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Dialogues in Clinical Neuroscience Jun 2017As a form of therapy, cognitive behavioral therapy (CBT) is more than a mere "toolbox." CBT allows us to better understand how the human mind is functioning because it...
As a form of therapy, cognitive behavioral therapy (CBT) is more than a mere "toolbox." CBT allows us to better understand how the human mind is functioning because it is based on neuroscience and experimental and scientific psychology. At the beginning, the was "nontheoretical," but nowadays (the most recent version being DSM-5), it is increasingly based on CBT paradigms (with the insertion of important notions such as cognitions and behaviors). This Brief Report presents what we currently know about generalized anxiety disorder (GAD) and how we can treat this condition by nonpharmaceutical means. In the last few years, GAD theories have evolved, becoming more precise about the cognitive functioning of GAD sufferers. Here, we look at current theoretical models and the main techniques of therapeutic care, as well as the advances in research about the "transdiagnostic" process and GAD in childhood. CBT is an effective treatment for GAD, typically leading to reductions in worry, and a study has shown that such therapy is equal to pharmaceutical treatment and more effective 6 months after study completion.
Topics: Anxiety; Anxiety Disorders; Cognition; Cognitive Behavioral Therapy; Diagnostic and Statistical Manual of Mental Disorders; Humans
PubMed: 28867944
DOI: 10.31887/DCNS.2017.19.2/lborza -
Clinical Child and Family Psychology... Jun 2021In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety,... (Review)
Review
In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.
Topics: Anxiety; Anxiety Disorders; Autism Spectrum Disorder; Child; Child Behavior Disorders; Humans; Mutism; Phobia, Social
PubMed: 33462750
DOI: 10.1007/s10567-020-00342-0 -
Trends in Neurosciences Apr 2023Anxiety and fear are evolutionarily conserved emotions that increase the likelihood of an organism surviving threatening situations. Anxiety and vigilance states are... (Review)
Review
Anxiety and fear are evolutionarily conserved emotions that increase the likelihood of an organism surviving threatening situations. Anxiety and vigilance states are regulated by neural networks involving multiple brain regions. In anxiety disorders, this intricate regulatory system is disturbed, leading to excessive or prolonged anxiety or fear. Anxiety disorders have both genetic and environmental risk factors. Genetic research has the potential to identify specific genetic variants causally associated with specific phenotypes. In recent decades, genome-wide association studies (GWASs) have revealed variants predisposing to neuropsychiatric disorders, suggesting novel neurobiological pathways in the etiology of these disorders. Here, we review recent human GWASs of anxiety disorders, and genetic studies of anxiety-like behavior in rodent models. These studies are paving the way for a better understanding of the neurobiological mechanisms underlying anxiety disorders.
Topics: Humans; Genome-Wide Association Study; Anxiety Disorders; Anxiety; Fear; Brain
PubMed: 36828693
DOI: 10.1016/j.tins.2023.01.007 -
Psychiatria Polska Aug 2019Due to the co-occurrence of symptoms of anxiety disorders and obsessive-compulsive disorders, and the hypothesis about common etiopathological factors, we performed a... (Comparative Study)
Comparative Study
OBJECTIVES
Due to the co-occurrence of symptoms of anxiety disorders and obsessive-compulsive disorders, and the hypothesis about common etiopathological factors, we performed a research addressing the occurrence and severity of anxiety symptoms, the severity of groups of neurotic symptoms, and conducted factor analyses in two groups of patients: diagnosed with obsessive compulsive disorder (OCD) and with generalized anxiety disorder (GAD).
MATERIAL AND METHODS
A retrospective study was conducted on two groups of patients: 76 - diagnosed with OCD, and 186 - diagnosed with GAD. The source of information about the presence and severity of symptoms was the Symptom Checklist "O" (KO"O"). The impact of sex and the presence or absence of cognitive impairments (Bender's and Benton's tests) on the investigated associations were accounted for.
