Anxiety Is Most Common Associated

Anxiety is most common associated with feelings of fear. Arachnophobia, fear of heights, fear of public speaking, all these are in its range. However, while fear is the key word in addressing these disorders, mental health professionals are very explicit when pointing the existing distinctions between them. Charles Donald Spielberger identified state anxiety and trait anxiety and the Spielberger State-Trait Anxiety Inventory (STAI) continues to be used as an instrument for measuring anxiety. State anxieties are what condition the individual to manifest fear in certain situations or when the individual is exposed to specific factors. Individuals facing state anxieties are only confronted with the afferent discomfort when he or she is exposed to the situation that triggers the fear, such as spiders, heights or public appearance. Furthermore, these types of anxiety are temporary and, once the individual has eluded the threatening situation or factor, his condition returns to a normal state. State anxieties also imply that, while an individual may express fear in one situation, another faced with the same situation may develop no emotion at all. In contrast, trait anxiety is related to personality and is believed to have developed due to previous experiences from childhood or inheritance and implies that the individual experiences stable stress predispositions regularly. While anxiety associated with phobias, for example, do affect the quality of life, it is understood that dealing with them is easier than facing more extreme facets, such as social anxiety disorder. In this paper, our goal is to address the latter which, however common it may be, poses a serious threat to individuals' quality of life and their general well being. We will be focusing briefly on some theoretical perspectives and we will continue with specifically assessing SAD. Furthermore, we will consider different techniques of intervention which are commonly used to treat the disorder and we will emphasize, where relevant, the interrelation between them. By the end of the paper, we would have analyzed the benefits and discomforts of these particular treatment methods and we should be able to point towards the most appropriate.

Chronic anxiety can cause both physical and mental paralysis to the point where the individual can no longer respond naturally to even the most common situations of daily life. His ability to communicate, interact, and live a nutrient life can be severely diminished, thus leading to various other negative effects. The term anxiety has actually become so common and it is so frequently used that it gives conditions associated with the term a rather trivial meaning. It is often that many of us use expressions such us ?I'm very anxious about my exam? Or ?I'm anxious about the job interview? which clearly reflect our emotional state. Nevertheless, in such situations, anxiety is understandable as it relates to our expectations and outcome following the exam or interview or whatever else common situation we may be experiencing. In fact, mild forms of anxiety are known to have conservation roles, meaning they might actually protect us from various dangerous situations. However, the moment we come to experience anxiety as pathological states, the circumstances imply a much more serious condition that reflects our mental health. This is when anxiety becomes a disorder which needs to be treated accordingly.

Billions of dollars are estimated to be the costs for treating anxiety disorders every year which is more even compared to the costs of treatment for certain physical illnesses. Costs being estimated at $1,500 per individual, a simple math would indicate the large number of people confronted with such disorders. It was not until the 1980s that explicit interest was given to researching social phobia and investigating the disorder per se. Until then, there had been attempts to research and address various forms of the disorder, such as shyness or embarrassment and how individuals respond to social environments in relation to these sometimes emotions, sometimes traits. To explain the difference between shyness and embarrassment being emotions or traits, we consider that being shy is a personality trait for someone who is constantly shy and experiences shyness even among and with people closest to him or her. In contrast, shyness appears to be more of an emotion when individuals who respond naturally to interactions with people, at times, experience fear, uncertainty, etc. However, we tend to disagree with the idea that ?the difference between the concepts of shyness and social phobia may be more quantitative than qualitative. (Rapee, 1995, p. 42) Considering that phobic individuals would look to avoid fear inducing situations more so than shy people, the matter is not simply of either more or less. This is because quality and quantity are interrelated and often determine the well being of an individual and his or hers mental health condition. People experiencing severe social phobia are often subject to panic attacks and, in situations where it is not treated in time, it may escalate into agoraphobia or severe depression. It is less likely that shy people would ever come to experience such severe states of anxiety, although they may be more exposed to developing them. Because avoidance is a main issue in dealing with social anxiety, it would appear that one appropriate method is the exposure therapy. Advocated by Emil Kraepelin, the technique requests the patient to be exposed to the object of his or hers fear with the intention of diminishing instinctual responses of avoidance. However, because we consider situations of acute social phobia, the exposure therapy may not represent the most appropriate treatment which is why we will consider exposure along with cognitive therapies. In addition, pharmacotherapy may also be combined. However, the combination is not imperious for an effective treatment. Indeed, it may very well be that any of the two work individually. Unlike medication, cognitive-behavioral treatment (CBT) is known to have more long lasting effects. This is because, while medication may treat the symptoms, and is effective in physically treating the individual on the neurological level, CBT applies cognitive methods to change the thinking pattern of an individual. It psychologically teaches the patient to understand the roots of his or hers anxiety. Moreover, it provides insight as to how the patient reacts to stimuli in the environment and it connects him or her to the source of anxiety. Also, prevalent in the twenty first centuries, are alternative therapies to which many patients adhere to alleviate either stress or physical symptoms associated with social anxiety. Many people who suffer from the disorder face additional fear which is propagated by their belief that symptoms such as sweating, blushing, etc. which are common for SAD are embarrassing and are subject to judgment from other people. In the following, we will address each of the aforementioned treatments with specific emphasis and we will proceed with analyzing the interrelation between them, is it exists. Also, we will be pointing to actual results of treatment to understand the effect on the patient.

