Category: Anxiety

Introduction

The nature of the environment in which people live is characterized with extremely high levels of uncertainties about future events. While people often anticipate good things to happen in their lives, there is always an almost established fact that bad things are also most likely to be experienced.

These expectations form the basis of anxiety in people that defines a sense of worry or an uneasy feeling due to unascertained phenomenon that are always expected to happen. Though some impacts of anxiety are normal, there are some that are realized to have adverse effects and end up being termed as disorders.

This paper seeks to discuss anxiety disorders in children and adolescents. The paper will look into anxiety disorder with respect to its causes, prevalence, classification, progression and treatment among other aspects.

Anxiety Disorders

Impacts of anxiety with respect to either good or bad occurrences are under normal circumstances understood as normal reactions to whatever is expected to happen. An anticipation of a negative happening is however in most cases realized to have an induced level of fear or even stress to an individual. When a negative expectation results in an extreme negative reaction in terms of fear and worry then it is classified as an anxiety disorder.

The definition of anxiety disorder thus distinguishes it from normal anticipations that may not enlist any form of worry to an individual.

Instances such as anxieties following anticipation for an appointment are for example considered to be normal in adults while a child who is being taken away from home to attend school may be extremely scared at the fact that he or she is going to be separated from the mother or whoever was closely taking care of him or her.

The disorders are further identified when the individuals get extremely fearful while there is actually no solid reason to develop such fears. A child who is being taken to school for example develops fears while he or she is going to be securely brought back home.

Instances of young children who are actually in perfect health conditions developing extreme fears of suffering from diseases such as cardio vascular complications or even cancer when they absolutely have no symptoms or reasons for such fears also forms basis for anxiety disorders among children and adolescents.

Though anxiety disorders were not anciently considered by professionals, attention has currently been devoted to it to realize that a significant numbers of the young generation are victims. It was, for instance, realized by the year 2008 that teenagers are almost constantly under anxiety disorder complications with either subsequent or even simultaneous cases of disorders by an individual (Chandler, n.d.).

Causes of Anxiety Disorders

Factors that cause anxiety disorders have not individually been identified with specific disorders that are realized. These factors have at the same time not been agreed upon by experts as to their exact impacts on anxiety disorders. Causes of the disorders are however postulated to range from “biological, psychological to social factors” (Bernstain, 2010, p. 476).

The factors may individually or in combination result in any particular or groups of anxiety disorders. Biological factors as identified with anxiety disorders are associated with the genetic engineering that explains the transfer of traits from parents to their offspring along blood relations.

This means that children and adolescents are more likely to suffer from the disorders if their parents were associated with anxiety disorder complications.

The opinion over causes of anxiety disorders has been supported by research that has linked anxiety disorder to genetic relations. It has for instance been established that twins developed similar responses to anxieties. Attitudes that are realized among such twins to illustrate connectivity in their responses have been used to explain their anticipations and fears as well.

It is thus crowned that this connectivity is derived from genetic relation of twins that are derived from their parents. Though research has not been successfully completed to identify the specific genes that are related to anxiety disorders, it has been agreed that the association between anxiety disorders and genetic properties are significant.

Psychological factors such as stress and environmental conditions also directly contributes to anxiety disorders (Bernstain, 2010)

Bourne Edmund (2005) on the other hand explains causes of anxiety disorders in form of a wider point of view. One of his classifications of causes of anxiety disorders is a set of long term factors that accumulate on an individual child or adolescent to lead to anxiety disorder. He in addition to the genetic factors illustrated the conditions that surround a child’s life as factors to anxiety disorders.

The communication that children receive from their parents or that which they witness around them is identified to be a cause of the disorder. Negative opinions that children grasps from their environment as they grow up for instance induces fear among them over uncertainties that life has for them.

The manner in which children are raised such as having a perfectionist parent who has extreme standards for children also induces insecurity into fears. Treatment and social environment that children are offered that may induce stress together with a destabilized emotional condition of a child is also a long term factor into anxiety disorder.

Apart from the hereditary elements into anxiety disorders, other biological causes include “panic attacks, physiology of panic, generalized anxiety among others” (Bourne, 2005, p. 32).

There are also a number of occurrences that are realized to cause anxiety disorders on a short term basis.

Realized attacks on an individual that can include “significant personal loss, significant life change and stimulants and recreational drugs” (Bourne, 2005, p. 32) together with “conditioning and origin of phobia and trauma, simple phobias and post traumatic stress disorders” (Bourne, 2005, p. 32) are also realized to be causes of anxiety disorders.

Anxiety disorders are also caused by developments in an individual’s life that could be in the form of mental capacity or behavior (Camh, 2009).

Prevalence of Anxiety Disorder

There are varying reports over data with respect to the prevalence of anxiety disorders in the society in general. According to Sadock et al. (2007), prevalence rate of anxiety disorders range from a minimum rate of about eight percent to a maximum value of almost thirty percent. The wide range of values was however narrowed down to reflect a prevalence of about ten percent among young individuals.

According to a research as discussed by the authors, there existed a variety of types of anxiety disorders with different prevalence rate that contributed to the overall realized rates. Generally realized anxiety disorder was for example realized to be the most common with a prevalence rate of almost seven percent followed by disorder due to separation.

Disorder due to response to environment was realized to follow in level of significance. A consideration of anxiety disorder due to separation was realized to be more serious in younger children and reduced with age to have adolescents realize less of separation based anxiety disorder.

At the same time, the anxiety disorder due to separation was realized to be evenly distributed among boys and girls giving the sense of insecurity some level of independence with respect to sex, at least at the younger age. This particular type of disorder was at the same time realized to be more significantly realized within the age gap of seven to eight years of a child (Sadock et al., 2007).

Dziegielewski (2009) on the other hand presented the figures over prevalence of anxiety disorder to be about ten percent among children and adolescents. This was however far below the generally realized prevalence level which was reported to be almost twenty five percent.

The level of anxiety disorder was attributed to factors such as difficulties that the children and the adolescent encounter in their academic environment as well as even their social environment in general. This prevalence level according to the author is expected to rise in future due to developments that have improved the capacity to identify and diagnose anxiety disorders (Dziegielewski, 2009).

The presentation of anxiety disorders in children to be just one of the factors to the disorders among adults as the children grow is an illustration of higher prevalence rate of the disorders in adults as compared to children and the adolescents. More factors such as “medical conditions, medication use and functional status” are reported to contribute to the complications among adults (Dziegielewski, 2009, p. 302).

History of prevalence of the complications in earlier periods also revealed averagely the same rate of prevalence. A consideration of the prevalence of anxiety disorders in the 1980s for instance revealed a rate of about ten percent which is consistent with the currently reported data.

Whereas developments have been made with respect to diagnosis of anxiety disorders, meaning that more disorders are noticed contrary to previous periods, the constancy in the realized cases imply that the actual prevalence of the disorders are decreasing.

This is because the data which were previously reported had a lot of omissions that are currently taken care of. If this factor is taken into consideration and adjustments made to the previous data, then it would be realized that the earlier durations would have realized higher prevalence rates (Essau & Petermann, 2002).

Differentiating Criteria

Differentiating criteria is an approach to diagnosing disorders on the basis of observations that are made on an individual. The criteria use the change in conduct of the patient to identify the existence of disorder complications.

According to the concept, an individual suffering from anxiety disorder will suffer from change or difference in behavior to exhibit factors such as “negativistic, oppositional and defiant behavior” (House, 2002, p. 46) that will be contrary to normally observed behavior.

Progression of the Disorder

There are a variety of approaches to the view of progression of anxiety disorders. One of the approaches as illustrated by Connolly et al. (2006) is the stage in life in which a child or an adolescent can suffer from anxiety disorder. This can thus be viewed as the progression of anxiety disorders in and individual’s life as he or she grows up.

The progression is at the same time realized in an individual’s entire life as anxiety disorders develop to even be realized by individuals in their old age. The initial experience of young babies to factors such as darkness or even sudden touch that can include falls are examples of fears and worries that can be reported at early stages of life.

The infants with time develop fondness to people around them and at the same time exhibit fears over people whom they do not recognize. This is normally realized in terms of the infants rejecting strangers and even crying when the strangers get too close to them. As the kids grow older even to the preschool age, they are realized to develop other forms of fears.

At this stage, the children are more worried over imaginative things and even fears of separation from individuals with whom they have close ties such as their mothers, fathers and even siblings. Further advancement in age of the children at the same time realizes new fears and worries.

In the early ages in school, children are realized to have fears that relates to features such as “illness, injuries and natural disasters” (Connolly et al., 2006, p. 1). These fears eventually develop to other levels as the children become concerned over their capacities in academic work.

There are normally developed fears about how other people perceive their performance. Parties such as their peers knowing their level of performance becomes a bother and in most cases lead to concealment of their work. They also at this stage of life develop fears over any form of threat to their health (Connolly et al., 2006). These changes are at the same time characterized with disorders (Connolly et al., 2006).

Physical Considerations

The nature of anxiety disorders that leads tom variations in behavior of individuals such as a person being rebellious or just changing to abnormal practices contrary to that which is normally expected by the society has a variety of impacts. One of the direct impacts of such withdrawals by individuals is the self confinement and involvement in substance abuse.

As a result, the victims build an association in which they can derive consolation from substance abuse. It is from this avenue that violence is realized with respect to anxiety disorders. Though the level of rebellion that is directly induced by disorders my be translated into physical reactions such physical fights due to emotional changes and stress, involvement in drugs fuels violence among this category of individuals.

Withdrawal into these groups exposes an individual to habits such as hostility that leads to violent physical encounters. Under extreme cases, these issues culminate to “assaults and murder in some cases” (Oltmanns et al., 2008, p. 160). Anxiety disorders are thus associated with negative physical impacts (Oltmanns et al., 2008, p. 160).

Implication for Assessment

Assessment of aspects of lives of individual children or even adolescents is identified to be a continuous process that is realized through out their lives. Conducted by a variety of parties from the moment that a child is conceived and in all his all her life time, assessment is realized from parties such as parents and family members in domestic set ups.

At the same time, assessments in academic institutions as well as among age mates and those encountered during interactions with medical professionals offer an individuals status on evaluation. Assessment thus has the implication of revealing any possible disorder (Mash & Barkley, 2007).

Treatment Consideration

The wide percentage of anxiety problems as realized among children and the effects tat such complications have on the individuals as they grow up lays down the mandatory need to offer treatments to victims of anxiety disorders. This is because if the complications go unattended to, the implications means a lost efficiency or even productivity of the individual victim due to the associated mental effects of the complications.

A great deal of consideration is thus normally called for to offer medical attention to the victims. According to Mash Eric, the process of administering treatment to a patient who is suffering from anxiety disorders is supposed to a comprehensive one that has a diverse consideration of elements. The first step in administering treatment is the identification of the need for such treatment.

This is because there are normally some fears and worries that are not necessarily anxiety disorders. This will form the basis of whether or not a person should be subjected to treatment. In the consideration of whether or not treatment should be administered, it should also be predetermined as to whether the treatment will be effective in solving the problem as realized by the individual.

Since the problem is more psychological than medical, consideration of the approach to be applied as well as the people to be involved in the treatment process must also be seriously made. The atmosphere in which treatment is to be offered with considerations of how well the patient will receive the treatment is also a factor to be considered.

Timing of treatment and monitoring to check its effectiveness as well as any need for adjustment in the process also forms important basis for treatment of anxiety disorders. The consideration of the approach to treatment is then followed by development of an appropriate model to be applied.

One of the identified models for treatment as explained by Mash involves identification of the problem realized by the patient which is then followed by making appropriate research into the problem. An outline is then made for the treatment which makes provisions for the main activities to be involved in the treatment process.

This is then followed by administering of treatment and further monitoring steps to ensure that the treatment is successfully applied. One of the particular treatment approaches that have been realized and implemented over time is the use “cognitive behavior” approach (Mash, 2006, p. 9).

This approach employs the forces of relation as realized between the individual patient and his or her relatives has been applied together with psychological treatments to help victims out of anxiety disorders (Mash, 2006).

