treatment options Helpguide Archived from the original on 7 March 2009 Retrieved 3 March 2009 Folk J 13 October 2021 1987 Liashko V ed Anxiety Symptoms Causes Treatment Anxiety Centre Archived from the original on March 7 2009 Retrieved 3 March 2009 Milfayetty S Fadli RP Ifdil I Zola N Amalianita B Putri YE Ardi Z September 2020 The Effectiveness of Multidimensional Counseling in the Intervention of Student Anxiety Addictive Disorders amp Their Treatment 19 3 131 5 doi 10 1097 ADT 0000000000000187 S2CID 209255441 Folk J 27 March 2021 1987 Folk M ed Anxiety symptoms Fear of dying Anxiety Centre Archived from the original on March 5 2009 Retrieved 3 March 2009 Rank O 1932 Art and Artist Norton W W amp Company Inc ISBN 9780393305746 a b Tillich P 1952 The Courage To Be New Haven Yale University Press p 76 ISBN 978 0 300 08471 9 Abulof U 2015 The Mortality and Morality of Nations New York Cambridge University Press p 26 ISBN 978 1 107 09707 0 Hjelle L Ziegler D 1981 Personality Theories Basic Assumptions Research and Applications McGraw Hill p 494 ISBN 9780070290631 Teigen KH 1994 Yerkes Dodson A Law for all Seasons Theory amp Psychology 4 4 525 547 doi 10 1177 0959354394044004 S2CID 145516099 Colangelo Raychel Audet Karyn 2020 12 31 Stress in Post Secondary Toward an Understanding of Test Anxiety Cognitive Performance and Brief Mindfulness Meditation Behavioural Sciences Undergraduate Journal 3 1 31 44 doi 10 29173 bsuj500 ISSN 2562 4687 Liebert RM Morris LW June 1967 Cognitive and emotional components of test anxiety a distinction and some initial data Psychological Reports 20 3 975 978 doi 10 2466 pr0 1967 20 3 975 PMID 6042522 Beidel DC Turner SM June 1988 Comorbidity of test anxiety and other anxiety disorders in children Journal of Abnormal Child Psychology 16 3 275 287 doi 10 1007 BF00913800 PMID 3403811 S2CID 38476947 Rapee RM Heimberg RG August 1997 A cognitive behavioral model of anxiety in social phobia Behaviour Research and Therapy 35 8 741 756 doi 10 1016 S0005 7967 97 00022 3 PMID 9256517 Mathur S Khan W 2011 Impact of Hypnotherapy on Examination Anxiety and Scholastic Performance among School PDF Delhi Psychiatry Journal 14 2 337 342 CiteSeerX 10 1 1 1027 7497 Archived PDF from the original on 2022 10 09 Ovadia Blechman Z Tarrasch R Velicki M Chalutz Ben Gal H 2022 Reducing Test Anxiety by Device Guided Breathing A Pilot Study PDF Frontiers in Psychology 13 678098 doi 10 3389 fpsyg 2022 678098 PMC 9167931 PMID 35677145 Archived PDF from the original on 2022 10 09 a b Rice SM Purcell R De Silva S Mawren D McGorry PD Parker AG September 2016 The Mental Health of Elite Athletes A Narrative Systematic Review Sports Medicine 46 9 1333 1353 doi 10 1007 s40279 016 0492 2 PMC 4996886 PMID 26896951 a b c Ford JL Ildefonso K Jones ML Arvinen Barrow M 2017 10 27 Sport related anxiety current insights Open Access Journal of Sports Medicine 8 205 212 doi 10 2147 OAJSM S125845 PMC 5667788 PMID 29138604 Kang H Jang S 2018 08 13 Effects of competition anxiety on self confidence in soccer players Modulation effects of home and away games Journal of Men s Health 14 3 62 68 doi 10 22374 1875 6859 14 3 9 ISSN 1875 6867 Rowland DL van Lankveld JJ 2019 Anxiety and Performance in Sex Sport and Stage Identifying Common Ground Frontiers in Psychology 10 1615 doi 10 3389 fpsyg 2019 01615 PMC 6646850 PMID 31379665 a b Jarvis M 2006 Sport psychology a student s handbook London