RESULTS
No significant differences in the severity of most anxiety symptoms were found between the groups of patients diagnosed with OCD or GAD. Patients with GAD were characterized by a significantly higher intensity of phobic disorders, conversion disorders, cardiac autonomic dysfunctions, and hypochondria, when compared to patients with OCD. Factor analyses identified the existence of three similar factors in the OCD and the GAD groups: 'anxiety/depressiveness', 'obsessions' and 'compulsions'. Additional factors were, among others, 'depressiveness' in OCD and separation anxiety in GAD.
CONCLUSIONS
The research indicates that anxiety plays a significant role in the clinical picture of OCD and may reach a severity similar to that observed in GAD. The presence and severity of anxiety and somatization symptoms can be associated with the presence of cognitive impairments, which requires further investigation.
Topics: Adult; Anxiety; Anxiety Disorders; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Retrospective Studies; Severity of Illness Index
PubMed: 31760413
DOI: 10.12740/PP/105378 -
Expert Opinion on Emerging Drugs Sep 2015Anxiety disorders are among the most prevalent and disabling psychiatric disorders in the United States and worldwide. Basic research has provided critical insights into... (Review)
Review
INTRODUCTION
Anxiety disorders are among the most prevalent and disabling psychiatric disorders in the United States and worldwide. Basic research has provided critical insights into the mechanism regulating fear behavior in animals and a host of animal models have been developed in order to screen compounds for anxiolytic properties. Despite this progress, no mechanistically novel agents for the treatment of anxiety have come to market in more than two decades.
AREAS COVERED
The current review will provide a critical summary of current pharmacological approaches to the treatment of anxiety and will examine the pharmacotherapeutic pipeline for treatments in development. Anxiety and related disorders considered herein include panic disorder, social anxiety disorder, generalized anxiety disorder and post-traumatic stress disorder. The glutamate, neuropeptide and endocannabinoid systems show particular promise as future targets for novel drug development.
EXPERT OPINION
In the face of an ever-growing understanding of fear-related behavior, the field awaits the translation of this research into mechanistically novel treatments. Obstacles will be overcome through close collaboration between basic and clinical researchers with the goal of aligning valid endophenotypes of human anxiety disorders with improved animal models. Novel approaches are needed to move basic discoveries into new, more effective treatments for our patients.
Topics: Animals; Anti-Anxiety Agents; Anxiety; Anxiety Disorders; Disease Models, Animal; Drug Design; Humans; Molecular Targeted Therapy
PubMed: 26012843
DOI: 10.1517/14728214.2015.1049996 -
Psychological Bulletin May 2014Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is... (Review)
Review
Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.
Topics: Adolescent; Antidepressive Agents; Anxiety Disorders; Child; Cognitive Behavioral Therapy; Comorbidity; Depressive Disorder; Female; Humans; Male; Sex Factors; Suicidal Ideation
PubMed: 24219155
DOI: 10.1037/a0034733 -
Dialogues in Clinical Neuroscience Jun 2017From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated... (Review)
Review
From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the () in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised (), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive aspect of anxiety has become the core criterion of GAD. The validity of GAD as an independent category has been questioned from up to preparation of . Areas of concern have included the difficulty to establish clear boundaries between GAD and (i) personality dimensions, (ii) other anxiety-spectrum disorders, and (iii) nonbipolar depression. The National Institute of Mental Health has recently proposed the Research Domain Criteria (RDoC), a framework destined to facilitate biological research into the etiology of mental symptoms. Within the RDoC framework, generalized anxiety might be studied as a dimension denominated "anxious apprehension" that would typically fit into the research domain called "negative valence systems" and the more specific construct termed "potential threat."
Topics: Anxiety; Anxiety Disorders; Depression; Diagnostic and Statistical Manual of Mental Disorders; History, 19th Century; History, 20th Century; Humans; Terminology as Topic
PubMed: 28867935
DOI: 10.31887/DCNS.2017.19.2/macrocq -
Journal of Affective Disorders Dec 2016There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
BACKGROUND
There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
GOAL
This study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment.