According to Connolly, Suarez and Sylvester (2011), the treatment of anxiety disorders should begin with a plan which should identify the level of seriousness of the complication as well as the impacts that are being realized by the victim.

Possible treatments that can then be applied include “psychotherapeutic treatments, cognitive behavioral therapy, parent- child and family interventions and pharmacologic treatment” among others (Connolly, Suarez & Sylvester, 2011, pp. 102 & 103). There is thus a variety of treatments for anxiety disorders.

References

Bernstain, D. (2010). Essentials of Psychology. Belmont, CA: Cengage Learning.

Bourne, E. (2005). The anxiety & phobia workbook. Oakland, CA: New Harbinger Publications.

Camh, A. (2009). What causes anxiety disorders? Web.

Chandler, J. (n.d.). Anxiety disorders in children and adolescents. Web.

Connolly, S., Suarez, L & Sylvester, C. (2011). Assessment and Treatment of Anxiety Disorders in Children and Adolescents. Web.

Connolly et al. (2006). Anxiety disorders. New York, NY: Infobase Publishing.

Dziegielewski, S. (2009). Social work practice and psychopharmacology: a person-in-environment approach. New York, NY: Springer Publishing Company.

Essau, C & Petermann, F. (2002). Anxiety disorders in children and adolescents: epidemiology, risk factors and treatment. New York, NY: Psychology Press.

House, A. (2002). DSM-IV diagnosis in the schools. New York, NY: Guilford Press.

Mash, E. (2006). Treatment of childhood disorders. New York, NY: Guilford Press.

Mash, E & Barkley, R. (2007). Assessment of childhood disorders. New York, NY: Guilford Press.

Oltmanns, T., Martin, T., Neale, M., & Davison, C. (2008). Case studies in abnormal psychology. Hoboken, NJ: John Wiley & Sons.

Sadock et al. (2007). Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins.

Introduction

Anxiety disorders are some of the common psychological problems that many people have to deal with at various stages of their lives. The magnitude of the disorder will define the appropriate method of medication that should be used. A patient suffering from anxiety is always treated either through medication, such as the use of antidepressants or through talk therapy (Craske, 2009). Researchers have conducted studies to determine the most appropriate way of addressing this disorder. While some experts still prefer using medication to treat anxiety disorders, another section of the professionals holds that cognitive therapy is the best approach to addressing anxiety disorder (Lemma, 1996). In this essay, the researcher seeks to confirm the hypothesis that medication is not as successful in treating anxiety disorders as the use of cognitive therapy.

Discussion

Anxiety disorder affects people because of a number of social events that cause some form of strain in mind. It may express itself in various forms, such as compulsive disorder, panic disorder, posttraumatic stress disorder, generalized anxiety disorder, social phobia, agoraphobia, or even claustrophobia (Andrews, 2003). These mental problems have the effect of redefining the behavioral pattern of a person. According to Craske (2009), a person who is suffering from anxiety disorder may behave differently from a normal person when is exposed to the depressant agent. Many people suffer from serious anxiety disorders that they may not even know because they have not been exposed to the depressant agent (Craske, 2009). For example, many people fear snakes. The phobia can be so strong that anything that resembles a snake may cause serious panic, and the reaction may cause serious harm to them. What they fail to realize is that when one handles himself or herself with care and without panicking when encountered by a snake, then chances of being bitten are minimal. Erratic actions caused by the fear will make an individual make silly moves that will increase the chances of being harmed. In other cases, the anxiety may be caused by an experience in one’s life. For example, cases such as rap or grisly accidents always leave a permanent mark in one’s mind. Such a person will live in trauma as these events unfold in one’s mind (Lemma, 1996).

When an individual visits a health facility, what always comes to the minds of the health practitioners is to offer antidepressants. This is very common when someone complains that he or she cannot sleep at night. According to Lemma (1996), when given the antidepressants, the medicine will numb the pain, making it easy for one to sleep. However, there has been a debate as to whether these medications are the most appropriate for treating these health problems. The proponents of medications have argued that antidepressants are very effective in addressing this problem (Velotis, 2005). They argue that this remedy addresses the problem from a biological angle. When one takes these medications, he or she will not feel the pain that is associated with some of these disorders. According to Clark and Beck (2011), these medications act as stimulants that help one to overcome their anxiety without much struggle. With the use of emerging technologies in the pharmaceutical industry, this scholar notes that modern medicines have no serious side effects on the users.

A research conducted by a team of experts drawn from John Hopkins Hospital, London University College, and Oxford University conducted research, and their findings strongly refute the arguments given by (Clark & Beck, 2011). Their findings reveal that antidepressants or any other form of medication do not offer a lasting solution to the problem of anxiety. In order to understand the concept involved in treating anxiety, it is important to analyze the psychological and biological processes involved when one develops anxiety. According to Wells (2013), Anxiety is a physiological problem. This problem cannot be solved by a neurosurgeon who will conduct brain surgery to address the problem within the brain (Lemma, 1996). This scholar argues that the problem cannot be diagnosed in the nerve system, which is always the most affected part of the body. Giving medical treatment to a person who is suffering from severe mental depression is very helpful in easing the pain in order to make the patient comfortable. However, Andrews (2003) warns that this is always a temporary measure meant to make the patient comfortable before the problem can be addressed effectively. The medicine only alters the normal functioning of the nervous system for a while without offering a lasting solution. However, this may not continue forever.

According to Wells (2013), anxiety is a psychological problem whose solution can only be through psychological processes. It is a problem of the mind, not the brain. Cognitive-behavioral therapy (CBT) is the best way of addressing this problem. An individual who is suffering from posttraumatic stress disorder cannot rely on medical solutions to address the problem permanently. For instance, a patient who is suffering from stress caused by a rape case will need CBT in order to overcome the problem. The person will need therapy that will help him or her learn how to live with the problem without feeling wasted. According to Velotis (2005), the medicine that can make a person forget a painful life, experiences such as rape case does not exist. When a doctor is presented with such a case, there may be very little he or she can do to address the sad memory from a medical perspective. This is where a psychologist or a counselor comes in with a lasting solution.

A counselor will need to offer a therapeutic solution, which will involve getting into the root cause of the problem. He or she will allow the patient to narrate the whole ordeal with all the possible emotions. This is always the first part of the therapy. A patient always feels lighter after narrating the whole incident that caused the disorder. After this has happened, the expert will need to engage the patient in a therapeutic discussion that will help the patient appreciate that the event was part of life that should make one stronger instead of feeling weak. This will eliminate the fear, panic, or stress that one had because of the occurrence of a given incident. It is only through such psychological processes that any anxiety disorder can be solved (Lemma, 2008).

Conclusion

The discussion above has confirmed the hypothesis that medication is not as good in addressing anxiety disorder as therapeutic processes. The discussion reveals that the antidepressants are good at easing the pain when one is suffering from these mental problems. However, it does not offer a lasting solution to the existing problem. It is only through cognitive therapy that one can get into the root cause of the problem and address it in an effective manner.

References

Andrews, G. (2003). The treatment of anxiety disorders: Clinician guides and patient manuals. Cambridge: Cambridge University Press.

Clark, D. A., & Beck, A. T. (2011). Cognitive therapy of anxiety disorders: Science and practice. New York: Guilford Press.

Craske, M. G. (2009). Anxiety disorders and their treatment. Boulder: Westview.

Lemma, A. (1996). Introduction to psychopathology. Thousand Oaks: Sage Publications Ltd.

Velotis, C. M. (2005). Anxiety disorder research. New York: Nova Science.

Wells, A. (2013). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Hoboken: Wiley.

Dental anxiety is one of the most common ordeals and challenges faced by dental practitioners around the world. Yet very little is known about the reasons for this anxiety. While many models have been put forward to identify and define reasons for anxiety and phobia production, there is still very little known about the true nature of fear, phobia, and anxiety, and especially, fear and phobia within clinical settings. The clinician in most circumstances is left to his own devices in managing a clinical case of anxiety and phobia, with mixed results each depending on the individual dentist him or herself.

Dental fear and anxiety are one of the common issues faced by practitioners in clinical settings. There are no rules or age limits in this matter, and whereas a young child may show no signs of fear or apprehension in the clinical procedures, an older patient may experience extreme anxiety to even prophylactic procedure, and vice versa. Similarly, various studies have shown that dental anxiety is not sex-specific.

Many efforts have been undertaken in order to understand the basis of dental anxiety, and theories have been postulated to clarify this dilemma. For example, it is hard to comprehend extreme dental phobia in a child who may not have had any clinical exposure to a dental setting before. Now dentists are able to understand the importance of a positive and stress-reducing environment in reducing anxiety.

The percentages of people suffering from anxiety-related issues in dental settings are relatively high, which emphasizes the need for understanding the key issues that contribute to it. Anxiety can lead to altogether avoidance in a person to undertake dental care. While external factors may lead to the creation of the anxiety pattern in a patient, the subsequent dental treatment and procedures and their experiences may either exacerbate or altogether nullify the condition. Therefore, predental and post-dental experiences and thought patterns are serious contributors to anxiety-related issues in a patient. ¹

Age, sex, and previous experiences of dental procedures, also seem to play an important role and may affect the psychological approach to dentistry. Understanding the role of age and the onset of particular anxiety may be very helpful in the management of such patients. For example, children may be exposed to a minimum of bloody procedures to help them deal with anxieties of blood. Accepting and easing adolescents in an open and friendly doctor and patient relationship can help address the social anxieties that these individuals are going through. And adults may be facing agoraphobia or claustrophobia, along with the feeling of loss of control, which can be handled with proper care.

Social factors may include the experiences of a family member or peers, and their positive or negative experiences may condition the responses of a previously unexposed patient to the dental setting. Similarly, negative feedback from a parent and fear of needles may evoke a strong phobic response in a child. It may be that some individuals may become fearful of dental procedures after adolescence, and may have had no such problem in their childhoods. These procedures are classic examples of conditioning following painful dental procedures. In all age groups, the fear needs to be handled on the psychological make as well as the mental caliber of the patient.

The current debate is the applicability of the various fear and anxiety-related theories that have been revolving in the literature for many years. The application of these theories in dental clinical setup is no doubt different when comparing to other everyday life events. Patients are more prone to show dental anxiety than generalized medical anxiety, and this is counterproductive to both parties. The patient in his fear may not resort to treatment, which eventually may lead to exacerbation of his symptoms, poor results and outcomes, and a further increase in the cognitive response of fear for the dentist and the procedures of dentistry. On the other hand, dental anxiety among the patients is among the biggest challenges for the practicing clinicians and this conserves much of their time and energies to help the patient relax.

The theoretical models of fear and anxiety in this regard are able to identify some crucial aspects of the personality and its possible role in the development of dental anxiety yet is still unhelpful given the vast variety of reactions that can be exhibited in every patient. Previously, such theories were relying on the conditioning responses and/ or the Darwinian concepts of inherent fears and reaction patterns. If such is the case, almost all the patients would respond to a fear or anxiety factor in more or less the same way. However, this is not the case. Studies that have been carried out in the research for dental anxiety all have come to one conclusion. That individual variation can lead to an entirely different response to the expected or predictable pattern thought of before. While it is wrong to claim that such predictions and theories are completely unable to address or help clinicians identify with anxiety issues, they nevertheless do show gaps in their theoretical knowledge and need more extensive researches for proper identification of human nature.

Of the many factors thought to contribute to dental anxiety, a study by Moore has shown some elements of embarrassment as contributory to dental phobia and anxiety. ²His research is based on understanding the factors other than the usually debated ones, such as pain, previous experiences, etc., and focusing on the personality of the patient and various stimuli and environmental factors that may be contributory to the present state of response in the dental environment. The key lies in identifying various psychological behaviors among patients that are left undiagnosed, such as public and social anxieties and phobias. Moore’s study was significant in identifying that fear of pain and “social powerlessness” and “lack of control in the dental settings” are the main reasons for anxiety within the dental settings. Certain factors such as the doctor’s approach to the treatment, or seemingly lack of attention given to the patient may contribute towards it, as well as embarrassment over lack of attention given by the patient about his or her oral hygiene state or consulting a dentist at the appropriate time. This Moore explained through examples, was especially seen in patients who may have a take-charge attitude towards life. In such cases, the person may not be willing to accept failure to handle his own oral hygiene, and this, in turn, can lead to the integration of embarrassment as a factor in seeking dental treatment.