Routledge ISBN 1 84169 581 5 OCLC 60971762 Weiner IB Craighead WE eds 2010 01 30 The Corsini Encyclopedia of Psychology 1st ed Wiley doi 10 1002 9780470479216 corpsy0626 ISBN 978 0 470 17024 3 Hofmann SG Dibartolo PM 2010 Introduction Toward an Understanding of Social Anxiety Disorder Social Anxiety pp xix xxvi doi 10 1016 B978 0 12 375096 9 00028 6 ISBN 978 0 12 375096 9 Thomas B Hardy S Cutting P eds 1997 Mental Health Nursing Principles and Practice London Mosby ISBN 978 0 7234 2590 8 page needed Settipani CA Kendall PC February 2013 Social functioning in youth with anxiety disorders association with anxiety severity and outcomes from cognitive behavioral therapy Child Psychiatry and Human Development 44 1 1 18 doi 10 1007 s10578 012 0307 0 PMID 22581270 S2CID 39915581 Stephan WG Stephan CW 1985 Intergroup Anxiety Journal of Social Issues 41 3 157 175 doi 10 1111 j 1540 4560 1985 tb01134 x Richeson JA Trawalter S February 2008 The threat of appearing prejudiced and race based attentional biases Psychological Science 19 2 98 102 doi 10 1111 j 1467 9280 2008 02052 x PMID 18271854 S2CID 11212529 Mathews A Mogg K May J Eysenck M August 1989 Implicit and explicit memory bias in anxiety Journal of Abnormal Psychology 98 3 236 240 doi 10 1037 0021 843x 98 3 236 PMID 2768658 Richards A French CC 1991 Effects of encoding and anxiety on implicit and explicit memory performance Personality and Individual Differences 12 2 131 139 doi 10 1016 0191 8869 91 90096 t Amodio DM Hamilton HK December 2012 Intergroup anxiety effects on implicit racial evaluation and stereotyping Emotion 12 6 1273 1280 CiteSeerX 10 1 1 659 5717 doi 10 1037 a0029016 PMID 22775128 Plant EA Devine PG June 2003 The antecedents and implications of interracial anxiety Personality amp Social Psychology Bulletin 29 6 790 801 doi 10 1177 0146167203029006011 PMID 15189634 S2CID 8581417 Schwarzer R et al Psychosocial Working Group December 1997 Anxiety MacArthur SES amp Health Network Archived from the original on 7 March 2018 a b Jeronimus BF Kotov R Riese H Ormel J October 2016 Neuroticism s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history but the adjusted association hardly decays with time a meta analysis on 59 longitudinal prospective studies with 443 313 participants Psychological Medicine 46 14 2883 2906 doi 10 1017 S0033291716001653 PMID 27523506 S2CID 23548727 Archived from the original on 2019 07 24 Retrieved 2019 07 28 Giddey M Wright H 1993 Mental Health Nursing From first principles to professional practice Stanley Thornes ISBN 978 0 412 41210 3 page needed Gulf Bend MHMR Center Archived from the original on October 11 2018 Retrieved October 11 2018 Downey J April 27 2008 Premium choice anxiety The Times London Archived from the original on February 3 2014 Retrieved April 25 2010 Is choice anxiety costing british blue chip business Archived December 22 2015 at the Wayback Machine Capgemini August 16 2004 a b Hartley CA Phelps EA July 2012 Anxiety and decision making Biological Psychiatry 72 2 113 118 doi 10 1016 j biopsych 2011 12 027 PMC 3864559 PMID 22325982 What are the five major types of anxiety disorders U S Department of Health amp Human Services June 8 2015 Archived from the original on October 25 2019 Retrieved October 25 2019 Panic Disorder amp Panic Attacks The Cleveland Clinic Archived from the original on 2019 10 05 Retrieved 2019 10 25 Hurley K Anorexia amp Depression