Anxiety: causes, symptoms, and treatment approaches

Human Emotional Patterns

There are many different ways to study human emotional patterns in specific situations. Generally, there are five methods of research, those of experimental, correlation, naturalistic observation, surveys, and case studies. Within each group, there are also subsets, designed to further expand study options (Levine, 2001). This paper will discuss the various methods of research, compare and contrast those methods, and determine which method would be most suitable for studying anxiety of patients attending the radiology department of a hospital.

The most common method of research used in anxiety testing in hospitals is that of the survey, or patient self-report. The survey is a non-experimental, descriptive study that does not involve observation, thus making it a cost-effective solution. Additionally, surveys allow for multiple subjects to be studied at any given time, often without the need for additional researchers. The survey, if designed properly, can be administered by regular hospital staff, provided that staff has the proper instructions (Levine, 2001).

Survey research can be done in many forms. Self-report surveys include those written documents patients can fill out themselves. There are also surveys which involve telephone interviews, asking specific predetermined list of questions relating to anxiety. Additionally, surveys can include face-to-face interviews, again asking specific questions. Computers and web-portals can also be used to gather survey information. These methods can often be used in conjunction with each other to increase the number of responses (Gray, 2003).

There are some limitations to survey research however. First, any interview or questionnaire must be predetermined. This makes the survey limited in that the responses cannot be further probed for more details. In the case of anxiety research, this makes for difficult interpretation of results. If the questions are not designed as open-ended questions, the true cause of the anxiety may be difficult to determine, since the question would be a yes or no, or a scale answer. These types of questions do not lend to gaining more knowledge about the cause of the anxiety (Torpy, 1997).

Additionally, unless multi-language and multi-level surveys are used, there can be limitations in the understanding by the subjects of the survey questions (Grosshans, 1991). Especially in a hospital setting, where the survey respondents are not chosen but are instead determined by their hospital related activities, the study sample is not pre-screened for language or educational levels. This means there is a higher chance that the respondents will be from varying language backgrounds, and have various levels of education. Additionally, even their ages may be differing in such a way that creating a survey would be difficult.

There is also a danger of creating questions which inadvertently cause higher response rates, such as detailed medical questions causing higher anxiety (Grosshans, 1991). Since survey data relies on self-reported information, and since the levels of anxiety in a patient can increase and decrease based on the experience of the patient, it is possible that lack of care in working the question can actually increase the patient's anxiety. For example, a question that states "If the radiology department finds cancer in your bones....," the patient may be forced to think about issues which increase their anxiety levels, thus inaccurately raising the levels of reported anxiety in the radiology department.

The other major limitation to the survey design is that, in any self-report, there is a possibility for patients to answer in a way that is contrary to reality (Snaith, 2003). In the case of anxiety research, the subject may not be aware of his or her levels of anxiety, or may choose to answer in such a way that denies the anxiety. As mentioned previously, anxiety levels are difficult to confirm, even through biofeedback. When forced to determine whether or not one is anxious, the patient may not even realize he or she is experiencing anxiety, even though their body may be reacting to that anxiety (McKinley, 2004).

A study by Rachman in 1974 determined that, since fear and anxiety are closely related, subjects have a difficult time determining which is which. Thus, subjects in a fearful situation such as a radiology lab may have a tendency to over-estimate their levels of anxiety, due to their inability to distinguish fear from anxiety. On the other hand, smaller levels of anxiety may be undetectable to the subject, if the corresponding feeling of fear is absent (Ewert, 1986).