The “latent inhibition” theory explains the phenomenon as a direct result of the kind of experience the patient had undergone. ³ This theory states that a positive experience in a dental environment helps the patient cope with more demanding procedures, with lesser anxiety or negative conditioning. However, a negative experience, especially in childhood can cause pain, anxiety, and negative response from the patient in even very mild procedures. The psychological makeup of the patient, such as an anxious patient may exacerbate the patient’s outlook towards the treatment. This theory, however, lacks in identifying fear in patients who may never have undergone any dental procedure or may not have been conditioned negatively about it by peers or family members. Still, such patients may exhibit intense phobia and fear of the procedure. Also, some patients in normal clinical situations and life, in general, maybe very open and relaxed with no anxieties, yet still may become intensely scared of the dental procedure. The latent inhibition theory, therefore, although used in the past, fails to clarify such patients.

The inhibition theory still has shown its efficacy in identifying dental anxiety reasons in a part of the population. Such patients may show intensely anxious or very relaxed attitudes towards the dental treatment, independent of the type of procedure carried out. Hence, the initial treatments are done on the patients, if mild and of less intensity, can evoke favorable conditioning, and may help such patients in managing and dealing with their dental anxieties.

Moore’s study is an attempt to clarify the various personality issues that are often ignored when considering dental phobias and anxieties. However, among these only neuroticism has shown some suggestive relation with dental anxiety. There are many factors that contribute to the feeling of embarrassment, and these may include bad conscience, and self-punishment attitudes, secrecy or taboo thinking, self-esteem issues, and personality changes usually accompanied by social withdrawal. Understanding this factor may be of immense help in the clarification of issues surrounding dental anxiety. Many assumptions have been made regarding personality issues in dental phobias and anxieties. Many psychologists agree that negative images of self are largely contributory to not only dental but also to surgical and dermatological treatments.

Broadly speaking, dental anxiety has been assumed to take shape due to various psychological factors. These include “personality characteristics, conditioning experiences, vicarious learning or modeling, body image perceptions, blood injury fears, various coping styles and pain reactivity”.

But the main problem is the multi-dimensional nature of dental anxiety and therefore, the complexity of the factors that contribute towards it. Classified as either Exo or endogenous, the patients are usually done so due to the nature of the stimuli they have received over the years or the type of conditioning that they experience. Exogenous patients are those who have had negative dental experiences in the past, and therefore, assume that any visit to the dentist will be a bad one. Endogenous patients, may, however, not have had any dental experience at all, but may feel apprehensive due to their natural psychological makeup.⁴

The vicious circle theory is a little different from the classic division of exogenous and endogenous patients primarily as it focuses on the addition and snowball effect of various experiences into full-fledged phobias, fears, and anxieties. However, in contrast to the Exo and endogenous people reaction development, this reaction may occur within minutes, with a rapid rate of development. The anxiety stimulus may be very insignificant, such as a prick of the injection needle by the dentist, yet the anxiety reaction elicited may lead to a person collapsing into a state of shock. The simple action can in such cases elicit a state of chain reaction, which can lead to the rapid development of acute anxiety states.

Other theories of dental and anxiety phobia include the 3-alarms theory, catastrophic cognition theory, and others. The associative and non-associative theories of anxiety are among those theories which are undergoing extensive changes of outlooks. The depth of these types of fears has now shown independent patterns to those that were used to define them. Catastrophic theory, one of the most cited and debated ones of its times, explains the phenomenon of anxiety and fear based on the different physical as well as environmental sensations, that may evoke anxiety. The body sensations become an important contributor to the fear and can lead to attacks of panic.⁵ Since this theory believes that positive feedback intensifies the reaction state, it follows that a previous procedure may cause intense reactions even a mild exposure or revision of the event. The levels of reactions may vary, and may not, in fact, be so intense to cause alarm, but this theory has in many ways explained the intensely close relationship of the mind to the body, and the way both can affect and influence each other.

Yet this theory is very much dependant on the thought process of a person, and this may be difficult to fathom and may be unreliable, as opposed to a concrete physical symptom or sign. Again this physical sign may be up for debate, for the reflex and conditioned thoughts may lead to physical and bodily responses. Yet these thoughts again are a myriad of complexities, made of both emotional and mental processes. And excluding these two basic components of the human mind hardly leaves us with any real substance to debate on.

The core theory is perhaps one of the best models of fear acquisition and anxiety models. This elaborate model details the presence of three-alarm kinds and two alarm systems. The alarms may be triggered in response to stresses, early experiences, genetic influences, etc. Whether the alarm is true or false, the application of the body’s defense mechanisms is essentially the same, and the responses are likewise not different. The two anxiety systems include innate primitive present-oriented fear system and the future–oriented defensive anxiety system.

The theoretical approach however how much developed, becomes unnecessary and even sometimes useless should a clinical situation arises. In clinical situations, the dentist may not be properly able to address and remove the patient’s anxiety due to several reasons. These may include the time constraints, the failure or the inexperience of the dentist to realize and recognize the needs of the patient, the inability to distinguish various personality types, and how they would react and respond to the different situations. The lack of information about the patient’s mental, emotional and social state, and the effect of the external environment including family, peers, and the public on the development of anxiety and fear in relation to dentistry. This is because each individual demands separate attention and understanding, which may not be easy to do so for a new practitioner. Therefore, the identification of the fear factor or its proneness to it is actually dependant on the clinician’s experience.

in conclusion, dental anxiety and phobia have been topics of discussion and theoretical frameworks for many years, yet understanding this phenomenon still remains until and unless we find out the true nature of fear and anxiety, and what governs and affects it. Proper patient care and satisfaction are highly dependant on the level of ease the patient feels with the dentist, the dental procedure, and the dental settings. A good dentist can help reduce phobias in such patients, but a bad dentist is more likely to create a permanent negative picture of the profession as well as the motivation to do something about his or her oral health. The identification of this area is therefore very important for anyone aspiring to be a good clinician.

REFERENCES

1. George C. Economou, 2003. Dental Anxiety and Personality: Investigating the Relationship between Dental Anxiety and Social Consciousness. Journal of Dental Education, Volume 67, No. 9.
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Background of the Client

The client is a fifteen year old student called Joann. She has had trouble in school since her second grade. Joann reported class work problems and difficulties in test taking, as well. In earlier grades, she complained about difficulties in reading words and concentrating. However, as she grew older, the problems got worse; Joann experienced frequent headaches and reported occasional fainting spells.

These symptoms started when Joann was just about to complete her fifth grade, and they have persisted to date. Her teachers also noticed that excessive panic during tests also characterizes her school days. This panic often manifested as a physical illness, and came about when Joan needed to do group assignments or quizzes. She also had a fear of classroom questions throughout her childhood.

Joann’s academic performance seemed unaltered by these situations because her report cards were always above average, with A’s and B’s as her mean grades. Once in a while, Joann would get a C; furthermore, Joann attended school regularly, but she never enjoyed her experiences. Previously administered standardized tests also indicated that she had above average academic skills. Some of the tests that she did include: TerraNova and Metropolitan Achievement Tests.

Presenting the problem

This adolescent is a highly anxious one. The trait stems from Joann’s fear of tests, quizzes, and group assignments. She also has certain physical problems that include frequent headaches and occasional fainting episodes; they often manifest prior to these high-stress situations.

Joan tends to react negatively to compliments on her performance. She tries to neutralize any of these compliments by cutting down her efforts. Joann has the same reaction when adults try to give her reinforcement or compliment her for her exceptional work. This individual enters into a state denial when another person comments about her high-quality performance in an activity.

This adolescent feels isolated; she dislikes school and claims not have a favorite subject. However, she does relatively well in other non academic activities such as volleyball or basketball. Teachers and other instructors have not noticed any emotional distress in these areas. Joan continues to experience the same social and emotional problems that she had in the past; these include falling physically ill prior to: exams, group assignments and quizzes. Furthermore, she still suffers from frequent headaches and fainting spells. She also faces significant challenges with question-answering in class.

Assessment or Diagnosis of the problem and justification of the assessment

The adolescent under analysis suffers from performance anxiety that manifests as test anxiety and fear of classroom participation. This individual, therefore, possesses a social phobia, which the American Psychological Association (APA) recognizes in its DSM IV criteria (American Psychological Association, 2000). A person with performance anxiety, such as Joann, differs from others who experience universal fear because she experiences immense distress and disabling impairment in unrealistic dangers.

Common manifestations of performance anxiety include the fear of theatrical performance, the fear of eating in public, or the fear of writing in front of a large group of people. In this case, Joann has a fear of talking in public when asked to respond to classroom questions or participate in group assignments. Additionally, she has a problem with test taking. This is also another performance situation because she has to prove herself before the concerned assessors.

In order to classify an individual as one who suffers from performance anxiety, one must look for specific behavioral and cognitive signs. First, the person must object to performance situations or social situations that would expose him or her to scrutiny. He or she also fears performance situations because they might lead to embarrassment or humiliation. Furthermore, such a person usually thinks that he or she will not meet the required standard and will fail. In this case, Joann has all these signs; she dreads tests, classroom participation, and group assignments because she fears exposure to scrutiny. Since she often downplays her achievements, then it may also be true that Joann expects to fail in the tests or classroom activities.

Secondly, a person with performance anxiety manifests intense level of anxiety when placed in that performance situations (American Psychological Association, 2000). Examples of such anxious behavior include freezing, crying, tantrums and many more. Joann’s teachers continually report that this adolescent is extremely anxious prior to classroom tests and other academic milestones. Her headaches, fainting spells and physical illness indicate this level of stress.

Thirdly, a person with performance anxiety needs to recognize that his or her fear is excessive. However, analysts say that children do not have the ability to do so. Joann is an adolescent, so she has adult-like characteristics and child-like traits. The case study notes do not mention whether Joann recognizes that her fear is excessive. Nonetheless, one may assume that this is true owing to the differences in behavior that exist between Joann and her classmates before tests or classroom tasks.

Fourthly, an individual with this problem may try to avoid the performance situation, or may go through it with intense distress. Joann falls in the latter category. She explicitly stated that she dislikes school and has no favorite subject. Because Joann has no choice but to attend school, she does it with immense distress. Her headaches and fainting spells also prove this.

Lastly, people with this condition tend to function abnormally in social or occupation activities because of the avoidance, anxiety and anticipation inherent in their disorder. Joann is distressed about her phobia because she keeps struggling in her academic work. This problem is so severe that her educational administrators decided to study her situation.

One should not consider test anxieties and other performance anxieties as recognizable DSM IV disorders, i.e. social phobias, unless they are long lasting and cause marked psychological effects. Joann’s case has been quite prolonged, and it has clear effects on her behavioral and cognitive functioning. Furthermore, the condition should have lasted for longer than six months; Joann has had her condition from the second grade. This individual is quite sensitive to negative evaluation or rejection.

Joann manifests this symptom because tests and assessments are her main problem, yet people design tests to evaluate individuals. They may either result in positive or negative feedback; it is likely that Joann has a problem with negative comments from her instructors. If this problem persists, Joann’s academic performance may decrease substantially. In the long run, she may avoid other situations in her career that require her to take tests. This may hinder pursuance of jobs or promotions. She may settle for unsatisfying work because of the fear of evaluation of test taking in lucrative jobs.

Treatment recommendations

This situation requires a multifaceted approach to the treatment of the problem, but all these components fall under cognitive behavior treatment. Psychologists assert that the most effective treatment for this psychological condition is cognitive-behavioral therapy (CBT). This method is not one-sided; it involves collaborative efforts between the therapist and the client. Joann and a therapist should each come up with ways of conquering her anxiety. The general goal in this choice of behavior is to transform the client into her own therapist; therefore, therapeutic sessions should last for a short time (Antony & Rowa, 2008). In this case, Joann should do 16 sessions only. This method of treatment also requires a focus on the present.