When Eating Disorders Co Exist with Depression Psycom net Mental Health Treatment Resource Since 1986 Archived from the original on 2020 06 04 Retrieved 2020 06 05 Gottschalk MG Domschke K June 2017 Genetics of generalized anxiety disorder and related traits Dialogues in Clinical Neuroscience 19 2 159 168 doi 10 31887 DCNS 2017 19 2 kdomschke PMC 5573560 PMID 28867940 Anxiety medlineplus gov Archived from the original on 2021 10 27 Retrieved 2021 10 27 Derrick K Green T Wand T December 2019 Assessing and responding to anxiety and panic in the Emergency Department Australasian Emergency Care 22 4 216 220 doi 10 1016 j auec 2019 08 002 PMID 31530499 S2CID 202672894 a b Anxiety Disorders NIMH March 2016 Archived from the original on July 27 2016 Retrieved August 14 2016 a b c d Craske MG Stein MB December 2016 Anxiety Lancet 388 10063 3048 3059 doi 10 1016 S0140 6736 16 30381 6 PMID 27349358 S2CID 208789585 Kessler RC Angermeyer M Anthony JC DE Graaf R Demyttenaere K Gasquet I et al October 2007 Lifetime prevalence and age of onset distributions of mental disorders in the World Health Organization s World Mental Health Survey Initiative World Psychiatry 6 3 168 176 PMC 2174588 PMID 18188442 LeDoux JE 2015 Anxious the modern mind in the age of anxiety London ISBN 978 1 78074 767 5 OCLC 920462582 Smoller JW Andreassen OA Edenberg HJ Faraone SV Glatt SJ Kendler KS March 2019 Correction to Psychiatric genetics and the structure of psychopathology Molecular Psychiatry 24 3 471 doi 10 1038 s41380 018 0026 4 PMID 29540840 Kendler KS July 2004 Major Depression and Generalised Anxiety Disorder FOCUS 2 3 416 425 doi 10 1176 foc 2 3 416 Stein DJ Fineberg NA Bienvenu OJ Denys D Lochner C Nestadt G et al June 2010 Should OCD be classified as an anxiety disorder in DSM V Depression and Anxiety 27 6 495 506 doi 10 1002 da 20699 PMID 20533366 S2CID 17606388 Omoregie J Carson J 1 January 2022 Reductive mechanisms for unwanted intrusive thoughts exploring affectivity in clinical and non clinical samples Mental Health and Social Inclusion 27 51 65 doi 10 1108 MHSI 06 2022 0040 S2CID 251511163 Scarre C 1995 Chronicle of the Roman Emperors Thames amp Hudson pp 168 9 ISBN 978 5 00 050775 9 page needed Reynolds CA June 16 2013 Robert Plomin John C DeFries Valerie S Knopik Jenae M Neiderhiser Behavioral Genetics 6th Edition Behavior Genetics 43 4 360 361 doi 10 1007 s10519 013 9598 6 S2CID 141211176 Smoller JW Block SR Young MM November 2009 Genetics of anxiety disorders the complex road from DSM to DNA Depression and Anxiety 26 11 965 975 doi 10 1002 da 20623 PMID 19885930 S2CID 35349081 Craske MG Stein MB Eley TC Milad MR Holmes A Rapee RM Wittchen HU May 2017 Anxiety disorders Nature Reviews Disease Primers 3 1 17024 doi 10 1038 nrdp 2017 24 PMID 28470168 S2CID 52852105 Park Eun Hee Werder Karl Cao Lan Ramesh Balasubramaniam 3 July 2022 Why do Family Members Reject AI in Health Care Competing Effects of Emotions Journal of Management Information Systems 39 3 765 792 doi 10 1080 07421222 2022 2096550 Rosen JB Schulkin J April 1998 From normal fear to pathological anxiety Psychological Review 105 2 325 350 doi 10 1037 0033 295X 105 2 325 PMID 9577241 Nolen Hoeksema S 2013 Ab normal Psychology 6th edition McGraw Hill page needed Fricchione G 2011 Compassion and Healing in Medicine and Society On the Nature and Use of Attachment Solutions to Separation Challenges Johns Hopkins University