Cognitive behavioral treatment proposes exposure therapy in socially controlled environments. That is to say that it encourages the patient to acknowledge situations and try to gain control over the existing emotions. Usually, in triggering these emotions, thinking patterns play a dominant role. As such, patients often think they will be negatively assessed, thus inducing and sometimes creating opportunities for their anxiety to manifest. Because of the social condition of our world, social phobic individuals are compelled either to avoid many situations, which is difficult in itself and very improbable or to face social situations in extreme distressful circumstances. CBT for social phobia works to change the pattern of patients' thinking so that when there is ?particular emphasis on self-focused attention, negative self-processing, and safety behaviors, the treatment particularly emphasizes ways of reversing these features in order to reconfigure social phobics processing strategies in a way which will maximize opportunities for disconfirming negative beliefs by direct observation of the social situation, rather than oneself. (Clark, 2001, p.419) This is to say that the focus of attention is deviated from self-perception towards circumvention of negative perception and ultimately to the real social circumstances rather than imaginary. In this respect, patients may be asked to become participants in group therapy as a form of exposure. This is applied in order to work closely with the patient, to observe his demeanor while facilitating the treatment by conducting it in a safe environment where the patient feels more secure. Exposure in group therapy also provides the relevant environment to simulate fear inducing situations and patients are thus more likely to develop skills in confronting the disorder. In 1998, a study was conducted on one hundred and thirty three patients dealing with social phobia. A number of therapies were considered such as cognitive behavioral group therapy (CBGT), phenelzine treatment (which is an inhibitor), etc. The pattern which was adopted for patients in matters of CBGT consisted of four steps as follows: identifying automatic thoughts which is what usually trigger anxiety, patients were then required to pay attention to the logical errors in their pattern thinking; next, it was expected that automatic thoughts be challenged with rationality and last, it was encouraged that patients establish behavioral goals (Heimberg et al., 1998, 1134). Altogether, the study was conducted for a period of twelve weeks. After completing six, more patients responded positively to the phenelzine therapy as opposed to CBGT and the other two included in the study (Heimberg et al., 1998, p. 1137). After completing the twelve weeks assessment, CBGT and phenelzine received the same result (Heimberg et al., 1998, p. 1137). Moreover, post treatment indicated that patients who had undergone the two therapies experienced less fear and anxiety in pattern thinking and real life situations. Although response was later in regards to CBGT effectiveness, phenelzine treatment, like in many situations when medication is administered, may be less indicated as it determines the patient to become dependent. Moreover, while CBGT promotes a proactive attitude in controlling anxiety, medication may determine the patient to rely exclusively on such therapeutic interventions. Furthermore, on the long run, the outcome is more favorable for cognitive treatment than phenelzine. Liebowitz et al. (1999) acknowledged that upon interrupted treatment period, ?PZ patients continued to relapse, whereas CBGT patients did not, ? (p. 96) which further highlights that medication treatment is effective insofar as no interruption is considered. With CBGT therapy, it is understood that patients learn more about their situation in order to control it. Nevertheless, physicians and therapists are unlikely to dismiss medication in favor of cognitive therapy as the technique is more time consuming (Blomhoff et al., 2001, p. 23) It is possible that medication is often preferred to cognitive therapies because, be it or not a group therapy, the approach is based on a relationship between the therapist and the patient, at least. This in itself is a social interaction to which both the patient and the therapist need to contribute. It is important to understand that social anxiety is addressed in relation to various situations which patients confront. To some of these situations, CBT may represent decreases in negativity while it produces no effect on other levels. For example, relapse for patients treated with CBGT was infrequent while non-relapsed PZ patients who were assessed acknowledged more positive results overall. Liebowitz et al. (1999) considered that the two may be more beneficial to patients when combined (p. 96).