Although certain childhood experiences may have contributed to the problem, it is imperative to focus on behavioural patterns that exist presently, and perpetuate the client’s symptoms. The therapist should structure all the sessions in CBT. This means that the therapist will identify gaols for every single session. Joann will have to do ‘homework’, or unsupervised activities. The intention is to ascertain that she can experience real-life scenarios that necessitate a renewed manner of thinking. Lastly, research is the foundation for this proposed therapeutic method. Analysts have worked on clients with similar conditions and have found that CBT works (Hoffman & Otto, 2008).

The first step should involve psycho-education. One should learn about one’s problem in order to deal with test anxiety and performance anxiety. If a person recognizes that he or she has a psychological problem, then he or she can start working towards a solution. Joann needs to be educated about performance anxiety and social phobia in general. She should be told about its possible origins as well as its persistence in her since childhood. The individual should also learn that her performance anxiety – like all performance anxieties – is unique, so she should work hand in hand with the therapist in order to understand her conditions well (Hoffman & Otto, 2008).

Cognitive restructuring is another step that they should consider in treatment. The main cause of performance anxiety is holding negative beliefs about oneself and others. These beliefs often manifest as unhelpful thoughts in those performance situations. Cognitive restructuring will involve a joint effort between Joann, and her therapist to establish the negative thought patterns that cause her to have performance anxiety. The main point is to practice these thought patterns until Joann becomes skilled in detecting them.

That will allow her to come-up with strategies for looking at her experiences in different or harmless ways. Joann should keep saying positive things to herself whenever a stressful situation arises. For instance, when her teacher asks her to respond to a certain question, Joann might think “Oh my! I will give a silly answer, and everyone is going to think that I am stupid”. The therapist should teach her to say things such as “Everyone can give a wrong answer in class; it does not mean they are stupid” or “I am here to learn; no one expects me to have all the right answers”.

The therapist will need to write down these phrases and require Joann to memorize them. With time, the irrational thoughts that lead to her physical illnesses may start to subside. The same self-talk should go on when she receives compliments or reinforcements from her parents or peers. In the cognitive restructuring processes, the therapist should focus on teaching Joann how to believe in her own abilities as a student. Since she has above average grades, then she needs to realize that she can accomplish academic goals independently.

Treatment should also entail in vivo exposure. Joann will discuss with her therapist the situations that cause her to manifest the performance anxiety. Some of these situations are question-answering and group discussions. Joan will gradually enter those scenarios without fighting the anxiety; she will allow it to dissipate naturally. It is likely that Joann will find this as one of the most difficult components of therapy. Therefore, the therapist should pay a lot of attention. Exposure must be done gradually, and both parties should plan for it. The difference between Joann’s exposure in the present and Joan’s exposure in the past is that this time the therapist will be beside her when confronting that situation. He will give her support and ascertain that she learns valuable lessons from her experiences (Hoffman & Otto, 2008).

In this case study, no details are available regarding the existence of interoceptive situations. However, there is a serious possibility that this might be a problem for Joann. Some clients tend to fear anxiety-related physical symptoms that accompany the actual performance situation such as shivering, sweating and many others. Interoceptive exposure should be another method of dealing with Joann’s problems. Since she has physical symptoms such as headaches, she may have anxiety about dealing with that symptom when in pressure-filled situations; that may intensify her condition. The therapist should expose this adolescent to situations that can cause some mild physical symptoms. Familiarizing Joann with the performance-related ailments is likely to minimize anxiety.

Lastly, the treatment process should also involve social skills training and academic training. When in the middle of an academic-related performance situation, Joann feels like she does not have the necessary academic or social skills needed to meet expectations. Extreme self consciousness and negative self talk have created this scenario.

However, Joann would probably find it helpful to learn new skills like how to: have conversations, do effective listening, be assertive, and many more. She will probably appreciate some tips on classroom etiquette as well as improvement of her academic performance. Since her problem also revolves around tests, Joann could benefit from study tips on early test preparation and the like. She needs to prepare for the tests and read ahead. The latter step will assist her in dealing with the tensions that relate to poor performance (Antony & Rowa, 2008).

The session should also involve prevention of the physical illnesses in the performance situation; this specifically centers on the tests as well as the classroom discussions. Joann should learn about relaxation techniques in order to achieve this. Research shows that relaxation techniques play a tremendous role in coping with performance situations. One way of achieving this is through controlled breathing. The technique involves carrying out slow, regulated breathing. Joann should concentrate on the process of exhaling and inhaling.

To do this effectively, she will need to close her eyes so as to seal off other interfering factors. She can then take-in one breath, hold it for a while and exhale. Joann must then start counting the periods between her breaths. She can take in a deep breath and hold it for 5 seconds then exhale and hold it for five seconds. When she feels confident about the process, she can then count to ten when exhaling and inhaling. She may do this in class when the performance situation arises. Another method of relaxation is positive self talk.

Client goals

This therapy session will involve self efficacy as the major goal. Self efficacy is a person’s ability to believe in his or her performance capability. The actions under consideration ought to relate to a desired outcome. Joan believes that one requires certain actions to sit for tests or to participate in group assignments. She also possesses those skills, but lacks the belief in her ability to execute them when in that situation. The client’s classmates may think that she has the right skills, but her subjective appraisal differs from this belief.

Therefore, working on this subjective belief can improve her outcomes. Other smaller goals (that will facilitate achievement of self efficacy) include verbal persuasion, performance accomplishment, and emotional or physiological arousal. When used out of context, verbal persuasion is the least successful method for handling performance anxiety. The therapist will only use this in relation to anxiety management. However, Joann will use verbal persuasion as explained in cognitive restructuring (Hoffman & Otto, 2008). Another treatment goal is performance accomplishment. The therapist will assist Joann to approach her fears rather than run away from them. Role playing and grading of tasks should help her.

It is likely that Joann will achieve self efficacy when she has mastered this situation. The therapist should avoid interruptions during role plays so as to allow Joann to commit to the condition. She must give feedback about her performance too. Lastly, the treatment will entail the mastery of physiological or emotional arousal. When excessive physiological arousal takes place, it tends to hinder performance. Joann’s headaches and fainting spells are a manifestation of this. Reducing this arousal is one of the goals of treatment. Joann will achieve this through relaxation techniques such as breathing and internal verbalizations like “I am packing my body with peaceful energy”.

Questions to the supervisor regarding assessment, treatment or goal issues of the client.

“Does Joann’s stress increase when she thinks about the accompanying symptoms?”: In one of the treatment approaches, the therapist should induce situations that mirror the performance situation so as to physiologically arouse Joann. If the physical illnesses do not bother Joann, then this may not be an effective intervention strategy.

“Do Joann’s parents have the financial resources for therapy?”: The methods suggested in this paper require regular sessions for at least four months; Joann will meet the therapist four times in a week for sixteen sessions. If her parents cannot afford these sessions, then this may undermine the method’s effectiveness.

“Is Joann motivated enough to solve this problem?”: Cognitive behavior therapy does not solve a client’s problems overnight. It takes a lot of patience and perseverance from the parties involved. Joann should have a deep desire to deal with her psychological challenges; otherwise, the method may not work.

“Is it ethical to induce some of the physiological symptoms of stress?”: Joann may be afraid of these symptoms, and these may add to her anxiety. It may be necessary to expose her to those situations to allay these fears. However, it may be unethical to cause the client too much discomfort.

“What happens when CBT fails?” It is necessary to know whether Joann be put on drugs.

References

American Psychological Association (2000). Diagnostic and Statistical manual of mental disorders. Washington DC: APA.

Antony, M. & Rowa, K. (2008). Social anxiety disorder: physiological approaches to assessment and treatment. Gottingen, Germany: Hogrefe Press.

Hoffman, S. & Otto, M. (2008). Cognitive behavior therapy for social anxiety disorder. Evidence based and disorder specific treatment techniques. NY: Routledge.

Introduction

Anxiety is a common situation that many people experience in their day-to-day activities. This issue can be defined as a situation where one feels unease, threatened by ambiguous events, becoming tense and unsettled. Many researchers have focused on understanding this issue and how it relates to performance in many areas, such as work and school. In the educational system, academic excellence is a significant factor for all the relevant stakeholders, such as parents, students, and teachers (Campbell et al., 2018). Anxiety in the education sector is a significant issue as it reduces the students’ confidence level. Various factors result in anxiety among students. For instance, preparing for tests gives students fewer worries (Kena & Faustina, 2020). However, students who have not prepared well or revised for the paper tend to have anxiety problems because it is associated with negative feelings towards the exam and the results. Students with great difficulties understanding their notes may lose hope in studying, which makes them avoid reading and leads to high test anxiety during examinations.

Exam anxiety is associated with various factors that enhance its ability to later the students’ performance. These factors include psychological effects and behavioral components, resulting in anxiety leading to poor academic performance when combined (Kena & Faustina, 2020). Anxiety during and before the exam is a common psychological problem among students. However, some students perform poorly because of their high level of anxiety. These students have the skills and knowledge to perform well, which requires identifying this issue (Chao & Sung, 2019). Testing the relationship between anxiety and academic performance has been typical for many researchers because it is a variable-related test. Anxiety is an ongoing problem that can be identified from the pre-education level up to the college level.

Anxiety is a good thing, but it varies with the levels a student is recording. Students with low levels of anxiety tend to perform well as it motivates them to increase their academic achievements. Students with high test anxiety have a significant concentration problem when taking exams leading to disengagement. Although the problem is perceived as an issue for a few, it can lead to serious academic problems. Revise time is when the students go through their classwork (Yusefzadeh et al., 2019). This has proven to be a significant factor, as preparedness is vital for academic performance. Revising helps the student gain significant courage when before and during exam time. Various studies have investigated the relationship between revision time and academic performance, although most are outdated. Revise time involves how students engage with the school work, the study period procedure, and students’ reading habits.

The quality of sleep affects how one operates daily tasks. This is also linked with students’ anxiety during and before the examination. Most studies investigate the effect of anxiety, which results in difficulty in sleep. This has made students engage in other activities, such as using antianxiety agents and other sleeping pills (Köse, 2018). Rest is necessary for everyone, and students require a significant sleep to ensure that they can cope with academic activities. During examination periods, students need quality sleep to enable them to get relaxed and handle their examinations with ease.

The current study identifies the relationship between revision time, sleep quality, anxiety, and exam performance. This is because there is a research gap where most studies identify the relationship between exam performance, revision time, and anxiety, not including sleep quality. Furthermore, studies show that anxiety leads to a lack of sleep during exams. However, this study investigates how inadequate sleep before an exam is related to exam anxiety, leading to poor exam performance. The findings of this research will be helpful for both the students and teachers in identifying appropriate intervention methods.

Hypothesis

H0: Exam anxiety is not affected by sleep quality and the number of hours spent revising before the exam.

H1: Exam anxiety is significantly affected by the quality of sleep and the number of hours spent revising before the exam.

Material and Procedure

Material

The study utilized a questionnaire to collect data regarding time spent by students revising, the number of hours the student slept the night before the exam, sleep rating before the exam, and the amount of time spent revising a category. Demographic information such as gender, age, and age category was also recorded. The questionnaire assessed the quality and quantity of sleep because they are significant in determining the level of anxiety and students’ performance. The questionnaire used two forms of questions: closed and open-ended.

Procedure

The participants were recruited using various school social media groups where the current and active students were selected. The students were informed regarding the data collection process and that they would be required to participate in the survey at a given period. The students were informed that the survey would be conducted on Sunday or late Monday before the exams. The students were provided with a link to the survey brief to ensure that they were aware of the purpose and objectives of the current study and the instruction on how the survey will be conducted. The researcher used text messages and emails to remind the students of the survey time and those who had not participated and were willing to participate in responding to the survey before its deadline. The participants were given distinct codes, which helped maintain their anonymity. The codes also ensure that no personal information is shared among the participants and keep the collected information confidential.