Press p 172 ISBN 978 1 4214 0220 8 Harris J 1998 How the Brain Talks to Itself A Clinical Primer of Psychotherapeutic Neuroscience Haworth p 284 ISBN 978 0 7890 0408 6 a b Bar Haim Y Fox NA Benson B Guyer AE Williams A Nelson EE et al August 2009 Neural correlates of reward processing in adolescents with a history of inhibited temperament Psychological Science 20 8 1009 1018 doi 10 1111 j 1467 9280 2009 02401 x PMC 2785902 PMID 19594857 a b Kennedy PJ Cryan JF Dinan TG Clarke G January 2017 Kynurenine pathway metabolism and the microbiota gut brain axis Neuropharmacology 112 Pt B 399 412 doi 10 1016 j neuropharm 2016 07 002 PMID 27392632 S2CID 12743048 a b Dinan TG Stilling RM Stanton C Cryan JF April 2015 Collective unconscious how gut microbes shape human behavior Journal of Psychiatric Research 63 1 9 doi 10 1016 j jpsychires 2015 02 021 PMID 25772005 a b c de Weerth C December 2017 Do bacteria shape our development Crosstalk between intestinal microbiota and HPA axis Neuroscience and Biobehavioral Reviews 83 458 471 doi 10 1016 j neubiorev 2017 09 016 PMID 28918360 S2CID 40601114 a b Bravo JA Forsythe P Chew MV Escaravage E Savignac HM Dinan TG et al September 2011 Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve Proceedings of the National Academy of Sciences of the United States of America 108 38 16050 16055 doi 10 1073 pnas 1102999108 PMC 3179073 PMID 21876150 Burokas A Arboleya S Moloney RD Peterson VL Murphy K Clarke G et al October 2017 Targeting the Microbiota Gut Brain Axis Prebiotics Have Anxiolytic and Antidepressant like Effects and Reverse the Impact of Chronic Stress in Mice Biological Psychiatry 82 7 472 487 doi 10 1016 j biopsych 2016 12 031 PMID 28242013 S2CID 206106596 Benton D Williams C Brown A March 2007 Impact of consuming a milk drink containing a probiotic on mood and cognition European Journal of Clinical Nutrition 61 3 355 361 doi 10 1038 sj ejcn 1602546 PMID 17151594 Schmidt K Cowen PJ Harmer CJ Tzortzis G Errington S Burnet PW May 2015 Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers Psychopharmacology 232 10 1793 1801 doi 10 1007 s00213 014 3810 0 PMC 4410136 PMID 25449699 Davies MR Kalsi G Armour C Jones IR McIntosh AM Smith DJ et al December 2019 The Genetic Links to Anxiety and Depression GLAD Study Online recruitment into the largest recontactable study of depression and anxiety Behaviour Research and Therapy 123 103503 doi 10 1016 j brat 2019 103503 PMC 6891252 PMID 31715324 Gottschalk MG Domschke K June 2017 Genetics of generalized anxiety disorder and related traits Dialogues in Clinical Neuroscience 19 2 159 168 doi 10 31887 DCNS 2017 19 2 kdomschke PMC 5573560 PMID 28867940 Waszczuk MA Zavos HM Gregory AM Eley TC August 2014 The phenotypic and genetic structure of depression and anxiety disorder symptoms in childhood adolescence and young adulthood JAMA Psychiatry 71 8 905 916 doi 10 1001 jamapsychiatry 2014 655 PMID 24920372 Nivard MG Dolan CV Kendler KS Kan KJ Willemsen G van Beijsterveldt CE et al April 2015 Stability in symptoms of anxiety and depression as a function of genotype and environment a longitudinal twin study from ages 3 to 63 years Psychological Medicine 45 5 1039 1049 doi 10 1017 S003329171400213X PMID 25187475 S2CID 15183002 Eley TC McAdams TA Rijsdijk FV Lichtenstein P Narusyte J Reiss D et al July 2015 The Intergenerational Transmission of Anxiety A Children of Twins Study The American