Social anxiety is very unlikely to be short termed which is why, when medication is not an option for patients, neither cognitive therapies seem to prevail in gaining some sort of control over social situations, individuals are encouraged either by physicians or personal documentation to take on alternative therapies. Acupuncture has often been scientifically assessed as to observe its relation to stress and anxiety reduction. However, its effectiveness has been considered in relevance to insomnia. That is to say that some studies have sought to picture the benefits of acupuncture in light of anxiety causing insomnia and vice versa, the latter being a consequence of the former. Indeed, because anxiety, subsequently, generalized social phobia, is stress inducing, the connection appears viable since stress is further known to cause insomnia. One study, focused on 18 individuals who followed acupuncture treatment for a period of five weeks did indeed show improvements in sleep patterns (Spence et al., 2004, Discussion). However, because the study did not introduce psychopathological patterns, we can assume that, in relation to the study, acupuncture might solve sleep issues, but it would fail in addressing the overall condition of the patient. Indeed, subsequent studies affirmed that ?positive findings are reported for acupuncture in the treatment of generalized anxiety disorder or anxiety neurosis. (Pilkington et al., 2007, p. 9) Nevertheless, Pilkington et al. also acknowledged that ?there is insufficient research evidence for firm conclusions to be drawn. Our concern is that acupuncture is applied in rather safe environments where exposure is less. That is to say that, although some social contact is required, we are inclined to believe that the treatment does not address the patient's real condition, rather it alleviates the distress upon previous social interactions. In other words, patients are not exposed to environments where fear inducing situations arise. Thus, simply because a patient does not experience anxiety in that particular moment, it does not mean that anxiety is not there anymore. Acupuncture is not mind driven, which is to say that no challenges are required from the individual. Since social phobia is experienced precisely because pattern thinking, other mind engaging therapies may provide more relevant results. However, somewhere at the beginning of our paper, we stated that some chronic social phobics may experience an escalation of their condition leading to panic attacks. In experiencing generalized anxiety disorder, for example, muscle tension is often encountered, which is a physiological symptom specific to social phobia, as well. For our purpose, we will consider social phobia as correlated with generalized anxiety disorder (GAD) since the latter yields that patients experiencing the disorder often incorporate more than one specific anxiety disorder. In a study by Peter Sainsbury and J.G. Gibson it was discovered that ?anxious patients showed more muscle tension than the healthy subjects. (1954, p. 219) It is important to understand that muscle tension may imply either a physic or an emotional state of feeling. However, in Sainsbury's and Gibson's study, the majority of the subjects who were assessed explicitly experienced physical tension which is relevant to our purpose for indicating acupuncture's benefits. Thus, it is evidenced that individuals experiencing GAD are more likely to develop muscle tension. Acupuncture aims, among others, at relieving muscle pains and eliminating the discomfort. However, it remains largely a holistic technique and, while it is recommended by some physicians, it is less likely to ease anxiety per se.

After addressing three very distinctive techniques of intervention in treating social phobia, subsequently anxiety disorders, we feel compelled to acknowledge that neither one therapy by itself appears to be one hundred percent effective. When considering medication, side effects are to be taken into account. This is specifically important when patients treated of social phobia are also subject to depression. Indeed, medication is to be considered thoroughly when prescribed, especially when certain patients have been diagnosed with physical illnesses as well. This is because of the effects that combined medication may have over the patient's physical health. For example, depression is sometimes treated with electroconvulsive therapy which, in combination with phenelzine, may lead to unwanted negative effects on patients with diagnosed physical illnesses. Subsequently, medication in treating social phobia offers temporary relief. The patient may feel he or she is much more able to control social interactions when medicated and thus may rely on this technique permanently. Because medication does not address the core of social anxiety, once treatment is stopped, symptoms are likely to return, leaving the individual more anxious and disappointed of not having been able to manage treatment free periods. However, in severe forms of anxieties, medication can indeed represent the primarily solution. Nevertheless, we believe cognitive therapy in addition to exposure therapy to be more relevant in terms of long run outcomes and manageable control over social situations. This is because cognitive behavioral therapies address the underlying cause for social anxiety. Furthermore, it works to bring the patient into a state of acknowledgement and can actually absorb the patient's victimization roles. Nevertheless, as opposed to medication, CBT is proactive and perhaps more challenging, asking the patient to confront fearful situations. This is why we believe stress and cognitive behavioral therapies work side by side. However, we also believe that alternative therapies, such as acupuncture, may work in synergy to gain more positive results. While being exposed to social interactions, it is expected that the patient will experience stress, especially when he is at the beginning of the treatment. While not recommended for singularly addressing social anxiety, acupuncture is known to provide relief of specific anxiety disorder effects, such as muscle tension, mind tension, etc. Indeed, a study focusing on 240 individuals concluded the existence of more positive effects when there was a combination of acupuncture treatment and desensitization (Jorm et al., 2004, Physical Treatments: Acupuncture). Desensitization is one technique which conveys cognitive behavioral therapy more relevance as it focuses on diminishing the negative emotional response of patients exposed to certain situations.