The survey questionnaire was organized into sections to allow the participants to respond easily to the questions. During the survey, the participants were required to click on the link provided, which was sent to them with unique codes to enable them to access the online questionnaire. After clicking the link, the students were taken to the first page of the research study, which allowed them to read the consent form provided, and all the participants were free to exit the survey at any point. The study was conducted per the ethical consideration of the school of psychology, and since the participants were above the age of 18, they were required to fill out and sign the consent form. After completing the questionnaire, the submission button was displayed to enable the students to end the survey.

Results

Table 1:Descriptive statistics of the variables under study

Table 2: Descriptive based for the males

From table 1 above, the hour spent revising has a mean of 19.85 and a standard deviation of 18.159. The maximum hours spent revising is 98, and the minimum hour is 0. Exam performance has a mean of 56.57 and a standard deviation of 25.941. The maximum exam performance is 98, while the minimum is 2. Exam anxiety has a mean of 74.34 and a standard deviation of 17.181. The maximum exam anxiety score is 97.58, while the minimum is 0.06. The sleep hours before the exam has a mean of 4.34 and a standard deviation of 2.49. The maximum number of hours slept is nine while the minimum hours is 0. From table 2 and table 3 above, males have a higher average time spent in revising (M = 19.85, SD = 335.832) compared to females (M = 18.03, SD = 325.25). The females portray a higher exam performance (M = 56.69, SD = 26.31) than females (M = 56.45, SD = 25.81). However, females have a high average spent revising (M = 4.33, SD = 2.68) than males (M = 18.33, SD = 18.33). Males have a less average sleeping time before exam (M = 4.35, SD = 2.32) compared to females (M = 4.35, SD = 2.32).

Table 3: Descriptive for the females

Table 4:MANOVA results without interaction

Table 5: MANOVA test of time spent revising and sleep hours before the exam

From table 4 above, the time spent in revising is significant for both dependent variables. Time spent revising and exam performance F (1, 103) = 11.053, p =0.01. Time spent revising and exam anxiety F (1, 102) = 58.773, p < 0.01. The p-value for time spent revising on exam performance is 0.01, while exam anxiety is less than 0.01. The number of hours slept the night before the exam and exam performance F (1, 103) = 1.65, p =0.263. The number of hours slept the night before the exam and exam anxiety F (1, 102) = 22.253, p <0.01. Gender and exam performance F (1, 103) = 0.143, p =0.706. Gender and exam anxiety F (1, 102) = 0.533, p =0.467. Gender is insignificant in determining exam performance and anxiety, as both p-values are greater than 0.05. The R-squared for exact statistics is 0.597, while the adjusted R-squared is 0.585. Table 5 shows that the interaction between time spent revising and the number of hours sleep before the exam is significant. Time spent revising and the number of slept interactions with exam performance F (1, 103) = 19.118, p <0.01. Time spent revising and the number of hours slept interaction design with exam anxiety F (1, 102) = 132.189, p <0.01.

Table 6 above shows no significant difference between the anxiety level of males and females t (101) = 0.024, p = 0.981.

Table 6:Independent sample t-test of exam anxiety between males and females

Table 7 above shows a positive correlation between time spent revising and exam performance, r (103) =.397, p <.001. A negative correlation exists between exam performance and exam anxiety, r (103) = -.441, p <.001. There is a positive correlation between exam performance and the number of hours slept the night before the exam, r (103) =.277, p = 0.005. There is a strong negative correlation between exam anxiety and the number of hours slept the night before the exam, r (103) = -.598, p <.001. This relationship is portrayed in figure 1 below. There is a strong negative correlation between exam anxiety and the number of hours spent revising, r (103) = -.709, p < 0.01. This relationship is shown in figure 2 below.

Table 7:Correlations

Discussion

From the results above, the hypothesis exam anxiety is not affected by sleep quality, and the number of hours spent revising is rejected because the p-value is less than 0.05. The MANOVA results show that exam anxiety is strongly affected by the number of hours students sleep and the time spent revising. This implies that it is necessary for the students to set aside enough time for their studies as well as time for sleep to reduce the level of anxiety before exams. The model effectively predicts the relationship between exam anxiety, time spent revising, and the number of hours slept. The R-square value shows that 59.7% of the variation in exam performance and anxiety can be explained by the variation in time spent revising and hours slept.

The independent t-test results are similar to MANOVA findings as it portrays no significant difference between the anxiety level of both the males and the females. The correlation results show that students who spent a significant amount of time revising have a lower anxiety level than those who spend less time. This is portrayed by the positive relationship between the two variables. Exam anxiety and exam performance have a negative correlation as students experiencing high anxiety levels tend to perform poorly. Furthermore, the students who spend less time sleeping the day before an exam have a high level of anxiety. This is associated with the psychological tiredness that one experiences because of sleeping fewer hours. Exam anxiety and the number of hours spent have a strong negative correlation. This relationship is very strong as a lack of adequate preparedness makes students develop negative emotions regarding exams leading to anxiety.

The limitation of the current study is that it does not involve the measurement of stressors, which may lead to anxiety and lack of sleep leading to exam anxiety. Stressors play a significant role in altering the performance of individuals, making them disoriented. The future study should include more variables and include other measurement instruments, such as Pittsburgh Sleep Quality Index (PSQI). Furthermore, the study should be conducted in stages, increasing the sample size.

Conclusion

The findings of this research study show that Anxiety is significantly determined by the number of hours the students take to prepare for the exam and the number of hours they sleep. The interaction of the two effects shows high anxiety levels. The anxiety levels do not vary with gender, hence the need for interventions that enable students to set aside quality study time and sleep hours. This study provides critical information on the relationship between anxiety and the number of hours of sleep.

References

Campbell, R., Soenens, B., Beyers, W., & Vansteenkiste, M. (2018). University students’ sleep during an exam period: the role of basic psychological needs and stress.Motivation and Emotion, 42(5), 671-681. Web.

Chao, T., & Sung, Y. (2019). An investigation of the reasons for test anxiety, time spent studying, and achievement among adolescents in Taiwan. Asia Pacific Journal of Education, 39(4), 469-484. Web.

Kena, A., & Faustina, A. (2020). Effect of test anxiety and revise time on students’ test performance. Global Scientific Journal, 8(8), 872-894. Web.

Köse, S. (2018). The relationship between exam anxiety levels of senior high school students and sleep quality. Journal of Psychiatric Nursing, 9(2), 105-111. Web.

Yusefzadeh, H., Iranagh, J., & Nabilou, B. (2019).

The effect of study preparation on test anxiety and performance: a quasi-experimental study

. Advances in Medical Education and Practice, Volume 10, 245-251. Web.

In early childhood, the child’s psyche is incredibly fragile, so everything new or certain stressful situations can lead to alarming consequences in the future. One of the problems in the modern world is anxiety or fear of school. However, even long-term stressful events can be handled quite well.

School phobia is an irrational unwillingness to go to school. This disorder was discovered in 1941. Its symptoms are quite severe and often physical: diarrhea, headaches, nausea and vomiting, tremor and uncontrollable trembling, and abdominal pain. Fear is also accompanied by psychological symptoms such as nightmares and tantrums. Children suffering from such a phobia are not truants against the learning process; they do not want to leave home.

The baby’s psyche does not tolerate separation from home or parents, and his grief can be even stronger if parents begin to stand on their own. Most often, such stories occur at the age of 6-12 years: before the first grade or during the transition to secondary school. Some children have their reasons for being afraid. If this is a gifted child, he may be bullied by classmates. If a child does not study well, this is also a reason for suffering.

However, most often, the school has nothing to do with it. The reason is not the lack of abilities, the attacks of other guys, and not the “backwardness” of teachers who do not want to adapt to an unusual student. Moreover, oddly enough, school phobia overtakes quite successful, capable students. Studies have shown a link between anxiety disorder in children and school refusals (Elliott, 2019, Finning, 2019, Anxiety & Depression Association of America, 2022). Children who experience toxic stress or live in highly stressful situations of abuse for extended periods may suffer long-term consequences (Beyer, 2020). However, the effects of stress can be minimized if caring adults support the child.

Summing up all the above, we can say that school phobia is a significant problem. Fear of school is a widespread phenomenon in the modern world, so it is essential to track the symptoms as quickly as possible and eradicate the cause of stress. Although stress substantially impacts later life, with proper care and treatment from adults, all these consequences can be minimized.

References

Elliott, J. G., & Place, M. (2019). Practitioner review: school refusal: developments in conceptualisation and treatment since 2000. Journal of Child Psychology and Psychiatry, 60(1), 4-15. Web.

Finning, K., Ukoumunne, O. C., Ford, T., Danielson‐Waters, E., Shaw, L., Romero De Jager, I.,… & Moore, D. A. (2019). The association between anxiety and poor attendance at school–a systematic review. Child and Adolescent Mental Health, 24(3), 205-216. Web.

Anxiety & Depression Association of America. School Refusal. Web.

Abstract

This paper shows that the main differences between the psychoanalytic and behavioural interpretations of conflict and anxiety are the conceptions, treatments, and perceived causes of both concepts. Broadly, evidences from this paper show that most behaviourists perceive anxiety as a product of social influences, while psychoanalysts say it is a product of psychological influences. Based on these differences, this paper shows that both groups of scientists perceive conflict and anxiety differently. Lastly, this paper shows that psychoanalysts consider conflict as a clash between the id, ego, and super-ego, while behaviourists consider the same concept as a product of environmental influences.

Introduction

Scholars often categorise theories of anxiety and conflict into groups of psychoanalytic, behavioural, phenomenological, and cognitive theories (Strongman, 1995). Their differences stem from the causes of conflict and anxiety. This paper focuses on two of the above theoretical groups of analysis – psychoanalytic and behavioural theories. Both groups are disciplines in behavioural science, but psychoanalysts mainly specialise in mental processes, as opposed to human activities and interactions (as behavioural scientists do). The structure of this paper explains how both sets of theories explain anxiety and conflict.

Anxiety

Psychoanalytical View

Psychoanalysts often borrow their concepts of anxiety from an Austrian physician, Sigmund Freud (Strongman, 1995). His views on conflict and anxiety stem from childhood influences on adult behaviours and experiences. Stated differently, Freud believes that unresolved childhood issues often explain conflict and anxiety, especially in adult years (TWP, 2014). Therefore, the psychoanalytical views of conflict and anxiety come from mental and emotional disturbances that often manifest as anxiety disorders. Freud (cited in Strongman, 1995) also believes that anxiety disorders stem from people’s inability to understand their irrational drives.

Furthermore, he says, often, such people have “defence mechanisms” in their subconscious minds that prevent them from doing so (many psychologists refer to this issue as “psychological resistance”) (Strongman, 1995). Psychological resistance often develops during a person’s childhood because human beings are “helpless” during this phase and their survival mainly depends on adults (their parents). Relative to this developmental period, Longe (2006) says,

“It is thought that this early experience of helplessness underlies the most common anxieties of adult life, including fear of powerlessness and fear of being unloved. Thus, symbolic threats can make adults anxious about their sense of competence and significant relationships, even though they are no longer helpless children” (p. 201).

Nonetheless, when people become aware of their irrational drives, they can easily overcome these psychological defences and eliminate their symptoms (anxiety). This view largely informs the psychoanalytic treatment of anxiety disorders. Overall, the psychoanalytic view of anxiety has developed many theories and models, including the psychoanalytic model, conflict theory, Freud’s theory, and cognitive theory (among others).

Behavioural View

Behaviourists often believe that anxiety is a learned behaviour and not a conflict of the conscious, or subconscious, mind, as the psychoanalytic view proposes (Rachman, 2004). Stated differently, behaviourists view anxiety as a concept, which is rooted in societal values and patterns, as opposed to developmental issues. This view mainly thrives on the social nature of human beings. It presupposes that some people could develop anxiety and conflict in the quest for social approval, or the need to feel loved. Social phobia is a common anxiety that many people associate with this view because victims develop it through their fear of embarrassment in social settings (Rachman, 2004). Prejudice is also another type of anxiety that stems from behavioural analogies.