Journal of Psychiatry 172 7 630 637 doi 10 1176 appi ajp 2015 14070818 PMC 8515953 PMID 25906669 a b Howe AS Buttenschon HN Bani Fatemi A Maron E Otowa T Erhardt A et al May 2016 Candidate genes in panic disorder meta analyses of 23 common variants in major anxiogenic pathways Molecular Psychiatry 21 5 665 679 doi 10 1038 mp 2015 138 PMID 26390831 S2CID 3394824 a b c Purves KL Coleman JR Meier SM Rayner C Davis KA Cheesman R et al December 2020 A major role for common genetic variation in anxiety disorders Molecular Psychiatry 25 12 3292 3303 doi 10 1038 s41380 019 0559 1 PMC 7237282 PMID 31748690 Otowa T Hek K Lee M Byrne EM Mirza SS Nivard MG et al October 2016 Meta analysis of genome wide association studies of anxiety disorders Molecular Psychiatry 21 10 1391 1399 doi 10 1016 j euroneuro 2016 09 604 PMC 4940340 PMID 26754954 Deckert J Weber H Villmann C Lonsdorf TB Richter J Andreatta M et al October 2017 GLRB allelic variation associated with agoraphobic cognitions increased startle response and fear network activation a potential neurogenetic pathway to panic disorder Molecular Psychiatry 22 10 1431 1439 doi 10 1016 j euroneuro 2016 09 607 PMID 28167838 S2CID 54353612 a b Matthews SG Phillips DI January 2012 Transgenerational inheritance of stress pathology review Experimental Neurology 233 1 95 101 doi 10 1016 j expneurol 2011 01 009 PMID 21281632 Klengel T Binder EB June 2015 Epigenetics of Stress Related Psychiatric Disorders and Gene Environment Interactions review Neuron 86 6 1343 57 doi 10 1016 j neuron 2015 05 036 PMID 26087162 Baldwin J Cox J September 2016 Treating Dyspnea Is Oxygen Therapy the Best Option for All Patients The Medical Clinics of North America 100 5 1123 1130 doi 10 1016 j mcna 2016 04 018 PMID 27542431 Vanfleteren LE Spruit MA Wouters EF Franssen FM November 2016 Management of chronic obstructive pulmonary disease beyond the lungs The Lancet Respiratory Medicine 4 11 911 924 doi 10 1016 S2213 2600 16 00097 7 PMID 27264777 Tselebis A Pachi A Ilias I Kosmas E Bratis D Moussas G Tzanakis N 2016 Strategies to improve anxiety and depression in patients with COPD a mental health perspective Neuropsychiatric Disease and Treatment 12 297 328 doi 10 2147 NDT S79354 PMC 4755471 PMID 26929625 Muscatello MR Bruno A Mento C Pandolfo G Zoccali RA July 2016 Personality traits and emotional patterns in irritable bowel syndrome World Journal of Gastroenterology 22 28 6402 6415 doi 10 3748 wjg v22 i28 6402 PMC 4968122 PMID 27605876 Remes Troche JM December 2016 How to Diagnose and Treat Functional Chest Pain Current Treatment Options in Gastroenterology 14 4 429 443 doi 10 1007 s11938 016 0106 y PMID 27709331 S2CID 19634934 Brotto L Atallah S Johnson Agbakwu C Rosenbaum T Abdo C Byers ES et al April 2016 Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction The Journal of Sexual Medicine 13 4 538 571 doi 10 1016 j jsxm 2016 01 019 PMID 27045257 Archived from the original on 2020 07 26 Retrieved 2019 12 07 McMahon CG Jannini EA Serefoglu EC Hellstrom WJ August 2016 The pathophysiology of acquired premature ejaculation Translational Andrology and Urology 5 4 434 449 doi 10 21037 tau 2016 07 06 PMC 5001985 PMID 27652216 Nguyen CM Beroukhim K Danesh MJ Babikian A Koo J Leon A 2016 The psychosocial impact of acne vitiligo and psoriasis a review Clinical Cosmetic and Investigational Dermatology 9 383 392 doi 10 2147 CCID S76088 PMC 5076546 PMID 