METHOD
Twenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation.
RESULTS
Childhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation.
CONCLUSIONS
These results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.
Topics: Adolescent; Adult; Anxiety Disorders; Comorbidity; Female; Humans; Male; Panic Disorder; Parenting; Phobia, Social; Phobic Disorders; Risk Factors; Young Adult
PubMed: 27466747
DOI: 10.1016/j.jad.2016.07.008 -
Journal of Psychopharmacology (Oxford,... Jan 2010Generalised anxiety disorder (GAD) is defined as excessive and uncontrollable worry and anxiety about everyday life situations. It is a chronic disorder, and is... (Review)
Review
Generalised anxiety disorder (GAD) is defined as excessive and uncontrollable worry and anxiety about everyday life situations. It is a chronic disorder, and is associated with substantial somatisation, high rates of comorbid depression and other anxiety disorders, and significant disability. The evidence base for pharmacotherapy and psychotherapy has continued to grow, and a wide range of drug choices for GAD now exists. Current guidelines for GAD generally restrict themselves to presentation of the evidence for various treatments, which, as a result, generally do not offer detailed discussion or recommendation of strategies beyond the first level of treatment, or take into account the individual circumstances of the patient. Thus, there is a lack of algorithm-based treatment guidelines for GAD. Our aim is, therefore, to present an algorithm for the psychopharmacologic management of GAD, intended for all clinicians who treat patients with GAD, where issues of pharmacotherapy are under consideration. We also hope that these GAD algorithms and other guidelines can help to identify high-priority areas that need further study. In this algorithm, we provide a sequenced approach to the pharmacotherapy of GAD, taking into account salient symptomatology and comorbidity, levels of evidence and extent of response. Special issues, including comorbidity, insomnia, suicidality, substance abuse, treatment adherence, pregnancy and lactation, cross-cultural issues, use of medication in the elderly, psychosocial treatment and dosing issues are also addressed.
Topics: Aged; Algorithms; Anti-Anxiety Agents; Anxiety Disorders; Comorbidity; Female; Humans; Medication Adherence; Practice Guidelines as Topic; Pregnancy
PubMed: 18832431
DOI: 10.1177/0269881108096505 -
Current Psychiatry Reports Feb 2022With a focus on reviewing adequately powered randomized controlled trials, we present recent research on the potential of cognitive behavioral therapy for insomnia... (Review)
Review
PURPOSE OF REVIEW
With a focus on reviewing adequately powered randomized controlled trials, we present recent research on the potential of cognitive behavioral therapy for insomnia (CBT-I) to improve depression and anxiety outcomes among patients with insomnia and one of the following comorbid psychiatric disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD). We also examine potential moderators of CBT-I on depression and anxiety outcomes in this population.
RECENT FINDINGS
Despite high comorbidity rates, current behavioral and pharmacological treatments for MDD, GAD, and PTSD do not substantially target or improve insomnia symptoms; residual insomnia is exceedingly common even among patients who experience remission. Insomnia plays a critical role in the onset and maintenance of depression and anxiety, and treating insomnia with CBT-I may improve global outcomes for patients with MDD, GAD, and PTSD. CBT-I is superior to traditional depression/anxiety treatment in improving insomnia symptoms among patients with comorbid psychiatric disorders. Results are mixed on whether CBT-I (either alone or augmented with depression/anxiety treatment) is effective in improving overall MDD, GAD, and PTSD outcomes. Evening circadian preference and depression/anxiety symptom severity may moderate the effect of CBT-I on depression and anxiety outcomes.
Topics: Anxiety; Anxiety Disorders; Cognition; Cognitive Behavioral Therapy; Depression; Depressive Disorder, Major; Humans; Sleep Initiation and Maintenance Disorders; Treatment Outcome
PubMed: 35061137
DOI: 10.1007/s11920-022-01326-3