Unrelated studies show that many people develop anxiety because of upsetting stimuli (Rachman, 2004). For example, some controversial studies show that some people could develop anxiety by seeing upsetting images in the news (TMD, 2014). Some behaviourists show the same concept by explaining how workers often develop anxiety because of their environmental and occupational environments. Relative to this observation, TMD (2014) says, “People who must live or work around sudden or loud noises, bright or flashing lights, chemical vapours, or similar nuisances, which they cannot avoid or control, may develop heightened anxiety levels” (p. 6).

Based on the above analogy, behaviourists often say the best way for managing anxiety is reducing exposure to upsetting stimuli (Rachman, 2004). Similarly, this view explains that some people develop anxiety through “generational conditioning.” For example, TMD (2014) says since anxiety disorders often exist in some families, children could develop such disorders by acquiring them from their environments. A similar ideology proposes that some people could acquire anxiety disorders biologically. For example, evidence shows that anxiety disorders are more common among identical twins, as opposed to people who do not share the same gene pool (Rachman, 2004). Broadly, the behavioural view explains anxiety through social and environmental influences.

Conflict

Psychoanalytical view

The psychoanalytical view of conflict mainly premises on the principles of the conflict theory. This theory also developed from the work of Freud. He said conflict exists from three mind agencies – id, ego, and super-ego (Nevid, 2011). The id is the unconscious mind and the prime reservoir of physical energy (it only strives to discharge and release) (TWP, 2014). It gives birth to the ego, which is the conscious part of the human mind (the ego premises on the reality principle) (Nevid, 2011). This agency includes societal perceptions on human psychology. Similarly, it influences the instincts that the id has. Based on this analysis, the id does not include external influences of human instincts. However, the ego does. The super-ego is a small part of the ego, which blocks instinctual discharge and premises on the morality principle (TWP, 2014). It often comes into conflict with the id and the super-ego. For example, external reality often conflicts with the ego. Relative to this assertion, TWP (2014) says,

“An excessive strength of instinct can damage the ego in a similar way to an excessive stimulus from the external world. It is true that the former cannot destroy it; but it can destroy its characteristic dynamic organisation and change the ego back into the id” (p. 12).

The id, ego, and super-ego often appear in Freud’s five-stage psychosexual development model. The model consists of the “oral, anal, phallic, latency, and genital” (Nevid, 2011, p. 388) stages.

Behavioural View

Behaviourists view conflict as inevitable and natural (Jacobs, 2013). Although they say conflict could yield positive outcomes, they see it as a negative stimulus of human relations (Jacobs, 2013). Nonetheless, their views suggest that all people should accept and manage conflict when it arises (Jacobs, 2013). Therefore, they propose that all societies should “welcome” conflict because it is not necessarily a problem. The main underlying principle of the behavioural theory is the influence of contextual forces in predicting conflict. For example, the field theory presupposes that conflict is often a product of contextual forces (Jacobs, 2013). Stated differently, conflicts often happen within environmental or social limits. For example, a husband may show aggressive tendencies during a football game but become quiet, or passive, when he is around his family or colleagues.

Relative to this observation, Jacobs (2013) says the behavioural view “is the reality because it explains the disparity or unpredictability of behaviour, thereby producing different perspectives and increasing the likelihood of conflicts” (p. 21). Comprehensively, the behaviourist view of conflict differs from the psychoanalytical view because it conceives conflict as an environmental phenomenon, as opposed to a “conflict” of the human mind – id, ego, and super-ego.

Conclusion

This paper shows that many psychoanalysts and behaviourists have different views of conflict and anxiety. Their conceptions of anxiety, its treatment, and sources of conflict are the main differences that distinguish the two groups of theories. Behaviourists perceive anxiety as a product of social influences, while psychoanalysts perceive the same concept as a product of psychological influences. These views show how both groups of scientists conceive conflict and anxiety. They both acknowledge that the two issues are problematic to human functioning and recommend different treatment regimes, based on their conflicting views.

For example, psychoanalysts say therapists could treat anxiety disorders by helping victims to overcome their psychological barriers, while behaviourists believe that removing negative stimuli from the environment treats anxiety disorders. The same perceptual differences also spread to their conceptions of conflict. For example, this paper shows that many psychoanalysts consider conflict as a clash between the id, ego, and super-ego, while behaviourists consider conflict as a product of environmental influences. Comprehensively, these analyses show the main differences between the psychoanalytic and behaviourist interpretations of conflict and anxiety.

References

Jacobs, V. (2013). Conflict behaviours: Can personality type, culture, hierarchical status, and/or gender predict conflict behaviour? Web.

Longe, J. (2006). Gale Encyclopedia of Nursing and Allied Health. New York, NY: Thomson Gale. Web.

Nevid, J. (2011). Essentials of Psychology: Concepts and Applications. London, UK: Cengage Learning. Web.

Rachman, S. (2004). Anxiety. New York, NY: Psychology Press. Web.

Strongman, K. T. (1995). Theories of Anxiety. New Zealand Journal of Psychology, 24(2), 4-10. Web.

TMD. (2014). Anxiety. Web.

TWP. (2014). Revolutionary Desire Classical Freudian Psychoanalysis. Web.

Introduction

The Reiss-Epstein-Gursky Anxiety Sensitivity Index (ASI-R) is the psychological assessment instrument which is used to measure such a variable as the anxiety sensitivity which can be explained as the fear of anxiety.

Thus, the anxiety sensitivity is the fear of the anxiety-related factors which can lead to the negative and threatening physical, psychological, and social consequences.

To have the opportunity to receive the important information on the patient’s level of the anxiety sensitivity, Reiss developed the ASI-R as the 16-item measurement which is rated on a 5-point scale. The original ASI-R was developed and improved with references to Epstein and Gursky’s researches.

The ASI-R is used to determine whether the patient is characterized by the high anxiety sensitivity, and the test is effective to identify the patients who suffer from the panic disorder and from the posttraumatic stress disorder (Barlow, 2004, p. 350; Reiss-Epstein-Gursky Anxiety Sensitivity Index, 2014).

While choosing the appropriate and valid psychological assessment instrument, it is necessary to refer to the aspects of the decision theory and such indicators as the hit rate, miss rate, false positive errors, and false negative errors which can influence the test interpretation procedure and the overall validity of the psychological assessment instrument.

Correct and incorrect decisions related to interpreting such a psychological assessment instrument as the ASI-R are based on discussing the hit rate, miss rate, false positive errors, and false negative errors, and they can affect the accuracy of the test interpretation and following diagnosis.

It is also important to determine what type of errors can be discussed as acceptable while conducting measurements.

Analyzing Interpretive Errors in ASI-R Assessment

Definitions of Hits, Misses, False Positive Errors, and False Negative Errors in Relation to the ASI-R

While interpreting the psychological assessment instrument such as the ASI-R, correct decision should be based on the analysis of the hit rate. From this point, the hit rate is the number of those persons who possess the qualities measured with the help of the analyzed assessment instrument (Cohen, Swerdlik, & Sturman, 2012, p. 169).

These identified people are discussed as having the definite characteristic or quality. Referring to the ASI-R, it is important to note that ‘hits’ are the measure which are related to those persons who are determined as characterized by the certain level of the anxiety sensitivity.

The correctness of the decision made by the psychologist also depends on the miss rate. ‘Misses’ are the failures in identifying the patients who are characterized by the certain attribute or characteristic.

The miss rate determines those people who were not identified appropriately as possessing the certain attribute or characteristic (Cohen et al., 2012, p. 169).

The ASI-R is developed according to the principles of the self-report, and the test can be proposed for individuals and for the groups of people. That is why, the ‘misses’ can be identified only while focusing on the anxiety sensitivity examined in the group of clients.

‘Misses’ can also be discussed as false negative and false positive errors. False negative errors are the ‘misses’ which are associated with stating that the person possesses the definite attribute in spite of the fact that the person is not characterized by the certain quality (Cohen et al., 2012, p. 169).

Referring to the ASI-R, it is possible to note that false positives occur when the persons who really do not have the high level of the anxiety sensitivity are identified as possessing this quality.

False negative errors can be defined as the ‘misses’ which occur when those persons who possess certain qualities are identified as not having them (Cohen et al., 2012, p. 169).

Discussing the case of the ASI-R assessment, it is important to note that false negatives and false positives are typical for the test because the ASI-R is based on the principle of the self-report, and the factor of subjectivity can prevent the psychologist from receiving the accurate results to conclude on the problem effectively.

How Hits, Misses, False Positive Errors, and False Negative Errors Might Apply to Interpreting the Construct Measured by the ASI-R

The ASI-R is discussed as the traditional psychological assessment instrument used to measure the patients’ fear of anxiety.

The assessment tool is designed as the self-report that is why hits, ‘misses’, false positive and false negative errors can affect the process of interpreting the anxiety sensitivity measured by the ASI-R significantly.

While focusing on the hits, it is important to pay attention to the fact that the ASI-R is the multidimensional psychological assessment instrument that is why it is necessary to determine the level according to which the anxiety sensitivity is characteristic for the person.

On the contrary, it is rather difficult to determine the hit rate because the accurateness of the test results depends on the level of the observed anxiety sensitivity without references to the number of persons examined with the help of this psychological assessment instrument (Barlow, 2004, p. 350).

As a result, the focus on hits and the hit rate is not reasonable for the ASI-R.

However, while referring to the examination of the groups with the help of the ASI-R, it is important to state that the hits and misses play the important role in interpreting the anxiety sensitivity as the construct measured by the assessment tool.

In spite of the fact that the ASI-R is based on the principle of the self-report, the percentage of persons who can be identified wrongly according to the ASI-R or the percentage of ‘misses’ cannot be rather high because of the people’s focus on their fears and anxiety while answering the proposed questions.

There are situations when false positive and false negative errors can be observed in relation to measuring the anxiety sensitivity.

Referring to the interpretation of the construct, it is important to note that false positive and false negative errors are closely associated with the factor of subjectivity and inadequate perception of the situation (Hunsley & Mash, 2008, p. 236).

Certain psychological problems and disorders can influence the persons’ data, and these factors can lead to false positive and false negative errors.

In this case, false positive errors as the determined ‘misses’ can be discussed as acceptable types of errors in relation to the ASI-R because such results can stress on the persons’ other psychological problems and fears.

How Hits, Misses, False Positive Errors, and False Negative Errors Can Affect the Evaluation of the ASI-R’s Validity

While discussing the question of the ASI-R’s validity, it is important to note that hits, ‘misses’, false positive and false negative errors can affect the evaluation of this psychological assessment instrument.

Validity can be defined as the test’s characteristic according to which the assessment tool can be discussed as measuring the certain construct effectively or non-effectively.

Referring to the validity of the ASI-R, it is necessary to focus on the effectiveness of the assessment tool in relation to measuring the anxiety sensitivity.

In spite of the fact that the ASI-R is usually discussed as characterized by the good internal consistency, such factors as the hits, ‘misses’, false positive and false negative errors can influence the general appropriateness of the ASI-R for measuring the level of the patients’ anxiety sensitivity.

The hit rate is not appropriate to be discussed as influencing the validity of the ASI-R because the assessment is mainly used to measure the anxiety sensitivity in individual patients.

The issue of ‘misses’ can affect the procedure of evaluating the test’s validity because of the necessity to decide on the test’s sensitivity and specificity (Barlow, 2004, p. 350).

Nevertheless, the failure to identify the patients suffering from the high level of the anxiety sensitivity is minimal because of the test’s focus on determining the patients with panic disorders.

The false positive and false negative errors’ role in discussing the validity of the ASI-R is also minimal because the percentage of false negatives and false positives is usually low while discussing the ASI-R results (Hunsley & Mash, 2008, p. 236-237).

Nevertheless, there are situations when the determined anxiety level makes the psychologists provide wrong conclusions about the psychological disorders. However, the ASI-R is discussed as useful to make decisions regarding the patients’ level of the anxiety sensitivity and associated psychological disorders.