27799808 Cacola P 2016 Physical and Mental Health of Children with Developmental Coordination Disorder Frontiers in Public Health 4 224 doi 10 3389 fpubh 2016 00224 PMC 5075567 PMID 27822464 Mosher CE Winger JG Given BA Helft PR O Neil BH November 2016 Mental health outcomes during colorectal cancer survivorship a review of the literature Psycho Oncology 25 11 1261 1270 doi 10 1002 pon 3954 PMC 4894828 PMID 26315692 a b c d e f g h i Testa A Giannuzzi R Daini S Bernardini L Petrongolo L Gentiloni Silveri N February 2013 Psychiatric emergencies part III psychiatric symptoms resulting from organic diseases European Review for Medical and Pharmacological Sciences 17 Suppl 1 86 99 PMID 23436670 Archived from the original on 2021 03 04 Retrieved 2018 10 26 Samuels MH October 2008 Cognitive function in untreated hypothyroidism and hyperthyroidism Current Opinion in Endocrinology Diabetes and Obesity 15 5 429 433 doi 10 1097 MED 0b013e32830eb84c PMID 18769215 S2CID 27235034 Buchberger B Huppertz H Krabbe L Lux B Mattivi JT Siafarikas A August 2016 Symptoms of depression and anxiety in youth with type 1 diabetes A systematic review and meta analysis Psychoneuroendocrinology 70 70 84 doi 10 1016 j psyneuen 2016 04 019 PMID 27179232 S2CID 19858996 Grigsby AB Anderson RJ Freedland KE Clouse RE Lustman PJ December 2002 Prevalence of anxiety in adults with diabetes a systematic review Journal of Psychosomatic Research 53 6 1053 1060 doi 10 1016 S0022 3999 02 00417 8 PMID 12479986 Zingone F Swift GL Card TR Sanders DS Ludvigsson JF Bai JC April 2015 Psychological morbidity of celiac disease A review of the literature United European Gastroenterology Journal 3 2 136 145 doi 10 1177 2050640614560786 PMC 4406898 PMID 25922673 Molina Infante J Santolaria S Sanders DS Fernandez Banares F May 2015 Systematic review noncoeliac gluten sensitivity Alimentary Pharmacology amp Therapeutics 41 9 807 820 doi 10 1111 apt 13155 PMID 25753138 S2CID 207050854 Neuendorf R Harding A Stello N Hanes D Wahbeh H August 2016 Depression and anxiety in patients with Inflammatory Bowel Disease A systematic review Journal of Psychosomatic Research 87 70 80 doi 10 1016 j jpsychores 2016 06 001 PMID 27411754 Zhao QF Tan L Wang HF Jiang T Tan MS Tan L et al January 2016 The prevalence of neuropsychiatric symptoms in Alzheimer s disease Systematic review and meta analysis Journal of Affective Disorders 190 264 271 doi 10 1016 j jad 2015 09 069 PMID 26540080 Wen MC Chan LL Tan LC Tan EK June 2016 Depression anxiety and apathy in Parkinson s disease insights from neuroimaging studies European Journal of Neurology 23 6 1001 1019 doi 10 1111 ene 13002 PMC 5084819 PMID 27141858 Marrie RA Reingold S Cohen J Stuve O Trojano M Sorensen PS et al March 2015 The incidence and prevalence of psychiatric disorders in multiple sclerosis a systematic review Multiple Sclerosis 21 3 305 317 doi 10 1177 1352458514564487 PMC 4429164 PMID 25583845 National Institute on Drug Abuse 2012 08 03 Prescription Drug Facts Effects Teen Use NIDA for Teens Archived from the original on 2022 05 18 Retrieved 2022 05 24 Brady KT Haynes LF Hartwell KJ Killeen TK 2013 Substance use disorders and anxiety a treatment challenge for social workers Social Work in Public Health 28 3 4 407 423 doi 10 1080 19371918 2013 774675 PMC 3775646 PMID 23731428 Turner S Mota N Bolton J Sareen J September 2018 Self medication with alcohol or drugs for mood and