Anxiety States and their Commonalities with other Psychological Disorders
By Kevin Patton
With symptoms which include feelings of unreality, hot and cold flushes, nausea, shortness of breath, sweating, dizziness, irritability, heart palpitations, chest pain, difficulties sleeping, choking sensations, tingling sensations, weakness in the limbs and feelings of losing control, there is some overlap between the distress of experiencing anxiety states and that of mood disorders such as depression, dissociative disorders and somatoform disorders. Similarly, the symptoms of anxiety can be indicative of an underlying psychotic disorder, organic disorder, personality disorder or problematic substance use. Experienced practitioners gather a history on clients presenting with these symptoms, often referring them to a medical professional in order to differentiate these possible causes before embarking upon a program of CBT.
CBT practitioners formulate anxiety states and other psychological disorders as the result of an interaction of an individual’s predisposition, situational cues, reinforcing cognitions, behaviours, physical sensations and emotions.
Genetic Predisposition
Data generated by twin studies indicating that anxiety disorders, psychotic disorders, obsessive-compulsive disorders, personality disorders, organic disorders and mood disorders may have genetic roots has been criticised from statistical and methodological standpoints (Schonemann, 1997) arguing that conclusions reached via this method are ambiguous or meaningless.
Predictably enough, with the rationale for social control at stake, this topic will continue to be debated for some time. Given that two people exposed to the same situational cues can behave differently, it may be reasonable to deduce that, like heart disease and type 1 diabetes, psychological disorders are complex and a combination of genetic, environmental, psychological, and developmental factors predisposing one individual to transform a situational cue into a trigger more readily than another.
Biology
Several parts of the brain are involved in the production of fear and anxiety. The use of brain imaging technology and neurochemical techniques indicates that the amygdala and the hippocampus play significant roles in most anxiety disorders (LeDoux, 1998).
The amygdala is believed to be a communications hub between the parts of the brain that process incoming sense data and the parts that interpret these signals. It can alert the rest of the brain that a threat is present and trigger a fear or anxiety response. It appears that emotional memories are stored in the central part of the amygdala and may play a role in anxiety disorders involving very distinct fears, such as a fear of dogs.
The hippocampus encodes threatening events into memories. It appears to be smaller in some people who were victims of child abuse or who served in military combat (Bremner et al, 1995). The significance of this phenomenon has yet to be established.
Several medical conditions precipitate symptoms associated with psychological disorders. Alzheimer’s disease, Parkinson’s disease, multiple sclerosis and certain cancers can find expression through symptoms associated with depression. Hyperventilation syndrome, hypoglycaemia, mitral valve prolapse, premenstrual syndrome, inner ear infections, emphysema and deficiencies of calcium, magnesium, potassium, niacin and vitamin B12 can cause symptoms associated with anxiety.
Caused by a deficiency of thiamine (a B vitamin destroyed by high levels of alcohol use) engendering tiny haemorrhages in the midbrain around the walls of the third ventricle and in the mamillary bodies, Wernicke’s encephalopathy is characterised by impairment of consciousness, paralysis of muscles controlling eye movements and an inability to co-ordinate voluntary movements. The chronic form of Wernicke’s encephalopathy, Korsakoff’s psychosis is characterised by severe amnesia, inability to form new memories, confabulation and difficulty in remembering events in chronological order. Treatment with thiamine leads to improvement in almost two-thirds of cases.
After a sustained period of using alcohol or benzodiazepines, brain cells begin to change through a process called neuroadaption in order to compensate for the depressant effect. If the level of alcohol drops below its normal level, the over-active cells, with less to suppress them, cause neuronal excitation precipitating heightened anxiety, irritability, sleep deprivation, dementia and auditory and visual hallucinations (delirium tremens).
The prolonged release of adrenaline and the depletion of dopamine characteristic of sustained use of stimulants such as cocaine or methamphetamine gives rise to sleep deprivation, heightened anxiety and aggression, paranoia, mood swings, depression, auditory and visual hallucinations and repetitive obsessive behaviours (over-grooming, cleaning).
Environment
Objective conditions in the physical or social environment which cause anxiety can inform an individual’s core beliefs. Discrimination, persecution, unstable or unpredictable domestic situations, over-criticism, overprotection, lack of nurturing during childhood, prolonged exposure to stress, bereavement and life changes such as loss of employment or relationship breakdown can affect how a person sees themselves and the world.
Life Experience
A bizarre or traumatic experience that cannot be contextualised within a person’s paradigm can precipitate anxiety and delusional beliefs as they attempt to make sense of what happened.
Personality
Once established, the anxiety and/or delusional beliefs can form the matrix through which future events are experienced, predisposing the individual to transform events into triggers. They may develop avoidance strategies, seeking to eliminate or control problematic feelings and, by striving, precipitate more anxiety, low self-esteem, depression and, possibly, paranoia.
Situational Cues
Situations such as speaking in front of a group, eating or drinking in public, meeting new people, visiting new places, being the centre of attention, dealing with authority figures, interacting with members of the opposite sex, performing some critical task, being observed when performing a task, being the centre of attention, being teased and being criticised can all call into question an individual’s sense of identity or worldview. As such, they require attention and may precipitate the release of adrenaline.
Cognitions
Inflexible thinking, characterised as dogmatising, catastrophising, disempowering and judging, interferes with constructive attempts to change or adapt to problematic situations. This distorted thinking engenders feelings, sensations and behaviours that heighten anxiety and perpetuate the problem.
Feelings
Through the release of adrenaline, serotonin and dopamine mood affects cognitions, physical sensations and behaviours. These, in turn, affect mood.
Physical Sensations
Hot and cold flushes, nausea, shortness of breath, sweating, dizziness, heart palpitations, chest pain, choking sensations, tingling sensations and “butterflies in the stomach” may result from the use of substances or an unrelated condition. Nevertheless, these sensations make rational thought more difficult and can precipitate or reinforce anxiety.
Behaviour
The means by which an individual interacts with their physical and social environment can relieve or reinforce problematic symptoms and generate consequences which may be positive or problematic.
CBT
Primarily present-centred, future-oriented and skills-focused, practitioners concentrate on thoughts, feelings, physical sensations and behaviours. Having established a collaborative relationship, a practitioner would gather information, encouraging the client to diarise their symptoms, and share information on the psychological disorder, confirming the normality of the experience and providing a rationale for the programme, before negotiating an action plan which will include anxiety management. Subsequent sessions would review the diary, examining cues and triggers along with reinforcing cognitions and behaviours to inform an alternative experimental behaviour to be tried at home.
Reviewing the diary and the homework, the practitioner would help the client hone and develop their coping strategies and skills, using imagery, reframing, rational self-talk and refocusing.
Towards the end of the program, the practitioner and client would continue to review the exercises, focussing on relapse management and prevention. They would review the program and journey travelled, celebrating the client’s skill in identifying and coping with irrational thoughts and identifying sources of support in dealing with potential difficulties in the future.
This article was posted by Kevin Patton