Conclusion

Different correct and incorrect decisions can occur while interpreting the ASI-R because of the impact of the observed hits, ‘misses’, false positive and false negative errors.

However, these issues can affect the psychologist’s decision regarding the patient’s state minimally because the ASI-R is designed appropriately, and it is characterized by the high validity.

While referring to the range of acceptable errors, it is possible to determine false positive errors as acceptable while interpreting the ASI-R results.

References

Barlow, D. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. USA: Guilford Press.

Cohen, R. J., Swerdlik, M., & Sturman, E. (2012). Psychological testing and assessment: An introduction to tests and measurement. USA: McGraw-Hill Education.

Hunsley, J., & Mash, E. (2008) A Guide to Assessments That Work. USA: Oxford University Press.

Reiss-Epstein-Gursky Anxiety Sensitivity Index. (2014). Web.

Abstract

Many people endure anxiety and stress in everyday life. However, in severe cases, it is necessary to measure such a condition as overwhelming anxiety can cause anxiety disorders. Two of the most effective assessment tools are the Multidimensional Anxiety Scale for Children (MASC) and the Beck Anxiety Inventory (BAI). MASC is made up of four scales that measure physical and emotional symptoms.

The BAI consists of cognitive and behavioral elements as well, but this tool is mostly used to assess physical symptoms. However, the effectiveness of these methods was proved by various researchers. These methods were applied to different populations and demonstrated positive results. However, the literature review revealed that the BAI is a more universal method and it can be successfully applied in different settings. The BAI is a more objective measurement as it focuses on physiological processes rather than emotional ones. Therefore, the BAI has the clearest application of measurement concepts.

Introduction

Many people endure anxiety and stress in everyday life. It is a normal condition for individuals who work long hours, suffer sleep deprivation, or live an unbalanced life. However, in severe cases, overwhelming anxiety can cause anxiety disorders. Therefore, it is necessary to measure such a condition. However, as anxiety is closely interrelated with emotions, it might be very difficult to measure. Various methods allow measuring the level of anxiety, but not all of them are effective. The main goal of this paper is to analyze and compare two assessment tools: the Multidimensional Anxiety Scale for Children (MASC) and the Beck Anxiety Inventory (BAI).

Measurement Constructs

The first assessment tool is the MASC. This tool allows for measuring self-reported anxiety. It has a hierarchical structure that helps to differentiate alternative anxiety manifestations from scale development and good item selection (Houghton, Hunter, Trewin, & Carroll, 2014). However, the MASC might not apply to certain minority communities due to a biased normative sample.

The second assessment tool is the BAI designed by Aaron Beck and his colleagues. This tool describes 21 items that represent symptoms of anxiety and allows ranking them by their severity on a four-point scale (“Interpreting the Beck Depression Inventory,” n.d). The BAI is a very convenient tool as it ensures simple scoring. The BAI offers short and easy instructions, answer sheets, and scoring software.

The MASC has adequate reliability and validity, which is why the tool is widely used by psychologists and counselors. The MASC is made up of four scales: physical symptoms, harm avoidance, social anxiety, and panic (Houghton et al., 2014). The first scale, physical symptoms, encompasses two other subscales: tense and somatic. The second scale, harm avoidance, is divided into perfectionism and anxious coping subscales. The third scale, social anxiety, consists of humiliation and performance fears subscales. However, the last scale, panic, do not have any subscales. Except for the above-mentioned scales, the MASC has two other important elements, which are a validity scale and an Anxiety Disorders Index. These methods allow measuring diagnostic criteria for anxiety established by the DSM-IV classification system.

The BAI offers four methods to administer the test: the Beck Hopelessness Scale, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Beck Scale for Suicide Ideation. The questions presented in these modes focus on anxiety symptoms that might include such physiological processes as sweating or tingling. Twenty-one questions help to measure such symptoms on a scale from zero to three.

The described methods on which these two tools are based ensure the reliability and validity of the measuring process. These scales allow identifying the level of anxiety by the most common symptoms. Although the BAI consists of cognitive and behavioral elements as well, it is mostly focused on physical symptoms. Meanwhile, the MASC measures a wider range of signs of anxiety. It evaluates emotional symptoms such as fears and self-esteem. Therefore, the MASC addresses the issue more comprehensively because it uses similar contracts as the BAI and also has components that are deemphasized in this tool.

Interpretation

The interpretation of results is the most important part of these tests. Therefore, it is necessary to pay particular attention to this aspect. The BAI offers four modes each of which should be interpreted individually. The Beck Depression Inventory allows evaluating the level of depression (“Interpreting the Beck Depression Inventory,” n.d.). This method describes six levels of depression. For example, the score from zero to 10 indicates a normal condition, and the score over forty indicates extreme depression. The Beck Anxiety Inventory indicates the level of anxiety (“Interpreting the Beck Depression Inventory,” n.d.).

This method describes four levels. The Beck Scale for Suicide helps to evaluate the risk for suicide (“Interpreting the Beck Depression Inventory,” n.d.). The score over twenty-four is a cutoff that indicates that a person is at a significant risk to commit suicide. The Beck Hopelessness Scale evaluates the same characteristic (“Interpreting the Beck Depression Inventory,” n.d.). The score above eight indicates a high risk of suicide.

The interpretation of the results of the MASC is similar to the BAI. It also determines the overall level of anxiety by scoring. The score over sixty-five indicates clinically significant symptoms that imply psychological and behavioral problems. However, the results are interpreted by different categories. These are separation anxiety disorder, social phobia, and generalized anxiety disorder (Wei et al., 2014). The score from twenty to thirty-six indicates social phobia. The score below ten indicates a generalized anxiety disorder. Therefore, the scores of one test correlate with the scores of another one. The higher score, the higher the level of anxiety or other associated conditions is.

Analysis of the Effectiveness

The effectiveness of these tools is discussed by many researchers. For example, the study by Sterling et al. (2015) presents the results of the application of MASC to teenagers with autism. The authors state that increased scores on the panic scale and physical symptoms scale effectively predicted separation anxiety disorder, social phobia, and generalized anxiety disorders in children on the autism spectrum. Another study by Houghton et al. (2014) evaluates the effectiveness of the MASC. The authors concluded that this tool is useful for measuring anxiety in teenagers. However, they also state that this tool requires revising as “the correlation between harm avoidance and separation anxiety” variables indicates “a multicollinearity problem” (Houghton et al., 2014, p. 402).

Although the authors admitted that the MASC is effective, it can be complemented by other methods. The next study examines “the psychometric properties, including discriminant validity and clinical utility, of the youth self-report and parent-report forms of the Multidimensional Anxiety Scale for Children (MASC) among youth with anxiety disorders” (Wei et al., 2014, p. 566). The authors concluded that MASC offers practical methods to identify anxiety disorders in adolescents.

There are also different studies on the effectiveness of the BAI. For example, the research conducted by Kagee, Coetzee, Saal, and Nel (2015) focused on the application of this tool to adults diagnosed with HIV. The authors concluded that a single score could effectively determine the overall level of anxiety in such a population. Another study by Bardhoshi, Duncan, and Erford (2016) offer a meta-analysis of multiple works in which the BAI was used.

Results demonstrated that the reliability and validity of the test depended on the sample size and cut-off score. The next work by Ng, Yeo, Shwe, Gan, and Chan (2016) analyzed the effectiveness of the application of the English and Chinese versions of the BAI. The authors focused on patients with breast cancer. The results revealed that both versions are valid and reliable for future use.

The effectiveness of these assessment tools was proved by various researchers. These methods were applied to different populations and demonstrated positive results. Although certain imperfections are present in both tools, their validity and reliability are supported by scientific evidence. However, the literature review revealed that the BAI is a more universal method. This tool can be successfully applied in different settings. The BAI is a more objective measurement as it focuses on physiological processes rather than emotional ones. However, under certain circumstances, this method is not as comprehensive as the MASC. Nonetheless, due to the literature review, the BAI has the clearest application of measurement concepts.

Conclusion

In conclusion, assessment tools to measure anxiety and associated conditions are highly important for practicing psychologists and other specialists in this field. However, the effectiveness of such methods might be questionable. The nature of anxiety is deeply rooted in the inner emotional state of a person. Therefore, the assessment tools should evaluate not only physiological symptoms but also cognitive impairments.

The above-discussed methods, the MASC and BAI, can effectively measure the level of anxiety in patients with different backgrounds and conditions. However, the literature review revealed that the latter could be applied in more diverse situations. The BAI emphasizes the importance of physical factors, which can be measured more objectively. Therefore, this method is perceived to be more applicable.

References

Bardhoshi, G., Duncan, K., & Erford, B. T. (2016). Psychometric meta‐analysis of the English version of the Beck Anxiety Inventory. Journal of Counseling & Development, 94(3), 356-373.

Houghton, S., Hunter, S.C., Trewin, T., & Carroll, A. (2014). The Multidimensional Anxiety Scale for Children (MASC): A further validation with Australian adolescents with and without Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders, 18(5), 402-411.

Interpreting the Beck Depression Inventory. (n.d.). Web.

Kagee, A., Coetzee, B., Saal, W., & Nel, A. (2015). Using the Beck Anxiety Inventory among South Africans living with HIV: Exploratory and higher order factor analyses. Measurement and Evaluation in Counseling and Development, 48(3), 204-213.

Ng, T., Yeo, H. L., Shwe, M., Gan, Y. X., & Chan, A. (2016). Psychometric properties and measurement equivalence of the English and Chinese versions of the Beck Anxiety Inventory in patients with breast cancer. Value in Health, 19(7), A854.

Sterling, L., Renno, P., Storch, E. A., Ehrenreich-May, J., Lewin, A. B., Arnold, E.,… Wood, J. (2015). Validity of the Revised Children’s Anxiety and Depression Scale for youth with autism spectrum disorders. Autism, 19(1), 113-117.

Wei, C., Hoff, A., Villabo, M. A., Peterman, J., Kendall, P. C., Piacentini, J.,… Sherrill, J. (2014). Assessing anxiety in youth with the multidimensional anxiety scale for children. Journal of Clinical Child & Adolescent Psychology, 43(4), 566-578.

Introduction

Anxiety is a common condition experienced by all human beings at some point in their lives. A person can feel anxious when he/she is faced with a stressful situation or is about to face a new and exciting condition. Mild anxiety is not only normal but it can even be useful by motivating the individual experiencing it to become more alert and focused when facing an important situation.

Blair and Yuval (2010) confirm that anxiety is a universal human emotion that helps people to be alert to potential threats and motivates them to prepare for challenges. However, anxiety can be detrimental when a person experiences extreme worry or fear. The condition where the person suffers from extreme worry or fear is referred to as anxiety disorder. Anxiety disorder is a common and costly condition in adults.

The National Institute of Mental Health (2009) reports that about 40 million adults in America (this is about 18% of the entire population) are affected by anxiety disorders. They are an important source of personal and societal cost as individuals incur significant health care costs to solve these problems.

This paper will set out to present a concise yet informative discussion on Anxiety Disorders in adults. It will begin by providing a definition of anxiety disorders and proceed to highlight the causes of these disorders, their impacts, and the treatment for the conditions.

Anxiety Disorder: A definition

Anxiety is a natural human experience that everybody has and it serves some useful roles in human life. However, an excess of this anxiety is considered abnormal and characterized as a disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines anxiety disorders as “a group of mental disturbances characterized by anxiety as a central or core symptom” (Gavin, 2003, p.12).

These disorders are characterized by excessive fear and worry that negatively impacts on the life of the person. Anxiety disorders transform a normal adaptive emotion into a disabling conditions affecting the ability of the individual to cope and causing significant distress. Avoidance and escape is one of the most powerful factors that perpetuate anxiety.

When faced with a threat, the anxious person is likely to escape and this fuels anxiety though negative reinforcement. Negative reinforcement occurs since the avoidance behavior leads to the avoidance of the discomfort of the anxiety, which is a desirable reward to the individual with anxiety disorder (Thomas & Michel, 2002). This promotes the avoidance behavior as a response to anxiety causing situations.