anxiety disorders A narrative review of the epidemiological literature Depression and Anxiety 35 9 851 860 doi 10 1002 da 22771 PMC 6175215 PMID 29999576 CDC The Emergency Response Safety and Health Database Systemic Agent BENZENE NIOSH www cdc gov Archived from the original on January 17 2016 Retrieved January 27 2016 Gu R Huang YX Luo YJ September 2010 Anxiety and feedback negativity Psychophysiology 47 5 961 967 doi 10 1111 j 1469 8986 2010 00997 x PMID 20374540 Watkins ER March 2008 Constructive and unconstructive repetitive thought Psychological Bulletin 134 2 163 206 doi 10 1037 0033 2909 134 2 163 PMC 2672052 PMID 18298268 Bienvenu OJ Ginsburg GS December 2007 Prevention of anxiety disorders International Review of Psychiatry 19 6 647 654 doi 10 1080 09540260701797837 PMID 18092242 S2CID 95140 Phillips AC Carroll D Der G 2015 Negative life events and symptoms of depression and anxiety stress causation and or stress generation Anxiety Stress and Coping 28 4 357 371 doi 10 1080 10615806 2015 1005078 PMC 4772121 PMID 25572915 Andrews PW Thomson JA July 2009 The bright side of being blue depression as an adaptation for analyzing complex problems Psychological Review 116 3 620 654 doi 10 1037 a0016242 PMC 2734449 PMID 19618990 Gluckman P 2009 Principles of Evolutionary Medicine Oxford University Press p 249 ISBN 978 0199236398 Zald DH Pardo JV April 1997 Emotion olfaction and the human amygdala amygdala activation during aversive olfactory stimulation Proceedings of the National Academy of Sciences of the United States of America 94 8 4119 4124 Bibcode 1997PNAS 94 4119Z doi 10 1073 pnas 94 8 4119 PMC 20578 PMID 9108115 Zald DH Hagen MC Pardo JV February 2002 Neural correlates of tasting concentrated quinine and sugar solutions Journal of Neurophysiology 87 2 1068 1075 doi 10 1152 jn 00358 2001 PMID 11826070 S2CID 6278342 National Research Council Us Institute Of Medicine Us Committee On The Prevention Of Mental Disorders Substance Abuse Among Children Youth and Young Adults 2009 Table E 4 Risk Factors for Anxiety In O Connell ME Boat T Warner KE eds Prevention of Mental Disorders Substance Abuse and Problem Behaviors A Developmental Perspective National Academies Press p 530 doi 10 17226 12480 ISBN 978 0 309 12674 8 PMID 20662125 S2CID 142581788 Archived from the original on 2014 04 18 Retrieved 2014 04 19 Arenas DJ Thomas A Wang J DeLisser HM December 2019 A Systematic Review and Meta analysis of Depression Anxiety and Sleep Disorders in US Adults with Food Insecurity Journal of General Internal Medicine 34 12 2874 2882 doi 10 1007 s11606 019 05202 4 PMC 6854208 PMID 31385212 Behnke RR Sawyer CR 2000 Anticipatory anxiety patterns for male and female public speakers Communication Education 49 2 187 195 doi 10 1080 03634520009379205 S2CID 144320186 Testa A Giannuzzi R Sollazzo F Petrongolo L Bernardini L Dain S February 2013 Psychiatric emergencies part II psychiatric disorders coexisting with organic diseases European Review for Medical and Pharmacological Sciences 17 Suppl 1 65 85 PMID 23436669 Archived from the original on 2021 05 05 Retrieved 2018 10 26 Stein MB Sareen J November 2015 CLINICAL PRACTICE Generalized Anxiety Disorder The New England Journal of Medicine 373 21 2059 2068 doi 10 1056 nejmcp1502514 PMID 26580998 Cuijpers P Sijbrandij M Koole S Huibers M Berking M Andersson G March 2014 Psychological treatment of generalized anxiety disorder a meta