Unlike the typical anxieties that all people face, anxiety disorders are prolonged and they generally last for six months and above.

Due to their frequency of occurrence, anxiety disorders are the most common class of mental health problems for adults in the US. Some of the common features of anxiety disorders include heightened fear, physiological arousal, and expectations of imminent threats against the person (Craske, et al., 2009).

In addition to this, the person suffering from this condition exhibits avoidant behavior as he/she seeks to escape from the causes of the anxiety. The person suffering from anxiety disorders will experience excessive worry that results in the person expressing concern about the worry inducing situation.

Craske et al. (2009) illustrates that anxiety comprises of a “future-oriented mood state associated with preparation for possible, upcoming negative events” (p.1067). A person experiencing anxiety is likely to engage in behavior aimed at avoiding the anxiety-causing situation.

Examples of Anxiety Disorders

One of the more common anxiety disorders among adults is Generalized Anxiety Disorder (GAD), which affects up to 5.7% of the population. This condition has long-lasting and widespread consequences on the individual (Francis et al., 2012). With GAD, the patient demonstrates excessive worry about minor, miscellaneous, and future events that do not trouble the mentally healthy individual.

The individual suffering from this order will demonstrate intolerance to uncertainty and find ambiguous situations to be stressful leading to chronic worry (Keller, 2002). In addition to this, Francis et al. (2012) reveal that individuals with GAD are “intolerant of uncertainty and tend to overestimate the probability of occurrence for highly unlikely future events and worry about how to handle them if they happen” (p.389).

In most cases, it is hard to identify the precise cause of the feelings, which cause GAD in the person. Even so, the fears and worries that accompany GAD are real to the person suffering from this condition and they affect his/her daily activities negatively.

GAD can start during a person’s childhood and proceed over the adolescence years and into adulthood. However, the likelihood of developing GAD for the first time significantly peaks after a person reaches 30 years old.

Another anxiety disorder is panic disorder, which is characterized by sudden feelings of dread and fear. Panic attacks are accompanied by some physical symptoms that include sweatiness, a pounding heart, and dizziness. In some cases, the individual may suffer from chest pains or experience nausea as he/she is going through the attack. Panic attacks often occur without any provocation or obvious triggers.

Individuals who suffer from panic disorder live in great fear since they do not know when the next attack will happen (Yonkers, 2005). This fear is detrimental to the life of the individual since he/she might avoid engaging in certain activities for fear that he/she will have a panic attack.

Panic attacks are often followed by a fear of losing control or going crazy and the person feels detached from himself/herself (Yonkers, 2005). Panic attacks can be passed though genes meaning that a person from a family with a history of panic disorders is likely to suffer from this condition.

Social anxiety disorder is another anxiety disorder that is highly prevalent among adults. Willutzki, Teismann, and Schulte (2012) document that SAD is characterized by an exaggerated focus on what the sufferer perceives to be deficiencies in him/her.

This focus on the perceived deficient characteristics condition leads to significant social and professional impairments as the afflicted person has great fear of social or performance situations. Individuals who have SAD have unhealthy inactive lifestyles since they are not comfortable interacting with other people.

The individual makes use of evasive tactics to avoid any social performance such as public speaking or confrontations with other people.

Post Traumatic Stress Disorder (PTSD) is one of the more severe forms of anxiety disorders that might afflict adults. This form of anxiety disorder is caused by a past exposure to physically or emotionally traumatizing events such as life-threatening events, violent crimes, serious accidents, or devastating natural disasters (Stein, 2007).

Many individuals are prone to experiencing PTSD since up to half the population will encounter a traumatic event within their lifetime. PTSD can be dangerous to the adult suffering from the condition and those around him since it can lead to self-destructive thoughts and behavior. Dyer (2009) reveals that the PTSD patient is prone to instances of anger and aggression which might lead to violence.

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that is characterized by persistent thoughts that might be of an upsetting nature. These persistent thoughts are on fundamental life themes such as aggression, sex, religion, and health (Tortora & Zohar, 2008). The obsessions might be of an aggressive nature such as killing somebody or robbing a bank.

Patients suffering from OCD fear that they might act on their obsession leading to some terrible outcome. These concerns might lead to extreme behavior to avoid acting on the impulse that the person has. Most patients feel the need to engage in routines that are meant to control the anxieties produced by the obsessive thoughts.

The routines developed to deal with the anxieties are called rituals and in many cases, they help to control the anxieties that the individual feels. However, the relief produced by these rituals is only temporary and the person will have to engage in the rituals many times

Causes of Anxiety Disorder

Anxiety has no known cause but there are a number of risk factors for the disorder have been identified. One risk factor is the genetic makeup of a person. The biology of a person plays a part in causing anxiety disorders since some people have a genetic predisposition to developing this disorder. If there is a history of anxiety disorders in the family, a person has a great susceptibility towards anxiety.

Nutt and Ballenger (2008) states that while the mechanism for inheritance of anxiety disorders is not fully understood, there is a general tendency to inherit traits such as sensitivity, fearfulness, and high reactivity. These traits are associated with higher probability of having anxiety disorders.

Anxiety disorder in adults can be caused by emotional or physical abuses experienced during childhood. Research indicates that anxiety disorders such as Social Anxiety Disorder (SAD) and Panic Disorder (PD) in adults may be caused by certain forms of childhood abuse suffered by the individual (Lochner, et al., 2010).

Individuals who have had traumatic childhood experiences such as familial violence, parents’ marital problems, parents’ separation or divorce, and sexual abuse in the family are more likely to develop these disorders. While both physical abuse and emotional abuse are predictive to the development of anxiety disorder, emotional abuses are more damaging.

Childhood emotional abuse such as excessive bullying, teasing, and ridicule is more associated with anxiety disorders than physical or sexual abuse. Lochner et al. (2010) state that emotional abuse is more predictive of anxiety disorders such as SAD and PD than physical abuse. Neglect in childhood also contributes to the development of anxiety disorders in adults.

Stressful life events can also lead to the development of anxiety disorders. These events are diverse in nature and they may include death of a family member or a loved one, poor health conditions, accidents, or interpersonal and family issues. The events lead to the development of anxiety disorder when the individual adopts poor coping mechanisms to the events.

A study on GAD prevalence among university students showed that individuals with stressful life events were more likely to report GAD compared to those without the stressful events (Francis et al., 2012). The relationship between stressful life events and anxiety disorders is that these events create new worry leading to the implementation of poor coping strategies that result in excessive anxiety.

Use of drugs and substances abuse can results in the development of anxiety disorders. Nutt and Ballenger (2008) document that excessive caffeine use or withdrawal might lead to the development of significant anxiety symptoms. In addition to this, some commonly prescribed medications have anxiety as a side effect. Using these drugs for a prolonged period of time might result in the anxiety progressing to an anxiety disorder.

Impacts of Anxiety Disorder

Anxiety disorders have a number of significant negative effects on the individual and the society as a whole. These disorders lead to a reduction in the quality of life for the individual. Anxiety disorders can be disruptive to the person’s life by making him unable to engage in normal activities.

For example, disorders such as panic attacks can be disabling since the person might avoid normal activities such as driving or going to for shopping due to fear of the next attack.

The National Institute of Mental Health (2009) notes that up to 33% of individuals with panic attacks disorder are housebound or are unable to venture outside without the accompaniment of a trusted person. In the case of OCD, the individual suffering from this disorder may avoid situations that trigger the obsessions. This might prevent the person from carrying out their responsibilities at home.

The coping mechanism employed by the adult who suffers from anxiety disorder might lead to additional symptoms. There is an association between anxiety disorders and chemical dependency in adults. Patients suffering from anxiety disorder are likely to seek escape from their condition through drugs and alcohol.

The National Institute of Mental Health (2009) elaborates that many people use alcohol and other chemical substances to mask anxiety symptoms and enable them to experience reduced anxiety. Gavin (2003), who reveals that substance abuse incidents are reported to be more frequent than expected in patients with anxiety disorders, corroborates this observation.

Anxiety disorders cause strain in the personal and professional relationships of the personal suffering from the conditions. A person with anxiety disorders is unable to maintain normal relationships due to the intense fear and worry that the person has. Nutt and Ballenger (2008) reveal that the patient has trust issues and finds it hard to cooperate with other people.

In the work setting, this lack of trust and cooperativeness will have adverse impacts especially when the person is expected to work in collaboration with other people. Anxiety disorders can lead to alienation and difficulty in maintaining personal relationships. For example, PTSD might lead to emotional numbness making it hard for the person suffering from the disorder to form close relationships with friends, family, or new relations.

There are significant financial burdens imposed on the person because of anxiety disorders. This disease leads to increased health care expenditure for the person. Since anxiety disorders can be managed through treatment, the person suffering from the disorders will visit health care professionals for medication. The person suffers from anxiety disorders, he/she will therefore have an increased use of health-related services.

The financial impact of anxiety disorders is made worse by the reduced productivity exhibited by the individual due to this condition. As such, the person suffers from additional expenses incurred through access to health care facilities while his/her earning opportunities are reduced.

Treatments for Anxiety Disorders

Many people underestimate the seriousness of anxiety disorders since anxiety is deemed a normal condition. However, anxiety disorders can lead to many adverse effects on the person suffering from the condition and the society (Gavin, 2003). It is therefore crucial to look for ways to treat these disorders and mitigate the severe consequences associated with them.

Anxiety disorders can be treated by use of medication prescribed by a physician. Appropriate detection of anxiety disorders is necessary if the individual is to be given the appropriate treatments. The type of anxiety disorder afflicting an individual will influence the choice of treatment used by the doctor.

Most physicians make use of medication to reduce symptoms and mitigate the major adverse effects of anxiety disorders. The anti-anxiety medication offered helps by reducing the anxiety or dealing with the physical symptoms that bring about anxiety (Bandelow, et al., 2012). Antidepressants are also used since there is a strong correlation between depression and anxiety disorders.

Proper medication enables the person to lead a normal life and avoid the disabling impacts of the disorders. Most of the medications prescribed are aimed at reducing the emotional sensitivity to stress and the avoidance behaviors related to specific situations.

Another form of treatment is psychotherapy and it is offered by psychiatrists. Through this treatment, the patient talks with the mental health professional and is helped to discover what exacerbates the disorder (National Institute of Mental Health, 2009). The harmful coping methods used by the patient are also identified during these sessions.

With this information, the trained mental health professional is able to assist the patient to come up with ways to deal with the condition. Unlike medications, which do not cure the disorders, effective psychotherapy will lead to complete curing.

In addition to medication and psychotherapy, proper dieting and exercising can be used to offset some anxiety disorders. For example, SAD, which is characterized by low social confidence, can be decreased by high-intensity aerobic exercise, which lowers anxiety sensitivity (Jazaieri, 2012).

Exercising assists by increasing personal confidence in an individual. Exercising also leads to a sense of wellbeing which reduces depression and leads to less anxiety.

Over the past decade, there has been increased awareness about anxiety disorder by health care professionals (Bandelow, et al., 2012). This awareness has led to a desire to improve the quality of life for the patients through medical intervention. More treatments for anxiety disorders are being discovered as greater research is done on the topic.

Utilizing these interventions will ensure that a person suffering from these conditions can be cured or have his symptoms mitigated. Willutzki et al., (2012) warns that if anxiety disorders are left untreated, they might lead to the development of other mental disorders such as depression in the patient therefore further decreasing his/her quality of life.

Conclusion

This paper set out to provide an informative discussion on anxiety disorders, their causes and treatments. The paper began by highlighting that a large proportion of the population experiences an excess of anxiety that is counterproductive or even disabling.

This paper has shown that individuals with anxiety disorders suffer from the adverse effects of their excessive anxiety since it impairs their work and personal relationships, and limits their activities and opportunities. The paper has shown that anxiety disorders should be treated to mitigate or completely eliminate the negative consequences associated with them.

List of Figures

Fig 1. Chart of Anxiety disorders

Fig 2. The vicious Cycle of Avoidance

Fig 3. Graph of performance Against Anxiety levels

Fig 4. Generalized Anxiety Disorder in the US

References

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