analysis Clinical Psychology Review 34 2 130 140 doi 10 1016 j cpr 2014 01 002 PMID 24487344 Otte C 2011 Cognitive behavioral therapy in anxiety disorders current state of the evidence Dialogues in Clinical Neuroscience 13 4 413 421 doi 10 31887 DCNS 2011 13 4 cotte PMC 3263389 PMID 22275847 Pompoli A Furukawa TA Imai H Tajika A Efthimiou O Salanti G April 2016 Psychological therapies for panic disorder with or without agoraphobia in adults a network meta analysis The Cochrane Database of Systematic Reviews 2016 4 CD011004 doi 10 1002 14651858 CD011004 pub2 PMC 7104662 PMID 27071857 a b Olthuis JV Watt MC Bailey K Hayden JA Stewart SH March 2016 Therapist supported Internet cognitive behavioural therapy for anxiety disorders in adults The Cochrane Database of Systematic Reviews 2016 3 CD011565 doi 10 1002 14651858 cd011565 pub2 PMC 7077612 PMID 26968204 Donker T Petrie K Proudfoot J Clarke J Birch MR Christensen H November 2013 Smartphones for smarter delivery of mental health programs a systematic review Journal of Medical Internet Research 15 11 e247 doi 10 2196 jmir 2791 PMC 3841358 PMID 24240579 Singh K Severn M 2018 e Therapy Interventions for the Treatment of Anxiety Clinical Evidence Report CADTH Rapid Response Report Summary with Critical Appraisal Canadian Agency for Drugs and Technologies in Health PMID 30329251 Retrieved 2022 12 28 Bandelow B Michaelis S Wedekind D June 2017 Treatment of anxiety disorders Dialogues in Clinical Neuroscience 19 2 93 107 doi 10 31887 DCNS 2017 19 2 bbandelow PMC 5573566 PMID 28867934 Moreno Peral P Conejo Ceron S Rubio Valera M Fernandez A Navas Campana D Rodriguez Morejon A et al October 2017 Effectiveness of Psychological and or Educational Interventions in the Prevention of Anxiety A Systematic Review Meta analysis and Meta regression JAMA Psychiatry 74 10 1021 1029 doi 10 1001 jamapsychiatry 2017 2509 PMC 5710546 PMID 28877316 Pote I February 19 2018 Preventing anxiety with psychological and educational interventions National Elf Service Archived from the original on December 16 2021 Retrieved December 12 2019 Schmidt NB Allan NP Knapp AA Capron D 2019 Targeting anxiety sensitivity as a prevention strategy The Clinician s Guide to Anxiety Sensitivity Treatment and Assessment pp 145 178 doi 10 1016 B978 0 12 813495 5 00008 5 ISBN 978 0 12 813495 5 S2CID 81782119 Anxiety Disorders at eMedicine LeDoux J October 2007 The amygdala Current Biology 17 20 R868 R874 doi 10 1016 j cub 2007 08 005 PMID 17956742 S2CID 16348363 Mitra R Sapolsky RM April 2008 Acute corticosterone treatment is sufficient to induce anxiety and amygdaloid dendritic hypertrophy Proceedings of the National Academy of Sciences of the United States of America 105 14 5573 5578 Bibcode 2008PNAS 105 5573M doi 10 1073 pnas 0705615105 PMC 2291109 PMID 18391224 Mitra R Ferguson D Sapolsky RM September 2009 SK2 potassium channel overexpression in basolateral amygdala reduces anxiety stress induced corticosterone secretion and dendritic arborization Molecular Psychiatry 14 9 847 55 827 doi 10 1038 mp 2009 9 PMC 2763614 PMID 19204724 External links EditAnxiety at Wikipedia s sister projects Definitions from Wiktionary Quotations from Wikiquote Media related to Anxiety at Wikimedia Commons Retrieved from https en wikipedia org w index php title Anxiety amp oldid 1161562742, wikipedia, wiki, book, books, library,

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